Brachial plexus injuries can be highly traumatic and leave a lasting mark on a child’s life. Often caused by medical negligence, injuries to a child’s shoulder nerves can lead to damaging complications that are both painful and expensive. A child may lose the ability to move or feel in their upper extremities, especially after a serious incident.
The whole family experiences stress and suffering when a child is injured. The child feels the physical pain, while the parents bear emotional and financial hardships. Understanding brachial plexus injuries and how they happen can help the family move forward.
What Is a Brachial Plexus Birth Injury?
The brachial plexus nerves permit arm and shoulder movement as well as the feeling and sensation in these areas. This is a complex network of nerves that run between the neck and shoulders. An injury occurs when these nerves are stretched, torn, compressed, or avulsed. Injuries could occur to all or only part of this critical area:
- Upper brachial plexus injuries: These damage the C5 and C6 vertebrae, often affecting muscles in the shoulder and elbow.
- Lower brachial plexus injuries: These injuries typically damage the C7, C8, and T1 vertebrae, affecting the forearm and hand.
Many injuries are minor and heal on their own. Others can lead to severe complications and lasting damage. This typically depends on the severity and type of trauma as well as the extent of nerve tearing.
What Causes Brachial Plexus Injuries?
Brachial plexus injuries during childbirth can occur in several ways. Determining the cause can help inform treatment options, identify potential complications, and help prove a doctor’s negligence in a medical malpractice case.
Common causes of brachial plexus birth injuries include:
- Maternal obesity
- Babies born in a breech position
- Delivery of an oversized baby
- Delivery of a baby through a small birth canal
- Shoulder dystocia
- Improper development of the child’s neck muscles in utero
- Difficult or prolonged labor
- Multiple-pregnancy birth
- Improperly applied force to the child’s neck and shoulders during delivery
- Use of vacuum assistive devices or forceps
- Maternal gestational diabetes
- Pressure on the baby’s arms during a breech delivery
These and other causes are often due to medical negligence. Mistakes during delivery or labor can do incredible damage to a new baby. When this happens, doctors and other medical staff should be financially responsible for the harm they cause.
Symptoms and Signs of a Brachial Plexus Injury
Brachial plexus injuries are often difficult to observe at birth. Instead, many of the symptoms and signs appear later. These typically include:
- The baby’s hand is in a claw-like position
- Irregular muscle contractions in the arm or shoulder areas
- Little to no movement in the arms or shoulders
- Temporary or permanent paralysis in the affected area
- The child presents with an uneven Moro reflex or startle reflex
- The child has a weak grip
- The child’s arm is in an odd position or hangs limp
Many children suffer life-changing consequences of severe brachial plexus injuries. Many lose partial or total feeling in their arms and shoulders. This may also lead to partial or total paralysis in these areas.
How Is a Brachial Plexus Injury Diagnosed?
These injuries are typically diagnosed by a baby’s pediatrician. This usually involves a thorough physical examination and a medical history analysis. The examination may be performed by the child’s general practitioner or a specialist. Parents of children who continue to experience issues beyond 6 weeks of age should consult a brachial plexus specialist or pediatric orthopedist for a more thorough diagnosis.
Doctors may also use specialty diagnosis methods such as:
- A magnetic resonance imaging (MRI) test
- Nerve conduction studies
- X-rays or CT scans
These and other diagnosis methods can help determine whether a child has this injury and the best way to treat it.
How Do Doctors Treat Brachial Plexus Injuries?
Less severe brachial plexus injuries heal on their own, with little to no medical intervention needed. In these cases, doctors simply observe and monitor the child closely. They observe whether the injury is healing and whether it heals by the time the child reaches between 3 and 12 months of age. A doctor will perform multiple exams over time to ensure the healing process is proceeding well.
In more serious cases, a doctor may order occupational and physical therapy. This helps maximize the the use of the affected arm and prevents the tightening of joints and muscles in the arms and shoulders. Parents can learn range of motion exercises to do at home with their child to continue this treatment.
Surgical Treatment for Brachial Plexus Birth Injuries
Severe cases may require surgical intervention. Children who have problems past three to six months often need surgery to help fix or partially remediate the damage done by the birth injury. This might include:
- Nerve surgery: This microsurgery reconstructs or repairs injured nerves. It usually consists of nerve grafting and nerve transfer procedures. This is best performed when children are between 3 and 9 months of age and is usually not beneficial to those over 1 year old.
- Tendon transfers: This surgery involves separating a tendon from its typical attachment and reattaching it elsewhere. It is usually performed on children over the age of 1. This is meant to help the child’s ability to raise their arm and typically requires a cast for four to six weeks after the surgery.
- Osteomy: In this procedure, the doctor cuts certain bones and reorients them to improve extremity function. This is most common on the upper arm bone, the humerus, or on the forearm.
- Free muscle transfers: This extensive surgery transfers muscles from elsewhere, typically a leg, to the upper body when no local muscle will suffice.
- Capsulorraphy: This procedure involves an open reduction of the shoulder joint. A doctor performs a surgical incision or arthroscopy to place the humeral head back in the joint and surgically tighten any loose tissue around the joint.
Surgical options are for more serious cases, and carry many of their own risks.
Options Exist After a Brachial Plexus Birth Injury
Brachial plexus injuries can leave a child disabled, especially in severe cases. While some mild cases resolve independently, serious cases deserve extra consideration. Determining the cause of the child’s condition may reveal a doctor’s negligence. A medical malpractice case may help an injured child and their entire family win financial compensation.
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