Brachial Plexus Injury

Benny Joyner; Mary Ann Soto; Henry M. Adam

doi:10.1542/pir.27-6-238

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Benny Joyner, MD, MPH
Mary Ann Soto, MD
Henry M. Adam, MD, Editor, In Brief

Children’s Hospital at Montefiore
Bronx, NY

Management of Birth Injuries. Uhing MR. Clin Perinatol. 2005; 32 :19– 38OpenUrl CrossRef PubMedBirth Injuries of the Brachial Plexus. Piatt JH. Pediatr Clin North Am. 2004;51 :421– 440OpenUrl CrossRef PubMedThe Newborn Infant: Birth-Related Injury, Including Perinatal Asphxia. Jones Jr, MD. In: Rudolph CD, Rudolph AM, Hostetter MK, Lister G, Siegel NJ, eds. Rudolph’s Pediatrics. 21st ed. New York, NY: McGraw-Hill; 2003:186

Injury to the brachial plexus during birth has been documented in the medical literature for more than 200 years. Although the ability to predict brachial plexus injury antenatally remains elusive, knowledge of its epidemiology, risk factors, variations in presentation, prognosis, and management can guide therapeutic decisions and potentially avoid lifelong disability.

Intrapartum trauma to the brachial plexus encompasses a spectrum of injuries involving the lower cervical and upper thoracic nerves (C5 through T1), which supply the plexus. These five spinal nerve roots combine to form the upper (C5 through C6), middle (C7), and lower (C8 through T1) trunks of the plexus, and the peripheral nerves originating from the plexus innervate the muscle groups of the shoulder, upper arm, forearm, wrist, and hand. The phrenic nerve, comprised of fibers from C3 through C5, and the sympathetic fibers of T1 are affected commonly in brachial plexus injuries, resulting, respectively, in ipsilateral diaphragmatic paralysis and Horner syndrome (miosis, partial ptosis, slight enophthalmos and anhidrosis of the affected side).

The incidence of brachial plexus injury is approximately 1 in 1,000 …