Soon-to-be parents look forward to celebrating all that comes with the long-awaited arrival of a new baby. But what can sometimes be the toughest part of that journey—the baby’s delivery—can occasionally cause problems down the road. Occasionally, a difficult labor and delivery can result in a birth brachial plexus injury, a relatively rare condition that affects roughly four infants in 1,000 per year.
Gillette orthopedic surgeon Ann Van Heest, M.D., explains what a birth brachial plexus injury is, the signs and symptoms to look for, and treatment options.
Q: What causes a birth brachial plexus injury
Dr. Van Heest: The brachial plexus is a network of nerves that begins at the spinal cord in the neck and allows messages from the brain to reach the shoulder, arm and hand. Birth brachial plexus injuries occur when the nerves stretch or tear during the birth process. For example, the baby’s shoulders might become wedged in the birth canal (shoulder dystocia). The damaged nerves can interfere with and impair movement or sensation in the hand, wrist, elbow and shoulder. A pediatric orthopedic specialist can evaluate babies and children who have these problems. They can also work with families to develop an effective treatment plan.
Q: How can I tell if my infant has a birth brachial plexus injury?
Dr. Van Heest: Most babies that have birth brachial plexus injury experienced a difficult delivery. The delivery may have required use of forceps or vacuum assistance. Most often your baby would have been a large baby that had difficulty fitting through the birth canal. Your baby might have a birth brachial plexus injury if you or your pediatrician notice any of these six signs immediately following birth. Talk to your pediatrician if you observe any of these.
- Your baby favors one arm or uses one arm more than the other arm
- One of your baby’s arms is weaker than the other arm
- Your baby doesn’t squeeze your fingers
- Your baby doesn’t bend his or her wrist
- Your baby doesn’t bend or straighten his or her elbow
- Your baby doesn’t raise his or her arm.
Q: What are the treatment options for birth brachial plexus injury?
Dr. Van Heest: In most cases, birth brachial plexus injuries can be effectively treated with occupational therapy—gentle exercises you can do with your baby several times a day to strengthen the weaker arm. If the nerves are severely damaged or don’t improve with occupational therapy, a pediatric orthopedic specialist might recommend surgery to correct bone, joint or muscle problems. If your child is older and if occupational therapy alone isn’t effective, other treatments could include splints, casts or constraint-induced movement therapy. Using these techniques on the stronger arm encourages children to use the weaker arm.
Pictured: Azaynia, who has birth brachial plexus injury, exercises her weaker arm with Gillette occupational therapist, Alyssa.