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.

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.

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.

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

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.

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

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

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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

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.

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. 

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

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. 

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.

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

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.

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.

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. 

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.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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

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