Brachial plexus injuries happen whenever nerves get stretched or injured. Some of these injuries happen during the birth process. Most often the baby’s shoulders may become wedged within the birth canal, causing nerve injury to the brachial plexus as the baby is delivered.
Types of Nerve Injuries
In general, there are four types of nerve injuries. All can occur at the same time in the same infant in different parts of the plexus.
A stretch injury that “shocks” but doesn’t tear the nerve is the most common type. This type is called a neuropraxia. Normally, these injuries heal on their own, usually within three months.
Neuropraxia can happen in adults as well as infants. For example, when it happens to football players who are injured during play, it’s called a “burner” or “stinger.”
A stretch injury that damages some of the nerve fibers might result in scar tissue. The scar tissue might press on the remaining healthy nerve. This condition is called a neuroma. Some, but not total, recovery is usually possible.
A stretch injury that tears the nerve apart (ruptures it) will not heal on its own. In this type of nerve injury, surgery will be necessary to re-attach the nerves.
An avulsion happens when the nerve is torn from the spinal cord. It is not possible to repair an avulsion from the spinal cord. This is the most severe type of nerve injury, and is not directly repairable.
Approximately two babies in every 1,000 experience brachial plexus injury at birth. Treatment for birth brachial plexus injury may be treated with physical or occupational therapy including splinting or stretching exercise. In some children, treatment may include casting or surgery.
Difficult births, such as breech births or births involving a long labor, increase a baby’s risk of brachial plexus injury. Many babies with brachial plexus injuries are larger than average at birth. However, newborns of all sizes (including premature babies) can have brachial palsy as well.