Brachial Plexus Injuries

What are brachial plexus injuries, and how are they treated?

Brachial plexus injuries can be painful and cause a loss of function in your shoulder, arm, wrist, and hand. Timely treatment can give you a better chance of recovery when the injury is severe.

If you are experiencing shoulder problems and believe you might have a brachial plexus injury, schedule an appointment with one of our board-certified orthopedic specialists at OrthoNeuro today! We have many locations throughout Greater Columbus for your convenience.

What Is the Brachial Plexus?

The brachial plexus is a network of nerves that originates from the spinal cord in the neck. It sends nerve signals to the upper limbs, including the arms and hands. These nerve signals allow us to move, feel sensations and perform fine motor movements.

Anatomically, the brachial plexus is made up of roots, trunks, divisions, cords, and branches. The five roots come from the fifth cervical through the first thoracic nerves of the spinal cord.

From there, it splits into three main trunks, which then divide into anterior and posterior divisions before combining again to form three large cords. Finally, these cords give rise to small terminal branches that innervate individual muscles of the arm, forearm, and hand.

There are several ways that the brachial plexus nerves can be injured, including the following:

  • Pressure on the nerves
  • Stress on the nerves
  • Nerves are overstretched
  • Cut or damaged by cancer or radiation treatment

Some children will have brachial plexus birth injuries. If labor lasts a long time or those that are born in a breech position may suffer brachial plexus injuries.

Common Brachial Plexus Injuries

There are several types of brachial plexus injuries. Below are some of the different types of injuries and their causes.

Brachial Plexus Neuropraxia (Stretch)

This type of injury occurs when the nerves are stretched to the point of injury. The stretching can either occur through compression or traction. Compression usually occurs at the nerve root as the head rotates.

Traction neuropraxia occurs when the nerve is pulled downwards. It is more common among young adults and adolescents. These types of injuries are known as brachial plexus burners or stingers because of the sensation that is felt.

Brachial Plexus Rupture

This type of injury occurs when the nerve is forcefully torn, either partially or completely. It causes weakness in the shoulder, arm, or hand and can cause instability in the muscles. You may also experience severe pain.

Brachial Plexus Neuroma

Neuroma refers to scar tissue that forms on the nerve after it has been cut. Cuts on your nerves can be caused by surgery. The scar tissue can cause a lot of pain in the nerve.

Brachial Neuritis

Brachial neuritis (also known as Parsonage Turner syndrome) is a rare, progressive disorder. Although the cause is unknown, it is thought to be related to an autoimmune response triggered by infections, injury, childbirth, or other factors. You may feel intense shoulder or upper arm pain, which progresses to muscle weakness and loss of sensation.

Brachial Plexus Avulsion

This refers to a condition where the brachial plexus nerves completely separate from the spinal cord. It is usually caused by heavy trauma, such as occurs in motor vehicle accidents. The result is severe pain.

It is very difficult to reattach the nerve roots to the spinal cord again. In many cases, it is not possible. This means that you may be left with permanent paralysis, weakness, or loss of feeling.

The Symptoms of Brachial Plexus Injury

The symptoms of brachial plexus injury will depend on where the injuries occur and how severe they are. Injuries high up on the brachial plexus can affect the shoulder, whereas those affecting the lower brachial plexus can affect the arm, wrist, or hand.

The severity of a brachial plexus injury varies depending on the cause and extent of the injury. Severe brachial plexus injuries can result in loss of arm, wrist, or hand movement and total loss of sensation. Minor brachial plexus injuries can cause a burning or stinging sensation along the nerve.

Some of the common symptoms of brachial plexus injuries include the following:

  • Loss of sensation or numbness in the hand or arm.
  • Loss of movement control in the shoulder, arm, wrist, or hand.
  • Burning, stinging sensation, or severe and sudden pain in the shoulder or arm.

Brachial plexus injury symptoms can last either a few weeks or much longer. This will depend on the extent of the injury. Some cases may require physical therapy.

How Is Brachial Plexus Injury Diagnosed?

Several diagnostic tests can be used to diagnose a brachial plexus injury. The following tests may be used by your doctor:

  • X-rays
  • Imaging tests
  • Nerve conduction tests
  • Tests using electrodes

How Is a Brachial Plexus Injury Treated?

Some mild brachial plexus injuries heal on their own without the need for treatment. This is often the case with babies who have a brachial plexus birth injury or adults with neuropraxia. It may, however, take several weeks or months to heal.

Non-Surgical Treatments for Brachial Plexus Injuries

Your doctor may recommend the following treatments to help you recover from a brachial plexus injury.

  • Pain Medication: To help relieve pain.
  • Corticosteroid injections or creams: These also help manage pain while healing.
  • Assistive devices: Braces, splints, and compression sleeves can support weakened muscles.
  • Physical therapy: Exercises can be given to help restore arm and hand function and improve flexibility and range of motion in stiff muscles and joints.
  • Occupational therapy: This can help you to regain practical skills to help you return to daily activities.

Surgical Treatment of Brachial Plexus Injuries

When brachial plexus injuries are unable to heal on their own, surgical treatments may be needed. These should be implemented within 6 months of the injury for best results.

Surgical procedures for brachial plexus injury include the following:

  • Nerve repair: Your surgeon will reconnect a torn nerve.
  • Neurolysis: Your surgeon will remove scar tissue from the injured nerve to improve nerve function.
  • Nerve graft: Your surgeon will take a healthy nerve from another part of the body to connect two ends of a nerve that has been separated.
  • Nerve transfer: Your surgeon will attach a less important but still functional nerve to the damaged nerve, creating a framework for new growth.
  • Tendon and muscle transfers: Your surgeon will take a less important tendon or muscle from one part of the body to the arm to restore function.

As nerves heal slowly, it may still take many months or years to see the results of surgery.

Make an Appointment with an OrthoNeuro Shoulder Specialist Today!

If you are experiencing a loss of feeling or discomfort in your shoulder, schedule an appointment with one of our specialists at OrthoNeuro today! Our expert doctors in Columbus, OH look forward to giving you the assistance you’re looking for. We will evaluate your unique lifestyle and goals to determine which type of treatment is best for you.

Medically reviewed by B. Rodney Comisar, MD, FAAOS

Shoulder Specialists

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