By Aaron Berger, MD, Director, Division of Plastic Surgery, Nicklaus Children's Hospital and NCPS Chief, Section of Plastic Surgery and Yvette Elias, OT/L, CHT 

Division of Plastic Surgery

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Struggling with a brachial plexus injury can be a confusing and challenging experience for both a child and their parents. The brachial plexus is a network of nerves in the neck that send and receive signals from the arm, controlling movement and providing sensory signals.

The Symptoms of Brachial Plexus Injuries

When the brachial plexus suffers from an injury, the symptoms experienced may range from mild sensory changes and weakness to a complete lack of sensation and a limp arm. The injury may affect only some parts of the arm, for example, the shoulder or elbow, or the entire arm, including the hand.  The injury may occur from penetrating trauma, for example a stab wound or laceration, or more commonly, a stretch injury. Parents may feel uncertain about what is happening to their child, adding to the stress of the situation.

Signs and symptoms of brachial plexus injury include:

• Lack of feeling or sensation in the arm or hand 

• Sudden stinging or burning pain in the arm or shoulder 

• The arm is limp and cannot move 

• No muscle control of the shoulder, elbow, wrist, and/or hand.
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What Causes It

The symptoms of a brachial plexus injury are usually seen in the aftermath of a traumatic injury. While the injury is most commonly seen in association with difficult birth delivery, older patients may develop brachial plexus injury after falls, motor vehicle accidents, or penetrating weapon—for instance, knife or bullet—injuries. Brachial plexus injuries may also be seen in the setting of high-impact sports like football.

What to Do If You Suspect a Brachial Plexus Injury 

If your child demonstrates the signs of brachial plexus injury or experiences any of the symptoms mentioned above, it is important to seek medical attention from a team that cares for brachial plexus injuries. This is especially important if symptoms persist in the days or weeks following an injury.

How Nicklaus Children’s Treats Brachial Plexus Injuries

At Nicklaus Children’s Hospital’s Brachial Plexus and Peripheral Nerve Program, we focus on the highest quality care and treatments for children with these injuries. Nicklaus Children’s Hospital takes a multidisciplinary approach to care, meaning your child will be evaluated and treated by a variety of pediatric specialists—therapists (Occupational and Physical) and surgeons (peripheral nerve surgeons and orthopedic surgeons)—who work together as a team to provide the best possible care.

One area of specific focus at Nicklaus Children’s Hospital is the care of infants with brachial plexus birth injuries. In anywhere between .5 and 4 per 1,000 live births, a baby will experience a stretch injury to the brachial plexus injury as it passes through the birth canal. Although some stretch injuries to the brachial plexus may recover spontaneously with the help of specialized therapy, penetrating injuries and severe stretch injuries may benefit from surgery. Surgical treatment may include repair or reconstruction of the nerves, transfer of nerve signals from other parts of the body, and muscle or tendon transfers. Again, care is best provided in a multidisciplinary fashion, with multiple specialists participating in the care of this complex injury.

For more information about Nicklaus Children’s Hospital’s Brachial Plexus and Peripheral Nerve Program, visit the program’s website. A variety of tools for families can be found on the Patient Resources web page.