The brachial plexus is a network of nerves that run from the spinal column in the neck down to the fingers. The mildest form of this injury is when the nerves have been stretched. When the nerves are torn (ruptured) or pulled out of their spinal "socket" (avulsed), surgical intervention may be the only hope to regain function of the arm.

How Does a Brachial Plexus Injury Occur?

Brachial plexus injuries most often occur during the birthing process. Availability of brachial plexus statistics vary widely because no hospital has to report an injury to any government agency at this time - , but where figures are actually available, the general consensus is that brachial plexus injuries occur in 2-5 out of 1000 births. Other causes of brachial plexus injuries include: automobile, motorcycle or boating accidents; sports injuries (known as “burners” or “stingers”); animal bites; gunshot or puncture wounds; as a result of specific medical treatments / procedures / and surgeries; or due to viral diseases.

Early Treatment & Assessment

See a Physical (PT) or Occupational (OT) therapist to learn how to do “Range of Motion” (ROM) exercises that you will on daily basis to keep the joints from becoming stiff. (Please note never to raise the arm above shoulder height - this is a new finding that has not been published yet.) On-going therapy is usually required for the first few years on a regular basis and later as needed. Choose a therapist who understands brachial plexus injuries and has experience at making splints. Research the resources for Brachial Plexus Specialists. These are doctors who specialize in the treatment and repair of these types of injuries. Their expert assessment will define whether or not the injury is temporary or permanent and severe. Assessment may include tests such as EMG, nerve conduction tests and/or MRI. Unfortunately, different specialists have different opinions and each child is so different from the next child - it is important to get multiple opinions. Even if you choose to go to one specialist, we recommend multiple opinions so that you can continue to educate yourself and find out about the latest techniques.

Time Is Of The Essence

The brachial plexus nerves originate in the neck - in the cervical spine. They branch down the arm all the way to the fingertips. When the nerve is severely injured, it has to regrow from the neck, down the arm. Regeneration of nerves occurs at a slow rate of one inch or three centimeters per month. As they regenerate, movements of the muscles associated with that nerve would begin to appear. At first they will be very weak and the affected person will use gravity as a helper. As the muscles get fully innervated (connection from nerve to muscle established), they will gain strength and move without the assistance of gravity.

For an infant, a real turning point in the prognosis will be the presence or absence of biceps function at three months of age. The brachial plexus specialists worldwide agree that if the child does not have biceps function by that time, surgical repair is discussed. If the infant has not hand / wrist/ or finger function, then it is important to get to a specialist as early as two months of age.

If the injury is defined as severe, the time frame for surgical repair becomes a crucial factor for recovery. Within 12 to 18 months following the injury, the muscles that have not already been innervated (connected to nerves) will have atrophied to the point where innervations are no longer possible.

Once the decision is made to do nerve surgery or not to do nerve surgery - everything that follows that will be called "secondary surgery". These are procedures used to handle the secondary issues of the brachial plexus injury. They include muscle and bone surgeries - releases, transfers, transplants, and fractures. Each child is different - each child will recover different movement and will create different imbalances. These secondary procedures will help to protect the shoulder joint and create as much free movement as possible.

The experts have written that if a child is not completely recovered by two months of age, then the injury if permanent and lifetime. Surgery will be able to help different issues that arise but the arm will always be, function and look different.

One of the most important things we have to watch even from an early age, is overuse of the uninjured arm. Learn how to pamper the uninjured arm so that it can handle a lifetime of double use.

Educate yourself as much as you can about brachial plexus injuries, meet other parents and individuals, find all the support sites and message boards. There is a wealth of knowledge out there now. And most important, over the years, please make sure that your child knows that he or she is not alone. It is extremely important for their well-being to know that they are not alone in this and that there are thousands of children just like them.

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