When you take your new baby home from the hospital, you can’t wait for all the wonderful — albeit exhausting — things that are about to happen. Late-night feedings and lullabies. Baby’s first bath. Having baby grasp onto your finger and seeing just how small this new life is in comparison to you. But what happens if baby was injured during birth?
A brachial plexus injury is one type of injury can happen during the birth process — most commonly with a difficult vaginal delivery. The brachial plexus is a set of nerves that sends messages from the spine to the shoulder, arm, and hand; injuries to these nerves occur in 0.3 to 2 live births per 1,000, and most often are identified immediately in the acute setting.
When the brachial plexus is damaged, paralysis can happen in any part of the arm or hand. Sometimes referred to as lower brachial plexus palsy or Dejerine-Klumpke palsy, Klumpke’s palsy is a condition that affects just baby’s hand — that hand you’re so desperately wanting to hold right now.
This post will discuss the specifics about Klumpke’s palsy, its signs and symptoms, causes of brachial plexus injuries, treatment for Klumpke’s palsy, and how to get help with your baby’s birth injury.
What is Klumpke’s palsy?
According to the U.S. National Institutes of Health (NIH), Klumpke’s palsy is considered as a “rare disease,” meaning fewer than 200,000 people in the U.S. population are affected by this form of nerve paralysis.
According to the American College of Obstetricians and Gynecologists (ACOG):
“The overall incidence of NBPP, both transient and persistent impairment, is 1.5 per 1,000 total births,” of which Klumpke’s palsy is only a smaller subset.
Most brachial plexus injuries heal during the first few months of the infant’s life without intervention. When an infant presents with the mildest form of Klumpke’s palsy, recovery typically occurs within the first 6 months of life. Treatments, when needed, may include physical therapy in mild cases, and surgery for more severe levels of brachial plexus injury. In more severe cases, brachial plexus injuries can lead to lifelong disabilities of the arm, hand, or fingers.
Signs and symptoms of a brachial plexus injury include:
- Immobility of the arm and/or hand on one side of the body
- Hand or arm weakness on one side of the body
- Lack of sensation in the arm or hand on the effected side
- Crying as if in pain or signs of distress when one arm or shoulder is moved
- Some babies exhibit a drooping eyelid on the opposite side from the injury, referred to as Horner syndrome
Brachial plexus injuries also can happen in older children and adults, especially with a fall where the arm is used to break the impact. Contact sports, such as football and wrestling, may also increase the risk of a brachial plexus injury.
Differentiating Klumpke’s palsy from other brachial plexus injuries
When the brachial plexus is damaged between the first thoracic nerve (T1) and the eighth cervical nerve (C8) before or after they have joined at the lower trunk, this paralysis typically affects the lower arm and hand, and is considered Klumpke’s palsy. With this type of nerve damage, the baby’s hand will seem to curl into a claw.
When the damage to the brachial plexus occurs between the fifth (C5) and sixth (C6) cervical nerves the paralysis appears in the upper arm and is typically referred to as Erb’s palsy (or Erb-Duchenne palsy). With Erb’s palsy, a baby’s arm will to curl up against the body and turn inward. In more severe cases, Erb’s palsy can lead to stunted growth and cause circulatory problems.
If all five of the brachial plexus nerves are damaged, this is called Global palsy. This leads to complete inability to move the affected arm or hand, and may completely eliminate sensation from the extremity.
Brachial plexus injuries additionally are divided into four categories based on severity:
- Avulsion: The nerve is torn from the spine, which is the most severe damage.
- Rupture: The nerve is torn, but not at spinal attachment.
- Neuroma: A healed nerve’s scar tissue puts pressure on other nerves, causing poor nerve signaling.
- Neuropraxia: Most common, this is also called stretch; nerve is damaged but not torn.
What causes Klumpke’s palsy? Are certain pregnancies more at risk?
Most babies are head-down (cephalic presentation) when labor starts, but many variations can happen even with this most common position at birth. Asynclitic cephalic presentation, meaning baby’s head is tilted toward the right or left shoulder as he passes through the birth canal, can cause undue stretching on the brachial plexus during the birth process.
In addition, some babies present bottom-first (breech presentation). While healthcare providers may opt for a cesarean birth with breech presentation, they may deliver vaginally; one of the risks of a brachial plexus injury this way is when baby’s arms are raised over his head as he descends for birth.
Brachial plexus injuries like Klumpke’s palsy also are more likely with the following:
- Shoulder dystocia: This is when one of baby’s shoulders gets stuck behind the pubic bone after the head is already delivered.
- Assisted delivery: The use of a vacuum extractor or forceps to speed a baby’s birth can lead to brachial plexus injuries.
- Fetal macrosomia: Defined as a birthweight greater than 8 pounds and 13 ounces, macrosomia increases the risk of brachial plexus injury.
- Premature birth or certain congenital issues when the muscles of the neck or shoulders are underdeveloped.
- Stronger-than-normal contractions.
While cesarean birth may lessen the risk of damage to the brachial plexus, the danger is not fully eliminated. Cesarean birth is also major abdominal surgery with its own risks and benefits that may outweigh the potential protection against brachial plexus damage.
Occasionally a baby will be born with a fracture (typically to the clavicle or humerus). While the baby may not move the arm due to pain, most times no nerve damage is involved. The healthcare provider will likely seek additional investigation to rule out brachial plexus injury in these cases.
Klumpke’s Palsy Diagnosis and Treatment
If you notice that your baby is holding one arm or hand in an awkward position, has a weak grip with one hand, or isn’t moving one arm, it may be due to brachial plexus injury. You may also notice that your baby cries or seems uncomfortable when you manipulate the arm or hand (such as when dressing or undressing baby). If your baby exhibits any of these symptoms, ask your healthcare provider to investigate brachial plexus injury.
The doctor may order x-rays of your baby’s shoulder or arm to rule out broken bones. An electromyogram (EMG) to measure muscle damage related to the injury or a nerve conduction study (NCS) to measure the damage to the brachial plexus nerves may also be ordered.
You may need to immobilize your baby’s arm for 7-10 days. You may also be given instructions for massage and exercises you can do at home.
For more severe types of brachial plexus injuries (such as when nerves are torn), your baby’s doctor may suggest surgery to repair the area in hopes of regaining feeling and motion. This might be in the form of a nerve graft or excision, or a tendon transfer to help the affected muscles work better.
Get Help with Your Baby’s Brachial Plexus Injury
Connecting with other parents who have experienced brachial plexus injury and related interventions can help support you throughout the treatment period. These groups have information for parents, and may be researching treatments to improve outcomes for babies and children diagnosed with brachial plexus injury. They also may have parent-to-parent forums for community participation:
Additionally, if your baby was injured during birth and your medical team could have prevented it, you may have legal basis for a medical malpractice claim. While the thought of a birth injury lawsuit might be overwhelming, an experienced birth injury lawyer can help guide you through the process and make things easier for your family.
Contact Safe Birth Project today to see how we can be of assistance!
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