Brachial Plexus Injury in Infants
What is the brachial plexus?
The brachial plexus is a group of
nerves that begins in the neck and
gives feeling and movement to the
shoulder, arm, forearm, and hand.
Signs of damage in this area
include: a limp arm or an arm with
no muscle control in the shoulder,
arm, or hand. Infants may also lack
feeling in their hand and arm. These
kinds of injuries in infants are not
What is a brachial plexus injury?
Brachial plexus injuries are caused when these nerves are stretched during the birth of a child.
Damage to the nerves occurs in 0.38 to 3.6 per 1000 live births. Eight to twenty-three percent of
these infants have nerve damage on both sides of the body. Ninety-three percent of these infants
get much of their function back by three months of age when treated with therapy or when they
are just watched. This is a good sign that these infants will do well in the future. These children
likely will not need surgery.
How are brachial plexus injuries treated?
A small number of infants with this type of problem will need surgery; Therapy before and after
surgery will improve long term results.
How do you measure the extent of a brachial plexus injury?
The tests listed below may be done before, during, or after surgery to show the extent of the
child’s nerve damage.
EMG (electromyography) measures how the nerve and muscle work together.
SSEPs (somatosensory evoked potentials) measures how the nerve communicates between
the spinal cord and brain.
NAPs (nerve action potentials) tests for nerve conduction across the injured site.
Myelogram CT (myelogram computer tomography) measures spinal cord and nerve root
damage by taking x-rays after a dye is injected into the spinal cord.
MRI (magnetic resonance imaging) provides a detailed picture of the spinal cord and nerve
What type of brachial plexus injury can occur?
A stretch injury may cause three types of damage. Your child may have one type or a combined
The nerve root separates from the spinal
cord. This problem will not repair itself
Neuroma-in-continuity with good
This is from damage to the nerve,
but a message still travels through it.
The nerve will grow back over time.
There is damage to the nerve, and
messages are not able to travel
through it. The nerve will need to be
repaired with surgery.
In most cases, it is only during surgery that we can tell if a message is able to travel through
damaged nerves or not.
Types of Repair
the surgeon removes the scar tissue around the nerve.
The damaged part of the nerve is removed or bypassed and
replaced with a nerve graft. A nerve graft is taken from
the leg, arm, or neck at the time of surgery.
A nerve from another place in the body, such the diaphragm,
the neck, or the chest wall, is used to repair the damaged
Your child’s surgery may include cutting away scar tissue, reconnecting two ends of a nerve, or
making a nerve bypass or a graft around the injured nerve. An incision is made from the neck to
the armpit. In some cases, an incision is made on the back near the shoulder blade.
You will be taught how to prepare your child for surgery at a clinic visit.
After surgery, your child will stay in the hospital a few days. The surgical arm will be fastened
to the chest with an ace wrap or sling for a couple of weeks so that it cannot be moved. Therapy
will begin in 2 weeks and will last for many months.
The nerve recovery takes many months or up to a year. The nerve grows back about one inch
When to Call Your Surgeon(s) or Nurse Practitioner
Call us if your child has any of these signs or symptoms.
ξ Redness, pain, swelling, or drainage at the incision site
ξ Fever greater than 100.5ºF
ξ Change in color, temperature, or feeling in the arm or hand
Please call your surgeon(s) or nurse practitioner with any questions or concerns.
Dr. Iskandar, Department of Neurosurgery: (608) 263-9651
Dr. Bentz, Department of Plastic Surgery: (608) 263-1367
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright ©10/2015 University of Wisconsin Hospitals
& Clinics Authority, All Rights Reserved. Produced by the Department of Nursing. HF#5470