Brachial plexus injury
Make an Appointment
Talk to DoctorOverview
Brachial plexus injury happens when the nerves in the brachial plexus are compressed, stretched, or in some severe cases ,pulled away from the spinal cord. The injury may cause pain, muscle weakness, loss of sensation, or loss of mobility in the shoulder, arm, and/or hand.
The brachial plexus is a network of nerves that control movement and sensation. These nerves deliver impulses from the spinal cord to the shoulder, arm, and hand. Each of the nerves in the brachial plexus has a distinct purpose, such as activating muscles or transporting sensory information from the hand to the brain.
The most serious brachial plexus injuries are frequently caused by high-speed motor vehicle accidents. It can result in paralysis of the arm. In contact sports, such as football, mild brachial plexus injuries, known as stingers or burners, are prevalent. Babies might also incur brachial plexus damage while in the uterus or during delivery. Other disorders that might affect the brachial plexus include inflammation and tumors.
Since each nerve in the brachial plexus serves a particular purpose, the location and kind of nerve injury within the plexus influences the symptoms and the type of treatment. Some may heal on its own, while more severe injuries might necessitate surgery.
Symptoms
The symptoms of a brachial plexus injury may differ according to the which nerves are affected, as well as the type and area of the injury. Common brachial plexus injuries occur due to forceful trauma, injuries at birth, tumors, and inflammation.
- Minor injuries: Certain trauma can damage the brachial plexus such as collisions in contact sports. These minor injuries, called burners or stingers, are often incurred in activities like football or wrestling.
The symptoms normally last only a few seconds or minutes, although some might endure it for days or longer. These symptoms are:
-
- An electric shock or a scorching feeling spreading down the arm
- A lack of feeling (numbness) or weakness in your arm or hand
- Severe injuries: Extreme brachial plexus damage brought on by traumatic events such as high-speed car accidents can tear the nerve root from the spinal cord. This significantly damages, tears, or destroys the nerves. As a result, the person may experience:
- Certain muscles in the hand, arm, or shoulder are weak or unable to be used.
- Total immobility and loss of sensation throughout the arm, including the shoulder and hand
- Intense pain in the arm, hand, or wrist
It is recommended to consult a healthcare provider if any of the symptoms persists, particularly if there is a neck pain, symptom in both arms, weakening or numbness of hand or arm, or having recurrent burners and stingers.
Minor brachial plexus injuries may still require medical attention. If left untreated, it can result in lasting paralysis or impairment. Therefore, it is important to have the injuries checked for proper diagnosis and immediate treatment.
Causes
The brachial plexus runs from the neck to the upper chest and ends at the armpit. This network of nerves is frequently injured when the arm is forcibly pulled or stretched, or when the head and neck are violently dragged away from the shoulder.
Brachial plexus injuries can be caused by:
- Contact sports: It is a common injury in contact-sport athletes such as football players. When the nerves in the brachial plexus are pulled past their limits after collisions with other players, burners or stingers occurs. These are considered minor brachial plexus injuries.
- Difficult births: Infants may suffer brachial plexus injuries as a result of uterine compression or after a difficult delivery. This is known as neonatal brachial plexus palsy (NBPP). The injury may be due to several circumstances such as putting pressure on the baby’s raised arms during a breech (feet-first) delivery, or when the infant’s shoulders become stuck within the birth canal. Erb’s palsy is a result when the upper group of nerves were damaged.
- Forceful trauma: Brachial plexus injuries can occur as a result of a number of events, including car accidents and motorbike accidents. Vehicle accidents cause approximately 70% of traumatic brachial plexus injuries, with motorcycles or bicycles accounting for 70%. Injuries can also happen due to penetrating injuries, such as a gunshot wound or a knife wound, falls, or direct, violent punches.
- Treatments for tumors and cancer: Radiation therapy to the chest or neck may cause tumors to develop in or along the brachial plexus, putting pressure on the plexus, or it may spread to the nerves. The brachial plexus may be harmed by radiation therapy for the chest.
Risk factors
The risk for brachial plexus injuries is notably higher to people involved in high-speed car accidents, or people playing football, wrestling, and other contact sports.
Babies who are breech birth, larger-than-average size, or with obese parent are also more susceptible to brachial plexus injury or newborn brachial plexus palsy (NBPP).
Diagnosis
Several tests may be needed following a physical examination to confirm the diagnosis of brachial plexus injury and to verify for other injuries. The tests include:
- X-ray: This will provide the doctor with images of bones and soft tissues. The images can reveal fractures or other problems on the shoulder, chest, arm, and neck.
- Magnetic resonance imaging (MRI). MRI can provide very clear images of the organs and structures inside your body. This test can demonstrate the amount of the damages produced by a brachial plexus injury and can aid in determining the health of arteries crucial for the limb or its repair. Magnetic resonance neurography, a new form of high-resolution MRI, could be used.
- Computerized tomography (CT) myelography. When MRIs do not provide enough information, this test is often used. A CT myelogram scan uses X-rays and computers to create images of structures within the body by injecting a specific dye around the spinal nerves. This imaging test is regarded as the most reliable for detecting spinal nerve avulsion injury.
- Electromyography (EMG): This is a diagnostic test that will help assess the health and function of the nerves and muscles. During the procedure, a needle electrode is inserted through the skin into several muscles. It will measure the electrical activity of the muscles while they contract and when they are at rest. An EMG may be advised if patients experience symptoms such as muscle weakness, numbness, or tingling.
- Nerve conduction studies: This is one of the electrodiagnostic exams that measure nerve conduction and muscle signals. This indicates how well the nerve is working. Typically, these examinations are conducted along with an EMG.
Treatment
The appropriate treatment for a brachial plexus injury is influenced by the type and severity of nerve injury, which nerves were damaged, the duration of time since the injury, if there were other injuries and other significant factors.
Minor brachial plexus injuries may recover without surgery within weeks to months. If the healthcare practitioner believes that the injury has a high chance of healing without surgery, they may wait to observe how it recovers before recommending surgery.
Surgical therapy is often recommended for brachial plexus injuries that do not recover sufficiently to restore vital function to the arm and hand. The surgery is usually performed within six months of the damage. Success rate is significantly reduced if performed after that timeframe.
Physical therapy may be recommended by the doctor to ensure that the joints and muscles are operating properly, preserve mobility, and avoid stiff joints.
An occupational therapist can assist the patient on how to use the unaffected arm for daily tasks such as eating and personal hygiene.
Nerves recover slowly. As a result, recovering from a brachial plexus injury takes time. It is possible that the benefits or improvement will take for several months.
Types of surgery
A healthcare specialist may use different methods to treat brachial plexus injuries. Common surgical treatments include:
- Neurolysis: This procedure involves decompressing the nerve by removing the scar tissue around the nerve.
- Nerve graft: The surgeon will stitch a healthy nerve from another region of the body between the two ends of a lacerated (severed) nerve. This acts as a bridge for fresh nerve development to occur throughout time. It will serve as a framework, supporting the wounded nerve ends while they repair.
- Nerve transfer: This surgery is performed by cutting and reconnecting a healthy donor nerve to the wounded nerve in order to provide a signal to a paralyzed muscle. This creates a path for fresh nerve development. This is often done when a nerve root is torn from the spinal cord.
- Muscle transfer: In this procedure, a transplanted muscle is connected to the nerves and blood arteries that supply the muscle. A minor healthy muscle or tendon from another region of the body, usually the thigh, is often extracted for muscle transfer.
Pain control
People with severe brachial plexus injuries may experience pain within three years. Drugs are often prescribed to relieve the pain. If the condition does not improve, the doctor may recommend a surgical procedure to block pain signals from the injured section of the spinal cord. The pain is often reported as a crippling, terrible crushing sensation or a continual burning sensation.
