Brachial Plexus Injury
What Is a Brachial Plexus Injury?
A brachial plexus injury is a type of nerve damage that can occur when the brachial plexus, which is a group of nerves that control the movement and feeling in your arm and hand, is injured. These injuries can range from mild to severe and can cause problems with movement and sensation in the affected arm and hand. If you are experiencing any problems with movement or sensation in your arm or hand, it is important to see a doctor to determine if you have a brachial plexus injury. Treatment for these injuries typically includes physical therapy and/or surgery.
What Is the Brachial Plexus?
It stems from nerve roots that are embedded in the cervical (neck) and upper trunk (torso) spinal cords (C5-T1). As a result, the brachial plexus creates an extensive network connecting to the arm’s nerves. The nerves of the brachial plexus enable your arm to type on your keyboard, or throw a baseball. These nerves control your wrists, hands, and arms.
A sensory connection exists between the brachial plexus nerves and the skin. When you grab a pan with your hand, it tells you it’s too hot for you to handle.
A description of the brachial plexus anatomy: In the neck, there are nerves that extend down the arms and shoulders.
Anatomy of the Brachial Plexus
Branches and sub-branches of the brachial plexus connect the roots to the shoulder and the arm, which are classified into a few sections: divisions, trunks, cords, and branches. While they may not be functionally distinct, they are both helpful in explaining brachial plexus anatomy.
Five major nerve branches exit the brachial plexus and run down the arm:
- Musculocutaneous nerve – Located in the nerve roots C5-C7 of the upper limb, this nerve flexes both the elbow and shoulder muscles.
- Axillary nerve – It arises from the C5 and C6 nerve roots and is responsible for the rotation of the shoulder and lifting of the arm.
- Median nerve – Branches from nerve roots C6-T1 and controls movement of forearms and hands.
- Radial nerve – Roots of C5-T1 control the muscles of the elbow, upper arm, forearm, and hand.
- Ulnar nerve – Located in C8-T1, it is responsible for fine motor control of the fingers.
How Does a Brachial Plexus Injury Occur?
Several factors can cause injury to the brachial plexus, including pressure, stress, and stretching to an excessive extent. In addition, nerves can be cut or damaged during cancer treatment or radiation. There is also a possibility of brachial plexus birth injuries.
When the brachial plexus is damaged, the spinal cord can lose communication with the arm, hand, and wrist. The injury may prevent a person from using their arm or hand. There is also a high risk of a partial or total loss of sensation in this area following a brachial plexus injury.
Traumatic brachial plexus injuries vary in severity depending on where the nerve is injured and if the patient sustained severe injuries. It is possible that some people are able to regain function and feel, while others may have lifelong disabilities due to the inability to use or feel a part of their arm.
Different Types of Brachial Plexus Injuries
Brachial plexus injury varies in severity and the way the nerves are damaged determines which category an injury belongs to.
Brachial Plexus Neuropraxia (Stretch)
The process of stretching the nerves until they are injured is called neuropraxia. This injury can be caused either by compression or traction. Generally, a rotation of the head causes the brachial plexus nerve root to be compressed. Most patients with compression neuropraxia are in their elderly years.
As a result of pulling the nerve downward, traction neuropraxia occurs. Young adolescents and young adults are more likely to sustain this injury than compression neuropraxia.
Burners and stingers refer to the injuries of the brachial plexus according to whether they cause a burning or stinging sensation as the primary symptom. A shock-like sensation can also be felt.
Brachial Plexus Rupture
A forceful stretch results in partial or complete tearing of the nerve in the brachial plexus. A brachial plexus rupture is more serious than neuropraxia. There is the potential for damage to the arm, hand, and shoulder, and even making certain muscles useless after a fracture. Severe pain can also accompany these injuries.
A rupture of this type can often be repaired surgically, depending on the severity and location of the injury.
Brachial Plexus Neuroma
A nerve that has been injured by a cut during surgery, or by an injury from another source, can develop scar tissue as it tries to repair itself. Nerves along the brachial plexus may experience painful knots caused by scar tissue called a neuroma.
Surgical removal of the scarred nerve tissue is one of the techniques for treating brachial plexus neuromas. In order to prevent the formation of another neuroma, the surgeon either caps or connects the nerve to another nerve.
Brachial neuritis, also known as Parsonage-Turner syndrome, is a progressive and rare disorder of the brachial plexus nerves. Symptoms include pain, weakness, loss of muscle strength, and even loss of sensation in the upper arm and shoulder areas caused by this syndrome. This syndrome typically affects the neck or shoulder area, but it can also affect the diaphragm and legs. It is unclear what causes brachial neuritis, but it might be caused by an autoimmune response triggered by infections, trauma, childbirth, and other factors.
Brachial Plexus Avulsion
When the nerve root is completely severed from the spinal column, it is described as a brachial plexus avulsion. A traumatizing event, such as a car or motorcycle crash, causes this injury. Avulsions are more painful than ruptures and are often more severe. Since reattaching the root to the spinal cord is typically difficult and impossible, avulsions often result in permanent weakness, paralysis, and loss of sensation.
What Are Some Causes of a Brachial Plexus Injury?
Typically, upper nerve damage to the brachial plexus occurs when the injured shoulder is forced down while the injured neck is stretched high and away from the injured shoulder. Forcefully lifting your arm above your head can aggravate your lower nerves.
Numerous causes can lead to these injuries, including:
Contact Sports – As football players collide with other players, the athletic injuries they sustain may be more than just a sprain, the nerves in their brachial plexus can get stretched beyond their limit and cause burning sensations or stingers. They may most likely suffer minor brachial plexus injuries, depending on the damage.
Complicated Birth – Newborns are at risk for a brachial plexus birth injury. These are often related to breech presentation, high birth weight, and prolonged labor. Should a baby’s shoulders get lodged within the birth canal, the risk that they might suffer brachial plexus injuries increases. An Erb’s palsy usually results from an injury to the upper nerves.
Accident Trauma – A traumatic brachial plexus injury may result from a number of traumas, such as motorcycle accidents, motor vehicle accidents, falls, or gunshot wounds.
Tumors & Cancer Treatments – It is possible that tumours can grow in or along the brachial plexus, they can press on it, or they can spread to the nerves. Brachial plexus damage may result from radiation therapy applied to the chest.
Symptoms of Brachial Plexus Injuries
Patients with brachial plexus injuries as well as others who sustained other injuries experience varying symptoms. Common brachial plexus injury symptoms include:
- Numbness or weakness
- Sensation loss
- Paralysis (loss of movement)
Brachial plexus injuries cause pain as a result of the nerve rootlets being avulsed from the spinal cord. The pain is usually neuropathic in origin, so managing it can be very challenging. It may last for quite some time.
The pain associated with brachial plexus injuries near the spinal cord is often worse than that associated with injuries further from the spinal cord. Furthermore, a spinal cord injury or one near it can cause numbness, a condition known as paresthesia or dysesthesia.
Brachial Plexus Injury Complications
Both children and adults can recover from brachial plexus injuries with little or no long-term damage given enough time. Other injuries can cause long-term pain or disability, such as:
- Stiff Joints – The joints of your hand and arm can stiffen if you’re paralyzed. Regardless of whether you eventually regain use of the limb, this can make moving quite difficult. As a result, your physician is likely to prescribe continued physical therapy during your recovery period.
- Pain – Damage to the nerves may result in chronic pain.
- Numbness – It is possible to burn or injure yourself involuntarily if you lose feeling in your arm or hand.
- Muscle Atrophy – Nerve injuries can take several years to heal since it takes several years for the nerve to regrow. A lack of use during that time may result in a breakdown of affected muscles.
- Permanent Disability – An injury to the brachial plexus can be devastating, especially if it is severe. Your recovery depends on several factors, including your age and the type and location of the injury. Even after surgery, some people end up with a permanent disability.
What Tools Do Physicians Use to Diagnose Brachial Plexus Injuries?
X-Ray – These imaging tests produce clear images of dense structures, such as bone. A chest X-ray, shoulder X-ray, and arm X-ray are taken to rule out any associated fractures. X-rays of the chest are taken to check for fractures or injuries to the lungs. Your doctor may suggest that you undergo pulmonary function testing with the assistance of a pulmonologist if you are unable to take a full, deep breath during the chest x-ray. This will rule out damage to nerve endings controlling deep breathing.
Computed Tomographic (CT) Scan
Testing the spinal nerve through a CT scan for avulsions is considered to be the most reliable way to diagnose spine injuries. CT images of the injured spinal cord can be enhanced by injecting contrast dye around the spinal cord. Typically, CT is performed at least three or four weeks after the injury so that any blood clots which may have formed in the area of the nerve root can dissolve. A magnetic resonance imaging (MRI) scan may be used in addition to or instead of a CT scan at some centers.
Neurotransmission and muscle signals are measured through these tests. Since they can confirm the diagnosis, locate the nerve injury, describe its severity, and assess how much the nerve is recovering, they are important evaluation tools. 3-4 weeks after the injury, a baseline electrodiagnostic test is conducted. During that time, any nerve damage can be identified. An electrodiagnostic study is repeated a couple of months after the initial test and then over time to determine if the nerves are recovering.
Brachial Plexus Injury Treatment
Brachial Plexus Injury Treatment: Non-Surgical Methods
A combination of nonsurgical treatments can be helpful in treating mild brachial plexus injuries. You may be advised to use any of the following methods:
- Physical Therapy – Exercises that can improve the range of motion and flexibility in stiff muscles and joints may be part of physical therapy to restore function to the arms and hands.
- Corticosteroid Creams or Injections – For pain management during healing, corticosteroids are used as creams or injections.
- Assistive Devices – A brace, a splint, or compression sleeves can be used as assistive devices.
- Medication – The use of medications for pain management.
- Occupational Therapy – Patients with severe muscle weakness, numbness, and pain will need occupational therapy to learn practical skills such as dressing and cooking.
- Brachial Plexus Injury Treatment: Surgical Techniques
In cases where the injuries to the brachial plexus fail to heal on their own, surgery may be required to repair the damage. Brachial plexus surgery produces results gradually, so it may take months or years for patients to see noticeable results.
It is best to have brachial plexus surgery within six months of an injury to maximize the nerve recovery rate. The following procedures might be prescribed by your surgeon:
- Nerve Repair – Putting a torn nerve back together.
- Neurolysis – To improve the function of the injured nerve, nerves are slashed to remove scar tissue.
- Nerve Grafts – A nerve graft is another way to treat severe brachial plexus injuries. Nerve grafting connects two ends of a damaged nerve with a healthy nerve from another area of the body in order to guide the healing process.
- Nerve Transfers – The nerve transfer process is the process of attaching a less important but still functional nerve to a damaged nerve, thus creating a framework for new nerve growth.
- Tendon & Muscle Transfer – A tendon or muscle may be transferred from one part of the body to another in order to restore normal function.
Consult your healthcare provider for help in deciding whether surgery is right for you.
Injuries to the brachial plexus can be quite serious and should be evaluated by a medical professional as soon as possible if you are experiencing any symptoms. Depending on the severity of the injury, individuals may require physical therapy or surgery in order to recover function and mobility in the arm and hand. It is important to take precautions to avoid injuring this area of the body and to be aware of the risks involved in any activity.
FAQs About Brachial Plexus Injuries
Does a Brachial Plexus Injury Heal on Its Own?
It is not always necessary to treat brachial plexus injuries. People with birth injuries to the brachial plexus, particularly babies, or adults with neurological disorders may recover without treatment, although it can take a few weeks or months for the injury to heal.
Even though certain exercises can help with healing and function, injuries that require surgery may require more severe treatment. When the brachial plexus is injured, it is essential to seek immediate medical attention from a healthcare provider.
What Happens if the Brachial Plexus Is Injured?
If the brachial plexus is injured, the individual may experience pain, numbness, tingling, and weakness in the arm and hand. The severity of the injury will determine the extent of symptoms and how long it takes for a full recovery. Some people may make a full recovery, while others may experience long-term problems. It is important to seek medical attention as soon as possible if you are experiencing any symptoms of a brachial plexus injury.
What Are the Main Injuries that Occur in Brachial Plexus?
There are several main injuries that can occur in the brachial plexus, which include:
– avulsion: this is when the nerve is completely torn away from the spinal cord
– rupture: this is when the nerve is damaged but still attached to the spinal cord
– traction: this is when the nerve is stretched or pulled too hard
These are the most common types of injuries that can occur in the brachial plexus.
How Do You Know if Your Brachial Plexus Is Injured?
If you are experiencing any of the symptoms of a brachial plexus injury, it is important to seek medical attention. Symptoms can vary depending on which nerve is affected but may include loss of muscle power or feeling in the hand, decreased ability to rotate the wrist or bend the arm, pain in the shoulder, neck, chest, upper back, and arm, and weakness in muscles associated with hand movements. It is important to seek medical attention as soon as possible if you are experiencing any symptoms of a brachial plexus injury.
How Does the Brachial Plexus Get Injured?
The brachial plexus can be injured in many ways, including car accidents, falls, sports injuries, and childbirth. Any type of physical trauma can cause a brachial plexus injury. It is important to seek medical attention if you or someone you know is experiencing any of the symptoms of this injury.
How Can an Injury to the Brachial Plexus Be Prevented?
There are several things that can be done to help prevent an injury to the brachial plexus, including:
– Wearing seatbelts during car accidents
– When playing sports, you should use the appropriate safety equipment
– Using the proper safety equipment when working around machinery
– Exercising caution during any activity that could possibly cause harm
It is important to be aware of the risks involved in any activity and to take precautions to avoid injuries. Learning proper stretches before playing sports can help prevent injuries. Wearing the right protective gear while playing sports or working at a hazardous job site can also help avoid accidents.
How Can an Individual Recover From Injury to the Brachial Plexus?
There is no one-size-fits-all answer to this question, as the recovery process will vary depending on the severity of the injury. However, many people will require physical therapy in order to regain strength and mobility in the arm and hand. It is also possible in some cases to undergo surgery. It is important to seek medical attention as soon as possible if you are experiencing any symptoms of a brachial plexus injury.
What Is Avulsion Injury?
An avulsion injury is a type of brachial plexus injury in which the nerve is completely torn away from the spinal cord. This is a very serious injury and can lead to permanent damage. Avulsion injuries are rare but can occur when the nerve is stretched or pulled too hard.
What Is the Definition of Rupture Injury?
A rupture injury is a type of brachial plexus injury in which the nerve is damaged but still attached to the spinal cord. This is a less serious injury than an avulsion injury, but can still lead to permanent damage. Rupture injuries are more common than avulsion injuries and can occur when the nerve is stretched or pulled too hard.
What Is the Definition of Traction Injury?
A traction injury is a type of brachial plexus injury in which the nerve is stretched or pulled too hard. This can lead to damage to the nerve and can cause long-term problems. Traction injuries are the most common type of brachial plexus injury.
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