The brachial plexus is a network of nerves that conducts signals from the spine to the shoulder, arm, and hand. Brachial plexus injuries are caused by damage to those nerves.

Brachial plexus injuries can occur as a result of shoulder trauma, tumors, or inflammation. In infants, brachial plexus injuries may happen during birth if the baby’s shoulder is stretched during passage in the birth canal.

Symptoms may include:

• A limp or paralyzed arm
• Lack of muscle control in the arm, hand, or wrist
• Lack of feeling or sensation in the arm or hand

Erb-Duchenne (Erb’s) palsy refers to paralysis of the upper brachial plexus. Dejerine-Klumpke (Klumpke’s) palsy refers to paralysis of the lower brachial plexus.

There is a rare syndrome called Parsonage-Turner Syndrome, or brachial plexitis, which causes inflammation of the brachial plexus without any obvious shoulder injury. This syndrome can begin with severe shoulder or arm pain followed by weakness and numbness.

There are four types of brachial plexus injuries:

• Avulsion, the most severe type, in which the nerve is torn from the spine
• Rupture, in which the nerve is torn but not at the spinal attachment
• Neuroma, in which the nerve has torn and healed but scar tissue puts pressure on the injured nerve and prevents it from conducting signals to the muscles
• Neuropraxia or stretch, in which the nerve has been damaged but not torn

The site and type of brachial plexus injury determines the prognosis. For avulsion and rupture injuries, there is no potential for recovery unless surgical reconnection is made in a timely manner. The potential for recovery varies for neuroma and neuropraxia injuries. Most individuals with neuropraxia injuries recover spontaneously with a 90-100% return of function.

Some brachial plexus injuries may heal without treatment. Many children who are injured during birth improve or recover by 3 to 4 months of age. Treatment for brachial plexus injuries includes physical therapy and, in some cases, surgery.