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Brachial plexus lesion

June - July 2011

At birth, it was noticed that my child could not move or could hardly move one arm. The doctors told me that my child has a brachial plexus lesion. I would like to know more about this condition.

What are the different types of injuries, or lesions?

Paralysis of the upper roots of the brachial plexus

It is also known as Erb Palsy.

The shoulder is unable to move, the arm remains straight, the wrist, often bent, has little or no movement, yet the fingers can move normally. The C5, C6 and sometimes C7 nerve roots are affected. This is the most common form of brachial plexus injury.

Paralysis of the lower roots of the brachial plexus

It is also known as Klumpke Palsy.

The shoulder can move properly, but the wrist and fingers have little or no movement. The C8 and T1 nerve roots are affected. Sometimes, the C7 nerve root can also be affected. In this case, the elbow has trouble extending.

Complete paralysis

All parts of the upper limb have little or no movement. All of the nerve roots are affected, which are C5, C6, C7, C8, and T1.

When a brachial plexus injury, or lesion, occurs at birth, it is not possible to predict whether or not the upper limb will regain the ability to move. In other words, a severe injury may very well improve without any long-term residual problems. In fact, 75 to 90% of children who have suffered a brachial plexus injury at birth recover on their own after several weeks or months.

How is the severity of the injury, or lesion, determined?

A number of factors determine the severity of the injury, or lesion:

  • Number of nerve roots affected
    For example, if 4 nerve roots are affected, it is likely that several muscles will not function properly than if only 2 nerve roots are affected.
  • Type of injury, or lesion
    From the least severe to the most severe:
    • A stretched or crushed nerve root: This type of injury generally improves rapidly, usually before the age of 3 months.
    • A torn or fully or partially ruptured nerve root: In this case, the nerve root must slowly grow back until it reaches the muscles.
    • A fully torn nerve root from the spinal cord: In this case, there is little to no possibility of restoring movement to the upper limb.

Determining the severity of the injury, or lesion, is usually done through a series of tests conducted by therapists and medical specialists, and particular tests may be requested by the specialist following a medical assessment.

Who can help my child?

In Montreal, there is an ultraspecialized clinic for brachial plexus injuries. It is led by an interdisciplinary team composed of different medical specialists:

  • Physiatrist (Dr. Julie Dubé)
  • Plastic surgeon (Dr. Patricia Egerszegi)
  • Orthopedists (Dr. Chantal Janelle, Dr. Constantin Stanciu)
  • And health care professionals in the following fields:
    • Physiotherapy
    • Occupational therapy
    • Social work
    • Psychology
    • Special education

Because this condition consists of damage to the nerves, it is critical that you see a specialist as soon as possible as certain treatments must be done in early childhood to help your child regain movement in their upper limb. A referral to the brachial plexus clinic can be obtained from a doctor or other health care professional who is familiar with your child.

About this page
Updated on 3/20/2015
Created on 1/16/2015
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