Brachial Plexus Injury at Birth: Long-term Effects
By James P. Goslee, Esq.
Oct 20, 2023
What Is a Brachial Plexus Injury?
There are several different types of brachial plexus birth injuries. These injuries can be categorized according to distinct forms of nerve injury: stretch (neurapraxia), rupture, and avulsion. Thankfully, brain injuries are typically unrelated to brachial plexus injury.
What Are the Types of Brachial Plexus Injuries?
- Stretch (Neurapraxia)
This is the least severe of the three forms of brachial plexus injury, for several reasons. First, the nerves are damaged outside the spinal cord. Second, the injured nerves often heals on their own within the first three months of life. Third, the nerves are merely stretched, not broken. Neurapraxia is the most common form of brachial plexus injury.
Ruptures are quite common and occur when the nerve is torn, making the injury more severe than neurapraxia. If a nerve is ruptured, it may require surgery. However, nerve ruptures occur outside the spinal cord, making the surgery less complicated.
In avulsion, the nerve root is torn out of the spinal cord. This means that the spinal cord is the site of the birth injury. While avulsion occurs in less than 20 percent of cases, it is a severe brachial plexus injury. It is also more difficult to operate on. Because it occurs at the spinal cord, it cannot be directly repaired by surgery. Instead, the damaged tissue must be replaced through a nerve transfer. In some cases, the function of the diaphragm may be impacted, compromising breathing.
Who Is at Risk for a Brachial Plexus Injury?
Brachial plexus injury affects more than infants. People can suffer this injury in car accidents, while playing sports, or during radiation therapy. If shoulder dystocia, a condition in which one or both of the baby’s shoulders get stuck inside the birth canal, occurs during vaginal birth, this increases the chance of neonatal brachial plexus palsy.
What Are Some Examples of Brachial Plexus Injury?
Doctors typically refer to a set of well-recognized conditions when making a brachial plexus diagnosis. These include:
- Erb’s palsy: This form of palsy affects the upper region of the brachial plexus. Babies with Erb’s palsy usually have weak shoulder and bicep movement and can start doing home physical therapy at the age of three weeks.
- Total plexus involvement: This injury covers the entire plexus. A baby with total plexus involvement may not be able to move their shoulders, arms, or hands at all.
Horner’s syndrome: Typically, this syndrome is caused by an avulsion. In some cases, it results in a drooping eyelid, or even a smaller eye pupil. In others, the baby loses the ability to sweat on their face at normal levels.
Long-term Effects of Brachial Plexus Injuries at Birth
While some brachial plexus injuries will heal in the short term, others have lasting effects. To provide proper care for the injured child, it’s vital to be well-informed about the most common effects of this personal injury.
What Are the Risks of Brachial Plexus Injuries?
Happily, the most common result of a brachial plexus injury is a full recovery. In fact, the University of Rochester Medical Center reports that most people with minor brachial plexus injuries recover over 90 percent of the normal function of their arms.
Still, in the short term, many injured individuals suffer from a loss of feeling throughout their upper body. With more serious cases, the loss of feeling comes with a loss of function. Surgical treatment may be necessary for people with more severe cases.
How Long Does It Take to Recover from a Brachial Plexus Injury?
There is no hard-and-fast rule for recovery, as every injury and every individual are unique. In neurapraxia cases, most babies recover fully within the first three months of life. Yet for more serious injuries to the spinal cord, full recovery may not be possible. It’s always important to consult with a medical professional to receive the most accurate prognosis possible.
What Are the Long-term Effects of Brachial Plexus Injuries at Birth?
As with cases of brachial plexus injury in adults, there are many long-term effects of brachial plexus injury at birth. In severe cases, these can include issues with balance and coordination, arm strength, lower body strength and severe range of motion limitations. Sometimes, children with a brachial plexus injury may have abnormal bone growth and joint function.
A related risk is muscle atrophy; if children do not move, their muscles will shrink. Physical therapy can help counter muscle atrophy. It can also help combat impairments to biomechanics, which often result from injury.
In rare cases, obstetric brachial plexus birth injury can cause scoliosis, in which the spine takes on an abnormal curvature. While physical therapy can help with scoliosis, in severe cases, surgery will be needed.
Surgery may also be necessary in cases of brachial plexus palsy. This condition sets in when the infant’s arm is either weak or paralyzed as the result of nerve injury in the brachial plexus. Erb’s palsy is just one example of brachial plexus palsy. Often, surgery results in an increased range of motion and greater sensitivity for the child.
If you believe that your child has suffered from a brachial plexus injury, you may want to consider speaking to a birth injury attorney.
Responding to the Long-term Effects of Brachial Plexus Birth Injury
Even in severe cases, several treatment options can be effective in ameliorating the symptoms of birth injury. Both surgery and physical therapy may help children with cerebral palsy, neurological disorders, and other injuries to the brachial plexus.
Can Physical Therapy Cure Brachial Plexus Injury?
A doctor will be able to evaluate the severity of a brachial plexus injury and recommend treatment. In mild to moderate cases, physical therapy is often an effective choice. Moreover, physical therapy is often a crucial component of recovery after surgery. A physical therapist can help people with brachial plexus by:
- Developing mobility in the injured regions
- Developing strength through targeted exercises
- Calming nerves with acupuncture and other practices
- Educating parents and children on symptom management
- Informing patients about devices that can help them cope
What Are the Surgical Options for Brachial Plexus Injury?
There are a number of different surgery treatment options available for brachial plexus patients. John Hopkins School of Medicine lists the following:
- Brachial plexus nerve repair
- Brachial plexus decompression and neurolysis
- Nerve grafting surgery
- Nerve transfer
- Tendon transfer
- Functional muscle transplant
Some of these types of surgery represent marked advances in medicine. For example, when performing nerve transfer surgery, doctors used to harvest nerves from completely different locations in the body. However, with new treatments, doctors are harvesting functioning nerves from sites located within the plexus itself. Because these nerves are more similar to the injured ones, patients are seeing increased chances of recovery with the new methodology.
What Are the Legal Options for Brachial Plexus Birth Injury?
If you believe that your child received a brachial plexus injury because of medical malpractice, you may want to consider filing a lawsuit. Childbirth should be a joyful experience, and no one should have to suffer an injury caused by negligence. If medical professionals do not properly monitor the baby and the mother, or mismanage delivery, severe brachial plexus injuries can result.
Brachial plexus birth injury can arise from the misuse of delivery tools like forceps or vacuums. While they may be medically necessary, these devices need to be used with great care in order to avoid harm to the infant and mother. Also, a common cause of severe brachial plexus injury is excess traction applied by a physician. If a physician uses too much force when delivering a baby, the brachial plexus can be permanently damaged.
Because birth injury is a complex field, it’s important to speak to a birth injury attorney with the expertise necessary to evaluate the details of your specific case. They will work with medical experts to determine whether it would make sense to seek compensation for your child’s brachial plexus injury.
Filing Your Brachial Plexus Birth Injury Claim Today
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