Brachial plexus injuries are among the most common birth-related nerve injuries, affecting approximately 1 to 3 infants per 1,000 live births. These injuries occur when the network of nerves that controls arm and hand movement is damaged during delivery. While many cases resolve on their own, severe injuries can result in permanent disability affecting a child’s mobility, function, and quality of life.
In New York, families dealing with brachial plexus injuries have legal options if the injury resulted from medical negligence. Understanding the types, causes, and outcomes of these injuries is essential for parents navigating both medical treatment and potential legal claims.
If your child suffered a brachial plexus injury during birth, connect with qualified New York attorneys who understand both the medical and legal aspects of birth injury claims. Free case evaluation. No cost unless you win.
What Is the Brachial Plexus?
The brachial plexus is a network of nerves that originates from the cervical spine (neck region), specifically from nerve roots C5 through T1. These nerves branch and combine to form nerves that control:
Arm Movement
Shoulder and elbow function, including the ability to lift and extend the arm
Hand Function
Wrist and finger movement, grip strength, and fine motor control
Sensation
Feeling in the arm, forearm, and hand, including pain and temperature perception
Muscle Control
Coordination and strength throughout the entire upper limb
This complex nerve network allows for the intricate movements and sensations we use daily. When damaged, it can significantly impair a child’s ability to use their arm and hand.
Types of Brachial Plexus Injuries at Birth
Brachial plexus injuries are classified based on the severity and location of nerve damage:
1. Stretching (Neuropraxia)
Severity: Mild to moderate
What happens: The nerve is stretched but not torn. The outer covering (myelin sheath) may be damaged, but the nerve structure remains intact.
Prognosis: Most children recover within 3-6 months. This is the most common and least severe type of brachial plexus injury.
Symptoms: Weakness in the affected arm, reduced movement, possible loss of sensation
2. Partial Tearing (Axonotmesis)
Severity: Moderate
What happens: The inner nerve fiber (axon) is damaged or torn, but the nerve sheath remains intact. This prevents normal electrical signals from traveling through the nerve.
Prognosis: Recovery takes several months to over a year. The nerve can gradually heal and regenerate, but the process is slow.
Symptoms: More significant weakness, limited arm function, reduced ability to grasp or lift
3. Complete Tearing (Neurotmesis)
Severity: Severe
What happens: The entire nerve is torn, severing the connection between the nerve and the muscles it controls.
Prognosis: Without surgical intervention, permanent nerve damage and loss of function are likely. Surgical nerve repair or grafting may be necessary.
Symptoms: Complete paralysis of the affected arm, total loss of function in that limb
4. Root Avulsion
Severity: Catastrophic
What happens: The nerve is torn at its origin from the spinal cord, completely detaching from the spine.
Prognosis: Permanent nerve damage. The damaged nerve cannot heal because it has been completely separated from the spinal cord. Surgical repair is difficult or impossible.
Symptoms: Complete paralysis, permanent loss of arm function unless corrective surgery can be performed
Causes of Brachial Plexus Injuries During Birth
Brachial plexus injuries occur during delivery when excessive force or improper technique stretches or tears the nerves. Common causes include:
Shoulder Dystocia
When the baby’s shoulder becomes stuck behind the mother’s pubic bone during delivery, excessive traction on the arm can damage the brachial plexus.
Lateral Traction
Pulling the baby’s head away from the body with excessive force during delivery, especially when combined with downward pressure.
Improper Forceps Use
Incorrect application or excessive traction with forceps can stretch or damage the brachial plexus nerves.
Vacuum Extraction Complications
While generally safer than forceps, vacuum-assisted delivery can still cause nerve damage if excessive traction is used.
Breech Delivery
Pulling a baby in breech position (feet-first) can place excessive stress on the brachial plexus nerves.
Large Baby Size
Macrosomia (abnormally large baby) increases the risk of shoulder dystocia and brachial plexus injury.
Risk Factors That Increase Injury Risk
Certain maternal and fetal conditions increase the likelihood of brachial plexus injury:
| Risk Factor Category | Specific Risk Factors |
|---|---|
| Maternal Factors | Maternal diabetes (increases fetal size), obesity (complicates delivery), advanced maternal age |
| Fetal/Baby Factors | Large birth weight (macrosomia), incorrect position in uterus (transverse), prematurity complications |
| Labor Complications | Prolonged labor, failure to progress, need for assisted delivery (forceps/vacuum) |
| Delivery Management | Excessive traction, improper shoulder dystocia management, lack of proper technique |
| Provider Inexperience | Lack of training in proper delivery techniques and shoulder dystocia management |
Important note: Even with risk factors present, proper delivery technique and appropriate medical management can prevent brachial plexus injuries in most cases.
Signs and Symptoms of Brachial Plexus Injury
Parents should watch for these signs that may indicate a brachial plexus injury:
Immediate Signs (Within Hours of Birth)
- Weak or absent arm movement on one side compared to the other
- Limp arm that doesn’t move when the baby is startled (absent Moro reflex)
- Inability to grasp with one hand while the other grasps normally
- Crying or pain when the affected arm is touched or moved
- Clenched fist position with inability to open the hand
Early Signs (First Few Weeks)
- Decreased movement of the affected arm during normal activities
- Lack of sensation – the baby doesn’t react to touch on the affected arm
- Muscle atrophy – visible shrinking of muscles in the affected arm
- Positioning preference – the baby holds the affected arm in a fixed, unnatural position
- Failure to use affected arm for reaching or grasping
Diagnosis of Brachial Plexus Injuries
Diagnosis typically involves:
Clinical Examination
A pediatrician or neurologist performs a physical exam to assess:
- Arm and shoulder movement compared to the unaffected side
- Muscle tone and strength
- Presence of the Moro reflex on both sides
- Hand and finger movement and grip
- Response to touch and pain stimuli
Imaging Tests
Ultrasound
Can show swelling, fluid collection, or nerve damage. Often the first imaging study performed because it’s non-invasive and shows soft tissue detail.
MRI
Provides detailed images of nerve structure and can identify tearing, avulsion, or nerve root damage. May be performed if ultrasound shows severe injury or to plan surgical intervention.
EMG/NCS
Electromyography and Nerve Conduction Studies measure electrical activity in muscles and nerves to assess the severity of nerve damage and guide prognosis.
CT Scan
May be used to evaluate nerve root avulsion and assess bony structures. Often reserved for cases where surgery is being considered.
Short-Term Outcomes and Recovery
The outlook for brachial plexus injuries varies significantly based on injury severity:
Mild to Moderate Injuries (Neuropraxia/Axonotmesis)
Recovery Timeline: 3-12 months
Outcome: Most children (70-90%) make a full or near-complete recovery without surgery. The nerve gradually regenerates, and normal function returns over weeks to months.
What Parents Should Expect:
- Gradual improvement in arm movement and strength
- Return of sensation over time
- Resolution of pain or sensitivity
- Normal arm development and function by 1-2 years old
- Physical therapy helps facilitate recovery
Severe Injuries (Neurotmesis/Root Avulsion)
Recovery Timeline: 2+ years or permanent
Outcome: Without surgical intervention, permanent nerve damage and loss of function are likely. Even with surgery, complete recovery is difficult to achieve.
What Parents Should Expect:
- Need for surgical evaluation and possible nerve repair or grafting
- Multiple surgeries may be necessary
- Long-term physical and occupational therapy
- Possible residual weakness or limited function
- Ongoing management and monitoring through childhood
Long-Term Outcomes and Disability
Long-term outcomes depend on the severity of the initial injury and quality of early intervention:
Favorable Outcomes
Full Recovery
Many children with mild-to-moderate injuries (approximately 70%) achieve full functional recovery with essentially no residual effects by age 2-3 years.
Near-Normal Function
Remaining children may have minor strength differences or limited range of motion that doesn’t significantly impact daily activities or sports participation.
Poor Outcomes
Persistent Weakness
The child has ongoing weakness in the affected arm, limiting strength for lifting, carrying, or pushing activities.
Limited Range of Motion
Restriction in shoulder or elbow movement affects the child’s ability to reach, throw, or participate in sports.
Chronic Pain
Some children experience persistent pain or abnormal sensations in the affected arm, impacting quality of life.
Permanent Disability
In severe cases (root avulsion without successful repair), permanent paralysis or significant loss of arm function requires ongoing support and adaptation.
Factors Influencing Long-Term Outcomes
| Factor | Impact on Outcome |
|---|---|
| Severity of Initial Injury | Stretching injuries generally have better outcomes than complete tears or root avulsion |
| Type of Nerve Affected | Upper trunk injuries (Erb’s palsy) often have better outcomes than lower trunk or whole plexus injuries |
| Early Treatment | Prompt physical therapy and appropriate medical management improve outcomes significantly |
| Surgical Timing | Surgery within 3-6 months of injury (if needed) has better outcomes than delayed surgery |
| Surgical Technique | Skilled nerve repair or grafting by experienced surgeons improves functional outcomes |
| Child Compliance | Consistent physical and occupational therapy during critical developmental years improves recovery |
Treatment Options for Brachial Plexus Injuries
Non-Surgical Treatment
Physical Therapy is the foundation of treatment for most brachial plexus injuries:
- Passive range of motion exercises prevent stiffness and contractures
- Active-assisted exercises encourage the baby to use the affected arm
- Strengthening exercises build muscle power as recovery progresses
- Positioning and splinting prevent complications and support recovery
- Functional training teaches the child to use the affected arm for daily activities
Occupational Therapy helps with fine motor skills, hand function, and adaptation strategies for daily living.
Timeline: Physical therapy typically begins immediately and continues for months to years depending on severity.
Surgical Treatment
Surgery may be recommended when:
- No improvement is seen after 3-6 months of conservative treatment
- Severe nerve injury (complete tear or root avulsion) is documented
- Imaging shows clear nerve damage requiring repair
Surgical Options:
- Nerve repair – reconnecting completely severed nerves
- Nerve grafting – using healthy nerve tissue to bridge gaps in damaged nerves
- Nerve transfer – rerouting healthy nerve branches to damaged nerve pathways
- Muscle transfer – surgically moving functional muscles to restore arm movement
Timing: Ideally within 3-6 months of injury, before irreversible muscle changes occur.
Preventable Injuries: Medical Negligence Considerations
While some brachial plexus injuries occur despite appropriate medical care, many are preventable with proper delivery technique and management. Medical negligence may be involved if:
Improper Technique
The healthcare provider uses excessive traction, pulls incorrectly, or applies forceps improperly
Failure to Recognize Risk
The provider fails to identify risk factors for shoulder dystocia or prepare appropriately
Inadequate Training
The provider lacks proper training in shoulder dystocia management or has insufficient experience
Delayed Surgery
The provider unnecessarily delays surgical evaluation or repair when urgently needed
Failure to Manage Complications
The provider doesn’t respond appropriately when shoulder dystocia or other delivery problems occur
Inadequate Monitoring
The provider fails to monitor for warning signs of injury or doesn’t alert specialists promptly
If you believe your child’s brachial plexus injury resulted from medical negligence, it’s important to consult with attorneys who understand both the medical and legal aspects of these complex cases.
Frequently Asked Questions About Brachial Plexus Injuries
Will my child recover completely from a brachial plexus injury?
Many children (approximately 70%) with mild-to-moderate brachial plexus injuries achieve full or near-complete recovery within 3-12 months. However, children with severe injuries (complete nerve tearing or root avulsion) may have lasting effects. Early intervention and consistent therapy improve outcomes significantly.
Do brachial plexus injuries always require surgery?
No. Most brachial plexus injuries (approximately 70-80%) improve with physical therapy alone over weeks to months. Surgery is typically recommended only if there’s no improvement after 3-6 months or if severe nerve damage is documented on imaging studies.
When can I expect improvement in my child’s arm function?
Improvement varies by injury severity. Mild injuries may show noticeable improvement within weeks. Moderate injuries typically improve over 3-12 months. Severe injuries that require surgery may take 1-2+ years to show significant improvement, and some residual effects may persist.
What causes brachial plexus injuries during birth?
Brachial plexus injuries typically result from excessive pulling or stretching of the nerves during delivery. Common causes include shoulder dystocia (baby’s shoulder stuck during delivery), excessive traction with forceps or vacuum, breech delivery, and improper delivery technique by healthcare providers.
Can brachial plexus injuries be prevented?
Yes, in many cases. Proper delivery technique, appropriate management of shoulder dystocia, and experienced healthcare providers can prevent most brachial plexus injuries. Risk factors like maternal diabetes or large baby size should prompt careful monitoring and specialized management.
What’s the difference between Erb’s palsy and Klumpke’s palsy?
These are two patterns of brachial plexus injury: Erb’s palsy affects the upper nerves (C5-C6) causing arm weakness, and Klumpke’s palsy affects the lower nerves (C8-T1) causing hand and finger weakness. Erb’s palsy is more common and typically has better outcomes than Klumpke’s palsy.
Is my child’s brachial plexus injury a sign of medical negligence?
Not necessarily. Even with appropriate medical care, some brachial plexus injuries occur, particularly with risk factors like maternal diabetes or large babies. However, if negligent delivery technique, inadequate training, or failure to manage complications caused the injury, you may have a legal claim. Consult with experienced birth injury attorneys.
What should I look for in ongoing treatment?
Look for: consistent physical and occupational therapy, regular monitoring by a pediatric neurologist or specialist, appropriate use of splinting and positioning, age-appropriate strengthening exercises, and consideration of surgery if no improvement occurs after 3-6 months. Ensure your child’s healthcare team has experience with brachial plexus injuries.
Can brachial plexus injuries cause long-term disability?
In severe cases, yes. Injuries involving complete nerve tearing or root avulsion can cause permanent weakness, limited range of motion, or paralysis requiring long-term support. However, many children achieve full functional recovery. The specific outcome depends on injury severity, quality of early treatment, and the child’s response to therapy.
Connect with Experienced Birth Injury Attorneys in New York
Brachial plexus injuries can have significant medical, financial, and emotional impacts on families. If you believe your child’s injury resulted from medical negligence during delivery, experienced New York birth injury attorneys can help you understand your options.
We connect families with qualified attorneys who:
- Understand the medical complexity of brachial plexus injuries
- Have experience with birth injury medical malpractice cases
- Know New York medical malpractice laws and requirements
- Work on contingency – families pay nothing unless they win
- Provide free case evaluations with no obligation
Key Information Attorneys Need:
- Medical records from the delivery and any subsequent treatment
- Details about the delivery (vaginal vs. cesarean, use of forceps/vacuum, complications)
- Your child’s current medical condition and treatment timeline
- Any communication with healthcare providers about the injury
- Information about your child’s long-term needs and prognosis
Ready to Explore Your Legal Options?
Connecting with a qualified birth injury attorney is a free, no-obligation step toward understanding whether you have a case.
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Summary: Key Takeaways About Brachial Plexus Injuries
- Brachial plexus injuries affect the nerves controlling arm and hand movement and occur in 1-3 per 1,000 births
- Injury types range from mild stretching (neuropraxia) to severe complete tearing (neurotmesis) and root avulsion
- Common causes include shoulder dystocia, excessive traction, improper forceps use, and breech delivery
- Approximately 70% of children recover fully or nearly completely with physical therapy
- Early diagnosis and treatment significantly improve outcomes
- Surgery may be needed if no improvement occurs after 3-6 months or for severe injuries
- Long-term outcomes depend on injury severity, treatment quality, and the child’s response to therapy
- Medical negligence may be involved if improper technique or inadequate management caused the injury
- Legal consultation is important if you believe negligence played a role in your child’s injury
This article is educational information only and does not constitute legal or medical advice. For medical concerns, consult with your child’s healthcare provider. For legal advice, consult with a qualified attorney.
