Brain, Nervous System and Mental Conditions

Brachial Plexus Palsy

What is a brachial plexus palsy?

A brachial plexus (BRAKE-ee-uhl PLEKS-uss) palsy happens when the nerves of the brachial plexus have been damaged. The brachial plexus is a set of nerves that control the muscles of the arm. Palsy means not being able to move muscles in an area (paralysis).

Nerves are soft, tube-like structures inside the body. They contain many small fibers (filaments), like a telephone cable or a thick electrical cord. These small fibers carry signals from the brain to control the muscles. Nerves also carry signals from the skin to the brain. This is how we feel things on our skin.

Anatomy of the Brachial Plexus

The nerves in the brachial plexus control the arm

The nerves of the brachial plexus go out from the spinal cord under the collarbone and into the armpit. From there, they branch out into individual nerves that control the muscles in the shoulder, elbow, wrist and hand.

When nerves in the brachial plexus get damaged, signals cannot travel like usual from the brain to the arm muscles. So some or all of your child’s arm muscles may no longer work. When this affects only the shoulder and elbow muscles, it is called an Erb’s palsy. When it affects all of the muscles of the arm, hand and wrist, this is known as a total plexus palsy.

Brachial Plexus Palsy in Children

Brachial plexus palsies usually happen because of a stretch injury to your child’s head, 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 result in a stretch injury as your child is being delivered.

Vertex delivery with shoulder dystocia

The brachial plexus may be injured if a baby's shoulder gets stuck on the mother's pelvis during birth

In older children, a brachial plexus palsy can occur because of an injury where the neck and shoulder get stretched.

Many children with a brachial plexus palsy recover on their own. But if the condition does not completely resolve within 1 month, it usually has lasting effects. That’s why we encourage you to have your child assessed 1 month after their birth or injury if they have not fully recovered. If treatment is needed, it’s important to begin early and to have ongoing therapy.

Physical and occupational therapy can reduce problems with stiffness or other bone problems that can happen as a result of the injury. Some children need to wear splints to help position their joints while the nerves are recovering. Some need surgery to repair their nerves.

Brachial Plexus Palsy at Seattle Children's

Seattle Children’s Brachial Plexus Clinic is the only comprehensive clinic in the Northwest for children with this condition. We are one of only a few in the country. Our team of doctors, surgeons, physical therapists, occupational therapists, nurses and other health professionals work together closely to provide care for children of all ages with a brachial plexus palsy.

The team will assess your child's injury carefully and design a treatment plan that's right for your child. We will work with you and your child from the time of their injury until your child is an adult.

Our radiologists have special expertise using ultrasound to look for bone and joint changes so we can work with your child to help prevent future problems. We emphasize non-surgical treatments, including unique splinting options. Seattle Children’s is the only hospital in Washington state to offer these new options, which may reduce the need for surgery in some children. Most children don’t require surgery. For those who do, splinting and therapy combined with surgery has better results than surgery alone.

To schedule an appointment with the Brachial Plexus Clinic, please call 206-987-4680.