Brachial palsy is a condition where an infant's arm is partly or completely paralyzed at birth.
Brachial palsy is a birth injury that can happen to newborns during delivery of the head and shoulders. It may be more common in a bigger baby when the shoulder may get stuck in the birth canal.
The brachial plexus is a network of nerves that join together to form the nerves of the arm, hand, and fingers. If the brachial plexus is stretched during delivery, the newborn may have weakness or paralysis involving all or part of an arm.
A newborn with brachial palsy holds the affected arm close to the body. The elbow is not bent, and the hand is turned palm down. The infant cannot move the affected arm. Sometimes only the upper part of the arm is affected, and the baby can move the hand and fingers. Often the entire arm, including the hand and fingers, is affected.
The injury is more likely to happen if the baby is large and the bony outlet of the mother's pelvis is small, relative to the baby. The brachial plexus can be stretched if the person assisting in the delivery has to pull on the baby's head and neck in order to deliver the shoulders. It can also happen with breech delivery, if the baby's arms are extended above his or her head during the delivery.
It is not easy to predict whether there is going to be difficulty delivering the baby's shoulders. If the mother is known to have a small pelvic outlet and to be carrying a large baby, the infant may be delivered by cesarean section.
The healthcare professional can generally diagnose brachial palsy by observing the infant's arm position and movement. The provider may order an X-ray, CT scan, or MRI scan if a collarbone fracture is suspected.
The long-term effects of brachial palsy will vary, depending on the degree of damage to the brachial plexus. If mild damage occurs, the symptoms may improve within several days to 6 months. With severe damage, permanent paralysis may occur.
Brachial palsy poses no risk to others.
If the injury to the nerves is mild, arm and hand function usually return after several months. If the nerves are actually torn, normal function may never be recovered.
Fortunately, injuries of this severity are rare. If it appears that nerve function is not returning quickly, the arm and hand can be placed in splints while the infant is sleeping to maintain the normal joint function. Range-of-motion exercises may be recommended to keep muscles strong and active.
In rare cases, surgery may be necessary. The surgery may involve repair of the torn brachial plexus. Sometimes orthopaedic surgery is required to correct deformities, release muscle tightness and/or transfer tendons to improve function.
Splints can cause skin irritation or rash.
A child who has full recovery from brachial palsy will need no further treatment. A child who has mild to moderate nerve damage may need physical therapy to improve use of the arm and hand. A child who has full paralysis may need periodic physical therapy to adjust to using different equipment.
Brachial palsy can best be monitored by the caregiver and, as the child gets older, by the child. Any new or worsening symptoms should be reported to the doctor.
Current Pediatric Diagnosis&Treatment, Hathaway, et al, 1993
