Brachial plexus injury: symptoms, causes, treatment and recovery

The symptoms depend on which nerves are damaged and how badly. Leeds Teaching Hospitals explains that the plexus provides movement and sensation (feeling) in the arm, so injury can mean part or all of the arm will not move normally and may have reduced feeling. When assessing an injury, the Leeds team examines movement, power and sensation.

The brachial plexus controls the muscles in the shoulder, arm, elbow, wrist, hand and fingers as well as giving them feeling, according to the Scottish National Brachial Plexus Injury Service. Where the upper nerves are affected, shoulder and elbow movements are most affected. The Scottish service says that in babies the nerves that control lifting the shoulder and bending the elbow (the C5 and C6 nerve roots) are most commonly involved, and the arm tends to lie by the baby's side from birth.

Leeds Teaching Hospitals explains that the plexus (Latin for "braid") is formed by five nerve roots which leave the spinal column in the neck: C5, C6, C7 and C8 from the lower neck vertebrae, and T1 from the first thoracic vertebra. The roots join to form three trunks (upper, middle and lower). Each trunk divides into anterior and posterior divisions, which join to form three cords (lateral, posterior and medial) before splitting into the major nerves of the arm. The nerves pass under the collar bone (clavicle) into the upper arm.

Because the pathway is long, injury can occur at the roots, trunks, divisions or beyond, and the pattern of weakness helps specialists work out where the damage lies.

Leeds Teaching Hospitals says that in adults the commonest cause of injury is traction, or stretching, of the brachial plexus, usually in a road traffic accident, mainly in motorcyclists. Occasionally damage also affects the major blood vessels that carry blood to and from the arm.

In babies, the Scottish service says obstetric brachial plexus injury (also called Erb's palsy or obstetric brachial plexus palsy) usually occurs during a difficult delivery, for example with a large baby, a breech presentation or a prolonged labour, or when the baby must be delivered quickly and some force is needed. Hull University Teaching Hospitals gives the same risk factors, including assistance delivering the shoulder. In older children, the Scottish service says injury occasionally occurs in contact sports, serious falls or car or motorcycle accidents, and very rarely inflammation or a tumour can affect the plexus.

Leeds Teaching Hospitals lists a range of injuries that traction can cause, from temporary to permanent. Which type you have is the main factor in whether you need surgery.

After referral to a specialist unit, Leeds says you are assessed by medical staff, either as an inpatient or in an outpatient clinic. They examine the injury, assessing movement, power and sensation. Tests may include nerve conduction studies, which assess the speed of an electrical impulse through the nerves, MRI scans and CT scans.

If the injury is mild and recovery is expected without surgery, Leeds says you are seen in an outpatient clinic to be supported and to have your progress reviewed. If it is clear that a rupture or avulsion has happened, surgical exploration and repair of the nerves may be offered.

Leeds says an individualised treatment plan may include surgical management (operating to repair the nerves) or non-operative management with physiotherapy and occupational therapy. The Royal National Orthopaedic Hospital (RNOH) describes its services as including exploration, repair and non-operative treatment in adult brachial plexus injury, and nerve repair and transplantation in both infants and adults.

In the commonest injuries, Leeds explains, the nerves are torn or stretched and the damaged section either side of the rupture must be removed and repaired using grafts of nerve taken from the legs, which then need to regrow. If the nerves are found to be ruptured, the gap is bridged by a nerve graft taken from less important sensory nerves at the back of the legs or from nerves in the injured arm. Surgery is under a general anaesthetic.

After surgery, Leeds says the arm is strapped to your side or in a sling and must stay in place without movement for four weeks, and you usually stay on the ward only a few days. Follow-up includes a dressing clinic at one week and at four weeks (when the strapping is removed and a physiotherapist starts passive exercises), then a multidisciplinary team clinic at three months, and regular review by a specialist physiotherapist. A further operation may be needed in future.

Leeds also notes that clinical psychologists are part of the team, because brachial plexus injuries can have a large effect on people's lives and it takes time to adjust.

Leeds says a stretched but intact nerve may recover over a period of months, while after repair with grafts recovery can be lengthy, because every microscopic nerve fibre has to reconnect, so complete recovery is unlikely. After surgery, as the nerves start to recover you will need to work hard at retraining them to move the arm, and at first you may need to use different movements to make the arm work, with guidance from the physiotherapy team.

We have not quoted time frames for functional recovery because the UK pages we read do not give a single figure. Timing and outlook depend on the type of injury, whether surgery is needed and when it is done, so ask the specialist team what to expect in your case.

The Scottish service says brachial plexus injury at birth is rare, affects about one in 1,800 UK babies, and the effect is very variable. Some babies show big improvements within days to weeks, while others recover much more slowly and may benefit from surgery. Hull University Teaching Hospitals says recovery is hard to predict but approximately 85 out of every 100 babies have a full recovery, and mild cases recover within one to eight weeks. The more complicated the injury, the longer the recovery period.

Hull advises that Erb's palsy needs rest to begin with: keeping the baby's arm supported and moving the shoulder as little as possible for the first 5 days, after which the paediatric therapy team begins treatment. Parents are told not to be afraid to handle the arm, to start with the affected arm when dressing, to support the affected arm when feeding and cuddling, and not to lift the baby from under the arms. The aims of therapy are to prevent tight muscles and stiff joints, encourage active movement and strength, and keep stimulating feeling in the arm. A family support group is the Erb's Palsy Group.

The Scottish service also runs a service for adults with birth injuries, and says children who need it may be referred for surgery, with a specialist team to support the family as the child grows.

Anyone with a significant injury to the neck, shoulder or arm followed by weakness, numbness or an arm that will not move should be assessed urgently in an emergency department. Leeds describes patients being referred to a specialist unit, where the type of nerve injury decides whether recovery is expected without surgery or whether exploration and repair are offered. Call 999 after a major road traffic collision or if there is heavy bleeding, a cold or pale limb, or difficulty breathing.

For a newborn, tell the midwife, neonatal team or GP as soon as you notice that the baby is not moving an arm. Hull and the Scottish service describe early physiotherapy and therapy referral for these babies.

In the NHS, brachial plexus injuries are managed in a small number of specialist nerve injury units, so you are usually referred by a trauma team, an orthopaedic or plastic surgeon, or a GP. The NHS units described in the sources call themselves regional or national tertiary centres, and one noted that, owing to high demand, it was temporarily restricting some referral types until October 2026, so waiting times can vary by service and location. Scotland has a national service for adults and children.

Private surgeons also offer assessment and nerve surgery, and the same imaging and surgical principles apply. Because the operation is specialised and timing matters, it is reasonable to ask any surgeon how many brachial plexus operations they perform and how physiotherapy and psychology are organised, and to make sure your NHS team and GP are kept informed.