Brachial Plexus Injury at Birth: Everything You Need to Know

brachial plexus injury

About one in every thousand children born in America experience a brachial plexus injury at birth.

The brachial plexus can be injured even during normal delivery but can also be the result of medical negligence. Even when cared for properly, it can sometimes lead to permanent damage or disability.

But what is a brachial plexus injury, and what can you do about it? Read on to find out.

What Is a Brachial Plexus Injury?

The brachial plexus is a complicated and delicate nerve network connecting your neck and shoulder. It contains both motor (movement) and sensory (feeling) neurons. These neurons reach into the muscles of the shoulder, chest, arms, and hands.

An injury to this area can happen when the arm and shoulder are forcibly stretched beyond their range of motion. In adults, it usually happens after a hard hit while playing contact sports or in a vehicle accident. In children, it’s often the result of a traumatic birth.

Most of these stem from the baby’s shoulders getting stuck in the birth canal, a condition known as shoulder dystocia. The force of being pushed out of the birth canal while a shoulder is caught on the pelvis can tear or overstretch the delicate brachial nerves.

Any injury to the brachial plexus region will lead to some problems with movement or feeling in the areas it innervates. In some cases, arm paralysis or permanent loss of feeling can result.

Types of Brachial Plexus Injuries

Some brachial plexus injuries are minor enough to heal on their own other time. Unfortunately, others are serious enough to cause permanent damage. These can require years of physical therapy to restore some level of function and normal feeling.

There are a few different types of brachial nerve injuries, each of which is categorized by the mechanism of injury and pattern of nerves involved.


Neurapraxia, also known as a stretching injury, is the most common type. It happens when one or more of the brachial nerves is stretched beyond the range of motion but isn’t torn. This type happens away from the spine and can often heal on its own in a few months’ time.


A neuroma is a disorganized growth of nerve cells that have been damaged due to physical trauma. In the case of a brachial plexus injury, the nerves have either been stretched or torn and developed scar tissue while healing.

This scar tissue grows and puts increasing amounts of pressure on the nerve bundles. When nerves are under pressure, they can’t send the appropriate signals to their target muscles. This type might need surgical intervention to remove the neuroma and reconstruct the remaining nerves.


Rupture injuries refer to a complete tear in a nerve, but not where it joins up with the spine. Surgery is often needed to repair the nerve, especially if it’s responsible for significant motor function. But even after the nerve is repaired, the muscle will progressively weaken without exercise or physical therapy.


An avulsion is the most serious type of brachial plexus injury. This term refers to the nerves being torn away from the spinal cord itself. An avulsion requires intense surgical intervention to replace the damaged tissue with a nerve graft.

Avulsions often lead to some level of permanent disability in the arm and shoulder. The affected person may experience paralysis, loss of feeling, and stunted arm growth.

In extreme cases, the nerve connected to the diaphragm (the phrenic nerve) can also be damaged. Though rare, this can cause difficulty breathing.

Erb’s Palsy

Erb’s Palsy isn’t used to describe a mechanism of injury, but rather a group of symptoms. Many brachial plexus injuries only affect function in the upper arm and/or shoulder. In Erb’s Palsy, both the upper and lower arm is affected.

Erb’s Palsy can sometimes heal on its own but often needs long-term physical therapy or surgical intervention. The hallmark sign of this type of injury is an arm stuck in the “waiter’s tip” position. In this case, the arm will be stiff and rotated inward while the wrist is bent all the way up and fingers are spread out.

Risk Factors and Prevention

Because brachial plexus injuries can happen even during normal births, there’s no way to prevent them entirely. Even so, there are some risk factors that greatly increase your chances of injury.

Babies with a high birth weight are at especially high risk because they have more difficulty fitting through the birth canal. If your baby is in a high weight percentile during pregnancy, it’s worth talking with your doctor about having a C-Section. Because the shoulders can’t get caught during a cesarean, the risk of brachial plexus injury drops dramatically.

Why Isn’t it Considered a Birth Defect?

Birth defects are health conditions that are present at the time of gestation. Medical teams are very rarely held liable for birth defects because genetics and lifestyle choices during pregnancy are the usual causes.

Birth injuries, on the other hand, occur during the labor and delivery process, either while or right after giving birth. Most birth injuries can be avoided by your medical team following best practice guidelines.

Because a brachial plexus injury doesn’t occur until delivery, it falls into the injury category rather than being considered a defect. Your physician may be liable for the injury if it was due to instrument misuse or improper delivery methods.

Filing a Medical Malpractice Case

If you think your child’s serious brachial plexus injury was the result of physician error, you may have grounds to file for medical malpractice. Even if you aren’t positive you have a case, it’s worth talking with an experienced attorney to find out.

The Law Offices of Joseph M. Lichtenstein have successfully handled multiple brachial plexus injury cases and are ready to help you file your claim for medical negligence. Contact us today to learn more and schedule a free consultation.

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