Brachial Plexus Injury in Children: Symptoms, Types, and Clinical Insights
Understanding Brachial Plexus Injuries in Pediatric Patients
In infants and young children, brachial plexus injuries can occur during birth or as a result of trauma. These injuries affect the network of nerves responsible for controlling movement and sensation in the arm. Depending on the severity and location of the damage, symptoms can vary significantly. Medical professionals typically classify these injuries into three main types: upper trunk (upper plexus), lower trunk (lower plexus), and total plexus involvement. Each type presents with distinct clinical features that guide diagnosis and treatment planning.
Upper Trunk Brachial Plexus Injury – Most Common Form
The upper brachial plexus injury is the most frequently observed type in pediatric cases, often resulting from shoulder dystocia during delivery. In this condition, the C5 and C6 nerve roots are primarily affected. Children with upper plexus damage typically experience weakness or paralysis in the shoulder and upper arm. They may struggle to lift their arm sideways or bring it forward, but crucially, they retain functional use of the hand and fingers. This means that fine motor skills such as grasping toys or holding objects remain largely intact, which is a key diagnostic clue.
Total Brachial Plexus Injury – More Severe and Widespread
A complete or total brachial plexus injury involves damage to both the upper and lower nerve roots (C5–T1). This form is less common than upper trunk injury but results in more extensive impairment. In these cases, the entire arm—shoulder, elbow, wrist, and hand—is paralyzed. The child cannot raise the arm at all, and there is also a loss of grip strength and limited ability to flex or extend the fingers. Sensation may also be diminished throughout the limb, increasing the risk of unnoticed injuries.
Lower Trunk Involvement – Rare but Clinically Significant
In contrast, lower brachial plexus injuries (affecting C8–T1) are relatively rare in newborns. When they do occur, they are more likely associated with tumors, birth trauma involving arm traction, or other pathological conditions. The hallmark of lower plexus damage is impaired hand function, including weak grip and reduced finger movement, while shoulder and elbow motion may remain normal. This pattern can sometimes be mistaken for other neuromuscular disorders, making accurate assessment essential.
Tailoring Treatment Based on Injury Type and Severity
Accurate diagnosis is critical for effective management. Physicians evaluate muscle function, reflexes, and sensory responses to determine the extent and location of nerve damage. Imaging studies like MRI or ultrasound, along with electromyography (EMG), help confirm the diagnosis. Early intervention—including physical therapy, occupational therapy, and, in some cases, surgical repair—can significantly improve long-term outcomes. The recovery potential varies by injury type, with upper plexus injuries generally having a better prognosis than total or lower plexus involvement.
Why Early Detection Matters
Parents and caregivers should be vigilant for signs such as lack of spontaneous arm movement, asymmetrical limb use, or persistent favoring of one arm. Seeking prompt medical evaluation within the first few weeks of life can make a profound difference in recovery. With timely care, many children regain substantial function, especially when treatment begins early. Ongoing monitoring and multidisciplinary support ensure the best possible developmental trajectory for affected children.