Q. What is ‘Obstetric Brachial Plexus Palsy’?

A. The ‘brachial plexus’ is a bunch of nerves starting from the neck and going towards the arm, one on the right and one on the left side. These nerves carry the signals for sensation and movement between the spine and the arm.

‘Palsy’ means weakness or paralysis.

Obstetric Brachial Plexus Palsy or OBPP is the condition when, around the time of child birth, these nerves are injured, resulting in weakness of the arm.

Q. What causes OBPP?

A. OBPP occurs when the nerves of the brachial plexus get stretched and/or torn around the time of birth. Causes include:

  • Long, difficult labour
  • Big baby
  • Breech delivery i.e. when the baby is delivered legs first instead of head first
  • Complicated delivery – where some maneuver like forceps/vacuum assistance needs to be used in an emergency, to save the life of the mother/baby

Q. How common is OBPP?

A. Around 1 to 2 out of every 1000 babies born have OBPP.

Q. Is OBPP painful for my child?

A. No, children with OBPP do not have any pain due to it.

Q. What are the signs of OBPP?

A. Typically, a baby with OBPP will have decreased movements of one upper limb as compared to the other.

There are varying severities of OBPP depending on which of the nerves in the brachial plexus have been affected and how severe the injury to the nerves is.

Q. How is OBPP treated?

A. Treatment starts with diagnosing and documenting your child’s weak muscles. In most cases of OBPP, the nerves heal on their own, and the arm regains function. Until the time that the arm is weak, it is important to do certain exercises to keep the joints in the arm supple and lose. Without this, the arm becomes stiff, and even if the nerves recover later on, the arm may not function fully. Sometimes, if the joints are becoming very stiff, they may need treatment with injections of ‘Botox’, to help them relax.

Your doctor will reassess your baby at regular intervals and monitor the speed of recovery.  This natural recovery of the nerves can take up to two years to be completed. Most children with OBPP will have some residual weakness in their arm, even after complete recovery of the nerves.

Q. Will my child need surgery?

A. Children with OBPP may require broadly two types of surgeries:

  1. Surgery on the nerves: If the natural recovery of the nerves is less than expected, your doctor may recommend surgery to repair and reconnect the torn nerves.
  2. Surgery on the muscles: Older children in whom the nerves have fully recovered but still have some residual weakness may benefit from surgery to release stiff joints, or to redirect strong muscles to help weaker ones.

Q. Will my child be able to participate in sports and activities?

A. Children with OBPP usually are able to participate in all sports and activities at the same level as children who do not have OBPP. Your child may have some residual weakness and may not be able to place the arm in certain positions. However, children are very adaptable, and they learn to compensate and perform activities in different ways.

Q. Will the OBPP get worse as my child grows older?

A. No, the weakness in the nerves does not get worse as the child grows. However, the nerve injury does affect the growth itself, and you may find that your child’s arm is slightly smaller/shorter as compared to the normal arm. Also, as the child grows, the imbalance between strong and weak muscles may worsen, and lead to loss of movement at a joint, most commonly at the shoulder.

Exercises for OBPP (during the first few months of life):

  1. Shoulder rotation: Bowling movement – Straight as well as reverse
  2. Shoulder rotation: Keep the arm by the side of the body and rotate the hand outwards, as far as it can go
  3. Elbow: Bending the elbow fully
  4. Forearm rotation: Hold your baby’s arm, one of your hands at the elbow, one at the wrist. Keeping the elbow stationary, rotate the forearm such that your  baby’s palm faces upwards fully
  5. Wrist movement: Bending the wrist fully in both directions
  6. Finger movements: Opening the hand by making all the fingers straight.

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