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Brachial plexus injury is a medical emergency caused due to an injury to the brachial plexus group of nerves that sends signals from your spine to your shoulder, arm, and hand. These nerves control and administer feelings in the muscles of the shoulder, elbow, wrist, hand, and arm. This damage is also known as brachial plexopathy. Brachial plexus injury appears when these nerves are compressed, stretched, or in the most serious case, ripped apart from the spinal cord. Some brachial plexus injuries known as stingers or burners are inconsequential and will completely recover in a few weeks. However, other brachial plexus injuries are severe enough and may cause some permanent impairment in the arm. In severe conditions, it can paralyze your arm, with a failure of function and sensation.

Brachial Plexus Injury Causes

Brachial plexus injury results when the brachial nerves are damaged by excessive stretching, pressure, or cutting. Stretching can occur when your shoulder is forced down while your neck stretches up and away from the injured shoulder such as during a motorcycle or a car accident. In case of a serious injury, the brachial nerve may rip off the spinal cord in the neck. This type of brachial plexus injury is classified as traumatic brachial plexus injuries. It may occur because of different reasons, including:

  • Contact sports: Contact sports players may experience burners or stingers, which can occur when the nerves in the brachial plexus get stretched above their limits during collisions with other players.
  • Trauma: Several types of trauma, including motorcycle and car accidents or bullet wounds, can result in a brachial plexus injury.
  • Inflammation: Inflammation may also cause damage to the brachial plexus. An uncommon condition known as Parsonage-Turner syndrome or brachial plexitis causes brachial plexus inflammation without any trauma.
  • Tumors: Noncancerous (benign) or cancerous tumors may damage the brachial plexus.
  • Childbirth: Injury during complication of childbirth.

Brachial plexopathy may also result from exposure to radiation at the time of stereotactic radiosurgery or specific procedures such as stereotactic breast biopsy.

Brachial Plexus Injury Symptoms

Symptoms of the brachial plexus injury depend on the seriousness of the injury. A minor injury can often occur during any contact sport and minor trauma when the brachial plexus nerves get stretched or compressed. Minor brachial plexus injury symptoms include the following:

  • Burning sensation and shocks shooting down your arm
  • Weakness and numbness in your arm

More serious brachial plexus injury symptoms result when nerves are torn or ruptured. Such injuries may produce the following symptoms:

  • Weakness or inability to use certain muscles of hand, arm or shoulder
  • Complete lack of movement and feelings (paralysis) in your arm, including your shoulder and hand
  • Severe pain

In case of childbirth brachial plexus injury, symptoms can be seen right after the birth of the child. These may include:

  • No movement in the upper or lower arm or hand of the baby
  • Arm flexed (bent) at the elbow and held against the body
  • Absence of Moro reflex on the affected side
  • Decreased grip on the affected side

Comprehensive understanding of the specific nature of injury in each patient is a must for proper management of brachial plexus injury. Multiple modalities are utilized for exact diagnosis of brachial plexus injury, including:

  • Evaluation of medical history
  • Clinical examination
  • Electrodiagnostic studies such as EMG, NCV, SNAP, and SSEP
  • Imaging studies such as CT and MRI

No brachial plexus injury treatment is required in case of minor injury as the condition improves by itself. However, severe and complex cases may require immediate treatment. The choice of treatment depends on the severity of the condition and the type of injury. Common brachial plexus injury treatment includes physical therapy and exercise, medication and in some cases, surgery.

In case of children, many infants recover within 6 months, but in case of poor recovery, further surgery may be needed to compensate for the nerve deficits.

The treatment approach selected by the surgeon depends on the extent of the damage to the brachial plexus nerves of the patient. The surgeon will select the best approach after thorough examination and diagnostic tests.

Some common types of surgical brachial plexus injury treatment include the following:

  • Nerve grafting: Surgically removing and replacing the damaged part of the brachial plexus with sections of nerves harvested from other parts of the body is called nerve grafting. 
  • Nerve transfer: This type of surgery is opted when the nerve root has been torn from the spinal cord. A surgeon often takes a less important nerve that is still attached to the spinal cord and connects it to the nerve that is ripped off from the spinal cord. Occasionally, a combination of nerve graft and nerve transfer is performed.
  • Muscle transfer: During this surgery, your surgeon removes a less important muscle or ligament from another part of your body and transfers it to your arm, and restores the nerves and blood vessels supplying that muscle.

It is very hard to assess an exact recovery time after brachial plexus injury treatment due to the broad spectrum. How likely a spontaneous recovery depends on the type and severity of the injury.

In the case of surgery, nerve tissue grows very slowly, about an inch a month, so it can take a few years to assess the success of brachial plexus injury surgery. However, during the recovery period, patients are encouraged to keep their joints flexible by following an exercise schedule. The success rate of surgery is quite good but recovery time and success rate must be assessed on an individual basis.

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Frequently Asked Questions

Q: Can physical therapy and exercise alone help treat brachial plexus injury?

A: In case of infants, gentle motion exercises performed by parents under the guidance of the physiotherapist is necessary. In case of adult brachial plexus injury, a physiotherapist may help rehabilitate cases with mild injury.

Your physiotherapist may recommend you some exercises to keep your joints and muscles working, prevent stiff joints and maintain a range of motion.  In more serious cases of brachial plexus injuries, a surgery is conducted to restore nerve function by nerve replacements, nerve repairs and remove tumors causing the injury.

Q: What is childbirth brachial plexus injury?

A: There is another type of brachial plexus injury classified as obstetric brachial plexus injury. Obstetric injury occurs from a mechanical injury involving shoulder dystocia, typically during difficulty in childbirth, such as prolonged labor.

If the shoulders of the infant get wedged within the birth canal, then the risk of brachial plexus injury during childbirth is high. Usually, only the upper nerves are injured. This condition is called Erb's palsy. Total brachial plexus birth injury occurs when both the upper and lower nerves are injured.

Q: How is pain controlled and managed?

A: Pain relief management is an important part of the treatment of brachial plexus injury. In case of severe brachial plexus injuries, you can feel a debilitating, severe crushing sensation or a constant burning. Therefore, in most of the cases, narcotic medications are used initially but may be replaced as your recovery progresses to optimize pain relief.