Brachial Plexus Clinic

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At the Brachial Plexus Clinic of Children’s Hospital Los Angeles, our team of surgeons, nurses and occupational therapists offer medical evaluation and treatment for children with perinatal brachial plexus injuries (PBPI). We help kids regain function and reach their full potential.

At CHLA, your child benefits from working with our orthopaedic surgeons, neurosurgeons, occupational therapists, orthopaedic nurses and orthotists. The Brachial Plexus Clinic at CHLA specializes in providing complete care and unique treatment plans for children from infancy to school-age. 

CHLA-Brachial-Plexus-Clinic-PBPI-01.jpgPerinatal Brachial Plexus Injury

The brachial plexus is a network of nerves that connect the muscles of the arm, including the shoulder, elbow and hand, to the spinal cord. Injury to the brachial plexus interrupts the signals that flow from the brain to the arm and often results in the reduction or loss of function or sensation in the arm. When an injury to the brachial plexus occurs just before, during or after childbirth, the resulting injury is called a perinatal brachial plexus injury (PBPI). These injuries are fairly common and affect approximately one child out of every 1,000 live births.

Infants with PBPI are often unable to move their affected shoulder, elbow or hand muscles in the same way as they can their unaffected side. This may result in a temporary or lifelong difference between the arms and hands in activities and appearance. The Brachial Plexus Clinic at CHLA provides a clinical evaluation to assess muscle function and sensation in the affected area. This often requires X-rays or other imaging studies such as MRI for clear diagnosis.

Most children recover spontaneously and are minimally hindered by their injury. Even children who have moderate or severe injuries are capable of leading full and productive lives, and participating in school activities, sports, music and art.

Brachial Plexus Treatment

Early therapy is important for the recovery of muscle use and control. Our Occupational Therapy team works with infants and their families to create a personalized program including rangeof-motion (ROM) exercises, strength training and adjunctive nerve recovery modalities to improve function of the shoulder, arm and hand. Botox therapy, casting, orthotic bracing or surgical treatment—including nerve repair, graft or transfer, tendon or muscle transfer, or bone correction—may be recommended, based on the child’s specific needs.

Most PBPI cases (approximately 75 to 85 percent) do not require surgery, but more severe injuries may benefit from early surgical intervention to restore muscle function, range of motion and strength. Generally, children recover from surgery within six to 12 months with the help of occupational therapy.

Brachial Plexus Support

The Brachial Plexus Clinic at CHLA places great value on the psychosocial support of families and children with perinatal brachial plexus injuries. The "CATCH" Hand Differences Program is a supportive community and resource for children with all hand and arm differences being treated at CHLA. Learn more at CHLA.org/catch-hand-differences-program.