What is a Brachial Plexus Birth Injury (BPBI)?

What is a BPBI?


A brachial plexus birth injury (BPBI) is caused by damage to the nerves in the neck during delivery. It can cause lasting effects, such as Klumpke’s palsy or Erb’s palsy both of which are types of neonatal brachial plexus palsies (NBPP). Klumpke’s palsy is caused when there is injury to the lower brachial plexus while Erb’s palsy is injury to the upper brachial plexus. Injuries range from mild to severe, with various symptoms that can be temporary or can go on to cause a lifelong handicap. Some of the symptoms of a brachial plexus injury include: 

  • Full or partial lack of movement in the arm 
  • Numbness or weakness  
  • A weakened grip 

Some of the lasting effects of Klumpke’s and Erb’s palsy include a weak or paralyzed arm, shoulder and hand. While many cases of NBPP spontaneously recover, some may need therapy in order to gain movement, and an earlier diagnosis improves long term results.  Even with early diagnosis, therapy, and even surgery, some children may have a lifelong injury.   


Risk Factors for BPBI and a subsequent NBPP 

  • Shoulder dystocia. This occurs during a vaginal delivery when a baby’s shoulders get stuck inside the mother and the baby has to be maneuvered out. (March of Dimes) 
  • Instrumented birth. There is a 9 times greater risk for a brachial injury if a doctor chooses to deliver by forceps.  
  • Fetal Macrosomia. This occurs when the baby is in the 90th percentile or above for weight, which increases the risk that the baby will not fit easily through the mother's pelvis, and may require extra force to deliver.  
  • Breech delivery. Babies that are delivered feet-first (breech) increases the chance for shoulder dystocia.  
  • Maternal height. Mothers who have a short stature have an increased likelihood of encountering shoulder dystocia, with the increased risk correlating to the degree of short stature. The level of risk increases as the mother's height decreases. 
  • Excessive Weight Gain During pregnancy. Mothers who have excessive weight gain during pregnancy have an increased risk of shoulder dystocia.
  • Older age at delivery. The increasing age of a mother has been shown to be directly related to complications arising from factors such as prolonged labor and shoulder dystocia (Yarfi et al, 2019).  



While a BPBI in an infant may resolve on its own, there also may be lasting effects that require further care. Occupational therapy and physical therapy may be needed, while some infants require surgery along with therapy. Some infants do not fully recover despite all efforts to treat the brachial plexus injury.  This could be a costly mistake that could result in a lifelong handicap.  


Your Baby Deserves Quality Representation 


If your baby suffered injuries during delivery, you should speak with an attorney. The legal team at The Holton Law Firm can review your case, help determine if you have a birth injury case, and provide superior representation, if necessary. To get started on your case, contact a team member today.