Brachial Plexus Injuries at Birth

What is Brachial Plexus?

Obstetric brachial plexus injury (OBPI), also known as birth brachial plexus injury (BBPI), is an injury more commonly seen in new-born children. It is an injury to the brachial plexus nerves. An injury occurs when the nerves are stretched, compressed, torn/pulled/ripped away from the spinal cord. The result of a brachial plexus injury can vary from a minor loss of movement to no movement at all in the arm.

How does this affect new-born babies?

The causes of brachial plexus injuries in birth cases are usually due to the stretching of the nerves during a slow or complex birth. This is affected by the power used on the head of the baby, or the upper limbs to try to deliver the baby.

Risk factors

Brachial plexus injuries are more common in babies who are larger than average size. There is also a greater risk where the delivery of a baby requires intervention with instruments to assist the delivery (such as vacuum or forceps assisted delivery), a prolonged labour, a premature birth where the baby is in breech position, maternal diabetes or excessive weight gain in pregnancy, or a history of previous delivery resulting in brachial plexus birth injury. All of these situations can contribute to the complex difficulties associated with brachial plexus injuries in birth.

How is a new-born baby diagnosed with OBPI?

Diagnosis of this is usually straightforward as there is usually an obvious visible sign such as the affected limb often placed into a certain involuntary position, muscle weakness or paralysis in the affected arm/hand, decreased movement or sensation in the upper extremity. There are other conditions that can display some features similar to OBPI (such as Horner's syndrome) so if further complications are suspected, further tests and treatment may be required.

A condition that is commonly mistaken for BPI is injury to the growth plate of the humerus, particularly in the form of a fracture. Such injuries can produce painful unilateral pseudoparalysis that appears the same as the restricted movement seen in BPI. Ultrasound scans may be required, as the damage is often not visible on x-rays. Other conditions which may be mistaken for OBPI include congenital radial nerve injuries (which almost invariably improve) and cerebral palsy, although cerebral palsy usually worsen with time whereas OBPI doesn't.

What is the treatment?

Although spontaneous recovery is known in some cases, there is a large number of cases in which children do not recover and require surgical intervention. Once surgery has taken place, unfortunately this can sometimes leave residual deficit in limb function and can therefore have the potential to affect the ability of a child to carry out daily activities. Therefore, early intervention and care is key, as this can provide the opportunity of the best chance of recovery and reduces the risk of postural and developmental disorders, as well as any psychological impact that might arise from this in later life.

Support & advice

If you need support with this condition, Erb's Palsy Group is a charity that provides families with support, advice and information around erb's palsy - also known as what we refer to in this article as brachial plexus injury.

If you feel that you have suffered a similar experience with the delivery of your baby, or have any queries in light of the above circumstances, we have an experience Clinical Negligence Team at Forbes who can discuss this further.