ARM PARALYSIS (Brachial Plexus Palsy)

Definition: Paralysis or weakness of the arm muscles.

1. How did this condition occur in my baby?

Brachial plexus palsy is caused by a stretch injury of the nerves supplying the muscles of the upper extremity (brachial plexus) during delivery. Recognized risk factors include large birth weight, breech position, prolonged labor, difficult delivery, shoulder dystocia, and neonatal distress.

The causes of this stretch are due to the forces of labor, especially in cases of shoulder dystocia, and extraction maneuvers. Greater trauma occurs with forceful arm extraction maneuvers during a breech delivery. Exactly how much stretch is needed to produce permanent injury in any infant is not known.

2. Is my baby experiencing any discomfort?

No. This condition is caused by injury to the nerves supplying strength and sensation to the arm. Typical symptoms include asymmetric infantile reflexes and decreased spontaneous movement of the affected arm. If the child appears to be in pain, other conditions such as fractures of the clavicle (collarbone), humerus (upper arm bone), and shoulder should be ruled out with an X ray. Bone and/or joint infections should also be ruled out by blood tests, if pain is present.

3. What tests are needed to further define the condition?

X rays and blood tests may be required to rule out other conditions that can cause your child to have decreased movement of one extremity. Usually, no further tests are needed once the diagnosis has been made.

4. What is the treatment, and will physical therapy be needed?

Initial treatment includes protecting the involved limb by pinning the sleeve to the shirt or wrapping it to the body for the first several weeks. As soon as your child can tolerate it, gentle range of motion exercises should be started. These can typically be performed at home by the parents. Many infants will recover spontaneously on their own in the first six to eight weeks of life, and many will progress to a normal result. Those infants who do not initiate recovery until after three months of age may require future surgery to optimize the function of the arm.

5. How long will it take for the condition to be corrected, and will there be any residual weakness or decreased function of the arm?

If recovery is to occur on its own, it most commonly begins in the first six to eight weeks of life. If little or no active motion of the affected arm begins before three months of age, surgical procedures are commonly necessary to maintain motion of the shoulder, elbow, and wrist. Even after surgery, some residual decrease in function is very likely.

6. Should a neurologist or an orthopedist be consulted?

Consultation with an orthopedist should be initiated as soon as the diagnosis is made. Often, an orthopedist will assist in ruling out other conditions and in establishing the diagnosis in a newborn with decreased spontaneous movement of an arm.

7. When do you wish to see my baby again for this condition?

Your orthopedist will need to reassess the child every few weeks to ensure that the parents are performing the range of motion exercises properly and for signs of recovery. The decision whether to perform surgery or continue nonoperative treatment is usually made at three months of age. 

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