Your new little one has been diagnosed with a brachial plexus injury. Whether it’s a general brachial palsy, Klumpke’s palsy, or Erb’s palsy, you’re probably wondering what to expect.
As soon as you deliver, your doctor will perform a standard Apgar test on your baby. It involves checking your baby’s heart rate, reflexes, breathing, and muscle tone to make sure your baby is healthy. Doctors are looking out for labored breathing, high or low heart rate, and weakness of the muscles. If your baby has weak arm or hand muscles on one side, your doctor may want to perform further tests to check for a brachial plexus injury.
These tests may include checking for a “Moro reflex” or looking at the baby’s shoulder with an MRI to check for nerve damage. Your doctor may want an x-ray of the baby’s shoulder and arm to check for broken bones, which can have similar symptoms as a brachial plexus injury but require immediate treatment.
In some cases, a brachial plexus injury won’t be easily diagnosable right away. It may take time for symptoms to become evident. Once you’ve taken your baby home, you may notice that the baby’s arm is weak or turned inward or that the baby can’t move the arm at all. If you notice these symptoms, you should schedule an appointment with your doctor right away to check for brachial plexus injuries. Your doctor will use the same tests described above to determine whether a brachial plexus injury is the cause of your little one’s symptoms.
You may be given a specific diagnosis such as Erb’s palsy or Klumpke’s palsy. These names refer to different types of brachial plexus injuries. Erb’s palsy typically affects the upper arm and Klumpke’s palsy typically affects the forearm and hand.
Once you have a diagnosis, treatment depends on the severity of the injury. About two-thirds of cases will recover completely with minimal treatment. Your doctor may give you a set of gentle exercises to do with your baby to help strengthen the arm muscles and improve flexibility in the joints. If the injury is healing properly, the baby will probably start to bend and straighten the elbow by around 3 months of age. Shortly after that, you should see movement in the hand and wrist.
You will visit with your doctor regularly for checkups on your child’s progress and you’ll likely need to continue the exercises for several months. Most children will completely recover by their first birthday, although you may see some improvement into their second year.
If the injury is too severe to heal on its own, your child may need surgery to repair the damaged nerve. The timing of this type of surgery is crucial. You have to wait long enough to see if the injury will heal on its own. If you wait too long, however, the muscles may weaken so much that surgery becomes impossible. You’ll need to work with your baby’s care team to track the healing process and decide if and when surgery is the best option.
Several different types of surgery may be required to repair a brachial plexus injury. In some cases, it may be enough to remove the scar tissue around a damaged nerve or to remove the damaged portion of the nerve. In other cases, a nerve graft or transfer may be required.
If your baby needs surgery, you can expect a hospital stay of a few days to a week. After that, you’ll work with your baby’s surgeon and physical therapist to develop a treatment plan. In some cases, your surgeon may recommend a splint to hold your baby’s arm in the proper position for a few months after surgery. You may be given exercises to do with your baby at home or you may have regular appointments with a physical therapist.
As mentioned above, most children with brachial plexus injuries recover completely. Children with injuries severe enough to require surgery will likely not have perfect use of the affected arm. Surgery may restore some function and sensation but cannot offer a perfect fix. The arm may be stunted due to poor circulation and it will be weaker than the unaffected arm. If the damage was particularly severe, your child may never have use of the affected arm.
Your child may need ongoing physical therapy to strengthen the arm and maintain joint flexibility. If use of the arm is extremely limited, a physical therapist can teach your child strategies for completing everyday tasks with limited or no use of one arm.
Finally, you’ll need to keep a close eye on the affected arm. That arm will often have limited sensation and restricted circulation, so your child may not notice an injury right away and the injury may take a long time to heal. For the same reason, you’ll need to take extra care to keep the affected arm warm when the weather gets cool.
Adolescence and Beyond
It’s never going to be easy to see your child injured, but brachial plexus injuries are rarely serious. With some physical therapy and lots of love and support, even a severe brachial plexus injury won’t hold your child back.
Like any injury, brachial plexus injuries can come with big medical bills. In addition, your child may never have full use of the affected arm. These resources are designed to help children with disabilities and their families.
Medicare and Medicaid
Medicare and Medicaid can cover your child’s medical costs, including any necessary surgeries.
Your child may be entitled to Social Security Disability Benefits, which can help ease the financial burden of medical bills and other necessary expenses.
The United Brachial Plexus Network (UBPN) provides support for children with brachial plexus injuries. UBPN gives access to medical devices and educational materials focused on brachial plexus injuries.
Search online for websites and blogs dedicated to children with brachial plexus injuries such as Erb’s Palsy. These online communities can provide emotional and sometimes financial support for children with brachial plexus injuries and their parents.