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Obstetric Brachial Plexus Palsy

Where is the brachial plexus?

The brachial plexus is a network of nerves in the shoulder that carries signals from the spinal cord to the arms and hands. It allows people to control movements and feel sensations in the arms and hands. When the brachial plexus nerve in the shoulder is injured during the birthing process, this condition is called obstetric brachial plexus palsy.

What is obstetric brachial plexus palsy?

Injury to the brachial plexus is fairly common during the birthing process, occurring in 1-2 births per 1,000. Larger babies in difficult deliveries are particularly prone to this injury. The brachial plexus can also be injured when nerves are stretched by a blow to the shoulder or when bones around them are broken.

Erb's Palsy refers to an injury of the upper brachial plexus nerves leading to loss of motion around the shoulder and ability to flex the elbow. Klumpke's palsy refers to an injury of the lower brachial plexus leading to loss of motion in the wrist and hand.

Symptoms of brachial plexus palsy

Children and babies with brachial plexus injuries will typically have a number of the following symptoms:

  • Unable to lift their arm above their head
  • Unable to bring objects to their mouth
  • Unable to move their fingers
  • Unable to feel things in their arm, hand or fingers
  • Tingling or pain in their arm, hand or fingers

Treatment for obstetric brachial plexus palsy

Early diagnosis and treatment can seriously improve long-term outcomes for these injuries. The seriousness of these injuries can vary widely. Many children will regain all or most function through occupational therapy. If no improvement is seen after three months, however, a pediatric neurologist and pediatric neurosurgeon should determine if the child can benefit from other interventions or surgery. 1 in 10 babies with brachial plexus injury will require some level of surgery. If the injury occurred during the birthing process, the best age for surgery is between four and nine months, as waiting more than a year can result in long-term damage.

Learn more about pediatric plexus surgery.

To request a consultation or make an appointment, please contact Johns Hopkins Pediatric Neurosurgery at 410-955-7337.

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