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BBPI most often, but not always, occurs during the delivery process as the infant descends through the birth canal and the shoulder becomes lodged on the mother’s pelvic bone. As contraction begins, the infant’s neck and shoulder are stretched which can cause tears or ruptures of the nerves within the brachial plexus thus impacting the sensation and movement of the affected upper extremity. Incidence of brachial plexus injuries in the United States is 0.4 to 4 in 1,000 live births (Abzug, et al., 2018; Foad et al., 2008; Hoeksma et al., 2004; Waters, 1997). Although many of these infants will have spontaneous recovery of their injury within 2 - 3 months, 10 – 30% will have irreversible neuromuscular dysfunction and skeletal deformities (Nikolaou et al., 2011; Waters et al., 1998; Poyhia et al., 2005). One condition that impacts the shoulder specifically in BBPI is glenohumeral dysplasia. Glenohumeral dysplasia is a complex condition involving an imbalance between shoulder muscles, particularly the internal and external rotators. This can lead to progressive joint abnormalities, such as posterior subluxation and dislocation, causing further disruption in the development and function of the shoulder joint (Ruchelsman, et al., 2011; Olofsson, et al., 2019; Moukoko, et al., 2004). Early diagnosis and appropriate treatment are important to manage this condition and prevent complications (Pearl, 2009; Vuillermin & Bauer, 2016).

Publication Date



These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly, these guidelines should guide care with the understanding that departures from them may be required at times.

Objective of the Clinical Pathway

The objective of the Birth Brachial Plexus Injury (BBPI): Management of Shoulder Subluxation/Dislocation Clinical Pathway is to provide care standards for the infant diagnosed with BBPI and concern for shoulder subluxation or dislocation. The BBPI: Management of Shoulder Subluxation/Dislocation Clinical Pathway provides guidance regarding evaluation, surgical intervention, treatment, and reassessment to minimize variation in care.

Target Users

Radiologists; Radiology Technicians; Orthopedic Surgeons; Physiatrists; Occupational Therapists; Orthotists




Finalized Nov 2023

Clinical Pathways are updated on a revision schedule. Primary files will always be the most current update. Previous revisions are available upon request from Children’s Mercy Library Services.

Clinical Pathways promote evidence based, safe, and high-value care for patients with common or high-risk clinical conditions when national or international guidelines are not available or applicable. Clinical Pathways are informed by methodical review of scientific literature and the consensus of a multidisciplinary committee of subject matter experts and key stakeholders at Children’s Mercy Kansas City. Processes within Clinical Pathways may be specific to Children’s Mercy Kansas City and should be evaluated before applying to a different setting.

Birth Brachial Plexus Injury (BBPI): Management of Shoulder Subluxation/Dislocation

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Pediatrics Commons