Brachial Plexus Clinic
The Brachial Plexus Clinic at Seattle Children’s cares for children who have a problem with the nerves that go to their arm – most often brachial plexus palsy. If there are problems with these nerves, your child may have trouble controlling their muscles or feeling sensation on their skin.
Many children with brachial plexus palsy recover on their own. But if the condition does not get better within 1 month, it usually has lasting effects. That is why we urge parents to have their child checked 1 month after their birth or injury if they are not fully recovered. An early therapy program can reduce problems with stiffness or other bone problems that can happen. Early assessment also helps if surgery is needed because the results are often better when performed earlier.
Some children need ongoing care for brachial plexus problems. If your child does, we will follow them throughout childhood, adapting their treatment plan as their needs change.
Why choose Seattle Children’s Brachial Plexus Clinic?
Our multidisciplinary clinic is the only one of its kind for children in the Northwest and one of only a few in the country. A team of providers with special training in many areas will assess your child. The team includes doctors who specialize in:
Your team creates a treatment plan designed to get the best results for your child. This may include:
- Physical or occupational therapy
- Botulinum toxin injections
- A combination of these treatments
We base our treatment plans on the latest evidence about which therapies are most likely to help and when they should be used.
Our radiologists have special expertise using ultrasound to look for bone changes. This helps us start treatment early and prevent future bone and joint problems that often happen with brachial plexus palsy. We always try nonsurgical treatments first, including splinting options that are tailored to your child’s specific needs. In some children, ultrasound monitoring and splinting may reduce the need for future surgery. We are the only hospital in Washington to offer this. Most children do not require surgery. For those who do, splinting and therapy combined with surgery results in better, lasting flexibility and range of motion than surgery alone.
Conditions We Treat
In our Brachial Plexus Clinic, we see children with many conditions, including:
Brachial plexus birth palsy
Brachial plexus palsies usually happen because of a stretch injury to a child's neck and shoulder. This can happen during birth, especially when the birth is difficult or complex. Sometimes a child's shoulder will get stuck against the mother's pelvis. This can cause a stretch injury to the child as they are being delivered. Read more.
Traumatic brachial plexus palsy and isolated nerve injuries in older children or young adults
In older children and young adults, a brachial plexus palsy can happen because of an accident where the neck and shoulder get stretched. Car accidents and sports injuries are two examples. If the injury affects the entire set of nerves that control the muscles of the arm (the brachial plexus network), most of the arm’s muscles and skin may be affected. If only smaller nerve branches are injured, problems with control and sensation will affect fewer muscles and a smaller area of skin. Read more.
When nerves in the brachial plexus network get damaged, signals cannot travel from the brain to the arm muscles in the usual way. So some or all of a child’s arm muscles may no longer work. When this affects only the shoulder and elbow muscles, it is called Erb’s palsy.
Peripheral nerve tumors
Nerves that branch off the spinal cord are called peripheral nerves. If a tumor forms in the peripheral nerves that goes to the arm (brachial plexus), it may keep signals from traveling between the brain and the arm muscles in the usual way. These are usually benign soft tissue tumors called schwannomas or neurofibromas. Some tumors do not cause symptoms, but they still need treatment to prevent problems in the future. Read more.
Idiopathic and other nerve conditions
A nerve condition that affects the nerves that go to the arm (brachial plexus) may change how much feeling a child has in their shoulder, arm or hand. Or it may limit how well they can use their arm. These conditions can happen because the nerve is compressed. They can also happen for no obvious reason. Conditions that happen without a known cause are called idiopathic. Hand and arm paralysis may persist following the initial treatment of spinal cord problems such as Acute Flaccid Myelitis (AFM) or Transverse Myelitis (TM). Our rehabilitation team, which includes a physician and physical and occupational therapists, can help to maximize function through assessment and adaptation. Surgical treatment could include nerve transfers, muscle transfers, and/or bone procedures to improve function. Given the wide range of muscles that may be affected, care is highly individualized. Read more.
Services We Provide
Imaging studies can help your doctors decide the right treatment for your child at the right time. Ultrasounds show us how your child’s shoulder is developing. We use ultrasound at regular intervals, starting when babies are as young as 3 months. If we see problems with the shoulder joint, we can start splinting early to help hold the joint in the right position. To see if a nerve is detached near the spine, your doctor may order MRI (magnetic resonance imaging). Learn more.
Physical therapy and occupational therapy
Physical therapists and occupational therapists can help children with brachial plexus palsy stretch and strengthen their muscles. They can help your child learn ways to move so they can do as much as possible on their own. Therapists can also teach your family how to work with your child at home. We work with therapists in your community to help your child get the right type of ongoing care. Learn more.
Splinting and casting
Some children with brachial plexus palsy benefit from a splint or cast that holds their shoulder or arm in the proper position. Wearing the brace helps keep their joints more flexible. Some children may also need injections of a drug (botulinum toxin) to weaken muscles that are too strong. This lets them be stretched to improve the joint’s range of motion. Children’s is the only medical center in Washington state to offer these new options. Most children do not require surgery. For those who do, splinting and therapy combined with surgery has better results than surgery alone. It may reduce the need for surgery in some children. Learn more.
Microsurgical nerve reconstruction
The brachial plexus team may offer surgery to children with serious injuries to their nerves. Surgery involves exploring the injured nerves and reconstructing them if necessary. We use nerve graft and nerve transfer from another part of the body to repair damaged nerves. We only recommend surgery if it is likely your child will gain more use of their arm than with less invasive treatments such as physical therapy. Learn more.
Muscle transfer and osteotomy
Some children may have persistent weakness or an imbalance because a group of muscles recovered better than another group of muscles. We may recommend transferring one muscle to do the work of another muscle. This procedure is called muscle transfer or tendon transfer (because the tendon is part of a muscle).
Sometimes the bone grows abnormally because of chronic weakness or imbalance. We will sometimes recommend reshaping or repositioning the bone to improve how your child’s arm works. This is called osteotomy. Learn more.
Scheduling an Appointment with the Brachial Plexus Clinic
- If you would like a referral to the Brachial Plexus Clinic, talk to your primary care provider. If you already have a referral, please call 206-987-4680 to schedule an appointment.
- If you already have an appointment, learn more about how to prepare.
- Learn about brachial plexus palsy resources such as useful links, videos and recommended reading for you and your family.