About Physiatry

Neonatal Brachial Plexus Injury

Condition: The brachial plexus is a bundle of nerves connecting the base of the neck to the armpit. Neonatal brachial plexus injury (NBPI) is damage that occurs to these nerves in a baby either during labor or delivery. It can result in paralysis in all or part of the arm and hand.

Background: NBPI occurs in one to two of every 1,000 live births. It is considered the most common birth injury and the most common cause of paralysis of the arm in children.

Risk Factors: If the birth involves shoulder dystocia, the infant 100 times more likely to have NBPI. Shoulder dystocia occurs after the baby’s head is delivered during birth, but the shoulders do not follow, unless there is significant manipulation to get them to pass through. Other risks include high birth weight, maternal diabetes and having had a baby before with NBPI.

History and Symptoms: The affected arm will appear loose or weak immediately after birth. In addition to loss of function, the baby may also have abnormal muscle contractions. Although most newborns will recover in a few months, 20-30% have a permanent disability.

Physical Exam: The rehab physician/PM& physician will focus on determining the specific location of the injury. He or she may test the infant’s sensations and perform other tests.

Diagnostic Process: The rehab physician/PM&R physician will take an X-ray, to make sure there are not additional injuries besides the NBPI, such as bone fractures.

Rehab Management: For the first week after birth, the affected arm or hand should be supported and protected. After this, gentle range-of-motion exercises can begin. Parents should learn how to help the baby perform stretching and strengthening exercises, and how to incorporate the affected arm or hand into daily activity. Occupational therapy typically occurs throughout early childhood to maximize recovery. Surgical intervention including nerve transfers may be needed if the nerve roots have been completely pulled away from the brachial plexus, or muscle surgery may be needed to realign muscles in the arm to maximize function later in childhood.

Other Resources for Patients and Families: The United Brachial Plexus Injury Network has resources and information that may be helpful.


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