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Brachial Plexus and Peripheral Nerve Injuries


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The brachial plexus is the network of nerves that comes from the spinal cord in the neck. These nerves provide signals from the brain and spinal cord to provide movement to the shoulders, arms and hands. An injury to the brachial plexus can impact the sensation, movement and strength of you or your child’s arm.

Injury to the brachial plexus can be caused by force on the nerves either during the birthing process or through any other traumatic event.

The most frequently and common brachial plexus injuries are birth, or obstetrical, brachial plexus injuries. These are found in early childhood and are likely to occur during a difficult delivery. Specifically, the injury occurs during the birthing process when a baby’s shoulder is pressed down forcefully while the head is pushed up and away stretching or tearing the brachial plexus nerve fibers.

Brachial plexus injuries later in life occur most often due to an intense trauma such as a fall or a motorcycle, ATV, motorbike, or car accident.

Fortunately, most peripheral nerve injuries will resolve on their own. Physical or occupational therapy and time can also greatly help the damaged nerves to likely heal themselves. However, if by 2-3 months from the time of injury there is insufficient recovery of function, then surgery may need to be considered. Contact the WVU Medicine Children’s Brachial Plexus and Peripheral Nerve Clinic.

Types of Resulting Palsies

  • Upper Trunk Injury (also known as Erb’s Palsy) is the most common type of brachial plexus injury. This injury occurs to the upper set of nerves of the brachial plexus, usually effecting the movement and strength of the shoulder and upper arm.
  • Lower Trunk Injury (also known as Klumpe’s Palsy) is an injury that is very not common but can be seen with trauma injuries involving the lower set of nerves of the brachial plexus. These types of injuries usually effect the movement and strength of the lower arm and hand.
  • Total or complete palsy occurs when both upper and lower sets of nerves of the brachial plexus are injured. This injury may largely affect movement and strength of the child’s entire upper extremity including the shoulder, arm and hand.

Types of Nerve Injuries

Some of the words you may hear during your visit:

  • A “neuropraxia” is a stretch to a nerve, like a concussion to the nerve, it usually resolves on its own with time.
  • A “neuroma” results from a stretch nerve injury that has tried to heal itself resulting in a large amount of nerve scar tissue building up and does not allow for complete return of function. This type of injury may require surgery to improve long term outcomes.
  • When the nerve is stretched beyond tolerance, a “rupture” or a tear may occur along the nerve itself. It may have some fibers remaining connected, but this type of injury usually requires early surgery to try to recover function.
  • An “avulsion” of nerve is when the nerves are pulled from the spinal cord and unlikely to recover function. Early surgery is recommended in these cases but often require alternative types of surgeries to gain function.

Surgery Option

The results for brachial plexus and/or peripheral nerve injury surgeries at WVU Medicine Children’s, and the few other institutions in the region offering this care, show that between 40-80 percent of patients will see significant improvement and recover functional use of the arm or affected area. Following a secondary surgery, all our patients will have some level of improvement. Complications are few with a rate of less than 3 percent.

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