United Brachial Plexus Network

I have a question. Our physician thinks our 6 months old could have brachial plexus palsy because of the way she holds her arm when she crawls.
She has good hand to hand, and hand to mouth coodination, grasps toys fine, etc, just the way she crawls is strange. Here is the link to a photo.
http://img.photobucket.com/albums/v297/ ... nahand.jpg

It's her right hand that is most affected. She rarely flips her left hand over like that, but does on occasion.

Would you agree with this diagnosis for those who have experienced this?

As of now we were only told to do some home occupational therapy to see if she will start putting her hand palm down.

Blessings, Dawn

Hello, Dawn. It's hard to make a diagnosis from a photo, but it does help to visualize what you're referring to. I would suggest having the pediatrician giving you a referral to an occupational therapist and to a pediatric orthopedic specialist. It might be good even to try to see a BPI specialist, just to be sure. Where do you live? You can certainly do home occupational therapy, but you would want to at least have a screening and consult with a licensed OT to give you some direction. What I can say is that it's not good for the arm to be in that position -- with the wrist bent and hand folded under when crawling or doing any kind of weight bearing b/c it can stretch the tendons, so you definitely want to keep a close eye and correct this position whenever your daughter does it. An OT would also be able to make a splint to help strengthen your daughter's wrist if they see that as being appropriate. The Brachial Plexus is a complex set of nerves where it is possible to have everything uninjured except for the wrist. BP injuries really vary greatly from person to person. Did you have a difficult delivery? Do you know if your baby's shoulders were stuck? You don't have to get into that here, but those are just questions for you to consider. You might even think about getting a copy of your labor and delivery records to see if there was difficulty delivery the shoulders, which might be noted as "shoulder dystocia" (although drs. don't always note that in the records unfortunately), but it's worth a shot. Hope this helps. ~Tina

hello Dawn,
It does kinda look like she has waiters tip.
our Daughter is 9 m and still has waiters tip.
Get in to see someone right away you can email me if you like. Salina

"It's her right hand that is most affected. She rarely flips her left hand over like that, but does on occasion."

Your baby is beautiful:)
I cannot see her right hand, what does/doesn't she do with it?

Hi Dawn! You should ask your pediatrician to refer you to a pediatric neurologist...preferably one that specializes in brachial plexus injuries. That dr. can do a test called an EMG to determine if there is nerve damage.

We have an almost 10 year old little boy with this injury. I only occasionally come on the message board to even read the posts let alone post myself anymore but I saw your user name and thought I'd drop you a note because Jesus is my joy too! )

I'm sorry you have to go through this but it sounds like you are on the right track as far as gathering information!

Take care and blessings to you as well!
Joann

You say she has trouble with both hands? Did you have a traumatic birth? Did she have full use of her arms and hands immediately after birth? When babies are very little, they have a "Moro" reflex, where when they are startled they throw their arms wide, open their fingers and grab with their hands. In a BPI baby, this reflex is non-symmetric due to the nerve paralysis. Did she have this reflex and was it even on both sides?

I think a pediatric neurologist vist would be in order. My gut says it doesn't sound like BPI. Bi-lateral brachial plexus injury is also very rare. If it were me, I would want to see someone who is familiar with the full range of possible neurological issues that might be responsible for her crawling like that. A visit to a pediatric neurologist might be in order.

Kate

Dawn,
I agree that the position of your daughter's wrist/hand looks like the "waiter's tip" position.

As for both sides being affected, it does happen, but I agree that you should have your baby seen by a pediatric neurologist and possibly a BPI specialist, just to get their inputs and feedback. An EMG might be in order and if this is the case, make sure that someone in pediatrics does the EMG and has done them on other babies.

Please let us know what you find out.

By the way, she's beautiful!

Peggy

It might help you to know that my nephew, who is a teenager now, used to crawl 'funny' like that too, and he has absolutely no neurological issues at all, never did have. Also, when he started walking, he used to walk on his toes, and I mean ON them with them bent right back and under..used to make me cringe!

I agree with all the previous posters that you should get this looked into, but I thought I would just let you know that there is at least one kid out there who was similar, and that for him, this way of crawling was normal, and he suffered no after effects from doing it.

Lizzy B

Thank you all so much for your advice. I actually said one thing wrong.
*quote*
It's her right hand that is most affected. She rarely flips her left hand over like that, but does on occasion.
*end quote*
I meant to say the opposite, her LEFT hand is most affected and occasionally she does this with her right hand.

I didn't have a difficult birth. I have had 5 children and actually she was our smallest at 7 pounds, 4 ounces. The birth was fairly easy and fast, but maybe fast isn't good. She was delivered with just one hard push, so maybe she delivered *too* fast and could have caused the injury.

From my reading though if this was a birth injury, then the symptoms she is having should have been seen from birth. She didn't do this that I noticed when she first started pushing up her chest, it's only started in the last maybe 8 weeks or so.

Thank you all again for your advice!