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Obstetric Brachial Plexus Palsy
The brachial plexus is a network of nerves from the neck that work the muscles and sensation in the arms.
Injuries to these nerves can occur during birth when the plexus is put under tension. It is sometimes associated with the shoulder becoming stuck during delivery (shoulder dystocia).
For some, Obstetric Brachial Plexus Palsy occurs when the baby is large and/or in a breech presentation. There are different types of injuries depending on the level of pressure put on the plexus and the number of nerves involved.
Signs and symptoms
Diagnosis and treatment
Self-care
Follow Up Appointment
Signs and symptoms
Signs and symptoms of Obstetric Brachial Plexus Palsy include:
- Reduced active movement of the arm
- Decreased grip strength
- Difference of resting position of affected arm compared to other side
If you have been told that your child has an Obstetric Brachial Plexus Palsy you will be referred to physiotherapy.
Diagnosis and treatment
This condition is diagnosed by examining the baby’s arm position and movement, with consideration of the birth history.
Self-care
- If your baby’s arm is very floppy it should be well supported with the hand, elbow and shoulder in the neutral position. Often a towel under the affected arm during sleep helps to keep the arm in the neutral position.
- Move your baby’s arm gently for washing, dressing and skin care. It is helpful to dress the affected arm first and undress it last.
- When washing and drying, particular care should be taken with the skin folds.
- When handling, feeding and cuddling your baby, the affected arm should be well supported.
Follow Up Appointment
Your baby will be referred for a physiotherapy appointment to review the progress of the feet.
Range of Motion Exercises
Range of motion exercises are movements done with your baby’s arms to ensure that the joints maintain full movement.
These exercises should be performed slowly and held at the end of range for at least 10 seconds. The exercises should be done at least three times a day with each exercise being repeated three times unless otherwise directed by your physiotherapist.
There will be many more opportunities to do these stretching exercises such as during baths and times when your baby is being nursed, held or changed.
Shoulder exercises
- Gently grasp your baby’s forearm and hold their shoulder blade firmly with the palm of your hand.
- Then raise their arm slowly up over their head keeping the arm close to the ear and hold.
- This exercise resembles a high five.
- Raise your baby’s shoulder out half way and bend the elbow to 90°.
- Maintaining this position, rotate the baby’s arm back so that the arm touches the bed and hold.
- This is probably the most important exercise
- Bend both your baby’s elbows to 90° and keep elbows tucked into the side of your baby’s body.
- Turn the forearms out to the side and down towards the surface and hold.
Elbow exercises
- Hold your baby’s arm above and below the elbow.
- Keep your baby’s palm turned up.
- Gently but firmly straighten your baby’s elbow and hold.
- Then bend your baby’s elbow and hold.
- Keep your baby’s elbow bent at 90° with their upper arm against the body.
- Start with your baby’s palm turned down.
- Turn your baby’s forearm up until the palm is facing upwards and hold.
- Then turn your baby’s forearm until the palm is facing down and hold.
Wrist and finger exercises
- Hold your baby’s wrist in one hand and their hand in your other hand.
- Gently bend their wrist backwards and hold.
- Then straighten their fingers and hold.
- Hold your baby’s wrist in one hand and their hand in your other hand.
- Gently bend their wrist backwards and hold.
- Then straighten their thumb and hold.
If you have any concerns or queries about any information above, please contact St David’s Children’s Centre on 02920 536805.
