Frequently Asked Questions

Neonatal / Pediatric Brachial Plexus FAQs

What does NBPP stand for?

NBPP stands for Neonatal Brachial Plexus Palsy. Other names for NBPP include (but are not limited to) Erb’s Palsy, Obstetric Brachial Plexus Palsy, Birth Brachial Plexus Palsy, and Perinatal Brachial Plexus Palsy. Most practitioners in the US prefer to use “NBPP” to represent this condition.

What is the brachial plexus?  

The brachial plexus is the network of nerves that extend from the spinal cord in the neck through the arm to the fingers - that supplies all the information for the arm to move and feel.

What is a nerve?

Nerves carry information to and from the brain. Motor nerves carry messages from the brain to muscles to make the body move. Sensory nerves carry messages to the brain from different parts of the body to signal pain, pressure, and temperature.

What happens when a nerve is broken?

When nerves are broken, information carried by the nerves is disrupted, so motor and sensory functions are decreased or absent.

How can a broken nerve be fixed

Depending on the type of nerve injury, a nerve can be reconstructed directly by sewing the 2 broken ends together, indirectly through a nerve graft, or transferred from a working nerve to the broken nerve.  However, unlike splicing a wire where electricity flows immediately, the broken nerve must regrow the distance from the injury to the target muscle before function is regained.

How often does brachial plexus palsy occur?

The incidence of brachial plexus palsy is about 0.5- 4 for every 1,000 babies born.

How fast does a nerve heal?

Nerves regenerate at an approximate rate of 1 millimeter per day or 1 inch per month.

When will we see results? 

Recovery is slow as nerves only regenerate at 1 millimeter per day or 1 inch per month; therefore, 1-3 years may pass before results are seen.

Does my child need surgery?

Surgery may or may not be recommended for your child. Depending on your child’s spontaneous recovery and functional needs, we present the risks of surgery versus the expected benefits – then you must weigh the potential risks and benefits and decide if you would like your child to undergo surgery.

Why are rehabilitation and therapy so important if my child has surgery?

Ongoing therapy under the direction of a rehabilitation physician keeps the bones/joints and muscles healthy. If the joints do not remain flexible and the muscles lose tone, surgery for nerve reconstruction will not yield good results – and your child may not recover optimal function of his/her arm.

If NBPP is a problem with the nerves, then why does my child need orthopedic surgery or hand surgery (why are the bones / muscles affected)? 

Orthopedic and hand surgery are performed if the bones/joints and muscles do not work together well to move the arm.

Will my child be disabled?   

Disability is any “physical or mental condition that limits a person's movements, senses, or activities.” Depending on the extent of recovery of your child’s NBPP (spontaneously or with surgical intervention), your child may or may not have a disability.

Will my child's arm look funny?

The appearance of your child’s arm will depend upon the extent and severity of your child’s brachial plexus palsy. Variations in appearance include (but are not limited to) arm and hand size and shape and the position of the arm when used.

Does NBPP affect the brain?

NBPP does not formally affect the brain, as it is a condition that affects the nerves to the arms. Children with NBPP can also have other conditions such as torticollis and palsy of the diaphragm that result from injury to the nerves adjacent to the brachial plexus, not the brain.

Why do parents have to do anything? (Can’t the doctors fix NBPP?) 

Parental involvement in the care of these children is paramount to optimal recovery, because doctors cannot “fix” NBPP. Physicians can recommend medical management, supervise therapy, or perform surgery, but they see and evaluate the NBPP patients only periodically - only parents can be with their children most of the time to insure that the optimal functional outcome is achieved.

When should my child be seen in clinic?

The initial evaluation should occur ideally within the first week of birth and beginning therapy immediately if there is no clavicle or humerus fracture.  When evaluation is delayed beyond 6-9 months, treatment options for nerve grafting become limited.

What career limitations will my child have?

Because NBPP affects only the nerves to the arm but not the brain, many of our young adults do not believe they have any limitations and have gone on to successful careers.

What percentage of children with NBPP undergo surgery?

Less than 10% of children with NBPP undergo nerve reconstruction surgery.

How did my child get NBPP?

NBPP results from stretching or compression of the nerves of the brachial plexus during development in the uterus or during the descent and emergence of the fetus from the uterus and pelvis with maternal pushing and naturally expulsive forces. Biomechanically, nerve injury can result from exogenous forces (clinician-applied) or endogenous forces (natural physical events move the fetus from the uterus through the birth canal and out of the maternal pelvis). No high-quality consistent data exist to demonstrate that either isolated exogenous or endogenous forces cause NBPP, but the available data do suggest that the occurrence of NBPP may be a multifactorial event.

Is NBPP a lifelong condition or a temporary ailment?

The chronicity of NBPP depends upon the extent and severity of the brachial plexus palsy.   Therefore, if the NBPP is not extensive or severe, the condition can resolve within a few weeks, but if the NBPP is extensive and severe, then the condition can be life-long.

Are there any other associated medical conditions?  

Conditions, such as but not limited to, torticollis (tightness of muscles on one side of the head or neck) and Horner’s syndrome (droopy eye) are sometimes seen in conjunction with brachial plexus palsy.

What Tests Will be Performed for Diagnosis and Planning for Patients with Brachial Plexus Palsy?

The most important test is a careful physical examination.  This information, compared with prior or future examinations, is the most important piece of information. Magnetic resonance imaging (MRI) studies of the neck area can be performed but should be reserved and done in conjunction with an ultrasound (US) for preoperative planning if specific questions exist prior to undertaking possible nerve surgery. Similarly, electromyography (EMG) can be performed in our clinic and not recommended prior to one month of age.

What can be done to improve the healing process?

The majority of brachial plexus palsy cases heal spontaneously.  Early referral to therapy at onset is recommended if there is no humerus or clavicle fracture.  Occupational or Physical Therapy is beneficial to prevent tightness from developing and promote range of motion.

Will I be able to see a therapist near our home?

Yes, except for specialty services, follow-up occupational or physical therapy care can be done in your own community.  Our coordinators are available to help find the proper therapist in your area.  We remain available to help with treatment if desired.

What should I do if I have an attorney or case worker?

Attorneys and Case Managers should contact our clinic directly for further information.

Are there any local or national support groups?  

Support groups for NBPP do exist nationally and locally. We offer a monthly support group for our patients and their families, and we are developing an on-line internet brachial plexus social network for our patients and families.

Adult Brachial Plexus FAQ

How long should I wait before being evaluated for my nerve injury? 

Nerve injuries should be evaluated as soon as possible. Our multi-disciplinary team works together to come up with the best treatment plan for you in one clinic visit, like “one-stop shopping”.  Ideally, if surgery is required, it should be completed within one year of the date of injury. 

What does this burning/crushing pain in my arm mean and will it go away?

Our multi-disciplinary team approach includes pain management and our anesthesia/pain specialist will help you address the pain which often accompanies nerve injuries.

What is a nerve and how do they work?

Nerves carry information to and from the brain.  Motor nerves carry messages from the brain to muscles to make the body move. Sensory nerves carry messages to the brain from different parts of the body to signal pain, pressure, and temperature. 

What happens when a nerve is injured?

When nerves are injured, information carried by the nerves is disrupted, so motor and sensory functions are decreased or absent to the muscle that it powers.

How fast does a nerve heal?

Nerves regenerate at an approximate rate of one millimeter per day or one inch per month.

Can a nerve injury be repaired?

Depending on the type of nerve injury, a nerve can be reconstructed directly by sewing the 2 broken ends together, indirectly through a nerve graft, or transferred from a working nerve to the broken nerve.  However, unlike splicing a wire where electricity flows immediately, the broken nerve must regrow the distance from the injury to the target muscle before function is regained.

When will I see results?

Recovery is slow as nerves only regenerate at one millimeter per day or one inch per month; therefore, 1-3 years may pass before results are seen.

What can be done to improve the healing process?

Early referral to therapy at onset is recommended if there are no fractures of the bones to interfere with therapy. Occupational or Physical Therapy is beneficial to prevent tightness from developing in the muscles and joints and promote range of motion. 

How soon can I return to work after brachial plexus palsy?

Nerves regenerate at an approximate rate of one millimeter per day or one inch per month, therefore recovery is slow.  Depending on the type of job you perform will determine how soon you will be able to return to work.

Other Peripheral Nerve Conditions FAQ

What are Peripheral Nerves?

The peripheral nerves (PN) or the peripheral nervous system is made up of nerves that extend from the brain and spinal cord that help the arms and legs move. Most PN injuries occur in the arms or the legs.

What are examples of PN injuries?

Examples of PN injuries of the arm(s) include: Median neuropathy at the wrist also known as carpal tunnel syndrome, ulnar neuropathy (radiating numbness from elbow to ring and pinky finger), or radial neuropathy (wrist drop).

Examples of PN injuries of the leg(s) include: Peroneal neuropathy (foot drop), tibial neuropathy (pain and weakness in the ankle, foot or toes), sciatic neuropathy (radiating pain from the buttock down the leg) and peripheral nerve sheath tumors (tumors that grow on the nerves in the arms or legs). Click here for more information on peripheral nerve conditions.

What are treatment options for PN injuries?

Conservative management is always the primary recommendation prior to considering surgical intervention. Conservative treatment can include, but is not limited to physical/occupational therapy, massage and/or splinting/bracing.

What are treatment options for peripheral nerve sheath tumors?

Depending on the type of nerve sheath tumor will depend on treatment options. Tumors that are benign and not causing loss of function are followed conservatively. Other tumors that are causing loss of function and suspicious for malignancy may require surgery to resect the tumor.

How long should you wait before being evaluated for suspected nerve injury or a peripheral nerve sheath tumor?

The best approach is early referral, or as soon after injury or onset of symptoms. Regardless of the cause of the condition, early specialized evaluation by our multidisciplinary team is useful to determine an appropriate diagnostic and treatment plan.

What types of testing will be done?

Our clinic is designed as ‘one stop shopping’ and if necessary, our doctors are able to perform an EMG (electromyography) during your clinic visit. Other testing can include MRI or Ultrasound.

Will you need surgery?

Depending on the timing of injury (onset until diagnosis) and appropriate results from testing, (i.e. ultrasound, electromyography (emg), or other imaging studies), our multidisciplinary team will work with you to determine if and when surgery is appropriate.

Will your PN injury recover?

Recovery is slow as nerves only regenerate at one millimeter per day or one inch per month; therefore, 1-3 years may pass before results are seen. Each individual is unique in their severity and recovery. The extent of injury will determine the amount of recovery.

How soon can you return to work after a peripheral nerve injury?

The necessary functional movements required by your occupation and the extent /severity of the symptoms of your injury will determine if/when you will be able to return to work. Work retraining may be needed.

What if you cannot return to your former vocation/job?

We highly encourage our patients to contact Michigan Vocational Rehabilitation Services. Our team can facilitate a referral if necessary.

What if you have an attorney or case worker?

Attorneys and Case Workers/Managers should contact our clinic directly for further information.