Institute for Brain Protection Sciences

Brachial Plexus Clinic

The Brachial Plexus Clinic at Johns Hopkins All Children’s Hospital provides comprehensive care for children with all types of brachial plexus and peripheral nerve injuries. Early intervention can reduce or prevent long term effects. If surgery is needed, an early assessment can lead to better outcomes.

What to Expect

Your child’s first visit will include a meeting with Dr. Hart and a member of the neurology team. They will perform the initial screening, or record review for out-of-state patients.

A second visit typically consists of a consultation/evaluation by Drs. Tuite and Phillips, a member of the neurology teamDr. Hart, and Members of the rehab and occupational therapy team

After the consultation, the brachial plexus team will meet to plan the best treatment for your child and will work with your family to implement this plan.

Meet our Team

Members of the brachial plexus team include specialists in:

  • Neurosurgery
  • Physiatry
  • Neurology
  • Orthopedic surgery
  • Plastic surgery
  • Radiology
  • Anesthesiology
  • Physical and occupational therapy

At Johns Hopkins All Children’s, our collaborative team of specialists work together to provide the best care to your child. The care team includes:

  • Dr. Dennis Hart, a pediatric rehabilitation physician, will perform the initial evaluation of your child’s functional abilities and muscle tone. Dr. Hart will coordinate with the occupational and physical therapists and surgeons to ensure your child is receiving a comprehensive therapy and surgical plan to achieve the best outcomes.
  • Dr. Gerald Tuite, a pediatric neurosurgeon has specialized training in surgery on the nerves of the hand and upper extremity.
  • Dr. Lee Phillips, a pediatric orthopedic surgeon, specializes in hand surgery.

To make an appointment, you must have a physician referral

Referrals are required from a primary care physician or other specialist. If you already have a referral, please give us a call.

What are Brachial Plexus and Peripheral Nerve Injuries?

  • The brachial plexus is a network of nerves running from the cervical spinal cord that provide sensation to the skin and control the movement of your shoulder, arm and hand.
  • The brachial plexus nerve is situated in the lower part of the neck underneath the clavicle bone. 
  • A brachial plexus injury may cause weakness, loss of feeling or loss of movement. Injuries may be caused from the birthing process, trauma, sports injury or peripheral nerve tumors.
  • The most common cause of brachial plexus injuries is birth related:
    • This is more common in larger newborns (>9 pounds)


  • Avulsion-Nerve is torn from attachment to spinal cord.
  • Rupture-Nerve is torn but not at spinal cord.
  • Neuroma-Scar tissue that forms on sensory nerve after injury.
  • Neuropraxia or Stretch-Nerve is stretched but not torn.
  • Duchene-Erb Palsy – usually involves the upper part of the plexus or nerve (C5-6, &/or C7). 
  • The movement in the hand is typically intact, but there will be muscle atrophy of the arm with inability to flex the elbow.
  • Klumple’s palsy – involves the lower part of the brachial plexus (C8-T1 &/or C7). 
  • The dominant deficit is in the hand.
    • Sometimes there is associated injury called Horner syndrome where the pupil will be relatively small with eyelid droop on the same side of the injury.

Symptoms vary by the cause and nerve roots involved.  Some symptoms include:

  • Weakness or limpness of arm.
  • Problems moving the arm, wrist or hand.
  • Loss of sensation or numbness.
  • In turning of arm and hand.
  • Constant pain to arm or hand

Diagnosis and testing

  • Visit with your pediatrician for comprehensive physical exam if you feel your child has any of the above symptoms.  Your pediatrician will determine if a referral to a specialist is needed
  • Diagnosis involves the medical history, developmental history, neurological exam and physical exam.
  • Magnetic resonance imaging (MRI) of the brachial plexus and/or cervical spine.
  • Electromyogram (EMG) to assess muscle contraction.

The Johns Hopkins All Children’s Hospital Peripheral Nerve clinic

  • Made up of a multidisciplinary ream of professionals, including Orthopedics, Physical Medicine, and Neurosurgery
  • The clinic is run by the world renown peripheral nerve neurosurgeon Dr. Alan Belzberg


  • Some patients will recover spontaneously or at least improve significantly within a few months.
  • Nonsurgical treatments: Occupational and Physical therapy may be used to promote nerve recovery, stretch and strengthens muscles, maintain range of motion in the upper extremities and neck and to facilitate optimal use.
  • Surgical treatments include: Surgical exploration, Neurolysis-releasing nerve from scar, nerve grafting-using a healthy nerve to bridge a nerve gap and Nerve transfers- using working nerves to stimulate nerves and muscles.

Hospital Course

  • If your child is found to be a surgical candidate for repair of their brachial plexus injury, the patient will be admitted the morning of surgery.  After surgery, most of the children will be admitted to the general pediatric neurosurgical floor for 24-48 hours of observation and post-operative pain control. 
  • Post-operatively, most children go home on Tylenol and/or motrin as needed for pain or discomfort.
  • Activity
  • Return to school
  • We will see the child in post-operative clinic approximately 2 weeks after surgery to make sure they are healing appropriately.