Brachial palsy in the neonate is a paralysis or weakness of the arm caused by damage to the brachial plexus (the collection of nerves around the shoulder).

Alternative Names

Klumpke paralysis; Erb-Duchenne paralysis; Erb's palsy

Causes, incidence, and risk factors

Neonatal brachial nerve injuries can occur during a difficult delivery when the infant's head and neck are pulled toward the side while the shoulders are passing through the birth canal. The condition can also be caused by excessive traction on the shoulders during a vertex delivery (head first) or by pressure on the raised arms during a breech delivery (feet first). The infant may have varying degrees of arm paralysis :

brachial plexus

injuries typically affect only the upper arm

Erb's paralysis affects the upper arm and rotation of the lower arm

Klumpke paralysis affects the hand (the infant may also have an eyelid droop on the opposite side)

The incidence of brachial palsy has decreased with improved delivery techniques and the more prudent use of C-sections (caesarian birth, where the baby is removed surgically through the abdomen). Risk factors include a larger than average newborn (large for gestational age -- LGA), shoulder dystocia, and breech delivery. Arm and shoulder fractures can also affect this same population of newborns and the symptoms may be very similar, although the long-term prognosis is very different.

Signs and tests

Physical examination of the infant may show that the Moro reflex is absent on affected side. This reflex will be present in an infant with a fracture who is not moving their arm because of pain (pseudoparalysis). The affected arm may flop when the infant is rolled side to side.

Treatment

Full recovery is expected in most cases, but rarely, the palsy may persist. If some strength has not returned to the affected muscles by 3-6 months of age, neurosurgical intervention may restore it. Gentle massage of the arm and range of motion exercises are recommended for mild cases, but, in more severe cases, a pediatric neurologist and an orthopedic hand surgeon may need to be consulted.

Expectations (prognosis)

Most infants recover within 6 months, but those that do not have a very poor prognosis and will need further surgery to try and compensate for their functional deficits.

Complications

Complications include permanent, partial, or total loss of function of the affected nerves, causing paralysis of the arm or arm weakness.

Calling your health care provider

Call your health care provider if your newborn shows a lack of movement of either arm.

Prevention

Measures to avoid difficult delivery, whenever possible, reduces the risk of brachial palsy in newborn babies.