Brachial plexus injuries are one of the more common types of birth injuries in newborns. These heartbreaking injuries can range from relatively minor to severe. Some injuries will heal on their own with little to no medical intervention, while others will be life-long or even disabling.
At Birth Injury Guide, we are regularly asked about brachial plexus injuries. Here, we have compiled a list of some of the more common questions we are asked. Of course, if you have questions about your child’s injury, contact us directly to learn more.
What are Brachial Plexus Injuries, and How Often Do they Occur?
The brachial plexus is a complex cluster of nerves under the collar bone. The nerves communicate from the brain to the limbs, and from the nerves to the lower body. About 1.2 children out of every 1,000 live births will suffer a brachial plexus injury. In the last 15 years, rates of these injuries among newborns have decreased by about 50 percent, but for the unlucky few these injuries can cause lifelong disability and pain.
What Are the Risk Factors for a Brachial Plexus Birth Injury?
The primary risk factor for a brachial plexus injury is a large baby weighing 10 pounds or more. Babies weighing more than 10 pounds are generally born to mothers with gestational diabetes or whose pregnancies have lasted longer than 40 weeks. This mismatch in fetal and maternal pelvic balance can result in shoulder dystocia.
Shoulder dystocia is a condition in which the baby’s shoulder becomes lodged behind the mother’s pubic bone. Most obstetricians consider this condition to be an emergency. A stuck baby may go without oxygen and could suffer brain damage because of it. The dystocia itself can cause a stress injury to the brachial plexus if the physician proceeds with a vaginal birth.
Do All Brachial Plexus Injuries Need Surgical Treatment?
About 80 percent of brachial plexus injuries will heal on their own without surgical intervention. For the other 20 percent, however, the injuries not only require surgery, but may in fact be permanent. Recovery rates are poor because it is not always possible to differentiate a severe injury from a minor brachial plexus injury early enough to have a positive impact on the child’s prognosis.
Why are Severe Injuries Difficult to Identify at Birth?
Trauma to the brachial plexus can manifest in many different ways. The nerve cluster itself has five nerve roots that cross and then separate, forming a network that extends from the spinal cord near the collarbone and up to the shoulder.
Most brachial plexus injuries result in Erb’s Palsy, which is weakness and paralysis in the upper body and arms. A smaller portion of babies experience “extended Erb’s Palsy” which involves injury to the cervical spine area. Furthermore, an even smaller minority of patients suffer a global injury to the entire brachial plexus.
Sometimes, doctors can try to predict the severity and long-term effects of the injury by examining the parts of the brachial plexus involved, but that is not always a reliable indicator. That’s because up to 90 percent of babies who suffer Erb’s Palsy will spontaneously recover. Statistics get worse the larger the section of the nerve bundle is injured. Consider the following:
- Children with extended Erb’s Palsy recover about 60 percent of the time.
- Global brachial plexus injury sufferers recover in only a minority of cases.
With all the shifting factors and statistics, determining the child’s prognosis at birth is very difficult.
What is Horner’s Syndrome and What Does it Mean?
One reliable indicator of the severity of a brachial plexus injury is the presence of Horner’s syndrome. Horner’s syndrome is a collection of symptoms that appear alongside injury to the sympathetic nervous system. Symptoms include:
- Drooping eyelid
- Constriction of the pupil on the same side as the affected arm
- Absence of sweating on the face
- Sinking of the eyeball into the orbit
Where there is Horner’s syndrome, the nerves are generally torn or severed, and not simply stretched. Torn nerves do not usually spontaneously recover.
Do Traumatic Births Result in Severe Brachial Plexus Injuries?
Brachial plexus injuries are one of the most commonly litigated birth injuries. When families file these cases, they often question whether a doctor, nurse, or midwife’s use of force was excessive and contributed to the injury.
What Is the Most Successful Treatment for these Injuries?
Initiating treatment soon after a brachial plexus injury is important. Starting physical therapy as soon as possible is also important to full recovery. Of course, early access is not always possible because doctors sometimes fail to diagnose a brachial plexus injury at birth. Every day without restorative therapy makes it more difficult for the child to regain full function.
Usually, infants with diminished arm and shoulder function one month after birth need surgical intervention, but even surgery doesn’t promise a full recovery. Many victims of brachial plexus injuries will undergo multiple painful surgeries, some that can begin as early as three months of age. Despite this, some victims will never regain arm and shoulder function at all.
By 2-3 months of age, it should be clear whether or not a child with a brachial plexus injury will make a full recovery. Recovery is usually incremental. Babies who recover elbow function by this age will usually make a full recovery with continued treatment.
Unfortunately, there are no diagnostic tests to predict the chances of recovery. Every child with a diagnosis of a brachial plexus injury goes through similar treatment plans that promote recovery. Unfortunately, not every child will experience full recovery because every child is different. The individual health of the child also plays a role in treatment and recovery success.
Has a Birth Injury Impacted Your Family?
Birth injuries are not only physically traumatic to a newborn baby, but they are also emotionally and psychologically traumatic to the family as a whole. Multiple surgeries can be tremendously expensive and be a burdensome drain on a family’s pocketbook.
If this sounds like what your family is going through, there is most certainly help available. Talk to Birth Injury Guide about your options. If your baby’s injuries are the result of a negligent healthcare provider, you may have an actionable claim. Contact Birth Injury Guide to find out your options for holding the at-fault party accountable for your baby’s birth injury.
For a free case review, call 1-877-415-6603, or get started by completing our online form.