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A brachial plexus birth injury is a form of damage to the nerves of the arm caused by a difficult or long delivery. The vast majority of babies with a brachial plexus birth injury recover on their own without the need for medical intervention, although it may take several months. If signs of injury persist beyond three or four months, the infant may need surgery or other treatments to address lasting damage to the nerves. Working with a neurologist to regularly evaluate a baby with this kind of injury will help parents make decisions about treatment.
The brachial plexus could be considered the literal nerve center of the arm. It is a bundle of nerves that lead to various parts of the arm, wrist, and hand. During birth, it can be injured through compression or stretching, most commonly when a baby develops shoulder dystocia during delivery. If the baby's arm is stretched or the shoulder is pushed out of position, it can strain the nerves and cause a brachial plexus birth injury.
The baby's arm may appear weak and floppy. Reflexes develop more slowly in the injured arm, with the baby having trouble grasping with the fingers, raising the arm, making coordinated movements, and controlling the arm. Typically, as the nerves heal, the baby will develop more strength and dexterity. Between the ages of three and four months, noticeable improvements should be visible, although the patient can experience some residual weakness.
If a baby does not appear to be recovering from a brachial plexus birth injury, more evaluation may be recommended. Surgery is a possible treatment, as is physical therapy. There is a rare possibility of paralysis in the arm or permanent poor motor control as a result of the nerve injury. The arm may also develop unevenly, remaining smaller than the uninjured arm until it has a chance to catch up.
The prognosis for a baby with a brachial plexus birth injury is difficult to estimate, which can be frustrating for parents. Doctors can speak from their own experiences with the injury and may have recommendations for specialists and consultants their patients can see, but in the end, every case is different. It is hard to predict when a case will resolve spontaneously, and when a case will require more intervention. The best early treatment is close observation, paying close attention to any signs indicating an increase in severity or the development of new symptoms.
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