What the brachial plexus is
The brachial plexus is the network of nerves that runs from the spinal cord in the neck, across the shoulder and down into the arm and hand. It carries the signals that let the shoulder, elbow, wrist and fingers move and feel. Because it sits between the neck and the shoulder, it can be stretched when the head and shoulder are pulled in different directions.
How it can be injured at birth
MedlinePlus describes brachial plexus injury in newborns as nerve damage that can happen during a difficult delivery, for example when the baby’s shoulder becomes caught after the head is delivered (shoulder dystocia), with a larger-than-average baby, or with a breech birth. The nerves can be stretched, compressed or, less commonly, torn. The injury is usually noticed soon after birth because the baby does not move the affected arm normally.
Erb’s palsy and other patterns
Erb’s palsy is the most common form. It affects the upper nerves of the plexus, so the shoulder and upper arm are most affected: the arm may hang limp, turned inward, while the hand can still grip. Injuries to the lower nerves, which affect the hand and wrist, are less common, and injuries involving the whole plexus affect the entire arm.
What recovery looks like
Many babies with a stretch injury recover much or all of their arm movement over the first months of life, and gentle range-of-motion exercises guided by a therapist are usually recommended to keep the joints supple while the nerves recover. When improvement stalls, specialists may use imaging and nerve studies, and in some cases surgery on the nerves or, later, on muscles and tendons is considered. NINDS notes that the outlook depends on the type and severity of the injury: stretched nerves usually recover; torn nerves may not without surgery.
What the injury does not tell you
A brachial plexus injury at birth is a recognised complication of some difficult deliveries. It does not, by itself, establish that the delivery was managed below the standard of care. Shoulder dystocia, the emergency most often associated with these injuries, is described by the American College of Obstetricians and Gynecologists as largely unpredictable and unpreventable. Whether the emergency was recognised and managed appropriately is the question a legal review examines, and it can only be answered from the full record.
What a legal review would look at
A review typically examines the prenatal records including estimated fetal size and any risk factors noted, the labor record, how the shoulder dystocia or difficult delivery was recognised and which maneuvers were used, the timing, and the newborn’s examination and follow-up. Physician experts in obstetrics and in pediatric neurology or orthopedics are usually needed to address both the standard of care and causation. As with every condition on this site, time limits and procedures differ by state and are not stated here until reviewed by an attorney licensed in that state.
Questions worth asking your child’s care team
- Which nerves appear to be affected, and what pattern of movement does that explain?
- What exercises should we do at home, and how often?
- At what point would you refer us to a specialist, and to whom?
- How do we obtain the full labor, delivery and newborn records?
Sources
Every source below was opened and its title confirmed on the date shown. Sources are listed so you can read them yourself.
- Brachial plexus injury in newborns: MedlinePlus Medical Encyclopedia — MedlinePlus, U.S. National Library of Medicine
- Brachial Plexus Injury — National Institute of Neurological Disorders and Stroke (NIH)
- Shoulder Dystocia | ACOG (Practice Bulletin, 2017) — American College of Obstetricians and Gynecologists