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  • Dr. Paul Sinkhorn, M.D.

Brachial Plexus

Brachial plexus injuries are unusual, but may occur during a delivery when the nerves of the brachial plexus are stretched, compressed, or torn.

Results of such an injury may vary from temporary to permanent loss of muscle function, possibly at different spinal levels.

Whether you represent a plaintiff or a defendant, OB-GYN Expert Witness Dr. Paul Sinkhorn has the knowledge and expertise that you may need to examine your case when there has been a brachial plexus injury during childbirth.


What is the Brachial Plexus?


The brachial plexus is a network of nerves, traversing the neck and shoulders, that control sensation and motor function in the shoulders, arms, and hands.


Brachial Plexus | Brachial Plexus Birth Injury

Brachial Plexus Injuries


Brachial plexus birth injuries are often categorized according to the type of nerve injury involved:

Stretch

  • Most common brachial plexus injury

  • Nerve has been stretched but not torn

  • Injury occurs peripheral to the spinal cord

  • Affected nerve(s) have the ability to recover on their own, typically within the first three months after the injury occurred

Rupture


  • Common brachial plexus injury, but not as common as a stretched nerve

  • Nerve is torn, but not where it attaches to spine

  • Injury is peripheral to the spinal cord

  • May require surgery for repair

Avulsion

  • Least common brachial plexus injury (~10-20% of injuries are nerve avulsions)

  • Nerve roots are torn from spinal cord as the injury occurs at the cord level

  • Damaged tissue requires nerve transfer surgery and cannot be repaired directly

  • Multiple levels may be affected

Whether your child has had a brachial plexus nerve stretch, rupture, or avulsion, these injuries may lead to:

Erb’s Palsy

  • Erb’s Palsy involves the upper portion of the brachial plexus (C5, C6, sometimes C7) and can result in weakness or paralysis of the arm and/or hand.

  • A child typically also has weakness in the shoulder and biceps muscle.

  • Home physical therapy is encouraged when a baby is 3 weeks old in order to prevent stiffness, atrophy, and shoulder dislocation.

Total Plexus Involvement

  • All 5 nerves of the brachial plexus (C5-T1) are involved in a total plexus involvement injury.

  • This injury represents the severest of all brachial plexus injuries.

  • Children may not be able to move their shoulder, arm, or hand at all.

Horner’s Syndrome

  • Horner’s syndrome is associated with damage to sympathetic nerve fibers at the T1 level.

  • The child may have a droopy eyelid (ptosis) on the side of the injury, a smaller pupil of the eye (miosis), and diminished sweat production in the face (anhidrosis).

Klumpke’s Palsy

  • This injury involves the lower root brachial plexus nerves (typically including C8).

  • Klumpke’s palsy affects the muscles of the hand.


Brachial Plexus Injury Symptoms


If a newborn has a brachial plexus injury, they may experience:

  • Paralysis or muscle weakness in the affected arm or hand.

  • Decreased sensation, feeling, or movement throughout the upper limbs.

The affected child may or may not experience significant pain in the limb following a brachial plexus injury.


What Factors may be associated with a Brachial Plexus Injury?


  • Vaginal breech birth

  • Large fetal size

  • Vacuum-or forceps-assisted delivery

  • Difficult or prolonged delivery

  • Multiple pregnancy

  • History of a prior delivery resulting in a brachial plexus injury

  • Diabetes, particularly poorly controlled diabetes


How to Treat Brachial Plexus Injury


Brachial plexus birth injuries don’t always require treatment and some babies are known to recover without any treatment. Recovery may take up to several weeks or months for the injury to fully heal.

Severe injuries may require surgery, depending on the nerves involved in the injury, but certain exercises can help with healing and function.

Prompt examination by a health care practitioner is vital after any suspected injury involving the brachial plexus.

Mild injuries of the brachial plexus can be treated with these non-surgical options:

  • Physical therapy: exercises that may help restore function in the upper limbs to improve range of motion and flexibility in stiff muscles or joints.

  • Medications: can help relieve pain, if there is any.

  • Occupational therapy (for older children): exercises that help a patient work on their practical, daily skills such as dressing, exercising, writing, etc.

  • Assistive devices: braces, splints, compression sleeves.

Contact OB-GYN Expert Witness Dr. Paul Sinkhorn if you need assistance in analysis and discussion of an obstetric case involving a brachial plexus injury.


For more information, visit us on our website.

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