Brachial Plexus Injury

What Is Brachial Plexus Injury? | Orthopaedics

Overview of brachial plexus injury

A brachial plexus injury is a collection of nerves that arise from the spinal cord in the neck and travel from the arm. These nerves control muscles in the shoulder, elbow, wrist, and arm, as well as feeling in the hand. Some brachial plexus injuries are small and fully heal in several weeks. Other injuries are serious enough and can cause permanent deformity of the hand.

The brachial plexus can be injured in many ways: under pressure, strain, or over long distances. Cancer or radiation treatment can cut or damage nerves. Sometimes brachial plexus injuries occur in babies during delivery.

Types

  • Avulsion: The origin of the nerve is completely separated from the spinal cord (the most serious type).
  • Rupture: The nerve is torn, but not at the spinal insertion.
  • Neuroma: Scar tissue around the injured area increases, putting pressure on the injured nerve and preventing the nerve from sending signals to the muscle.
  • Neurapraxia: The nerve was stretched and damaged, but not torn.
  • Brachial plexitis: It is a rare syndrome and no cause can be identified. This is also known as Parsonage-Turner syndrome.

brachial plexus injury risk factors

Factors that may increase your risk include:

  • Shoulder dystocia (the baby’s shoulder holding restricted on the mother’s pelvis)
  • Maternal diabetes
  • Large gestational size
  • Difficult delivery needing external assistance
  • Prolonged labour
  • Breech presentation at birth
  • Above half of brachial plexus injuries have no identified risk factors

Brachial plexus injury causes

Damage to the upper nerves that make up the brachial plexus tends to occur when your shoulder is forced down while your neck stretches up and away from the injured shoulder. The lower nerves are more likely to be injured when your arm is forced above your head.

Brachial plexus injury is mild and can occur:

  • Contact sports.┬áMany football players experience burners or stingers, which can occur when the nerves in the brachial plexus get stretched beyond their limit during collisions with other players.
  • Difficult births. Newborns can sustain brachial plexus injuries. These may be associated with high birth weight, breech presentation or prolonged labor. If an infant’s shoulders get wedged within the birth canal, there is an increased risk of brachial plexus palsy. Most often, the upper nerves are injured, a condition called Erb’s palsy.

What are the symptoms of brachial plexus injury?

Depending on the severity and location of the injury, the symptoms of brachial plexus injury vary from person to person. Usually, only one arm is affected.

Minor brachial plexus injury symptoms

People often undergo minor brachial plexus injuries while performing contact sports – soccer, hockey, or wrestling.

Any of these symptoms can be difficult:

  • Loss of sensation
  • Muscle weakness
  • Numbness or tingling
  • Redness, warmth, or swelling
  • Reduction in limb flexibility
  • Shoulder, arm, hand, or finger pain
  • Soreness
  • Tingling or different unusual feelings in the shoulder, arm, or hand

Symptoms from moderate to severe injuries

A more severe brachial plexus injury can lead to significant weakness and, in more severe cases, complete paralysis of one or more muscles in the hand. If all the nerves in the brachial plexus are severely damaged, the entire arm from the shoulder to the fingers can also be paralyzed. These more serious injuries can include severe pain or even a full sensation from the injury.

Diagnosis

A brachial plexus injury is diagnosed with a complete history and physical examination. It is necessary to see a doctor who practices in examining, diagnosing, and treating a brachial plexus injury within the first few weeks of an accident or incident.

After an exam, your doctor may order tests to discover the location and severity of your injury.

The brachial plexus may have one or more of the following tests to help determine the severity of the injury:

  • Electromyography (EMG) and nerve conduction studies
  • Magnetic resonance imaging (MRI)
  • Computerized tomography (CT) scans
  • Myelography
  • Angiogram

Treatment

Treatment depends on several factors including the severity of the injury, the type of injury, the length of time since the injury and other existing conditions.

Nerves that have only been stretched may recover without further treatment.

Your doctor may recommend physical therapy to keep your joints and muscles working properly, maintain range of motion, and prevent stiff joints.

Surgery to repair brachial plexus nerves should generally occur within six months after the injury. Surgeries that occur later than those who have lower success rates.

Nerve tissue grows slowly, so it can take several years to know the full benefit of surgery. During the recovery period, you must keep your joints flexible with a program of exercises. Splints may be used to keep your hand from curling inward.

Complications

For acute brachial plexus injuries, immediate surgical treatment is required to regain function. Without it, you may have a permanent disability and will not be able to use your arm.

If you have a brachial plexus injury due to a lack of sensation, you should be especially careful when handling hot objects, razors, knives, or other objects that may damage it. Brachial plexus injury stops you from undergoing any other injury to the affected area, so you may not notice that you are suffering.

Prognosis

It depends on the severity of the nerve damage. For most babies, weakness is mild and heals within three to six months after birth. In these cases, the child should not experience any symptoms after the nerves have healed. For more serious injuries, including those in which the nerves are torn, more treatment is needed, including surgery to repair the damaged nerves.

When to contact the doctor

Brachial plexus injuries can cause constant instability or disability. Even if yours seems small, you may need medical attention. Consult your doctor if you have:

  • Recurrent burners and stingers
  • Weakness in your hand or arm
  • Neck pain
  • Symptoms in both arms

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