Brachial Plexus Palsy

Neonatal Brachial Plexus Palsy (NBPP) is a nerve injury that occurs around the time of birth.  This happens when the nerves in the brachial plexus get stretched or torn during birth.  The brachial plexus is a group of nerves from the neck that go to the arm.  These nerves control muscle strength and feeling in the arm. NBPP is sometimes also called Erb’s palsy.  About 2 out of 3 infants who have NBPP will recover fully in the first 3 months of life.


The mildest type of NBPP injures the upper part of the brachial plexus that controls the shoulder and elbow. This is the most common form of NBPP and is called “Erb’s palsy”.  The worst type affects all of the nerves to the arm. This type affects the entire arm including the fingers.  This is called a “global” or “total” palsy.

The injured nerve can have various forms of damage. There may even be different types of damage in different nerves. However, the symptoms (weakness and lack of feeling) are the same after the nerve is injured.  The least severe injury is called a neurapraxia.  This happens when the nerve is just stretched a little.  The nerve will usually recover on its own within a few months. With more stretching, scar tissue may form in damaged areas of nerve. This is called a neuroma.  Some nerve function can still recover, but it is not complete. A nerve rupture occurs when the nerve is stretched to where it breaks apart. The nerve is not able to recover on its own. The worst type of injury, an avulsion, occurs when the nerve is torn from the spinal cord in the neck. With a rupture or avulsion, nerve surgery is recommended to improve recovery.


It is important to start therapy in the first month to move the joints of the affected arm. If the joints become stiff, casting or surgery may be required.  Therapy is the mainstay of treatment for NBPP. Many children recover enough nerve function that surgery is not needed.
The doctor may recommend operating on the nerves if they don’t recover in the first 3-6 months. Surgery can improve arm function.

Sometimes the joint stiffness in the shoulder is so bad that the shoulder joint will start coming out of place. Mild cases may be treated with Botox and casting.  Sometimes the doctor may suggest surgery to put the shoulder back in place.  This is often combined with surgery to move muscles around the shoulder. This helps stabilize the shoulder and can prevent the shoulder from coming out again.

Older children with weakness and/or limitations of motion can sometimes be helped with bone and muscle surgery to improve function. The surgeries that the doctors may offer can be very different for each individual patient and are tailored for each child.


Q. Will my child be able to participate in sports and activities?

Studies have shown that children with NBPP participate in sports and activities at the same level as children who do not have NBPP.2 While your child may have difficulty placing his or her affected arm in particular positions for certain motions, most children learn to compensate and participate in activities such as football, baseball, band, orchestra, and cheerleading. Enjoying extracurricular activities and sports is important for your child’s physical and mental health!

Q. Will the NBPP get worse as my child gets older?

NBPP does not worsen as your child gets older. You may notice as your child gets bigger, that the arm with NBPP is smaller than the other arm (Figure 1). This is because the nerve injury may affect growth. The affected arm will grow, but it will grow more slowly than the other arm. As children with NBPP get older, the imbalance between weak muscles and strong muscles may lead to loss of motion of joints. Surgery can sometimes help when this happens.