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.
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
- 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.
- 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.
- 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.
- 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