What is Obstetric Brachial Plexus Palsy?Approximately 1 to 2 babies in 1,000 suffer a brachial plexus birth injury during delivery. Obstetric brachial plexus palsy is most common when there is difficulty delivering the baby's shoulder. During delivery, the baby's shoulder may become stuck on the mother’s pubic bone causing the brachial plexus nerves to stretch or tear. This is called shoulder dystocia. Erb's Palsy refers to an injury to the upper brachial plexus nerves leading to loss of motion in the shoulder and ability to flex the elbow. Klumpke's palsy refers to an injury of the lower brachial plexus nerves which leads to loss of motion in the wrist and hand.
Preventing Shoulder DystociaDoctors should carefully consider risk factors which could lead to shoulder dystocia prior to birth, including:
- maternal diabetes or gestational diabetes
- the size of the baby
- a history of prior deliveries of large babies or deliveries involving shoulder dystocia
- maternal obesity
- the mother’s abnormal pelvic size or shape
Types of Brachial Plexus InjuriesBrachial plexus injuries are categorized according to the type of trauma experienced by the nerve. The following are the types of brachial plexus injuries:
- Avulsion – this means the nerve has been pulled out from the spinal cord and has no chance to recover.
- Rupture – this means the nerve has been stretched and at least partially torn, but not at the spinal cord.
- Neurapraxia – this means the nerve has been gently stretched or compressed but is still attached (not torn) and has the excellent prognosis for rapid recovery.
- Axonotemesis – this means the axons (equivalents of the copper filaments in an electric cable) have been severed. The prognosis is moderate.
- Neurotemesis – this means the entire nerve has been divided. The prognosis is very poor.
- Neuroma – this refers to a type of tumor that grows from a tangle of divided axons (nerve endings), which fail to regenerate. The prognosis will depend on what percentage of axons do regenerate.
Signs Your Child Has a Brachial Plexus InjuryThe following are possible symptoms that your child may have a brachial plexus injury.
- No, muscle control and no feeling in the arm or hand
- Little control over the wrist and hand
- Unable to use the shoulder or elbow muscles
- Unable to use the fingers
- Limp or paralyzed arm