Brachial Plexus Injury

What is a brachial plexus injury?

 

A brachial plexus injury occurs when a group of nerves, located in the spinal cord, undergo a type of trauma. These nerves send signals to a person’s shoulder, arm, and hand. The injury involves the nerves getting:

  • Stretched
  • Squeezed together
  • Ripped apart or torn away from the spinal cord

Less severe brachial plexus injuries, known as stingers or burners, may occur in contact sports, like football or wrestling. Sports trauma is not the only possible cause of a brachial plexus injury. It can also stem from:

  • Birthing trauma to babies
  • Inflammation or tumors
  • Car or motorcycle accidents

A severe brachial plexus injury can leave a person’s arm paralyzed, but there is treatment and surgical procedures. Speak with a healthcare provider to determine your best treatment plan.

What are the symptoms of a brachial plexus injury?

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Symptoms related to a brachial plexus injury differ based on the severity of the injury and its location. One arm is typically affected with these injuries.

 

Less Severe Injuries

Common symptoms can include:

  • An “electric shock” or burning sensation shooting down the affected arm
  • Numbness and weakness in the arm

The duration of these symptoms may be a few seconds or minutes. Symptoms can last for days or longer. Speak immediately with your doctor if you notice ongoing or worsening pain.

 

Severe Injuries

More-serious symptoms of a brachial plexus injury may involve:

  • Intense pain
  • Loss of feeling in the arm (and the shoulder and hand)
  • Weakness or inability to use muscles (in the hand, arm, or shoulder)

 

The most severe symptoms typically occur when the brachial plexus injury results in tears or ruptures of the nerves, or if the nerve root is cut or torn from the spinal cord.

What can cause a brachial plexus injury?

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A brachial plexus injury is caused in different ways when the upper nerves or the lower nerves are injured. An injury in the upper nerves is caused when:

  • The shoulder is forced down on one side of the body
  • The head is pushed to the other side in the opposite direction

 

Lower nerves are generally affected by a brachial plexus injury if the arm gets forced above the head. The most common causes of these injuries are:

  • Contact sports (football, wrestling)
  • Birth (high birth weight, long labor, breech/bottom-first delivery)
  • Injuries (motor vehicle accidents, falls, bullet wounds)
  • Tumors and cancer treatments (neurofibromatosis, after undergoing radiation)

How is a brachial plexus injury diagnosed?

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Diagnosing a brachial plexus injury will require that you undergo a physical exam and have your healthcare professional review your symptoms. Additional tests will let your doctor get a clearer idea of the severity of your brachial plexus injury.

  • X-ray: Imaging the shoulder and neck may reveal fractures or other related injuries.
  • Electromyography (EMG): The test examines the electrical activity of muscles, both when they tighten and when they are at rest.
  • Nerve conduction studies: These tests utilize electrical signals to give your doctor an idea of how well a nerve is working.
  • Magnetic resonance imaging (MRI): Getting an MRI will help show detailed images of the organs and tissues, including how much damage exists in the brachial plexus.
  • Computerized tomography (CT) myelography: Contrast dye is injected during a spinal tap to help identify any issues in the spinal cord and nerve roots. The procedure is often used if an MRI does not show enough details.

 

It can be concerning, or even scary, if you have a brachial plexus injury and do not know the extent of it. Speaking with a healthcare professional can help you determine your next steps.

How is a brachial plexus injury treated?

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How a healthcare provider decides to treat a brachial plexus injury will depend on the:

  • Severity of the injury
  • Type of injury
  • Length of time since the injury
  • Other existing conditions in a patient

 

Nerves that were only stretched may heal independently without invasive treatment. Speaking to a healthcare provider may lead to a recommendation of undergoing physical therapy. Doing physical therapy can help to:

  • Improve the function of joints and muscles
  • Maintain your full range of motion
  • Avoid joint stiffening

 

Pain medication is a treatment method if you are in extreme pain, often described as:

  • Debilitating
  • Severe
  • A constant crushing/burning sensation

 

Pain tends to go away within three years for most patients, but that is not always the case. If it does not subside, surgery is another option and sometimes the best treatment plan for serious nerve injuries. Delaying surgery by more than two to six months might make it more difficult to significantly repair nerve damage.

 

Potential surgical procedures include:

  • Neurolysis, to free up nerves from any scar tissue
  • Nerve repair, to repair nerves injured by sharp objects (knives)
  • Nerve graft, which replaces the damaged part of the brachial plexus with nerves from other parts of the body
  • Nerve transfer, to help with allowing new nerve growth by using a less important but functional nerve
  • Muscle transfer, by taking a muscle or tendon from another part of the body (thigh) and reconnecting nerves and blood vessels to the muscle

 

Nerve tissue growth is a slow process. It may take years before the final results of any surgery are clear. Newer imaging techniques help healthcare providers determine when surgery is the best long-term option for an individual.

Are complications common with a brachial plexus injury?

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A brachial plexus injury generally heals over time and has few to no lasting complications. The instances when there are short-term or lasting problems may involve:

  • Lifelong pain
  • Numbness (leading to a risk of injuring or burning yourself without knowing it)
  • Muscle atrophy
  • Stiff joints (from hand or arm paralysis)
  • Permanent disability

 

An individual’s recovery time and success from a serious brachial plexus injury can also vary based on their age. Surgical procedures can improve the condition, but there may be lasting muscle weakness or paralysis.

How can you prevent a brachial plexus injury?

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It is not always possible to avoid experiencing a brachial plexus injury. If you are injured, the best path forward may be to assess how you can reduce the risk of complications.

 

Adults can:

  • Do daily range-of-motion exercises and physical therapy to prevent joint stiffness
  • Protect themselves from burns and/or cuts
  • Wear padding to protect the affected area when playing sports

 

If a child has brachial plexus palsy, speak with a doctor about how you can exercise their joints and work their muscles on a daily basis. Starting when a baby is a few weeks old helps prevent joints from becoming permanently stiff. These exercises will also help improve the strength and health of your child’s better-functioning muscles.

Even if the symptoms seem mild, it is important to seek prompt medical care for a brachial plexus injury. The injury may cause you lasting weakness or disability, but early treatment enables many people to lead healthy lives and improve their strength and mobility.

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