When you’re expecting a child, you dream about their future. You hope they’ll excel in many areas of life, such as academics and sports.
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During birth, if a child experiences a shoulder injury such as an injury to the brachial plexus, you might wonder how this could affect your child’s athleticism down the road.
“While it may limit what your child can do with his or her arm, many children who begin life with this type of shoulder injury can function like other children — and they can even go on to excel in competitive sports,” says orthopedic surgeon Joseph Styron, MD.
What are signs of a brachial plexus injury?
When an injury involves the brachial plexus, it affects the collection of nerves in the neck that powers the arm from shoulder to fingertips.
It usually occurs because the child’s shoulder gets stuck during delivery, and the head gets pulled away from the shoulder. This causes a stretch injury of those nerves. It only happens in 1 or 2 of every 1,000 live births.
Lack of movement is the first thing parents will notice, Dr. Styron says.
“It won’t be equal to the other side and it’s a pretty dramatic difference. It’s not painful for the child, but he or she may not have as much sensation in that arm as in the other,” he says.
How serious is this injury?
Every injury is different, but up to 90 percent involve stretching without tearing of the nerves, which is able to resolve without surgery over time. If the nerves tear, however, there is sometimes long-term damage — shoulder weakness, elbow flexion or problems externally rotating the shoulder.
Despite this, Dr. Styron says children can do well in many sports.
“I’ve seen plenty of kids and young adults with this injury go on to become varsity high school and college athletes. I’ve seen them play lacrosse and football, wrestle and swim,” he says.
What should parents do?
If your child has been diagnosed with a brachial plexus injury:
Don’t treat your child differently. Encourage children to stay active and play with their peers from an early age. This will help them learn how to be competitive athletes and not view this as a disability.
Consider how your child can adapt. “These kids are amazingly capable of developing workarounds for any kind of deficit they have. They use other muscles to help compensate, like using the shoulder blade more if they have a weak rotator cuff,” he says.
Know the possible limits. Sometimes there are limitations, depending on the injury. “Maybe they don’t play every position in a sport. Like they might not do the butterfly stroke, but they can still make the swim team. Or maybe they can’t manage quarterback, but they can play other positions in football,” Dr. Styron says.
Be aware. Parents should know that the affected arm is sometimes a bit smaller than the other. The arm also may not swing when the child is running. And the child can have some “winging” of the shoulder blade as they get older. All of these things are completely normal and shouldn’t worry parents.
What are treatment options?
Treatment usually starts within a few weeks of birth. Initially, physical therapists work on stretching and keeping the joints loose. This helps resolve many of the injuries.
If sufficient movement doesn’t return, surgeries can increase motion in the arm.
These may include:
- Nerve transfer or repair.
- Tendon transfers.
- Bone work to move the shoulder to a more functional position.
It’s important to work with an orthopedic or plastic surgeon who specializes in brachial plexus injuries, as well as a physical therapist.
Also, if you have one child with this injury, you’re at higher risk in other pregnancies. If you plan to grow your family further, talk to your doctor about having a cesarean section.