What Is Neonatal Brachial Plexus Palsy?

Neonatal brachial plexus palsy (NBPP) is a birth injury that affects the network of nerves controlling movement and sensation in a baby’s shoulder, arm, and hand. These nerves known as the brachial plexus run from the neck through the shoulder and into the arm, governing everything from lifting and gripping to feeling in the hand.

When these nerves are stretched or damaged during delivery, a baby may experience weakness or even paralysis in one arm. NBPP occurs at an incidence of approximately 1.5 cases per 1,000 live births, making it more common than many parents realize.

What Causes Brachial Plexus Injury in Newborns?

The most common cause of NBPP is shoulder dystocia when delivery of the baby’s anterior shoulder is obstructed, causing a traction force that widens the angle between the baby’s shoulder and neck and overstretches the brachial plexus.

The injury is more likely to occur in:

• Difficult or prolonged labour
• Large babies (macrosomia)
• Breech deliveries
• Cases where the baby’s shoulder becomes stuck (shoulder dystocia)
• Mothers with gestational diabetes

Types of Neonatal Brachial Plexus Palsy

• Erb’s Palsy: Affects the upper nerves (C5–C6). The arm hangs by the side, rotated inward. This is the most common type.
• Klumpke’s Palsy: Affects the lower nerve levels (C8–T1), resulting in weakness in the hand and wrist (grip problems).
• Total Brachial Plexus Palsy: Affects all nerve levels, leaving the entire arm weak or paralyzed.

Signs of Brachial Plexus Injury in a Newborn

Parents and caregivers should watch for these early warning signs:

• Weak or no movement in one arm
• Arm held in an unusual position
• Weak grip
• Absent reflexes on the affected side
• Sometimes decreased sensation in the arm or hand

How Is It Diagnosed?

Diagnosis begins with a thorough physical examination, with the doctor observing the baby’s arm movements and reflexes. Both diagnosis and assessment of spontaneous recovery are based on clinical examination. For more severe cases, MRI of the cervical spine may be recommended to evaluate for deeper nerve root injury prior to considering surgery.

Treatment Options for Neonatal Brachial Plexus Palsy

The mainstay of treatment is physical and/or occupational therapy alongside a regular home exercise programme. A select few patients may benefit from surgical intervention in the early stages. Common treatment approaches include:

• Gentle Physiotherapy: To maintain and improve range of motion.
• Neuromuscular Treatment: To stimulate nerve and muscle function.
• Range of Motion Exercises: Started as early as possible for best outcomes.
• Splints: Used in some cases to support and position the arm.
• Integrative / Multimodal Treatment: Combining therapies such as constraint-induced movement therapy (CIMT), neuromuscular electrical stimulation, and kinesiotaping for the best outcomes.

Early referral to a multidisciplinary specialist team (including a neuromuscular or occupational therapist and a paediatric doctor) optimises early management and significantly improves long-term outcomes.

When Should You Seek Medical Attention?

Seek prompt medical evaluation if your baby:

• Shows no improvement after a few weeks
• Has an arm that remains completely limp
• Displays signs of pain or abnormal positioning

If recovery is incomplete by one month of age, meaning active elbow extension and flexion remain absent, this predicts severe injury and the infant should be referred to a brachial plexus multidisciplinary healthcare team immediately.

What Is the Outlook?

Recovery rates for infants with Erb’s palsy range from 69% to 95%. However, almost 80% of children with global C5–T1 injuries have persistent deficits at 18 months. Early intervention gives babies the best possible chance of recovery and reduces the risk of long-term complications such as muscle contractures, limb length differences, and weakness.

If you suspect your baby has any signs of a brachial plexus injury, don’t wait speak to your pediatrician or a specialist as soon as possible. Early diagnosis and treatment make all the difference.