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The brachial plexus is a network of nerves present around the shoulder. These nerves offer a sense of feeling and muscular control in the hand, fingers, shoulder, arm, and forearm. When these nerves suffer injury, it causes loss of motion or weakness, which is called brachial plexus injury. There are many types of brachial plexus injuries based on the location of the nerve damage.

Some of the common causes that lead to brachial plexus injury in newborns are:

• Complicated birth, such as breech delivery.
• Mothers suffering long labor.
• Baby’s weight is more than 8 pounds.
• The shoulder of the baby is wide and does not fit the birth canal.

At the time of childbirth, this injury happens in case the neck of the baby gets pushed to one side. The brachial plexus nerve network starts from the nerve roots present in the spinal cord and extends to the armpit. From there, nerve branches start and continue towards the forearm, fingers, and hand.

When any kind of force upturns the angle between the shoulders and the neck, it causes stretching of the brachial plexus nerves. This injury can also pull the nerve roots from the baby’s spinal cord causing poor sensation and weakened muscular movement.

Symptoms of brachial plexus injury in newborns

• Complete or limited movement mainly in the elbow and shoulder
• A weak grip
• Numbness
• An odd position where the arm will bend towards the body or the hanging limb

Diagnosis

Brachial plexus injury is a common kind of injury, but its diagnosis is difficult. The affected arm is checked by a specialist for any signs of paralysis, position and gripping strength, numbness, etc. They might also check the startle response of the baby. After preliminary checking, the doctor might suggest the following tests:

• X-rays
• Nerve conduction study (NCS) and electromyogram for testing the functioning of nerve and muscle
• Magnetic resonance imaging (MRI)

Treatment of brachial plexus injury

Most babies suffering from brachial plexus injury have their movement and sense of feeling in their arms restored. If the injury is mild, it does not require treatment.

Most babies will require physical therapy, where the therapist will teach the parents different kinds of exercises to do at home to assist their baby in getting better. Certain massage techniques and stretching also help. 

If the injury is severe, then the baby needs care and treatment from a team of specialists, such as a neurosurgeon, orthopedics, occupational therapists, physical therapists, physical medicine, and rehabilitation.

Surgical treatments for brachial plexus injury in newborns includes:

• Nerve grafting: In this process, a nerve from another area of the body, like the rib, foot, or back, is taken to patch the brachial nerve that is injured.
• Nerve transfer: A healthy nerve is used for restoring the injured connections of the nerve.
• Muscle transfer: A muscle is taken from the thigh and is replaced with the paralyzed arm muscle.
• Tendon transfer: In this kind of surgery, tendons are taken from the working muscles present around the shoulder to enhance the motion and control of the arm.

Conclusion

Most babies recover completely within a span of 3 to 4 months. Those who fail to recover within that time have a poor outlook or less chance of complete recovery. In such cases, the nerve root is separated from the spinal cord.

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