What We Treat

What is the brachial plexus?

The brachial plexus is a group of nerves that exit the spinal cord at the base of the neck. These nerves carry signals to and from your brain and spine, down your arm. They control movement and sensation for the shoulder, arm, elbow, wrist and hand—from the shoulder to the fingertips.

Brachial plexus birth palsy (BPBP) 

BPBP is an injury to an infant’s brachial plexus nerves that happens during childbirth. It results in paralysis or loss of movement of the arm, shoulder, elbow, wrist, hand or fingers.

A child with BPBP will move one arm much less than the other. It is rare for both arms to be affected. Sometimes, no one notices for two to three weeks.

BPBP occurs in is about one in every 1,000 births. The most common causes are:

  • A difficult birth
  • Maternal diabetes
  • Large size before birth
  • Mother’s history of children born with BPBP

Fortunately, many children with BPBP will naturally recover completely.

illustration showing brachial plexus injury during child birth

Brachial plexus injury

Brachial plexus injuries, not related to birth, are not common but can be more significant. Paralysis, loss of sensation and other symptoms can be permanent if left untreated. A brachial plexus injury can be caused by:

  • Sports injuries, from football, wrestling or other sports (also known as “burners or stingers”)
  • Car, motorcycle and boat accidents
  • Falls
brachial plexus nerve illustration

Common types of injury

A brachial plexus injury damages some or all of these nerves. There are five common types of injury:

Stretching injuries

These injuries result from stretching the nerves too far. For instance when the head and neck are forced away from the shoulder, the nerves might be damaged When a brachial plexus nerve is stretched, your child may feel pain down the length of the arm.

These injuries are the most common in sport-related incidents, and are often referred to as "burners" or "stingers." Symptoms can last for a few minutes or a few days. The nerves may heal on their own, depending on how far they were stretched.

brachial plexus nerve illustration showing stretching


An avulsion happens when a nerve is stretched so far that it is actually pulled apart from the spinal cord. It is the most severe nerve injury and can only be treated with surgery. An avulsion often happens from a car accident and results in a completely or partially paralyzed arm.


A rupture happens within the nerve itself. A nerve is ruptured when it is forcibly stretched far enough that the actual nerve is torn apart into more than one piece. Like avulsion, a rupture can result in a completely or partially paralyzed arm, and can only be treated with surgery, such as nerve grafting or nerve transfer.

brachial plexus nerve illustration showing rupture


A contusion is a bruise. The brachial plexus nerves can be bruised when they are squeezed or crushed. A brachial plexus contusion can cause pain and numbness down the arm.

illustration of bruised brachial plexus nerve

Penetrating injuries

Penetrating injuries can result in cuts and tears in the brachial plexus nerves. For instance, shards of glass from a car accident can cut the nerves. These injuries happen less often.

Services We Offer

Before deciding on a treatment plan your child’s brachial plexus injury, our team will evaluate your child’s condition. There’s no simple test to figure out exactly how severe the injury is or what nerves are damaged.

Your child’s evaluation may include:

  • Complete medical history. We’ll ask you questions about your child’s previous health conditions.
  • A physical examination performed by a doctor (the only method to evaluate BPBP). The doctor will be looking for:
    • How well your child’s muscles are developed
    • Whether your child uses muscles in the shoulder, arm and hand
    • Whether he or she has feeling in the arm
    • What your child can do with the uninjured arm, compared to the affected arm

Our goal is to improve your child’s arm strength and movement. Full recovery depends on early testing, education and treatment. While it is best to begin treatment right after birth or injury, we are often able to help a child at any time.

It is difficult to tell soon after a brachial plexus injury whether it will result in permanent damage. The severity of the injury will likely determine your child’s treatment and outcome. The earlier a brachial plexus injury is treated, the better the chances for full recovery.

Physical, occupational and hand therapy

Brachial Plexus Birth Palsy

Before the age of two, treatment is geared towards maintaining mobile joints. Physical therapy and home exercise programs are an important part of keeping the joints moving so they do not get stiff. During this time, we watch for progress and look for problems like painless shoulder dislocation. If examinations and tests show that the shoulder is dislocated, surgery will be needed. If the shoulder is not dislocated, but is becoming increasingly tight, surgery may be needed to loosen the joint to prevent deformities later in childhood.

By age 2, a child has likely reached the limit of his natural recovery. At this point, a blend of therapy and surgery may help.

Brachial Plexus Injuries

Early treatment for a brachial plexus injury often involves physical, occupational or hand therapy, at home and in a physical therapists clinic. At first, therapy will focus mainly on maintaining joint motion. Our team will also work with your child to build range of movement and strength. Family members are encouraged to get involved. We will educate your child and family about which exercises to do at home and how to do them.

Learn more about our physical and occupational therapy


Surgery may be needed, depending on your child’s age, the length of time since the injury, and how well your child can move and function. Our surgeons will work with you to determine if surgery is best for your child.

Learn more about brachial plexus surgery

Meet the Team

Our doctors and surgeons work closely with pediatric surgeons in the community to help ensure complete, coordinated care is delivered seamlessly at our hospitals for children with orthopaedic conditions. Our Brachial Plexus Program is led by the following by our Medical Director, Allan E. Peljovich, MD.

Children's Physician Group 


Community providers

Hand surgery