Brachial Plexus Injury in Infants
What is the brachial plexus?
The brachial plexus is a group of nerves that begins in the neck and provides feeling and movement to the shoulder, arm, forearm, and hand. Signs of damage in this area include: a limp arm or an arm with no muscle control in the shoulder, arm, or hand. Infants may also lack feeling in their hand and arm. Brachial plexus injuries in infants are not painful.
What is a brachial plexus injury?
Brachial plexus injuries are caused when these nerves are stretched during the birth of a child. Damage to the nerves occurs in 0.38 to 3.6 per 1000 live births. Eight to twenty-three percent of these infants have nerve damage on both sides of the body. Ninety-three percent of these infants get much of their function back by 3 months of age when treated with therapy or when they are just watched. This is a good sign that these infants will do well in the future. These children likely will not need surgery.
How are brachial plexus injuries treated?
A small number of infants with this type of problem will need surgery. Therapy before and after surgery will improve long term results.
How do you measure the extent of a brachial plexus injury?
The tests listed below may be done before, during, or after surgery to show the extent of your child's nerve damage.
EMG (electromyography) measures how the nerve and muscle work together.
SSEPs (somatosensory evoked potentials) measures how the nerve communicates between the spinal cord and the brain.
NAPs (nerve action potentials) tests for nerve conduction across the injured site.
Myelogram CT (myelogram computer tomography) measures spinal cord and nerve root damage by taking x-rays after a dye is injected into the spinal cord.
MRI (magnetic resonance imaging) provides a detailed picture of the spinal cord and nerve roots.
What type of brachial plexus injury can occur?
A stretch injury may cause three types of damage. Your child may have one itype or a combined injury.
The nerve root separates from the spinal cord. this problem will not repair itself without surgery.
Neuroma-in-continuity with good conduction
This is from damage to the nerve but a message still travels through it The nerve will grow back over time.
Neuroma-in-continuity without conduction
There is damage to the nerve and messages are not able to travel through it. The nerve will need to be repaired with surgery.
In most cases, it is only during surgery that we can tell if a message is able to travel through the damaged nerves or not.
Types of Repair
The surgeon removes the scar tissue around the nerve.
The damaged part of the nerve is removed or bypassed and replaced with a nerve graft. Nerve grafts are taken from the leg, arm, or the neck at the time of surgery.
A nerve from another place in the body such as the diaphragm, the neck, the chest wall is used to repair the damaged nerve
Your child's surgery may include cutting away scar tissue, reconnecting two ends of a nerve, or making a bypass or a graft around the injured nerve. An incision is made from the neck to the armpit. In some cases, an incision is made on the back near the shoulder blade.
You will be taught how to prepare your child for surgery at a clini visit.
After surgery, your child will stay in the hospital a few days. The surgical arm will be fastened to the chest with an ace wrap or sling for a couple of weeks so that it cannot be moved. Therapy will begin in 2 weeks and will last for many months.
The nerve recovery takes many months or up to a year. The nerve grows back about one inch per month.
When to Call Your Surgeon(s) or Nurse Practitioner
Call us if your child has any of these signs or symptoms.
- Redness, pain, swelling, or drainage at the incision site
- Fever greater than 101.5ºF
- Change in color, temperature, or feeling in the arm or hand
Please call with any questions or concerns.
Dr. Iskandar, Department of Neurosurgery: (608) 263-9651
Dr. Bentz, Department of Plastic Surgery: (608) 263-1367
Dr. Mark Kiehn, Department of Plastic Surgery: (608) 263-1367
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 02/26/2010
Copyright © 02/26/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5470
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