Brachial Plexus Injuries
Are you at risk?
What is a Brachial Plexus Injury? How does a Brachial Plexus Injury occur? Is it preventable? What are the signs/symptoms of a Brachial Plexus Injury? What are the risk factors? What are the affects of a Brachial Plexus Injury to the body? What is it like to have a Brachial Plexus Injury or live with someone who does? Are there treatments or a cure? The real questions are does your doctor know what he/she is doing? And, are you and/or your baby at risk?
The Brachial Plexus is a network of nerves that send signals to the muscles of the shoulder, arm, and hand. A Brachial Plexus Injury (BPI) occurs when damage is done to this network of nerves. Each nerve that is affected is damaged in one of four ways.
˜ An Avulsion: The nerve is completely torn from the spine at the point of connection.
˜ A Rupture: The nerve is completely torn but not at the point of connection to the spine.
˜ A Neuroma: The nerve is badly stretched and tries to repair itself, however this causes scar tissue to form. The scar tissue puts pressure on the nerve and does not let any signals go through.
˜ A Praxis: A slight stretch that will usually heal all on its own.3,4,7
Damage to the Brachial Plexus may cause injury to one or both arms. This is known as a single or a bilateral injury.5
A Brachial Plexus Injury is the result of damage done to the Brachial Plexus. This injury results in partial or complete paralysis to one or both arms. The most common cause of a BPI is when a birthing emergency called Shoulder Dystocia occurs; the doctors get nervous and apply excessive force on the baby’s head and neck region. This process pulls the nerves out of the Brachial Plexus. This is called an Obstetrical Brachial Plexus Injury (OBPI). Other causes of this injury include, but are not limited to, automobile, motorcycle, and all terrain vehicle accidents. Sports injuries, animal bites, gunshot and puncture wounds, viral infections, or as a result of specific medical treatment/procedures, and surgery can also be causes of Brachial Plexus Injuries.3, 4
Is a Brachial Plexus Injury Preventable? That answer depends on the situation. If the injury is obtained due to an accident that was not your fault, like you were hit by a car, then there is nothing that you can do. However if the injury was obtained at birth it is 100% preventable. The key to prevention is education so ask every possible question you can to learn the background of your doctor before you put yourself or your baby’s future at risk.1
To determine whether or not you or your child has a Brachial Plexus Injury, look for a limp or paralyzed arm, lack of muscle control in the arm, hand, and fingers. 4 Another sign is a decrease in sensation in the arm and/or hand.7 There are other ways to determine if some one has a BPI but they are much harder to clearly identify.3
So what puts you or your baby at risk for a BPI? What might put you at risk for a Brachial Plexus Injury? Performing dangerous stunts, driving erratically, or living in an area highly concentrated with people that do these things. Those are all risk factors for a Traumatic Brachial Plexus Injury or TBPI.1 Risks for Obstetrical Brachial Plexus Injuries include suspected large baby (over 8 lbs. 14oz), maternal/gestational diabetes, maternal obesity, overdue baby (past 40 weeks), contracted or flat pelvic bone, and maternal weight gain of more than 35 pounds. Others include a short first stage of labor, a prolonged second stage of labor, breech birth or other abnormal presentation, history of shoulder dystocia, or 8 years or more have past since last pregnancy.3,4,6,7 Also, it has been shown that the use of forceps, or vacuum devices put a baby at a higher risk for a BPI.3 Although very uncommon Brachial Plexus injuries can also occur following a C-Section, probably due to intrauterine forces.2
What are the affects of a Brachial Plexus Injury to the body? The number one affect to the body is pain. For no reason at all, a person with a BPI may just feel a shooting pain go up their arm. This is caused from the nerves trying to send signals. Other difficulties may include having to write with the opposite hand in which your brain sends signals to. Children with Brachial Plexus Injuries are usually unable to crawl. Playing sports is also very challenging; to play softball or baseball is difficult if your dominant side is the affected side. You have to learn all new ways to do what every one else does not even think twice about. Another challenging task is learning to tie shoes. Many have found that using elastic laces is very helpful. On the bright side it is possible to play sports and have a functional life.1
So what is it like to have a BPI or even just live with some one who does? Well, either way there is a lot of stress. For a new parent dealing with the trauma of having an injured baby tends to be very challenging. Commonly a lot of harsh feelings are felt toward the doctor that delivered the child. Every day Range of Motion exercises must be done to prevent further damage to the muscles. When the muscles are not used they shrivel so to speak. This is called muscle atrophy. It is very hard to regain the use of an atrophied muscle. It takes hours and hours of both Physical and Occupational therapy to regain the use of these muscles. For an individual that has a BPI it is still stressful, but in a bit of a different way. These people may always have a concern about being accepted. Another concern is being able to participate in a given activity? What kind of job will I be able to do in the future? There are so many things to think about that you almost have to grow up faster than other kids just to deal with every thing. Is it fun to grow up faster? No, not really but it does have its advantages, like being respected and looked up to at an earlier age.1
To date there is no real cure for a Brachial Plexus Injury. They are however getting ever so close with nerve grafting. However, this seems to be most effective on infants but not very effective on older children. There are numerous surgeries out there to aid in the recovery of a Brachial Plexus Injury, some of which are, tendon transfers, and shoulder repair. Other than that, treatment options may include Physical and/or Occupational therapy, acupuncture, aqua therapy, or chiropractic adjustments.3,4 A new treatment is the use of Electric Stimulation of the muscles to teach them what they are supposed to do. There are other less popular options but they are possibly not as effective for many such as herbal therapy, reflexology, and kinesio taping.
Maybe some day there will be a cure for all nerve injuries, but until then we all need to take the time to inform as many people as possible about Brachial Plexus Injuries and the risk factors. Mostly just be careful, you only get one body. Please spread the word of caution to all new teen drivers, expectant mothers, or just people that you love. Trust me, it is not fun to have this kind of injury, so be careful and spread the word!
References
1. Amy Theis. Personal communication.
2. “Evaluating Brachial Plexus Birth Injuries” 2004. Department
of Neurological Surgery. 24 October 2004.
<http://www.neurosurgery.pitt.edu/brachialplexus/anatomy>
3. Francine Litz. “Injured Newborn.” 2004. Injured Newborn.
15 October 2004. <www.injurednewborn.com>
4. “Information for adults with BPI.” 2001. United Brachial Plexus Network. 15 October 2004. <www.ubpn.org>
5. “Quick facts about BPI.” ND. United Brachial Plexus Network.
15 October 2004. <www.ubpn.org>
6. “What is Brachial Plexus/Erb’s Palsy?” ND. NBPEPA.
15 October 2004. <www.nbpepa.org/erbs.htm>
7. “What is Erb’s Palsy” ND. Resources for Erb’s Palsy Families.
15 October 2004.
<http://www.erbs-palsy-help.com/links.html>