The brachial plexus is a nerve center that transmits signals from the spinal cord to the shoulder, arm, and hand. If a baby’s brachial plexus is injured during delivery, damage to the nerves in this network causes pain and various related conditions that may be temporary or permanent, depending on the site of the injury, its severity, and what damage is done to the nerves. This makes predicting a prognosis of brachial plexus injuries difficult.
Early detection and timely treatment of brachial plexus injuries are the most important factors that lead to a positive prognosis. Exact outlooks are difficult to determine due to the number of variables involved. In most cases, particularly those where the nerves are stretched or compressed but not torn, a baby with a brachial plexus injury can recover between 90-100% of arm function with occupational therapy treatments within three to six months.
If there’s no improvement in a baby’s arm or shoulder within that time frame, medical specialists in neurosurgery may suggest surgical intervention to treat the injured nerves. It is estimated that 10% of all babies with brachial plexus injuries require surgical treatments. One possible surgical technique, and of the most typical types of surgery for brachial plexus injuries involve harvesting nerves from the legs or other body parts and grafting them onto the damaged nerves in the brachial plexus. Once a healthy nerve is taken and then transferred to the damaged nerves, many infants may go on to recover full use of the affected area.
Per the NIH, however, it is not clear if these surgical interventions can help in every situation, especially with more serious injuries. Nevertheless, pediatric neurologists and neurosurgeons do attempt to repair this type of injury as evidence shows that success is possible. Surgeons prefer to perform these procedures when a baby is between four and nine months old. This prevents the nerve damage from becoming more serious and irreversible. In addition, since most brachial plexus injuries tend to clear up without surgery within three months after the injury, doctors usually wait during this time to see if the infant can heal without surgical intervention.
Per the National Institute of Neurological Disorders and Stroke (NINDS), the location and severity of a baby’s brachial plexus injury ultimately determines the prognosis. If a baby suffers neuropraxia (stretching of the nerve), which is the most common type of brachial plexus injury, the infant will recover spontaneously within three to six months with little or no loss of arm function.
In most cases, the injury will heal on its own without need for medical intervention. However, most physicians recommend physical therapy and massaging to help speed up the recovery. In addition, as mentioned earlier, occupational therapy may also be recommended
More severe injuries, such as neuromas or ruptures, need a timely combination of therapy and surgical intervention and often result in complications such as Erb’s or Klumpke’s palsy. Depending on the seriousness of the injury and the effectiveness of the treatments used, the baby might recover but not without impairment to the arm or shoulder.
In cases where avulsion occurs, quick surgical intervention may repair some of the damage, especially if nerve grafts are possible. However, this type of injury is hard to treat and usually results in permanent nerve damage and total inability to use the affected arm.
Other factors that lead to a negative prognosis include:
- Radial head dislocation caused by aggressive supination of the forearm. This condition affects the baby’s elbow by restricting the movement of the radial head and neck. In babies with brachial plexus injuries, the radial head does not return to its normal position and can cause permanent elbow flexion contractures.
- Some toddlers may mutilate their fingers and hands as a result of difficulties caused by damaged nerves in the brachial plexus.
- Children who experience leftover weakness caused by brachial plexus injuries may suffer from agnosia, posterior shoulder dislocation, and progressive contractures if they don’t do stretching exercises regularly.
- Asymmetrical motor patterns and muscle imbalance may cause scoliosis in children with brachial plexus palsy.