What is a Brachial Plexus Injury?
The brachial plexus is the combination of nerves in the lower neck that allows you to use and feel your hands and arms. The motor nerves allow you to raise your arm or shake hands. The sensory nerves let you feel your pet’s fur or a cold glass. Damage to any part of the brachial plexus can result in the loss of use or feeling in the arm or hand controlled by that nerve. The injury may be from stretching, trauma or scar healing. A physical exam will indicate the injured nerves and imaging tests can further show the damaged areas. A stretched brachial plexus may heal on its own or require conservative treatment like ice or heat and physical therapy. More severe nerve injuries may require surgical procedures to repair the nerves and restore function. Getting an accurate evaluation and appropriate care will help you get better as quickly as possible.
Symptoms will depend on where the brachial plexus is injured. Injury to the upper neck nerves can decrease shoulder function while lower neck nerve injury will affect the arm and hand. Pain or numbness is usually the first sign of a brachial nerve injury. You may have aching, tingling or burning sensations in the arm or hand. The pain is usually only on the injured side of the body. You may be unable to control the arms, hands and fingers or your arm may just hang by your side. When you are unable to perform your normal daily activities then it is time to see your doctor. A simple nerve stretch may be painful for a couple of weeks and then resolve while a detached nerve will have more severe pain and require surgery to repair.
Anything that stretches, bruises or cuts the brachial plexus can cause temporary or permanent damage to the nerve bundles. During childbirth, there is a 1 in a thousand chance of stretching the brachial plexus as the shoulders exit the birth canal. Some children will recover on their own and obtain most or all normal function with physical therapy. Some children with more severe injuries will require the addition of physical therapy to improve hand and arm function. Surgery is an option that may be needed as well. The appropriate diagnosis and management is especially important with this type of injury.
Adults injure the brachial plexus through contact sports, trauma, falls or motor vehicle accidents. Stabbing and gunshots can severe the nerves. During a surgical procedure for another condition, positioning of the nerves may be damaged or with shoulder and arm procedures the nerves may be cut. Cancer can invade the nerve and radiation therapy can damage the nerve as well. In most cases the cause will be known as the event that caused the injury occurs at the same time that symptoms began.
The cause of brachial plexus can be divided into multiple categories. Brachial plexus neuropraxia is stretching or compressing of nerves from trauma that can be called a “burner” or “stinger” due to the sensation caused. A brachial plexus neuroma occurs when the end of a cut nerve grows a painful knot on the end requiring scar removal and capping or reattachment to another nerve. Brachial plexus ruptures occur when the nerve is overstretched causing a very painful partial or complete tear which can frequently be repaired with surgery. Finally, a brachial plexus avulsion occurs when the nerve root is completely torn from the spine which will most likely not be reparable and causes permanent paralysis and loss of feeling.
Your doctor will take a complete history which usually will detail when or how your injury occurred. A physical exam will evaluate you for your source of your pain and discomfort. Your shoulder, arm and hand nerve function will be evaluated along with muscle strength and skin sensation.
Imaging tests can help your doctor identify injured areas of spinal bones and muscles. X-rays of the neck and shoulder may be used to look for fractures or other injuries around the brachial plexus. A computed tomography (CT) scan uses the electromagnetic energy of X-rays to provide a detailed look at the bony anatomy and tissue around it. A magnetic resonance imaging (MRI) uses powerful magnets and radio waves to create a detailed picture of soft tissue of the muscles, soft tissue and nerves. Contrast dye may be used during both the CT scan and MRI to better evaluate the area of injury. Nerve conduction studies look for nerve damage by using electrodes to measure how quickly a nerve impulse is transmitted. An electromyogram uses needle electrodes to look for muscle damage. Evaluation of your strength and sensation will be monitored on a regular basis to look for improvement and imaging tests may be repeated as well.
A mild brachial plexus injury will frequently improve within a few weeks or months. Resting or exercises given to you by a physical therapist can allow your injury to heal. Ice or heat in the area of discomfort may help you feel better. Over-the-counter medications like ibuprofen (Advil, Motrin) or naproxen (Aleve) are NSAIDs (nonsteroidal anti-inflammatory drugs) that can decrease pain and swelling. Muscle relaxants and nerve pain medications can also be used. Steroid injections can decrease pain and inflammation. An occupational therapist can help you with skills to improve daily functioning when there is prolonged pain or weakness.
Surgery may be needed if your brachial plexus injury is severe or if conservative treatments do not provide pain relief or improve function. Nerve repair can take months or even years for the nerve to function. You would also want to undergo surgery no later than 6 months after your injury for best results. Our neurologists can let you know if you are a good candidate for nerve surgery. You may require one or a combination of the following procedures:
- Nerve repair reattaches a cut, torn or avulsed nerve.
- Nerve grafts replace damaged nerves with a piece of a healthy nerve from another part of the body.
- Nerve transfers redirect a less important nerve and attach it to the injured brachial plexus nerve.
- Neurolysis surgically removes scar tissue from an injured nerve to increase the nerve function.
- Muscle transfers can move a less important muscle to a more important muscle to increase function.
For infants, 10% of brachial plexus injuries will require surgical repair if there is no improvement in the first 3 months. Delaying the surgery for over a year can decrease the amount of function that can be achieved.
The pain of a brachial plexus injury can be excruciating and debilitating. The Norelle Health neurosurgeons are highly trained and skilled in the diagnosis, management, and treatment of all nerve disorders. Our neurosurgeons can provide the optimal treatment. Neurosurgery is considered essential by insurances and should be covered with your plan. As out-of-network providers, we will check your benefits for you and let you know what they are so there are no surprises. We use an individualized treatment plan for your concerns to provide a personalized holistic plan of care. If you would like assistance, please feel free to contact us (link to contact page) or call our office (link to phone number).