Injuries: Brachial Plexus Injuries
A brachial plexus injury is an injury to the nerve roots that supply the brachial plexus. These nerve roots include cranial nerves 5 through 8, and the first thoracic nerve. There are different types of injuries that can occur, depending upon which nerves are damaged. Injury to the nerves in baby’s upper trunk involve the 5th and 6th cranial nerves, which would affect the upper arm, but not the hand and forearm. This type of injury is called Erb Palsy, or Duchenne-Erb palsy. Usually, the injury involves only one side, but in a small percentage of cases, both sides are involved.1
Injuries to baby’s lower trunk affect the 8th cervical nerve and the first thoracic nerve, affecting baby’s forearm and hand. This type of injury is called Klumpke’s Palsy. Another type of injury affects the nerve roots from the 5th cranial nerve to the 1st thoracic nerve.
An injury is suspected when baby does not move an arm or hand, the arm, or hand, is in a certain position. The baby’s Moro reflex may show a response on the uninjured side, but not the arm that is injured.
Levels of nerve damage
Injuries to the nerves are defined according to the degree of injury to the nerves, but also by the injury to the surrounding axons, cells, and tissue.1
- Neurapraxia refers to an injury that is mild. There is no damage to the axons, and baby has a good chance of recovery.
- Axonotmesis refers to injuries caused by crushing, percussion, or stretching. There is damage to the axon, as well as the myelin sheath, but the damage may not be permanent. Recovery may occur, but in some cases, it doesn’t.
- Neurotmesis refers to damage to the axon, myelin sheath, and the surrounding stroma. Recovery will not occur unless surgery is performed.
It is often difficult to determine what degree of damage has occurred. In some cases, a CT scan or MRI may show neurotmesis, but they are usually not very reliable in babies under three months of age. If a baby shows no improvement by the time he is between 3 to 9 months of age, surgery may be performed to repair the nerves.
A baby may suffer from an injury to the brachial plexus while inside the mother’s uterus, long before labor occurs. When this is the case, the muscles in the affected arm may be smaller than normal. The joints in the arm may be stiff, and the bones may be smaller than those of the unaffected arm.1
In order to determine when the injury occurred, it is important that the position of baby at the time of birth be documented, especially which shoulder (right or left) was anterior and which shoulder was posterior, as well as any bruises that baby may have.1
Brachial plexus injuries occur before delivery, too
A brachial plexus injury can happen to a baby before he is born for several reasons. Sometimes, the mother’s contractions are strong enough to cause the injury, or it may occur when the mother is pushing. If baby is not in the correct position, such as a breech delivery, a brachial plexus injury may occur. Any of these situations may cause an increase in traction on the brachial plexus. Sometimes there is something abnormal in the mother’s uterus, such as a double uterus. If there are fibroids in the uterus that may cause the injury. Injury may also occur when baby is an abnormal position, such as in a breech delivery.
During a vaginal delivery, it is normal for the physician, or midwife, to hold baby’s head once the head is delivered and apply gentle traction in a specific way to help with delivery of the shoulders.1
Although a newborn can have a brachial plexus injury for several reasons, shoulder dystocia is the only well-known risk factor.1 For this reason, the American College of Obstetricians and Gynecologists established the guidelines for delivery of babies that have an estimated fetal weight of 5000 grams in non-diabetic mothers, and 4500 grams in diabetic mothers.1
A baby that has a brachial plexus injury is often monitored for any improvement as he grows. He may have physical therapy. In cases where the nerve damage is severe, surgery may be performed to repair the nerves.
If you or your loved one was seriously injured by an act of medical negligence, Crandall & Pera Law may be able to help. We are a nationally recognized team of medical malpractice and birth injury attorneys serving clients throughout Ohio and Kentucky. To learn more about who we are, or to schedule a consultation with an experienced birth injury attorney, please call 877-955-0020 or fill out our contact form.
- Russman, B. (2016). Neonatal brachial plexus palsy. UpToDate. Retrieved from http://www.uptodate.com/contents/neonatal-brachial-plexus-palsy