Brachial plexus birth injuryBBrachial plexus birth injuryBrachial plexus birth injuryEnglishNeurologyNewborn (0-28 days);Baby (1-12 months)ArmNervesConditions and diseasesCaregivers Adult (19+)NA2020-05-14T04:00:00Z8.5000000000000061.80000000000001493.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Brachial plexus birth injury is an injury to the brachial plexus nerves leading from the spinal cord to the arm. This affects how the arm moves and feels things. Learn about the causes and possible treatments for a brachial plexus birth injury. </p><h2>What is the brachial plexus?</h2><p>The brachial plexus is a network of five large nerves located between the neck and shoulder. Nerves are cord-like structures of tissue, formed from a collection of nerve fibres. A single nerve may contain thousands of fibres.</p><p>The nerves of the brachial plexus leave the spinal cord between the bones in the neck. The brachial plexus nerves travel from the neck, under the collarbone and into the arm. The brachial plexus then divides into individual nerves that travel to different muscles in the arm. The nerves of the brachial plexus are C5, C6, C7, C8 ,T1. </p> <figure class="asset-c-80"><span class="asset-image-title">Brachial </span><span class="asset-image-title"></span><span class="asset-image-title"></span><span class="asset-image-title">plexus</span><img src="https://assets.aboutkidshealth.ca/akhassets/brachial_plexus_infant_MED_ILL_EN.jpg" alt="Brachial plexus in the upper body of a baby" /><figcaption class="asset-image-caption">The</figcaption><figcaption class="asset-image-caption"></figcaption><figcaption class="asset-image-caption"></figcaption><figcaption class="asset-image-caption"> brachial plexus is an arrangement of nerves coming from the spinal cord in the neck, running under the collar bone, through the armpit, to the arm. It supplies nerve function to the muscles of the arm and hand.</figcaption> </figure> <p>The nerve fibres carry electrical messages from the brain to the muscles and tissues of the arm and hand. For a muscle to work (contract), a message must travel from the brain along a nerve that goes directly to the muscle. The nerves in the brachial plexus are responsible for making the muscles in the arm and hand move and for the skin to feel things. </p><h2>Key points</h2><ul><li>The brachial plexus is a group of five nerves that leave the spinal cord between the bones in the neck. These nerves allow the arm to move and feel things. </li><li>In babies, the brachial plexus can be damaged during a difficult childbirth. </li><li>Nerves have some ability to heal and repair on their own. This depends on how severely damaged they are. </li><li>Many children regain good use of their affected arm and are able to do most of the activities that they want. There may still be some muscle weakness. </li><li>Babies with a brachial plexus injury that have difficulty moving or feeling in their arm should be referred to a multidisciplinary team specializing in the management of brachial plexus injuries by 1 month of age. </li><li>If movement in the arm or hand is weak and function is limited, therapy (physical and/or occupational therapy) is advised and surgery may be recommended. </li></ul><h2>The brachial plexus may be damaged during birth</h2><p>Brachial plexus birth injury usually occurs during a difficult childbirth. If the baby is large relative to the mother’s pelvis, their shoulder can become trapped against the mother’s pelvis after delivery of the head. To free the shoulder, the head must be tilted to the opposite side. Tension on the brachial plexus may stretch or pull apart the fibres within one or more nerves. Extra force on the brachial plexus may rupture the nerves completely or pull them out of the spinal cord. </p><p>If the brachial plexus is damaged, weakness shows up immediately in the arm. Most brachial plexus injuries are mild and resolve on their own. However, babies who continue to have muscle weakness in their arm need to be referred to a multidisciplinary clinic which includes therapists (e.g., physical and occupational therapists), plastic surgeons, orthopedic surgeons, nurses, and social worker. </p><h3>When nerve fibres are damaged, the muscles may be weakened</h3><p>When a brachial plexus injury happens, scar tissue may form at the site of the injury. This scar tissue may prevent electrical messages from getting to the muscles. Damaged nerve fibres located outside the spinal cord (peripheral nerves) may be able to regrow and reconnect to the muscles, which can help to improve muscle function. </p><p>A nerve that is completely torn apart or ruptured is not able to completely repair itself. This means that only a small amount of muscle recovery is possible. Ruptured nerves can be surgically repaired, which gives the muscles a better chance to work. </p><p>Nerves that have been torn from the spinal cord cannot repair themselves. In this case, other nerves may be surgically connected to allow the muscles to work. </p><p>Nerve fibres regrow at a rate of about 1 mm a day or 1 inch a month. It may take many months for these fibres to strengthen the muscles in the arm. </p><h2>Severity of the brachial plexus palsy</h2><p>The severity of the injury depends on the number of nerves that are affected and the amount of damage to each nerve. </p><p>The more nerves that are affected by the brachial plexus damage, the weaker the arm and hand will be. </p><p>The first three nerves of the brachial plexus (C5, C6, C7) are most often involved in a brachial plexus birth injury. Weakness or paralysis of the muscles which are connected to the first two or three nerves is called Erb's palsy. With Erb's palsy, there is often weakness of the shoulder and elbow. </p><p>If all five nerves of the brachial plexus are affected, the entire arm and hand will be weak or paralyzed. </p><p>If the nerves have been only mildly stretched, your child may recover use of the arm quickly. If the nerves have been more severely stretched or pulled apart, the muscles will take longer to recover and/or will remain weaker.</p><h2>Learning about your child's brachial plexus palsy</h2><p>Your child's doctor may need to perform different examinations over time to find out how severe the damage is. Babies with a brachial plexus injury that have difficulty moving or feeling in their arm should be referred to a multidisciplinary team specializing in the management of brachial plexus injuries by 1 month of age. On each visit, the multidisciplinary health-care team will watch how your child moves and plays and observe the movements of your child's arm. These movements will be scored. This will help the team to keep track of how well the nerves are healing. </p><p>If the health-care team decides your child could benefit from surgery, your child may need other tests. </p><h2>Treatment for children with brachial plexus palsy</h2><h3>Time</h3><p>Most importantly, brachial plexus birth injury needs time to heal. Most nerve and muscle recovery will happen in the first year. You will notice a gradual improvement in both the movement and strength in your child's arm. Further recovery may happen in the second year, but the effects will be more difficult to see. </p><h3>Physiotherapy</h3><p>Physiotherapy should be started early in a baby who has brachial plexus birth injury. Physiotherapy can help prevent problems such as joint stiffness and delays in development. It will not help the nerves to heal faster. </p><p>The physiotherapist will teach you how to hold and move your baby, as well as teach you the best sleeping positions for your baby. You will also learn exercises to keep your baby's joints flexible and strengthen the muscles that are beginning to recover.</p><h3>Occupational therapy</h3><p>Occupational therapists evaluate and treat children with brachial plexus birth injury in order to help them feed, dress and take care of themselves, and participate in school and leisure activities to the best of their abilities. If surgery is being considered in older children, the occupational therapist helps guide the surgeon by defining problems in the use of the arm. </p><p>In some children, occupational therapists may provide an orthotic (splint) to help support their joints in a more functional position for play, school activities or sports. An orthotic or cast may also be recommended as treatment for stiffness in the arm. Elbow stiffness is common in children with brachial plexus birth injury. </p><p>For more information, please see the article <a href="/article?contentid=3873&language=english">Elbow flexion contracture related to brachial plexus birth injury</a>. </p><h3>Nerve surgery</h3><p>In some patients, surgery may be recommended. Babies with brachial plexus birth injury are carefully monitored during the first year of life to record changes in muscle strength. If the muscle fails to strengthen beyond a certain point, and the baby's ability to move and use the arm is also limited, then the surgeon may suggest an operation to find out how severely the nerve is damaged. When the surgeon can observe the brachial plexus directly, they can decide on the best form of treatment. If your baby has an operation on the nerves of the brachial plexus, this will usually be done before your baby is one year old. </p><p>For more information, please see the article <a href="/Article?contentid=1033&language=English">Brachial plexus operation</a>.</p><h3>Other types of surgery</h3><p>Older children who still have movement problems or trouble using the arm may benefit from surgical procedures on the muscles, tendons or bones. Examples include tendon transfers and correction of bone alignment. Your child's surgeon will discuss these procedures with you and your child if they are recommended. </p><h2>At SickKids</h2><p>The Brachial Plexus Clinic at The Hospital for Sick Children is a multidisciplinary clinic designed to assess and treat children with brachial plexus problems.</p><p>All patients require a referral to visit the Brachial Plexus Clinic. For more information, please visit: <a href="http://www.sickkids.ca/PlasticSurgery/What-we-do/Brachial-Plexus-Palsy/index.html">http://www.sickkids.ca/PlasticSurgery/What-we-do/Brachial-Plexus-Palsy/index.html</a><br></p><p>Coroneos CJ, Voineskos SH, Christakis MK on behalf of The Canadian OBPI Working Group, et al. Obstetrical brachial plexus injury (OBPI): Canada's national clinical practice guideline. <em>BMJ Open</em> 2017;7:e014141. doi: 10.1136/bmjopen-2016-014141 from <a href="https://bmjopen.bmj.com/content/7/1/e014141">https://bmjopen.bmj.com/content/7/1/e014141</a><br></p>
Paralysie du plexus brachialPParalysie du plexus brachialBrachial plexus palsyFrenchNeurologyNewborn (0-28 days);Baby (1-12 months)ArmNervesConditions and diseasesCaregivers Adult (19+)NA2012-02-21T05:00:00Z10.000000000000056.00000000000001535.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Renseignez-vous au sujet des causes et du traitement de la paralysie du plexus brachial, une maladie qui influe sur les mouvements et la sensation du bras.</p><p>Si on a diagnostiqué une paralysie du plexus brachial chez votre enfant, le présent article vous renseignera sur son état et la façon de le gérer. Les enfants atteints de paralysie du plexus brachial sont tous distincts et se rétablissent différemment. Il est difficile de prévoir exactement dans quelle mesure la fonction du bras de votre enfant se rétablira. Demandez au médecin et au physiothérapeute de votre enfant plus de précisions sur les soins qui lui sont nécessaires.​</p><h2>En quoi consiste le plexus brachial?</h2><p>Le plexus brachial est le nom d’un groupe de cinq gros nerfs qui sortent de la moelle épinière entre les os du cou (vertèbres). Ces cinq nerfs sont appelés C5, C6, C7, C8 et T1. À la sortie du cou, les cinq nerfs affichent une configuration complexe. Le plexus brachial se divise ensuite en nerfs individuels atteignant différents muscles du bras. Les nerfs du plexus brachial sont responsables des mouvements et de la sensation du bras.</p> <figure class="asset-c-80"> <span class="asset-image-title">Plexus brachial</span> <img src="https://assets.aboutkidshealth.ca/akhassets/brachial_plexus_infant_MED_ILL_FR.jpg" alt="Le plexus brachial dans la partie supérieure du corps d’un bébé" /> <figcaption class="asset-image-caption">Le plexus brachial est un réseau de nerfs sortant de la moelle épinière à la base du cou qui pénètre dans l’aisselle en passant sous la clavicule pour se rendre jusqu’au bras. C’est le plexus brachial qui commande les fonctions de sensibilité et de motilité (mouvement) des muscles du bras et de la main.</figcaption> </figure><h2>À retenir</h2> <ul> <li>Le plexus brachial est un groupe de cinq nerfs sortant de la moelle épinière entre les os du cou. Ce réseau de nerfs est responsable des mouvements et de la sensibilité du bras.</li> <li>Chez les bébés, le plexus brachial peut être endommagé à l’accouchement.</li> <li>Selon la gravité des lésions subies, les nerfs peuvent guérir et se réparer seuls.</li> <li>Une chirurgie peut être recommandée si le mouvement du bras ou de la main est affaibli et si la fonction musculaire y est limitée.</li> <li>De nombreux enfants retrouvent un usage satisfaisant du bras touché et peuvent donc effectuer la plupart des activités qu’ils souhaitent faire. Toutefois, une certaine faiblesse musculaire peut persister.</li> </ul><h2>Le plexus brachial peut être endommagé à l’accouchement</h2> <p>La paralysie du plexus brachial survient habituellement pendant un accouchement difficile. Si le bébé est gros, ses épaules peuvent être piégées dans l’utérus une fois que la tête est expulsée. Pour dégager les épaules, la tête doit être inclinée du côté opposé. La tension exercée sur le plexus brachial peut étirer ou sectionner les fibres d’un nerf ou plus. Toute tension supplémentaire sur le plexus brachial peut causer la rupture complète des nerfs ou encore les détacher de la moelle épinière.</p> <p>Toute lésion au plexus brachial entraîne immédiatement une faiblesse du bras.</p> <h2>Les lésions aux fibres nerveuses peuvent affaiblir les muscles</h2> <p>Les lésions aux fibres d’un nerf peuvent affaiblir les muscles qui lui sont reliés. Le terme paralysie renvoie à une déficience de la fonction musculaire.</p> <p>Ce ne sont toutefois pas les muscles mêmes qui sont endommagés, mais les fibres des nerfs. Si les lésions se font hors de la moelle épinière (nerfs périphériques) les fibres nerveuses pourraient éventuellement se régénérer et se rattacher aux muscles.</p> <p>La lésion au plexus brachial peut se cicatriser. Le tissu cicatriciel peut alors empêcher les messages électriques d’atteindre les muscles pour assurer leur bon fonctionnement. Le remplacement du tissu cicatriciel par des tissus nerveux nouveaux peut cependant permettre d’améliorer la fonction musculaire.</p> <p>Un nerf entièrement sectionné ne peut que partiellement se régénérer, ce qui n’entraînera qu’un rétablissement limité de la fonction musculaire. En revanche, les nerfs sectionnés peuvent être réparés à l’aide d’une chirurgie, ce qui offrira une meilleure chance aux muscles de fonctionner normalement.</p> <p>Les nerfs arrachés de la moelle épinière ne peuvent pas se régénérer, mais d’autres nerfs peuvent y être rattachés par chirurgie.</p> <p>Puisque les fibres nerveuses se régénèrent à un rythme d’environ 1 mm par jour ou 1 pouce par mois, le renforcement des muscles du bras peut exiger des mois.</p><h2>Gravité de la paralysie du plexus brachial</h2> <p>La gravité de la paralysie dépend du nombre de nerfs touchés et de l’importance des lésions à chacun d’eux.</p> <p>Plus les nerfs sont affectés par les lésions au plexus brachial, plus l’affaiblissement du bras et de la main sera marqué :</p> <ul> <li>Ce sont les lésions aux trois premiers nerfs du plexus brachial (C5, C6, C7) qui sont le plus souvent responsables de la paralysie du plexus brachial chez les enfants. La faiblesse ou la paralysie des muscles actionnés par les deux ou trois premiers nerfs du plexus brachial s’appelle la myopathie de Erb. Les enfants atteints de la myopathie de Erb présentent souvent une faiblesse de l’épaule et du coude.</li> <li>Si l’ensemble des cinq nerfs du plexus brachial sont touchés, le bras et la main en entier seront affaiblis ou paralysés.</li> </ul> <p>Si les nerfs n’ont été que légèrement étirés, votre enfant pourrait retrouver rapidement l’usage de son bras. Toutefois, si les nerfs ont été fortement étirés ou ont été sectionnés, le muscle sera davantage affaibli.</p> <h2>​Détermination de l’importance de la paralysie du plexus brachial chez votre enfant</h2> <p>Le médecin de votre enfant devra peut-être faire un suivi pour observer votre enfant au fil du temps afin de déterminer l’importance de ses lésions. À chaque rendez-vous, l’équipe de soins de santé surveillera votre enfant pendant qu’il se déplace et joue afin d’observer les mouvements de son bras. Ceux-ci seront cotés, ce qui permettra au médecin de déterminer dans quelle mesure les nerfs guérissent. </p> <p>Si une chirurgie était jugée bénéfique pour votre enfant, son médecin pourrait commander d’autres examens.</p><h2>Traitement des enfants atteints de paralysie du plexus brachial</h2><h3>Une question de temps</h3><p>Le rétablissement d’une paralysie du plexus brachial exige avant tout du temps. Les nerfs et les muscles se rétabliront en majeure partie au cours de la première année. Vous constaterez une amélioration progressive tant du mouvement que de la force du bras de votre enfant. Le rétablissement se poursuivra l’année suivante, mais les améliorations seront alors plus difficiles à observer.</p><h3>​Physiothérapie</h3><p>Il est important de commencer rapidement les traitements de physiothérapie chez les bébés atteint d’une paralysie du plexus brachial. La physiothérapie n’accélérera pas la guérison des nerfs, mais elle peut permettre de prévenir des problèmes comme les raideurs aux articulations et les retards de développement.</p><p>Le physiothérapeute vous montrera comment tenir et déplacer votre enfant ainsi que les meilleures positions pour dormir. Il vous enseignera aussi des exercices servant à assurer la souplesse des articulations de votre enfant et à renforcer les muscles qui commencent à se contracter.</p><h3>Ergothérapie</h3><p>Les ergothérapeutes évaluent et traitent les enfants atteints de paralysie du plexus brachial afin de leur permettre le plus possible de se nourrir et de se vêtir seuls, de prendre soin d’eux-mêmes ainsi que de participer aux activités scolaires et récréatives. De plus, quand une chirurgie est envisagée chez les enfants plus âgés, ils peuvent orienter l’intervention du chirurgien en lui précisant les problèmes éprouvés à l’égard de l’utilisation du bras.</p><h3>Chirurgie des nerfs</h3><p>La chirurgie peut être indiquée pour certains enfants. On surveille minutieusement les enfants atteints de paralysie du plexus brachial pendant leur première année de vie afin de consigner tout changement de leur force musculaire. Si le renforcement des muscles est limité, et que la capacité de l’enfant de bouger et d’utiliser son bras est aussi restreinte, le chirurgien pourrait proposer une intervention pour connaître la gravité de la lésion au nerf. </p><p>En observant directement le plexus brachial, il pourra déterminer quel sera le traitement optimal. Les bébés chez qui une chirurgie des nerfs est indiquée la subissent habituellement avant l’âge d’un an.</p><p>Pour en savoir plus, veuillez consulter l’article intitulé : <a href="/Article?contentid=1033&language=French">Plexus brachial (chirurgie).</a><br></p><h3>Autres types de chirurgie</h3><p>Il peut être avantageux pour les enfants plus âgés chez qui les difficultés de mouvement ou d’utilisation du bras persistent de subir une chirurgie des muscles, des tendons ou des os. Les transferts de tendons et la correction de l’alignement des os en sont des exemples. Le chirurgien de votre enfant discutera de ces interventions avec vous si elles sont indiquées.</p>

 

 

 

 

Brachial plexus birth injury849.000000000000Brachial plexus birth injuryBrachial plexus birth injuryBEnglishNeurologyNewborn (0-28 days);Baby (1-12 months)ArmNervesConditions and diseasesCaregivers Adult (19+)NA2020-05-14T04:00:00Z8.5000000000000061.80000000000001493.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Brachial plexus birth injury is an injury to the brachial plexus nerves leading from the spinal cord to the arm. This affects how the arm moves and feels things. Learn about the causes and possible treatments for a brachial plexus birth injury. </p><h2>What is the brachial plexus?</h2><p>The brachial plexus is a network of five large nerves located between the neck and shoulder. Nerves are cord-like structures of tissue, formed from a collection of nerve fibres. A single nerve may contain thousands of fibres.</p><p>The nerves of the brachial plexus leave the spinal cord between the bones in the neck. The brachial plexus nerves travel from the neck, under the collarbone and into the arm. The brachial plexus then divides into individual nerves that travel to different muscles in the arm. The nerves of the brachial plexus are C5, C6, C7, C8 ,T1. </p> <figure class="asset-c-80"><span class="asset-image-title">Brachial </span><span class="asset-image-title"></span><span class="asset-image-title"></span><span class="asset-image-title">plexus</span><img src="https://assets.aboutkidshealth.ca/akhassets/brachial_plexus_infant_MED_ILL_EN.jpg" alt="Brachial plexus in the upper body of a baby" /><figcaption class="asset-image-caption">The</figcaption><figcaption class="asset-image-caption"></figcaption><figcaption class="asset-image-caption"></figcaption><figcaption class="asset-image-caption"> brachial plexus is an arrangement of nerves coming from the spinal cord in the neck, running under the collar bone, through the armpit, to the arm. It supplies nerve function to the muscles of the arm and hand.</figcaption> </figure> <p>The nerve fibres carry electrical messages from the brain to the muscles and tissues of the arm and hand. For a muscle to work (contract), a message must travel from the brain along a nerve that goes directly to the muscle. The nerves in the brachial plexus are responsible for making the muscles in the arm and hand move and for the skin to feel things. </p><h2>What is a brachial plexus birth injury? </h2><p>During a difficult delivery of a baby, the brachial plexus can be injured. In most cases, the nerves in the brachial plexus are only stretched and will fully recover. In other cases, the movement and feeling in a baby’s arm and hand do not fully recover. This happens when the nerves in the brachial plexus are severely stretched and scarred (neuroma), torn apart (ruptured) or pulled out of the spinal cord (root avulsion). </p> <figure class="asset-c-80"> <span class="asset-image-title">Brachial plexus birth injury</span> <img src="https://assets.aboutkidshealth.ca/akhassets/BrachialPlexus_Contracture_Birth_EN.jpg" alt="Brachial plexus injury during birth that can result in avulsion, rupture or neuroma" /> <figcaption class="asset-image-caption">During childbirth, a baby’s shoulder may become trapped against the mother’s pelvis. While freeing the shoulder, the nerve fibres may be stretched. This can result in a neuroma, rupture, or root avulsion. </figcaption> </figure> <p>When nerve fibres are damaged, the muscles connected to that nerve may be weakened. Damage to the nerves in the brachial plexus can cause your child’s arm to be weak and stiff.</p><h2>Key points</h2><ul><li>The brachial plexus is a group of five nerves that leave the spinal cord between the bones in the neck. These nerves allow the arm to move and feel things. </li><li>In babies, the brachial plexus can be damaged during a difficult childbirth. </li><li>Nerves have some ability to heal and repair on their own. This depends on how severely damaged they are. </li><li>Many children regain good use of their affected arm and are able to do most of the activities that they want. There may still be some muscle weakness. </li><li>Babies with a brachial plexus injury that have difficulty moving or feeling in their arm should be referred to a multidisciplinary team specializing in the management of brachial plexus injuries by 1 month of age. </li><li>If movement in the arm or hand is weak and function is limited, therapy (physical and/or occupational therapy) is advised and surgery may be recommended. </li></ul><h2>The brachial plexus may be damaged during birth</h2><p>Brachial plexus birth injury usually occurs during a difficult childbirth. If the baby is large relative to the mother’s pelvis, their shoulder can become trapped against the mother’s pelvis after delivery of the head. To free the shoulder, the head must be tilted to the opposite side. Tension on the brachial plexus may stretch or pull apart the fibres within one or more nerves. Extra force on the brachial plexus may rupture the nerves completely or pull them out of the spinal cord. </p><p>If the brachial plexus is damaged, weakness shows up immediately in the arm. Most brachial plexus injuries are mild and resolve on their own. However, babies who continue to have muscle weakness in their arm need to be referred to a multidisciplinary clinic which includes therapists (e.g., physical and occupational therapists), plastic surgeons, orthopedic surgeons, nurses, and social worker. </p><h3>When nerve fibres are damaged, the muscles may be weakened</h3><p>When a brachial plexus injury happens, scar tissue may form at the site of the injury. This scar tissue may prevent electrical messages from getting to the muscles. Damaged nerve fibres located outside the spinal cord (peripheral nerves) may be able to regrow and reconnect to the muscles, which can help to improve muscle function. </p><p>A nerve that is completely torn apart or ruptured is not able to completely repair itself. This means that only a small amount of muscle recovery is possible. Ruptured nerves can be surgically repaired, which gives the muscles a better chance to work. </p><p>Nerves that have been torn from the spinal cord cannot repair themselves. In this case, other nerves may be surgically connected to allow the muscles to work. </p><p>Nerve fibres regrow at a rate of about 1 mm a day or 1 inch a month. It may take many months for these fibres to strengthen the muscles in the arm. </p><h2>Severity of the brachial plexus palsy</h2><p>The severity of the injury depends on the number of nerves that are affected and the amount of damage to each nerve. </p><p>The more nerves that are affected by the brachial plexus damage, the weaker the arm and hand will be. </p><p>The first three nerves of the brachial plexus (C5, C6, C7) are most often involved in a brachial plexus birth injury. Weakness or paralysis of the muscles which are connected to the first two or three nerves is called Erb's palsy. With Erb's palsy, there is often weakness of the shoulder and elbow. </p><p>If all five nerves of the brachial plexus are affected, the entire arm and hand will be weak or paralyzed. </p><p>If the nerves have been only mildly stretched, your child may recover use of the arm quickly. If the nerves have been more severely stretched or pulled apart, the muscles will take longer to recover and/or will remain weaker.</p><h2>Learning about your child's brachial plexus palsy</h2><p>Your child's doctor may need to perform different examinations over time to find out how severe the damage is. Babies with a brachial plexus injury that have difficulty moving or feeling in their arm should be referred to a multidisciplinary team specializing in the management of brachial plexus injuries by 1 month of age. On each visit, the multidisciplinary health-care team will watch how your child moves and plays and observe the movements of your child's arm. These movements will be scored. This will help the team to keep track of how well the nerves are healing. </p><p>If the health-care team decides your child could benefit from surgery, your child may need other tests. </p><h2>Treatment for children with brachial plexus palsy</h2><h3>Time</h3><p>Most importantly, brachial plexus birth injury needs time to heal. Most nerve and muscle recovery will happen in the first year. You will notice a gradual improvement in both the movement and strength in your child's arm. Further recovery may happen in the second year, but the effects will be more difficult to see. </p><h3>Physiotherapy</h3><p>Physiotherapy should be started early in a baby who has brachial plexus birth injury. Physiotherapy can help prevent problems such as joint stiffness and delays in development. It will not help the nerves to heal faster. </p><p>The physiotherapist will teach you how to hold and move your baby, as well as teach you the best sleeping positions for your baby. You will also learn exercises to keep your baby's joints flexible and strengthen the muscles that are beginning to recover.</p><h3>Occupational therapy</h3><p>Occupational therapists evaluate and treat children with brachial plexus birth injury in order to help them feed, dress and take care of themselves, and participate in school and leisure activities to the best of their abilities. If surgery is being considered in older children, the occupational therapist helps guide the surgeon by defining problems in the use of the arm. </p><p>In some children, occupational therapists may provide an orthotic (splint) to help support their joints in a more functional position for play, school activities or sports. An orthotic or cast may also be recommended as treatment for stiffness in the arm. Elbow stiffness is common in children with brachial plexus birth injury. </p><p>For more information, please see the article <a href="/article?contentid=3873&language=english">Elbow flexion contracture related to brachial plexus birth injury</a>. </p><h3>Nerve surgery</h3><p>In some patients, surgery may be recommended. Babies with brachial plexus birth injury are carefully monitored during the first year of life to record changes in muscle strength. If the muscle fails to strengthen beyond a certain point, and the baby's ability to move and use the arm is also limited, then the surgeon may suggest an operation to find out how severely the nerve is damaged. When the surgeon can observe the brachial plexus directly, they can decide on the best form of treatment. If your baby has an operation on the nerves of the brachial plexus, this will usually be done before your baby is one year old. </p><p>For more information, please see the article <a href="/Article?contentid=1033&language=English">Brachial plexus operation</a>.</p><h3>Other types of surgery</h3><p>Older children who still have movement problems or trouble using the arm may benefit from surgical procedures on the muscles, tendons or bones. Examples include tendon transfers and correction of bone alignment. Your child's surgeon will discuss these procedures with you and your child if they are recommended. </p><h2>What your child wants to know<br></h2><p>Most children and teens with a brachial plexus birth injury usually want to know why the nerves make one of their arms smaller than the other.</p><div class="asset-animation">src="https://www.aboutkidshealth.ca/Style%20Library/akh/animation/Brachial%20plexus%20injury%20-%20Storyline%20output/story.html"</div><p>The nerve injury at birth affects how the muscles and bones in the arm and hand will grow. This is why their arm and hand on the injured side may be smaller in size.</p> <br><h2>Most children regain good use of their affected arm</h2><p>During the early months of life, it is hard to predict how your child's arm will heal. If muscle function returns quickly, it is a good sign. Many children regain good use of their affected arm and are able to do most of the activities that they want. Some muscle weakness may remain. In some cases, an injury to the brachial plexus may result in an <a href="/article?contentid=3873&language=english">elbow flexion</a> (bent and stiff elbow).<br></p><h2>At SickKids</h2><p>The Brachial Plexus Clinic at The Hospital for Sick Children is a multidisciplinary clinic designed to assess and treat children with brachial plexus problems.</p><p>All patients require a referral to visit the Brachial Plexus Clinic. For more information, please visit: <a href="http://www.sickkids.ca/PlasticSurgery/What-we-do/Brachial-Plexus-Palsy/index.html">http://www.sickkids.ca/PlasticSurgery/What-we-do/Brachial-Plexus-Palsy/index.html</a><br></p><p>Coroneos CJ, Voineskos SH, Christakis MK on behalf of The Canadian OBPI Working Group, et al. Obstetrical brachial plexus injury (OBPI): Canada's national clinical practice guideline. <em>BMJ Open</em> 2017;7:e014141. doi: 10.1136/bmjopen-2016-014141 from <a href="https://bmjopen.bmj.com/content/7/1/e014141">https://bmjopen.bmj.com/content/7/1/e014141</a><br></p>https://assets.aboutkidshealth.ca/akhassets/brachial_plexus_infant_MED_ILL_EN.jpgBrachial plexus birth injuryFalse