The Brachial Plexus and Types of Injuries
The brachial plexus is a complex array of nerves that branches off the spinal cord at your neck. It is responsible for sending signals from your brain to your shoulders, arms and hands. Each of the five nerves in the array has a specific function, including stimulating muscles or relaying information about temperature or touch to your brain.
Brachial plexus injuries vary in severity, often based on the type of injury and the amount of force encountered. Injuries can affect any combination of those five nerves, and each may suffer different levels of damage.
The primary types of injuries include:
- Stretch: The protective covering of the nerve can be damaged when there is mild stretching of the brachial plexus nerves. This can hamper conduction of nerve signals, even if the nerves underneath aren’t damaged. These injuries may heal on their own, with the assistance of physical therapy.
- Rupture: A more forceful stretch of the brachial plexus may cause partial or full tears. Often, these injuries are repaired through surgery.
- Avulsion: The most severe brachial plexus injury occurs when the nerve root is torn away from your spinal cord. These injuries require surgery to regain function.
Symptoms vary widely, based on the severity of the injury as well as the specific nerves involved. In some instances, these symptoms may last anywhere from a few seconds to several days. But brachial plexus injuries can cause permanent damage or weakness. Even if your injury appears to be minor, you should seek medical care. It’s important to get evaluated early for the best outcome.
- Limp arm
- Paralysis in your hand or arm
- Feeling an electric shock or burning sensation in your arm
- Numbness or weakness in your arm
- Diminished muscle control in your hand, wrist or arm
Upper brachial plexus injuries occur when your shoulder is pushed downward at the same time your neck is forced up and away from that shoulder. Lower brachial plexus injuries occur when your arm is suddenly forced above your head. Injuries often are the result of a traumatic incident. Examples include:
- Collisions in contact sports. It is not uncommon for football players to experience minor injuries known as burners or stingers after slamming into another player.
- Hard falls
- Direct blows
- Car or motorcycle accidents. These injuries are often the most severe.
- Traumatic injuries, including gunshot and knife wounds
While trauma is the most common cause of brachial plexus injuries, other causes include:
- Tumors: Those that grow in or along your brachial plexus can put pressure on the nerves. The most common examples are breast and lung cancer.
- Inflammation: The body’s immune system sometimes becomes overactive and attacks healthy cells. There is a rare condition called Parsonage-Turner Syndrome, in which these attacks occur in the brachial plexus without any obvious shoulder injury.
- Cancer treatment: Radiation treatment to the chest can damage the brachial plexus.
- Difficult births: Injury can occur during prolonged labor.
Evaluating brachial plexus injuries is particularly challenging. Among other things, it can be difficult to predict whether the injury will heal on its own or if treatment, including surgery, is required to restore normal function.
Diagnosis begins with a physical examination and thorough exploration of any traumatic event that may have caused the injury. Your doctors may suggest other tests, including:
- X-rays: These tests will create images of bones and other dense structures in your neck, chest, shoulder and arm to look for fractures that could be creating your problems.
- Computed tomography (CT) myelogram scan: After a special dye is injected into your spinal nerves, a series of images is created and assembled by a computer to offer a detailed look at the brachial plexus nerve array.
- Magnetic resonance imaging (MRI): This diagnostic tool creates images of the shoulder and neck. It is often chosen because of its ability to generate images of soft tissues.
- Electrodiagnostic exams: These tests measure nerve conduction and muscle signals. They can confirm a brachial plexus injury and pinpoint its location, reveal the severity of the injury and assess recovery prospects. These tests typically are done a few weeks after the injury and then two to three months later to evaluate healing.
One of the keys to regaining as much function as possible is getting evaluated as soon as possible after the injury occurs. Certain treatments are best performed within the first months and may not be an option beyond 12 months from the injury.
Our multidisciplinary team will work with you to develop a treatment plan that’s best for your injury. Among the options:
Often brachial plexus injuries will heal on their own over a period of weeks or months, as the nerves recover from their shock. This is the preferred treatment option, since these injuries tend to have better outcomes in terms of recovering muscle and nerve function.
Your doctor may initially recommend therapy to see how the injury responds before making a surgical evaluation. Our team includes physical and occupational therapists trained in brachial plexus injuries.
If the injury is not healing on its own or is recovering too slowly, your doctor may recommend surgery. It is important to understand that, depending on the severity of the injury, surgery may not be able to return your arm or hand to its pre-injury abilities.
Our team of physicians is trained in the latest surgical procedures for brachial plexus injuries.
Those options include:
- Nerve repair: Your surgeon reattaches two torn edges of the severed nerve. This procedure is typically done following a sharp cut (from a knife, for example).
- Nerve graft: In this procedure, your surgeon takes a healthy nerve from another part of your body and uses it to connect a severed nerve. This support structure gives your injured nerve a chance to grow back together.
- Nerve transfer: The procedure is performed when there are no functioning nerve stumps in your neck to which nerve grafts can be connected. Your surgeon will cut and reconnect a healthy donor nerve to the injured nerve to provide a signal to a paralyzed muscle.
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If you are experiencing symptoms or have been diagnosed with a brachial plexus injury, our doctors will meet with you to evaluate your injury, discuss your care options and develop a treatment plan that is right for you.
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