What is the brachial plexus?
The brachial plexus is a network of nerves which run from the cervical spinal cord to the muscles of the upper limb.

How can it be injured?
Injuries to the brachial plexus can be due to trauma, tumours or inflammation. Most commonly they are classified as traumatic (due to injury from falls, impact or violence and suchlike) or obstetric (occurring due to complications in childbirth).

Symptoms

  • Arm being limp or paralysed
  • A lack of muscle control in arm, hand or wrist
  • Lack of sensation in the arm
  • Diminished reflexes in the arm
  • Clawed hand

What are the types of brachial plexus birth palsy? 
There are four different types

  • Avulsion
  • Rupture
  • Neuropraxia
  • Neuroma

What is the prognosis for patients with brachial plexus birth palsies?
The prognosis is dependant upon the extent of the injury, and for this reason, varies from patient to patient. In the absence of adequate recovery, surgery can improve strength and/or motion and help optimize shoulder joint development.

How is brachial plexus birth palsy treated?

  • Most patients suffering from brachial plexus birth palsies (Erb’s palsy) will spontaneously recover
  • Many children improve by 3-12 months of age during which time serial examinations are conducted
  • Physical therapy is done by parents and therapists in the absence of which patients can develop contractures and stiffness of joints
  • Surgery
    • Microsurgery: If there is inadequate recovery during the first 3 -6 months of life, microsurgery  is recommended. Microsurgery involves exploring the brachial plexus and trying to repair or reconstruct the injured nerves. In many cases, this will require the use of nerve grafts, which are typically taken from the patient’s leg(s).
    • Upper Type (C 5 and 6): If the deltoid (shoulder abduction) does not return by two months and the biceps (elbow flexion) by  three months, surgery is necessary to restore proper continuity between the proximal and distal nerve stumps using nerve grafts in order to improve the quality of the eventual function.
    • C5-T1: If there is no hand and finger movement, then exploration and nerve graft surgeries at 3 months are a necessity in order for the patient to recover any useful function.