What We Treat

What is the brachial plexus?

The brachial plexus is a group of nerves that exit the spinal cord at the base of the neck. These nerves carry signals to and from your brain and spine, down your arm. They control movement and sensation for the shoulder, arm, elbow, wrist and hand—from the shoulder to the fingertips.

Brachial plexus birth palsy (BPBP) 

BPBP is an injury to an infant’s brachial plexus nerves that happens during childbirth. It results in paralysis or loss of movement of the arm, shoulder, elbow, wrist, hand or fingers.

A child with BPBP will move one arm much less than the other. It is rare for both arms to be affected. Sometimes, no one notices for two to three weeks.

BPBP occurs in is about one in every 1,000 births. The most common causes are:

  • A difficult birth
  • Maternal diabetes
  • Large size before birth
  • Mother’s history of children born with BPBP

Fortunately, many children with BPBP will naturally recover completely.

illustration showing brachial plexus injury during child birth

Brachial plexus injury

Brachial plexus injuries, not related to birth, are not common but can be more significant. Paralysis, loss of sensation and other symptoms can be permanent if left untreated. A brachial plexus injury can be caused by:

  • Sports injuries, from football, wrestling or other sports (also known as “burners or stingers”)
  • Car, motorcycle and boat accidents
  • Falls
brachial plexus nerve illustration

Common types of injury

A brachial plexus injury damages some or all of these nerves. There are five common types of injury:

Stretching injuries

These injuries result from stretching the nerves too far. For instance when the head and neck are forced away from the shoulder, the nerves might be damaged When a brachial plexus nerve is stretched, your child may feel pain down the length of the arm.

These injuries are the most common in sport-related incidents, and are often referred to as "burners" or "stingers." Symptoms can last for a few minutes or a few days. The nerves may heal on their own, depending on how far they were stretched.

brachial plexus nerve illustration showing stretching

Avulsion

An avulsion happens when a nerve is stretched so far that it is actually pulled apart from the spinal cord. It is the most severe nerve injury and can only be treated with surgery. An avulsion often happens from a car accident and results in a completely or partially paralyzed arm.

Rupture

A rupture happens within the nerve itself. A nerve is ruptured when it is forcibly stretched far enough that the actual nerve is torn apart into more than one piece. Like avulsion, a rupture can result in a completely or partially paralyzed arm, and can only be treated with surgery, such as nerve grafting or nerve transfer.

brachial plexus nerve illustration showing rupture

Contusion

A contusion is a bruise. The brachial plexus nerves can be bruised when they are squeezed or crushed. A brachial plexus contusion can cause pain and numbness down the arm.

illustration of bruised brachial plexus nerve

Penetrating injuries

Penetrating injuries can result in cuts and tears in the brachial plexus nerves. For instance, shards of glass from a car accident can cut the nerves. These injuries happen less often.

To get an appointment with our brachial plexus clinic:

  1. Contact your child's pediatrician.
    Find a doctor
  2. Your child’s pediatrician will need to make a referral to our brachial plexus clinic.
    Call to learn more: 404-785-KIDS (5437)
  3. Set up an appointment at our brachial plexus clinic.
    Learn about your clinic visit

Services We Offer

Before deciding on a treatment plan your child’s brachial plexus injury, our team will evaluate your child’s condition. There’s no simple test to figure out exactly how severe the injury is or what nerves are damaged.

Your child’s evaluation may include:

  • Complete medical history. We’ll ask you questions about your child’s previous health conditions.
  • A physical examination performed by a doctor (the only method to evaluate BPBP). The doctor will be looking for:
    • How well your child’s muscles are developed
    • Whether your child uses muscles in the shoulder, arm and hand
    • Whether he or she has feeling in the arm
    • What your child can do with the uninjured arm, compared to the affected arm

Our goal is to improve your child’s arm strength and movement. Full recovery depends on early testing, education and treatment. While it is best to begin treatment right after birth or injury, we are often able to help a child at any time.

It is difficult to tell soon after a brachial plexus injury whether it will result in permanent damage. The severity of the injury will likely determine your child’s treatment and outcome. The earlier a brachial plexus injury is treated, the better the chances for full recovery.

Physical, occupational and hand therapy

Brachial Plexus Birth Palsy

Before the age of two, treatment is geared towards maintaining mobile joints. Physical therapy and home exercise programs are an important part of keeping the joints moving so they do not get stiff. During this time, we watch for progress and look for problems like painless shoulder dislocation. If examinations and tests show that the shoulder is dislocated, surgery will be needed. If the shoulder is not dislocated, but is becoming increasingly tight, surgery may be needed to loosen the joint to prevent deformities later in childhood.

By age 2, a child has likely reached the limit of his natural recovery. At this point, a blend of therapy and surgery may help.


Brachial Plexus Injuries

Early treatment for a brachial plexus injury often involves physical, occupational or hand therapy, at home and in a physical therapists clinic. At first, therapy will focus mainly on maintaining joint motion. Our team will also work with your child to build range of movement and strength. Family members are encouraged to get involved. We will educate your child and family about which exercises to do at home and how to do them.

Learn more about our physical and occupational therapy


Surgery

Surgery may be needed, depending on your child’s age, the length of time since the injury, and how well your child can move and function. Our surgeons will work with you to determine if surgery is best for your child.

Brachial Plexus Birth Palsy

Surgery for infants may include:

  • Nerve repair and grafting: this surgery repairs the brachial plexus nerve or removes the damaged portion of one or more of the nerves and replaces it with a healthy nerve.
  • Nerve transfer: this surgery involves connecting a nerve with a different purpose to a nerve that is not working, to restore movement and feeling.

By age 2, a child has likely reached the limit of his natural recovery. At this point, a blend of therapy and surgery may help.

Brachial Plexus Injuries

Surgery for toddlers and older children may include:

  • Tendon transfer: this is when a healthy muscle or tendon is moved to the damaged area to help improve functions that are lost or weakened by the injury. For example, a muscle that allows us to bring our arms to our body can be moved to allow us to lift our arms above our heads and to our sides.
  • Humeral osteotomy: this is when the upper arm bone is cut and then moved to correct the position. In some children, the forearm becomes contracted in a way that a child cannot turn his hands palm up or down. A similar surgery can be done on the forearm to help improve position and function.
  • Free muscle transfer: this surgery involves transplanting an entire muscle, along with its nerve and blood vessels, from one part of the body into the arm. The muscle, usually an unimportant leg muscle, is controlled by a living nerve and revived by local blood vessels.
  • Bone and joint surgery: these surgeries are used to reposition joints with the goal of enhancing function. They are often used to treat the later effects of nerve injuries. 


Our Unique Approach

Meet the team

Specialized clinic

Twice a month, we provide a brachial plexus clinic at the Judson L. Hawk Jr, M.D., Clinic for Children inside our Medical Office Building on the Scottish Rite Campus.

Learn more about our Judson L. Hawk Jr, M.D. Clinic

Your first appointment may take two hours to give the entire team a chance to examine your child, speak with you and answer your questions. The team will also ask you about any changes you’ve noticed in your child’s condition.

During this visit you may meet:

  • Nurses
  • Occupational therapists
  • Physiatrists
  • Physical therapists
  • Surgeons

Remember:

  • Dress your child in clothes that are easy to remove so that we can see all the muscles in the shoulders and chest. A tank top is a good idea for older children.
  • Bring all of your child’s medical records, insurance card and any paperwork from your child’s doctor.
  • A legal guardian must sign consent forms for your child’s examination.

You should call your child’s doctor if your child has:

  • Constant pain in the neck and shoulders
  • Weakness in the hands or arms
  • Pain or weakness in both arms

Call 911 or your local ambulance service, or take your child to the closest emergency room right away if symptoms suddenly get worse.