Brachial Plexus


A doctor treating a baby on a table

Welcoming a newborn to your life is both an exciting and sometimes stressful time. Learning that your baby has an injury can add to your stress. The team at Shriners Hospitals for Children – Northern California is here as a resource. In over half of cases, Brachial Plexus will heal itself within the first month to six weeks. Nerve surgery may be recommended if marked weakness persists after three to six months. Some children benefit from muscle, tendon, bone and joint surgery between years age 2-5 years. BPBP is a serious but treatable condition.

Make an appointment

If your baby or child has been diagnosed with brachial plexus birth palsy (BPBP),  please call our referral department at (916) 453-2191or send an email to A referral coordinator will partner with you to gather the necessary information to allow our physician leadership to evaluate whether your child can benefit from care at Shriners Hospital.

Diagram of a baby with Brachial Plexus

BPBS Chart

What is Brachial Plexus?

The brachial plexus is a group of nerves in the neck that branch from the spinal cord to the shoulders, arms and hands.

What are nerves?

Nerves are fibers that send and receive messages from the brain and spinal cord to other parts of the body to control movement and feeling.

The brachial plexus nerves control the movement and feeling in the shoulders, arms and hands.

What nerves make up the Brachial Plexus?

There are 5 nerves, named for where they exit the spinal cord (C5, C6, C7, C8 and T1)

Children with injuries to the upper nerves of the brachial plexus may be able to move their fingers but not their shoulder.

Children with injuries to both the upper and lower nerves of the brachial plexus may be unable to move the entire arm (paralysis).

What is Brachial Plexus birth palsy??

Brachial plexus birth palsy (BPBP) is a nerve injury that happens when a baby is being born. The baby’s shoulders have trouble passing through the birth canal. During delivery, the nerves in the neck can stretch, rupture or even completely tear off from the spinal cord.The injured nerves can affect the feeling, movement and growth of the arm and shoulder.

What causes Brachial Plexus birth palsy?

About 1-4 babies for every 1000 births will have BPBP.
It is commonly related to:

  • Maternal diabetes
  • A large baby and/or a baby with shoulders that are too large for the birth canal (shoulder dystocia)
  • Prolonged labor

What are the types of nerve injuries?

  • Avulsion – a stretch injury in which the nerve is torn from the spinal cord. These injuries do not heal on their own and cannot be repaired. Some function can be restored with surgery.
  • Rupture – a stretch injury in which a nerve is torn apart. These injuries do not heal on their own but can be repaired with surgery.
  • Neuroma – a stretch injury in which damage nerves form scar tissue that presses on other healthy nerves. These nerves can partially heal on their own, usually in 4 to 6 months.
  • Praxis – a stretch injury that does not tear the nerve, these injuries heal on their own in 6 to 8 weeks.

Nerve injuries in growing children can cause problems, especially early in life. Your physician and occupational therapists will work together to evaluate the severity of your child’s injury and to develop a treatment plan.

Medical Team

Michelle James, M.D.
Pediatric Hand Surgeon
Chief of Orthopaedic Surgery

Claire Manske, M.D.
Pediatric Orthopaedic Hand Surgeon

Nanette C. Joyce, D.O., M.A.S.
Physical Medicine and Rehabilitation

Katie Cantrill
Occupational Therapist

Pauline Ng
Occupational Therapist

Carly Reynolds
Occupational Therapist


Motion Analysis Center

Young Girl in the Motion Analysis Lab

The high-tech movement analysis conducted in this laboratory is integral to the complex, comprehensive care provided by Shriners Hospitals for Children – Northern California.


Brachial Plexus Birth Injury

Medical and Therapeutic Management

Medical and Therapeutic Management of Brachial Plexus Birth Injury –Assessment and Treatment of Joints throughout the Upper Extremities is a continuing education course for physical and occupational therapists, nurses and mid-level providers who assess and treat children with Brachial Plexus Birth Injury (BPBI).

A woman and child holding their hands up to compare