Neonatal brachial plexus injury (NBPI) is a birth-related nerve injury affecting the network of nerves (brachial plexus) that controls movement and sensation in the shoulder, arm, and hand. It commonly occurs due to excessive traction on the baby’s neck during difficult delivery, especially in cases like shoulder dystocia. The severity can range from mild stretching (neurapraxia) to complete nerve rupture or avulsion. Clinically, infants may present with weakness or paralysis of the affected arm, reduced reflexes, and characteristic postures such as the “waiter’s tip” position in upper plexus injuries (Erb’s palsy). Early diagnosis and intervention are crucial to optimize recovery and prevent long-term functional impairment.

Management and Rehabilitation

Effective management of NBPI focuses on early physiotherapy, prevention of complications, and promoting functional recovery. A multidisciplinary approach involving pediatricians, physiotherapists, and sometimes surgeons is essential.

• Early physiotherapy: Gentle range-of-motion exercises to prevent joint stiffness and muscle contractures
• Positioning techniques: Proper limb positioning to avoid deformities and support healing
• Sensory stimulation: Helps improve neural recovery and awareness of the affected limb
• Parental education: Training caregivers in safe handling and home exercise programs
• Surgical intervention: Considered in severe cases if no improvement is seen within 3–6 months