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Brachial Plexus Injuries in Children

​​What is a brachial plexus injury or brachial plexus palsy?

The brachial plexus (BRAY-key-el PLEK-sis) is a complicated bundle of nerves in the lower neck behind the collarbone. These nerves provide movement and feeling to the shoulder, arm, hand, and wrist.

How does a child get a brachial plexus injury?

There are two ways that children can get an injury to the brachial plexus:

  • During birth: A brachial plexus injury occurs in 1.5 of every 1,000 live births. It is often caused when an infant's neck is stretched to the side during a difficult delivery. This injury results in partial loss of sensory and/or motor function of the involved arm.
  • Trauma: Traumatic brachial plexus injuries may occur due to accidents from motor vehicles, bikes, ATVs, sports, or a knife or gunshot injury. Nerve injuries vary in severity from a mild stretch to the nerve root tearing away from the spinal cord.

What are the symptoms of a brachial plexus injury?

A child's arm may appear to be limp or paralyzed. He or she may lack muscle control and/or feeling or sensation in the shoulder, arm, hand, or wrist.

How is a brachial plexus injury treated?

The way that the brachial plexus injury occurred will affect the way that it is evaluated and treated.

  • If the injury occurred at birth: Most infants with brachial plexus birth palsy are examined frequently to see if the nerves are recovering. Often, daily physical therapy exercises are recommended. Parents play an active role in helping their child recover maximum function in the affected arm. If there are not many changes after a few months, the child's doctor may recommend more testing or a surgical procedure.
  • If the injury occurred in an accident: If an object such as a knife has penetrated into the brachial plexus and cut it, the child's doctors will usually recommend a surgery to look at the area to see if the nerves need to be repaired.

There are some types of injuries to the brachial plexus that cannot be repaired with surgery. In these cases, the child's surgeon will recommend a combination of physical and occupational therapy to help to restore function to the child's arm.

How long is recovery from a brachial plexus injury or surgery?

Nerve injuries of all types take a long time to heal. The length of time for recovery after a nerve injury or a nerve surgery depends on the type of injury, as well.

  • If the nerves are only stretched without being disrupted: It can take several months for them to return to full function.
  • If nerves are cut or completely disrupted: They will not heal without surgery.

After a nerve repair or injury, the nerves must regrow from the site of injury. This occurs at a rate of about one inch (2.5 cm) every month. In the case of a brachial plexus injury, these nerves must then grow the whole way back down the arm towards the hand. While nerves are healing, a doctor will see a child regularly to follow his or her progress. Physical and occupational therapy are also an important part of the treatment after a brachial plexus injury. These therapies help children gain as much function back as possible.

What is the outlook like for children who have had a brachial plexus injury?

Sometimes after an injury to the brachial plexus, children do not regain all of their shoulder, arm, hand, or wrist function. Many children continue to have some weakness and pain, as well. Surgeons can sometimes use other muscles, tendons, or nerves that are working correctly to help improve function. As a child ages, his or her doctor will discuss various treatment options and recommendations. Regular follow-up visits after these injuries ensure the best possible outcome.    

Additional Information:

Last Updated
9/30/2015
Source
Section on Plastic Surgery (Copyright © 2015 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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