Brachial plexus injury

What is the brachial plexus?

The brachial plexus is a network of nerves originating in the spinal cord at the neck and traveling into the shoulder, arm and hand. It carries the signals controlling movement and sensation throughout the upper limb.

Because the nerves run through a region that experiences significant force during a difficult delivery, they are vulnerable to stretching or tearing at birth.

Injuries also occur outside the delivery context, including in motorcycle crashes and falls involving forceful separation of the head and shoulder.

The severity of these injuries varies enormously, which is why two children with the same diagnosis can have very different futures.

What types of injury occur?

Severity determines both treatment and prognosis.

• Stretching without tearing, which frequently recovers
• Scar tissue formation preventing normal signal transmission
• Rupture, where the nerve tears but not at the spinal cord
• Avulsion, where the nerve root is pulled from the spinal cord
• Erb's palsy affecting the upper nerves controlling shoulder and arm
• Injuries affecting lower nerves and therefore the hand

How is it treated?

Milder injuries are managed with physical and occupational therapy to maintain range of motion while nerves recover.

More severe injuries may be candidates for surgical repair including nerve grafting or transfer, which is typically considered within a defined window during infancy.

Long term effects can include reduced strength, limited motion and differences in limb growth, which is why the projection of future needs matters in valuing a claim.

When does a birth related injury support a claim?

When the record shows risk factors were present, were not appropriately managed, or that excessive traction was applied rather than recognized maneuvers for freeing an impacted shoulder.

Risk factors including large fetal size, maternal diabetes and prior difficult deliveries should shape the delivery plan, and failure to account for them is relevant.

Delivery notes describing the maneuvers used and the time taken form the core evidence, alongside expert obstetric review.

Photographs and video of the child's function over time supplement the medical record and help establish the practical effect.

Common questions

Can adults suffer brachial plexus injuries?

Yes. They occur in motorcycle crashes, falls and other trauma involving forceful separation of the head and shoulder, and can be severely disabling.

How long does recovery take?

Milder injuries often improve substantially over months. More severe injuries may not fully resolve, and a specialist can assess the specific prognosis.

Is surgery always needed?

No. Many injuries are managed with therapy alone. Surgical candidacy depends on severity and on the degree of spontaneous recovery observed.

Does this injury affect how the arm grows?

More severe injuries can produce differences in limb length and muscle development over time, since nerve supply affects growth. This is one reason the long term picture is projected rather than assessed from the initial presentation, and why paediatric specialist follow up matters. Occupational therapy addressing daily function matters alongside physical therapy focused on strength and range of motion.