During childbirth, it’s not uncommon for injury to occur. One of the more common forms of injury sustained during delivery is related to the brachial plexus. Brachial plexus injuries are wide reaching and not a single type of injury, but rather an overarching category of injuries itself.
What is the Brachial Plexus?
The brachial plexus is a bundle of nerves located between the neck and shoulders. Nerves are a type of fiber that send and receive electrochemical signals that transmit sensory and motor information throughout the body. Specifically, the brachial plexus controls sensation and function to the shoulder, arm, and hands.
Depending on the location of the brachial plexus injury sustained, varying areas of the body may be affected. For example, if the upper brachial plexus was affected, the shoulder and elbow may display the most symptoms. However, if the lower brachial plexus was injured in childbirth, the forearm and the hand may be most affected.
Types of Brachial Plexus Injuries
There are many different types of brachial plexus injuries that a newborn can sustain during childbirth. These include stretch, rupture, avulsion, Erb’s palsy, and total plexus involvement1.
A stretch injury of the brachial plexus, also known as neurapraxia, indicates that the nerves in the area have been stretched or extended but not ripped or torn. This is the most common form of brachial plexus injury in newborns. It is also regarded as the least severe, as babies typically recover on their own within the first few months of life.
As the name suggests, a rupture of the brachial plexus refers to a torn nerve. It’s important to note that in this type, the nerve isn’t torn at the spinal cord, but rather outside of the spinal cord. This is a relatively common form of brachial plexus injury that may require surgical repair if severe.
An avulsion of the brachial plexus refers to the tearing of the nerve roots away from the spinal cord rather than in the length of the nerve itself. This is a less common form of brachial plexus injury in childbirth. Avulsion injuries of the brachial plexus cannot be directly repaired with surgery. Instead, surrounding damaged tissue must be replaced. This form of injury could result in difficulty breathing or Horner’s syndrome. This is often regarded as the most severe form of brachial plexus injury since it affects the sympathetic nerve chain leading to eyelid drooping, smaller pupils, and decreased production of facial sweat.
Erb’s palsy is a type of brachial plexus injury that displays as a weakness in the shoulder and upper arm or bicep. This usually has a good prognosis if treated early on with physical therapy to prevent muscle stiffness and atrophy.
Total Plexus Involvement
When all five nerves of the brachial plexus are affected, a newborn has what’s called a total plexus involvement injury. This is typically characterized by the inability to move the shoulder, arm, or hand.
Brachial Plexus Injury Causes During Childbirth
During childbirth, there are a few standard causes of brachial plexus injuries. They all relate to the stretching or compressing of the shoulder area during delivery. First, if there is a prolonged birth or difficult labor, the baby can become compressed within the birth canal. This can lead to excess pressure on the area of the brachial plexus, thus leading to injury. Additionally, large birth size can relate to this complication since their size makes delivery more complex.
Other than large birth size or difficult delivery, brachial plexus injuries can be caused by medical intervention. If tools are used during childbirth to assist the baby in being born, these tools could cause injury. For example, the use of forceps might add unnecessary compression and pressure to the upper arm and shoulder areas which could lead to a brachial plexus injury. Similarly, vacuum tools can create the same issue if attached to the baby around the upper shoulder2.
A final standard cause of a brachial plexus injury is shoulder dystocia. This is a condition when a baby’s shoulder gets stuck above the mother’s pubic bone during delivery. When this happens, the head and neck can be pulled apart with force which adds excess pressure on the shoulder and neck areas, thus leading to brachial plexus injuries.
Symptoms of Brachial Plexus Injury in Newborns
Once your child is born, they may display common symptoms of brachial plexus injuries. Such symptoms can range from temporary to debilitating depending on the type of brachial plexus injury sustained. Generally, symptoms include muscle weakness, paralysis of the hand, and decreased movement and sensation in the upper and lower arm. In more severe cases, the baby might not display pain associated with the injury, as nerve damage is apparent.
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