Understanding Brachial Plexus Injuries in Newborns: Causes and Care

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A brachial plexus injury can be devastating for a newborn baby and its family. As a Philadelphia birth injury lawyer explains, brachial plexus injuries happen when there is damage to the network of nerves that run from the neck into the arm. This often occurs during a difficult childbirth. When brachial plexus nerves are injured or ripped, it impacts a baby’s ability to move the arm and hand properly. 

What exactly is the brachial plexus? What causes these painful nerve injuries in newborns? And what treatment options exist to help babies heal and regain strength and movement? This guide from a Philadelphia birth injury lawyer provides an overview of brachial plexus injuries in babies.

Raynes & Lawn Trial Lawyers has decades of experience guiding clients through birth injury cases. Our talented and dedicated attorneys can give you personalized and strategic attention. Call our offices today at 1-800-535-1797 for your free consultation. 

What is the Brachial Plexus? 

The brachial plexus is a network of nerves that relays signals from the spinal cord to the shoulder, arm, and hand. This intricate “plexus” features nerves originating in the neck vertebrae that branch out to control arm and hand functionality.

A Philadelphia birth injury lawyer partners with medical professionals who explain that the brachial plexus nerves begin at the spinal cord roots of spinal nerves C5 through C8 and T1. These roots combine to form three primary nerves:

  • Axillary nerve controlling deltoid muscles

  • Musculocutaneous nerve controlling elbow/arm flexors  

  • Median nerve controlling wrist flexors and elbow flexors 

Additionally, the ulnar nerve controls fingers, and the radial nerve networks innervate the triceps/arm extension. Together, this web of brachial plexus nerves allows intricate movements of the upper limbs and hands.

Brachial Plexus Injury Causes

Brachial plexus injuries typically occur when these fragile nerves stretch during birthing. As a Philadelphia birth injury lawyer can attest, most cases of brachial plexus injuries in babies arise during difficult or complicated vaginal deliveries. Specific causes include:

Difficult Delivery Requiring Excess Pulling/Twisting

If the baby presents in an awkward position in the womb, significant twisting and pulling on its head and neck may happen as it passes through the birth canal. This places excessive strain on the brachial plexus nerves.

Common trouble positions include sunny-side up or face-up orientation within the womb. Breeched or transverse lie positions can also lead doctors to intervene more forcefully, further increasing nerve damage risks.

Oversized Babies 

A larger-than-average baby or a small birthing mother may also predispose infants to brachial plexus injuries during childbirth. The baby simply has more difficulty fitting through the mother’s pelvis. The increased friction and pressure often cause doctors and nurses to intervene more assertively with tools.

This may involve vacuum devices or forceps to help guide an oversized baby through the birth canal. However, it significantly raises the chances of over-stretching the delicate brachial plexus nerves.


Early birth before 37 weeks gestation is another risk factor for brachial plexus injury, according to a Philadelphia birth injury lawyer. Premature infants have underdeveloped nerve sheaths and muscle structures around the brachial plexus network.  

So even gentle maneuvers during delivery or while removing fetal monitors can damage these immature nerves and lead to loss of arm control.   

Brachial Plexus Injury Symptoms

The hallmark sign of brachial plexus nerve damage is loss of motion and weakness on one side of the body. Since the intricate brachial plexus nerve network controls shoulder, arm, and hand movement, injury impacts various functions based on severity.

Mild To Moderate Brachial Plex Injuries

A Philadelphia birth injury doctor indicates babies retain shoulder control but lose some wrist control in mild cases. This leads to the telltale “waiter’s tip” position with the arm bent at the elbow and wrist/hand limp downward. 

Moderate injuries involve more loss of tricep control. The whole arm dangles at the baby’s side without the ability to bend the elbow or wrist effectively.

Severe Brachial Plexus Injuries  

The most severe brachial plexus injuries are called Erb’s Palsy or Klumpke’s Palsy. These involve complete paralysis and lack of movement in the shoulder, arm, wrist, or fingers due to extensive nerve damage.

Risk factors for permanent brachial plexus injury include:

  • Severity – Root avulsions cause worse prognosis

  • Birth weight over 9 pounds  

  • Maternal gestational diabetes 

  • Breech positioning requiring forceps

  • Phrenic nerve paralysis 

Without proper treatment, babies face lifetime disability impairing reach, grasp, sensation, and everyday arm usage.

Brachial Plexus Injury Diagnosis

Pediatricians screen for brachial plexus injuries immediately after birth and throughout early well-baby checks. Signs like arm paralysis, floppy limbs, or lack of reflexes prompt referrals to pediatric neurologists and orthopedic specialists.

Physical Evaluation

Doctors physically examine the baby’s arm movement, searching for weakness indicating nerve damage. They also check reflexes and watch for muscle atrophy over time.

Electrical Tests

EMG/nerve conduction provides objective data regarding specific nerves impacted. This guides surgical treatment and rehabilitation.

MRI Neurogram  

These detailed body scans show the status of individual nerves and nerve roots. It provides insight on severity to determine prognosis.

Brachial Plexus Injury Treatment

Early intervention provides the best chance for recovery from brachial plexus injuries, says a Philadelphia birth injury lawyer. Most initial treatment focuses on gentle stretching and range of motion exercises to stimulate nerves. Parents also receive instruction on proper baby-handling techniques to minimize added stress.

Physical And Occupational Therapy 

Specialized pediatric therapists design custom treatment programs for affected babies, as noted by a Philadelphia brachial plexus attorney. These target specific muscle groups like biceps/triceps, wrist flexors, etc. Goals involve strengthening intact nerves and stimulating damaged ones.

According to research, tactic options consist of:

  • Passive range of motion to prevent contractures

  • Massage to decrease spasms

  • Stretching to maintain flexibility

  • Functional electric stimulation to stimulate nerves 

With time, the programs focus on improving coordination, reach and grasp. Advanced occupational therapy later targets adaptation so kids can participate in school and social activities.

Nerve Surgery

A birth injury lawyer based in Philadelphia can explain how surgery aims to relieve pressure and scarring on damaged nerves. This provides the best chance for regeneration. One or more of these procedures may be utilized:  

  • Nerve grafting 

  • Neurolysis to remove scar tissue

  • Nerve or tendon transfer

Pediatric orthopedic surgeons often perform intricate hand reconstruction procedures in severe cases.


Muscle relaxants temporarily paralyze overacting muscles. This prevents deformity development while allowing gentle physical therapy. Pain medications also assist in progress during occupational and physical rehabilitation.

What Is The Prognosis For Brachial Plexus Injuries?

The prognosis for brachial plexus injuries widely ranges depending on severity, asserts a Philadelphia birth injury lawyer. Mild cases often fully resolve within a few weeks or months. However, complete avulsions cause permanent disability without surgical grafting.

In general, the birth injury lawyer shares this recovery overview:  

  • Mild cases gain back function within four months

  • Moderate cases see improvement after 4-6 months  

  • Severe cases necessitate nerve surgery  

Even with significant injury, starting occupational therapy by six months provides the best outcomes. 

Lasting Effects

Despite therapy and surgery, some babies experience lifelong issues like:

  • Muscle atrophy

  • Limb length differences

  • Permanent weakness impacting reach/grasp 

  • Fine motor impairment  

This affects future capabilities for certain sports, such as playing musical instruments and complex vocations requiring intricate hand coordination, according to a Philadelphia birth injury lawyer.

Could This Birth Injury Have Been Prevented?  

In some instances, brachial plexus injuries could have possibly been avoided, asserts a Philadelphia birth injury lawyer. If physicians had access to better prenatal intel or reacted appropriately during delivery troubles, nerve damage may have been reduced or eliminated.

Failure To Diagnose Oversized Baby

Underestimating fetal size often puts both mother and baby at risk, explains a birth injury lawyer. If labor begins and the baby has no room to descend, substantial pulling on its neck often ensues.

Routine late gestation ultrasounds better predict baby size, allowing doctors to schedule C-sections for safer delivery.

Waiting Too Long For C-Section

Failure to perform a cesarean when significant fetal distress signals appear may also increase injury risk. Once natural labor stalls, nerves remain under constant unsafe compression.  

Excessive Or Improper Use Of Vacuums/Forceps 

Finally, incorrect placement or overly aggressive use of vacuum cups and forceps often cause brachial plexus tears; thus, birth injury lawyers have come across this conclusion based on medical reports and history. Correct form and controlled maneuvering based on position help minimize injury risk when intervention aids become necessary.

Frequently Asked Questions

  1. Does Brachial Plexus Palsy Qualify As Grounds For A Birth Injury Lawsuit?  

It depends on negligence and lifelong effects. Failure to diagnose fetal position or size, along with improper use of delivery devices, do represent potential malpractice. 

  1. What Does Monetary Compensation Cover In Birth Injury Cases?

If liability is established, a Philadelphia lawyer handling birth injury cases seeks damages for medical costs, therapy fees, lost future income, specialized childcare, and household help.  

  1. How Much Is A Typical Brachial Plexus Lawsuit Worth?

There is no average payout for these unique cases. However, seven- and eight-figure rewards happen depending on severity and responsibility.

  1. How Do I Know If My Delivery Doctor Committed Malpractice?  

You need a third-party professional, like a birth injury lawyer in Philadelphia, to independently assess the prenatal records and birth details. This determines if acceptable protocols were followed.

Trust An Experienced Birth Injury Attorney To Evaluate Your Case

Coping with a child disabled at birth by preventable mistakes adds overwhelming stress for parents. While no financial award removes the damage done, it helps supply resources for the best care and brightest future attainable. 

Don’t hesitate to contact our talented and knowledgeable birth injury lawyers at Raynes & Lawn Trial Lawyers to protect your rights and your child’s future. Justice may be a long process, but the outcome and results our attorneys achieve can make a tremendous difference for your family. Call us today at 1(800) 535-1797 for more information.