Brachial Plexus Birth Injuries

What is a brachial plexus birth injury?

A brachial plexus birth injury is damage to the network of nerves that controls the arm and hand, sustained when that network is stretched, compressed, or torn during delivery. The brachial plexus is the bundle of nerves running from the spinal cord in the neck into the arm; when a baby’s neck and shoulder are forced apart during a difficult birth, those nerves can be overstretched or torn, leaving the arm weak or paralyzed. This is the umbrella term for a family of injuries that includes Erb’s palsy (upper roots) and Klumpke’s palsy (lower roots). Estimates put the incidence at roughly 1 to 2 per 1,000 live births.

How much function a baby loses, and whether it returns, depends on two things: which nerve roots are involved, and how badly each is damaged. The rest of this page walks through both, because together they determine prognosis and, when negligence is in question, the severity of the harm.

Brachial plexus anatomy

The brachial plexus is formed by five nerve roots leaving the spinal cord: C5, C6, C7, C8, and T1 (the fifth through eighth cervical nerves and the first thoracic nerve). They merge and divide into the nerves that power the entire arm. In broad terms, the upper roots (C5–C6) drive the shoulder and upper arm, C7 contributes to the wrist and triceps, and the lower roots (C8–T1) run the hand. Which roots are injured is what determines whether a baby has Erb’s palsy, Klumpke’s palsy, or a total (global) palsy.

Types of nerve injury: neurapraxia to avulsion

Just as important as which nerves are hurt is how badly. Nerve injuries are graded on a spectrum from a temporary bruise to a complete tear from the spinal cord, and the grade largely predicts whether recovery is possible without surgery.

A single baby can have different injury types at different roots (one root merely stretched, another ruptured), which is why specialist evaluation and, sometimes, imaging or electrodiagnostic testing guide the plan.

Injury patterns: Erb’s, Klumpke’s, and global

• Erb’s palsy (upper, C5–C6): the most common pattern; shoulder and upper-arm weakness with the classic “waiter’s tip” posture; grip usually spared.
• Klumpke’s palsy (lower, C8–T1): rarer; hand and forearm paralysis with a “claw hand,” sometimes Horner’s syndrome.
• Global (total) palsy (C5–T1): the whole arm is paralyzed; the most severe pattern, usually requiring surgery, and the one most likely to leave lasting disability.

Causes and risk factors

Most brachial plexus birth injuries are traction injuries: the nerves are stretched when the head and shoulder are pulled apart during a tight delivery. Recognized risk factors include:

• Shoulder dystocia, the leading association.
• Macrosomia (large birth weight), often linked to maternal gestational diabetes.
• Instrument-assisted delivery (forceps or vacuum).
• Breech presentation and other malpositions.
• Prolonged or difficult second stage of labor.

A minority of injuries arise from forces in utero or from maternal anatomy and can occur without excessive traction, a fact that matters both medically and in evaluating any claim.

Diagnosis

Diagnosis starts with the newborn exam: which arm movements are absent, whether grip is preserved, whether Horner’s syndrome is present. Serial examinations over the first months track recovery. Where surgery is contemplated, imaging (MRI) and electrodiagnostic studies (EMG/nerve conduction) help distinguish a repairable rupture from an avulsion. An accompanying clavicle fracture is common and should prompt a careful nerve exam.

Treatment

The approach is shared across the injury patterns: early physical and occupational therapy to preserve joint mobility and prevent contractures, followed by evaluation for nerve reconstruction (graft or transfer) when spontaneous recovery has not appeared by around three to six months, ideally operating within the first year. Later tendon and bone procedures can improve function for children who present late or have residual deficits. Our treatment and exercises page details the therapy program and surgical timing.

Was it preventable?

Not every brachial plexus birth injury is malpractice. Some occur despite a skillfully managed delivery, and a subset arise from forces no clinician controls. But because the dominant cause is excessive traction during shoulder dystocia, these injuries frequently trace to how an obstetric emergency was handled. The standard of care asks whether risk factors were recognized, whether a shoulder dystocia was managed with the recognized HELPERR maneuvers rather than brute force, and whether the resulting injury was documented and referred promptly. When avoidable traction caused a rupture or avulsion, the injury was likely preventable.

Legal options for families

A brachial plexus claim asks whether the delivery fell below the standard of care and whether that failure caused the nerve injury. These cases turn on the delivery records, the documented maneuvers, and expert review of how force was applied. Compensation can fund therapy, reconstructive surgery, adaptive needs, and lost future earning capacity, the elements a life-care plan projects and that published brachial plexus settlements reflect, though prior results never guarantee an outcome. Filing deadlines vary by state; see our statute of limitations guide.

Where your case is handled depends on where the birth occurred: Banville Law attorneys are licensed in New York and Washington, D.C.; The Weitz Firm attorneys are licensed in Pennsylvania and New Jersey; elsewhere, the alliance connects families with its vetted network of local birth injury attorneys.

Frequently asked questions

What is the difference between a brachial plexus injury and Erb’s palsy?

The brachial plexus is the whole nerve network to the arm. Erb’s palsy is one specific injury pattern within it: damage to the upper roots (C5–C6). Klumpke’s palsy (lower roots) and global palsy (all roots) are the other patterns.

Will my baby’s brachial plexus injury heal?

It depends on the injury type. A stretched nerve (neurapraxia) usually recovers fully; a ruptured or avulsed nerve will not heal on its own and may need surgery. Which roots are involved also matters; upper-root injuries recover better than global ones.

How common are brachial plexus birth injuries?

Roughly 1 to 2 per 1,000 live births, making them among the more common birth injuries. Most are associated with a difficult delivery, particularly shoulder dystocia.

What is a global brachial plexus palsy?

It is injury to all five nerve roots (C5–T1), paralyzing the entire arm. It is the most severe pattern, usually requires surgery, and is the most likely to leave lasting disability.

Sources

This page is for general education and is not medical advice. Medical facts above are drawn from the cited primary sources; legal statements reflect the reviewing attorneys’ professional experience. Always consult your child’s physician about medical concerns.