Brachial Plexus Injury

The brachial plexus is a complicated bundle of nerves in the lower neck behind the collarbone and above the first Rib.

These nerves provide movement & sensation to the shoulder,arm,hand & wrist.


During Birth

It is often caused when an infant’s neck is stretched to the side during a difficult delivery.


Due to accidents from motor vehicles,bikes,ATVs,Sports or a knife or gunshot injury.

Types of Brachial Plexus birth palsy 

Stretch ( neurapraxia )

  • Nerve has been stretched but not torn
  • Injury occurs outside the spinal cord
  • Most common form
  • Recover own usually within 3 month


  • Nerve is torn but not where it attaches to the spine
  • Injury occurs out side the spinal cord
  • common form
  • May require surgical repair


  • Nerve root are torn from the spinal cord
  • Injury occurs at the spinal cord
  • Less common form


  • Nerve has tried to heal but scar tissue has formed and presses against the injured nerve or interferes with nerve function.
  • May require surgical treatment with nerve reconstruction and/or secondary tendon transfers.

Other forms of brachial plexus injuries

Erb’s palsy   

  • Involves the upper portion ( c5, c6, some times c7 ) of the brachial plexus.
  • A child typically has weakness involving the muscles of the shoulder & biceps.
  • Home physical therapy begins when a baby is  3 week old to prevent stiffness, atrophy and shoulder dislocation.

Total plexus involvement

  • All five nerve of the brachial plexus are involved (C5-T1).
  • Children may not have any movement at the shoulder, arm or hand.

Horner’s syndrome

  • The sympathetic chain of nerve has been injured ( usually in T2 to T4 region )
  • The child may have-
    • Ptosis ( drooling eyelid )
    • Miosis ( smaller pupil of the eye )
    • Anhydrosis ( diminished sweat production in part of the face )
  • The child may have a more severe injury of the brachial plexus.

Klumpke’s palsy 

  • This almost nerve occur in babies or children.
  • It involves the lower root ( C8, T1 )  of the brachial plexus.
  • It typically affects the muscles of the hand.


  • Muscles weakness
  • Intense pain
  • Loss of sensation in the affected arm, hand or extremities.
  • Muscle paralysis in the shoulder or upper arm ( may be partial or total )
  • Erb’s palsy
  • Klumpke’s palsy
  • Horner’s syndrome


  • Some brachial plexus injury heal 3 to 4 month without treatment.
  • Some may take time up to 2 year
  • Treatment includes physiotherapy and in some cases surgery.

Physiotherapy treatment 

  • Activities and exercise to promote recovery of movement and muscle strength.
  • Sensory stimulation to promote increase awareness of arm
  • Electrical stimulation
  • Exercise to maintain ROM of joint and prevent stiffness & pain.
  • Kinesio taping
  • Joint mobilization
  • Aquatic therapy
  • Use of orthosis