Difficult Delivery Can Result In Nerve Damage

Question: Our daughter is two months old. I had a healthy pregnancy, and everything was perfect until the delivery. After her head came out, her shoulder was stuck. It took my doctor a little while before she was finally delivered. Shortly afterwards, we were told that she was not able to move her left arm as a result of the difficult delivery. In the first few days, she started moving her fingers, but we haven’t seen much improvement since then. She is otherwise a healthy girl. Our doctor told us that if she doesn’t improve more in the near future, she may require surgery. We are quite concerned about her arm, and even more worried about putting her through surgery at such young age. Please give us some suggestion as to what we should do.

Answer:

All the muscles in our body are controlled by nerve fibers that originate from the brain.  These nerve fibers leave the spinal cord in between the vertebrae (these are the bones that form our spine) as spinal nerves.  For the muscles that move our shoulders and our arms, they originate from the spinal nerves in the lower part of the neck.  These spinal nerves then rearrange themselves and form a web of nerves, which is called the brachial plexus, and finally branch out into individual nerves supplying different muscles that control the movements of the shoulders, the elbows, the wrists, and the hands.

Because of the strategic location of this web of nerves in the neck, they are very prone to injury at birth.  It has been estimated that about one in every 1000 births in North America will result in injury to the brachial plexus.  Fortunately 9 out of 10 children with this injury only suffer minor stretching and injury of the nerve fibers.  Although there may be little or no movement of the affected arm after birth, gradual recovery is evident within days, and full recovery can occur in the first few months of life.

However, a small percentage of these children are not as fortunate, and the spinal nerves can be completely torn instead of simply being stretched.  Although some recovery can still occur, it is often incomplete, and these children may not be able to use the affected arm for everyday functions.

With the advancement of microsurgery since 1980s, surgical repair of damaged nerves like the brachial plexus is possible, although only a few specialized centres across the country can perform this procedure.  There is, however, a critical period of time where a baby needs to be assessed to see whether surgery can be beneficial.  The time for assessment is usually at 3 months of age.  For most babies with brachial plexus palsy who don’t require surgery because their injury is milder, they would have regained most of the function in the affected arm by that time.

However, for those children with more severe injury, their recovery would be much slower and incomplete.  The surgeon would assess the child’s ability to move individual groups of muscles in order to determine the severity of nerve injury.  Nerves that are torn are unlikely to make full recovery by themselves.  Sometimes diagnostic imaging like MRI is necessary to help make that decision and to plan the surgery.

Nerves that are torn can be reconnected with pieces of nerves from another part of the body.  This is called nerve grafting.  After the surgery, a child’s recovery can take several months before one can determine how much function is gained from the surgery.  It is comforting to know that most children have benefited from this kind of surgery, although the recovery may not be complete.

From the description that you gave here, it is quite possible that your daughter had a significant brachial plexus injury because of the difficult delivery.  The next few weeks will be important to watch and see how much she can recover by herself.  If there is not much progress, you should see a surgeon who is specialized in this kind of surgery to find out whether your daughter might need it to help with her recovery.