Brachial Plexus Injury

Anatomy

The brachial plexus is a complex network of nerves that extends from the spinal cord within the neck through the axilla (armpit) and supplies nerves to the chest, shoulder, and arm.These nerves control your shoulder, arm, wrist and hand, allowing you to raise your arm, type on your keyboard, or throw a baseball. The brachial plexus nerves are sensory, too. For instance, these nerves let you know that the pan you just grabbed with your hand is too hot to hold or reach into your pocket and select a quarter instead of a nickel.

What Causes Brachial Plexus Injuries?

The brachial plexus can be injured in many different ways — but most commonly it is from a traumatic injury. The nerves may also be damaged by inflammatory disorders, cancer or radiation treatment. Sometimes, brachial plexus injuries happen to babies during childbirth. Brachial plexus injuries may reduce or eliminate the communication between the spinal cord and the shoulder, arm, wrist, and hand. This may mean that you can't move parts of your arm or hand. Often, brachial plexus injuries also result in loss of feeling in the area. The severity of a brachial plexus injury varies. In some people, function and feeling returns to normal. Others may have lifelong disabilities because they can't use or feel a part or all of the arm. Brachial plexus injuries are categorized by which part of the plexus is injured and how severely it is injured.  Nerves can be stretched and remain in continuity. Alternatively they can be ruptured or severed.  Occasionally the nerve can actually be pulled directly out of the spinal cord.  This is referred to as an avulsion injury.

Nerve injuries can be broadly categorized according to the Seddon Classification:

Neurapraxia.The nerves are intact but not functioning.  They can recover nicely if the compression has been relieved

Axonotmesis.  The wires within the nerve (axons) are actually severed and for recovery to take place they must grow back from the site of injury to the muscle and establish a new connection

Neurotmesis. This refers to a severed nerve.  The rupture described above is an example of a neurotmetic injury

Brachial Plexus Surgery - Partial Injuries

Upper plexus injury

Partial injuries most commonly occur in the upper part of the brachial plexus and result in paralysis of shoulder and elbow function. The arm is left hanging at the side, but hand function is usually preserved.

Lower plexus injury

More rarely, an injury can primarily affect the lower portion of the plexus and the hand will be disabled while the shoulder and biceps remain functional

Brachial Plexus Symptoms

Mild brachial plexus injuries typically feel like tingling and weakness in the arm, which will generally heal itself over time without surgical intervention. However, if there is more dramatic numbness and paralysis in the arm and/or hand, this signifies a more severe brachial plexus injury and it is critical you are seen by one of our paralysis specialists right away. 

Diagnosis & Treatment Of A Brachial Plexus Injury

A brachial plexus injury is the most complex nerve injury to repair. Accurate diagnosis of the severity of the injury is crucial. It is important to determine whether the injury will recover with time, or if surgery will be required in order to restore movement to the arm. Our specialist team provides a comprehensive approach in the diagnosis and management of severe brachial plexus injuries. In the event of a brachial plexus injury, our team uses a special form of magnetic resonance imaging (MRI) to determine:

•       exact location of the primary injury

•       if there are ruptures

•       if there are avulsions (separations or detachments of the nerve root from the spinal cord)

Further confirmation of the type of injury and prediction of potential for recovery can be provided by neurophysiological studies, including electromyography (EMG) and nerve conduction studies (NCS). Using the information gathered from these tests, our team of specialists will develop a comprehensive plan to restore movement to your arm as quickly and as safely as possible. 

This may involve:

1. Reconstructive neurosurgery 

2. Pain control management

3. Therapy

The earlier you receive a diagnosis following your brachial plexus injury, the more treatment options are available to you to improve function. Please don’t wait to see a brachial plexus specialist – call the Paralysis Center today to make your appointment.

Surgery For Brachial Plexus Injury

When the brachial plexus is completely injured, patients have no function at all in their extremity. They generally can neither feel nor move their arm. With these injuries, it is important to determine which nerves are scarred or torn, and which ones are avulsed (pulled out of the spinal cord). If nerves are avulsed, the surgeon can operate earlier instead of giving time for recovery, knowing that these injuries will not recover on their own. Nerves that are avulsed can be recovered using nerve transfers.  Nerves that are ruptured or scarred can often be repaired with nerve grafts. Reconstructive surgery for complete brachial plexus injuries generally consists of a combination of nerve grafting and nerve transfer procedures. The treatment for each patient will be determined according to his or her individual condition. Patients ideally undergo surgery within three to four months after their injury. In order to provide for the best recovery, it is often important that the patient receive physical therapy before the surgery to keep the joints mobile and to recruit the nerves that will be transferred.  After the surgery therapy becomes even more important for the patient to learn to use the recovering muscles that are now run by different nerves.

For severe brachial plexus injuries, prompt surgery provides the most options for successful reconstruction. Without it, you might have a lasting disability and be unable to use your arm or hand. If you have a brachial plexus injury resulting in a lack of feeling, you must take special care when dealing with hot items, razors, knives, or other objects that could harm you. A brachial plexus injury can keep you from feeling any other injury to the affected area. You may not notice that you're hurt. You may also have long-term pain or sensory changes in the affected area, or you could have paralysis.

Tips To Help You Get The Most From A Visit To The Paralysis Center

1. Before your visit, write down questions you want answered.

2. Bring someone with you to help you ask questions and remember what your Specialist tells you.

3. At the visit, write down the name of your diagnosis, and any new medicines, treatments, or tests.

4. Also write down any new instructions your specialist gives you.

5. Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

6. Ask if your condition can be treated in other ways.

7. Know why a test or procedure is recommended and what the results could mean.

8. Know what to expect if you do not take the medicine or have the test or procedure.

9. If you have a follow-up appointment, write down the date, time, and purpose for that visit.

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