Brachial Plexus

What is a Brachial Plexus Injury?

The brachial plexus (brachial means arm and plexus mean communication or meeting point) is a complex network of nerves that begins at the spinal cord in the neck and controls the movement and sensation in the fingers, hand, arm and shoulder. Brachial plexus injury comprises a variety of conditions that may impair function of the brachial plexus nerve network leading to a weak or paralyzed arm.

Causes of a Brachial Plexus Injury

Adults can experience brachial plexus injuries due to trauma, inflammation, entrapment or tumor.  Traumatic injury may arise from motorcycle accidents, snowmobile accidents, sporting activities or workplace activities. It can also result from a stabbing or gunshot wound. Inflammatory conditions, such as those due to a virus or immune system maladies or pressure from tumors in the area (especially from lung tumors) can compromise  the brachial plexus.  Damage that results from radiation therapy can also result in brachial plexus injury.

Types of Injuries

Because the brachial plexus is critical for the transmission of nerve signals from the spinal cord to the shoulder, arm, and hands, even mild injuries can cause problems. Brachial plexus injuries are categorized according to the type of trauma experienced by the nerve:

  • Neurapraxia: A stretched nerve which is the mildest type of brachial plexus injury is the result of the nerve getting slightly stretched. This injury has a good prognosis of recovery.
  • Axonotemesis – this means the axons (equivalents of the copper filaments in an electric cable) have been severed. The prognosis is fair.
  • Neuroma: A condition in which scar tissue has grown around a disrupted nerve  and can prevent re-growth of nerve fibers.
  • Rupture: this means the nerve has been stretched and at least partially torn, but not at the spinal cord.
  • Neurotemesis – this means the entire nerve has been divided. The prognosis is very poor.
  • Avulsion: The roots of the nerves are torn away from the spinal cord and have no chance to recover. Multiple root avulsions is the most common diagnosis in high-energy traumatic brachial plexus injuries, the type that occurs in a motorcycle or off-road vehicle accident.

Symptoms of Brachial Plexus Injury 

The symptoms of a brachial plexus injury typically depend on the extent (number of nerve roots involved) and severity of the injury. Immediate symptoms generally occur after a severe injury to the neck, shoulder, arm, or hand but may also occur after something as simple as laying on the arm for too long. The following are common symptoms of BPI:

  • Crushing or burning pain
  • Decreased muscle tone and strength in the upper arm, forearm and/or hand
  • Loss of function in the upper arm, forearm and/or hand
  • Numbness
  • Change in the Sweating patterns of the upper arm, forearm and/or hand 
  • Wrist drop or inability to extend the wrist

Diagnosis of Brachial Plexus Injury 

A brachial plexus injury is diagnosed with a thorough history and physical examination.  It is important to see a physician who specializes in examining, diagnosing, and treating brachial plexus injury within the first few weeks after the accident or incident occurs.

When you come to the University of Michigan:

  • We will take your complete medical history, ask you about your pattern of symptoms and conduct a physical exam.
  • We will consult with your referring physician, if there is one.
  • We may conduct tests such as X-rays, blood tests and muscle biopsies. 
  • When a brachial plexus injury is suspected, we will most likely do an MRI to help us assess the extent of damage. 
  • We may also conduct electrodiagnostic studies such as EMG, NCV, SNAP and SSEP to evaluate the electrical activity in your skeletal muscles. 

Treatment for Brachial Plexus Injury

Each injury is very unique and no two are alike.  It can be difficult to estimate the rate of spontaneous recovery, and it is very important to be followed by experts such as the interdisciplinary treatment team at the University of Michigan in order to make the appropriate recommendations at the necessary times.  The potential for spontaneous recovery depends on the extent and severity of injury.

Non-Surgical Treatment Options for Brachial Plexus Injury

There are many non-surgical treatments to help you recover. Physical rehabilitation therapy is always part of the recovery process for a brachial plexus injury. One of the main goals of rehabilitation is to prevent muscle atrophy until the nerves regain their function. The University of Michigan has a strong occupational therapy/ physical therapy program which will be important in helping you regain function.  Some brachial plexus injuries may heal without treatment; Your health care team can assess the extent of damage to your brachial plexus nerve and give you a prognosis for recovery and guide your treatment recovery .

Surgical Treatment for Brachial Plexus Injury

The degree of functional impairment and potential for recovery depend on the mechanism, type, complexity of the brachial plexus injury, and time from injury. The most important decision your surgeons will make is determining if and when surgical intervention should occur.  The exact timing and type of surgery is different for each patient. Therefore, it is important for the patient to be evaluated early so that they may consider all of their treatment options.

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