What Is the Brachial Plexus?
Peripheral nerve injuries are a common result of complex trauma to the upper extremity. This can have a lasting effect on how the shoulders, arms, and hands function. The brachial plexus is a network of nerves that sends signals from the spinal cord into the upper extremity down to the fingertips. It is most commonly damaged from injuries to the neck or shoulder area during motor vehicle accidents or falls from great heights. When the brachial plexus becomes injured or impaired, patients may experience a variety of symptoms ranging from pain and discomfort, electric shock-like feelings, to complete loss of movement or sensation. Depending on the location and amount of damage, a brachial plexus injury can temporarily or permanently affect a person’s ability to use part or all of their arm. This is why it is critical to see a reconstructive hand surgeon to make sure the nerves are not permanently damaged, and to get early treatment to regain as much of the function as possible.
Signs & Symptoms
Symptoms of brachial plexus and other complex neurologic trauma will vary based on which area was injured and the amount of damage that occurred. When these nerves are not working properly, patients may experience one or more of the following:
- Burning sensations
- Electric shock-like sensations that travel up or down the arm
- Numbness
- Weakness
- Pain
- Inability to move the hand, wrist, or arm
Symptoms typically only affect one side of the body; however, they can often be debilitating without treatment.
Causes
Brachial plexus injury is caused by a nerve being compressed or stretched; or in severe cases, the nerve may be completely torn. This can result from trauma to the upper or lower nerves in the brachial plexus. For example, when the shoulder is pushed down and your neck stretches away from it, this can damage the upper nerves. Or, when your arm is forced over your head, this may affect the lower nerves. The most common causes of brachial plexus injury include:
- Contact sports: Football players and wrestlers are especially prone to neurologic trauma in the upper extremity.
- Car accidents: Vehicle and motorcycle accidents can damage the brachial plexus, stretching the nerves beyond their normal range.
- Difficult childbirths: A baby’s shoulders can get caught within the birth canal, resulting in a stretched or torn brachial plexus.
- Inflammation: Inflamed tissue can put pressure on the nerves, causing them to not function properly.
- Tumors: These growths can compress the brachial plexus causing damage.
Treatments
To determine the best form of treatment, your doctor will perform a physical exam and may require imaging tests such as a CT scan or MRI. Most patients will also require nerve conduction testing and will be referred to the appropriate specialist for this test. This will allow them to understand the extent of your damage, which can range from a nerve being stretched to it being torn from the spinal cord. In order to regain optimal function and feeling in your arm, it is important to get treated as early as possible. Even if the injury seems minor, seeking medical care to evaluate the severity of the damage can help prevent permanent function loss.
If the brachial plexus has only been stretched, you may recover without the need for treatment. However, many cases require physical therapy or further treatment to restore function and prevent stiffness. If your injury requires surgery, your doctor may perform one or more of the following:
- Neurolysis, or scar release, around the injured section of the nerve
- Nerve graft to replace the damaged section of nerve
- Peripheral nerve transfer—replacing the torn nerve farther down the arm with a branch of a functioning nerve to another area
- Microvascular muscle transfer to replace the lost function with a muscle from another part of the body
- Tendon transfer to replace the lost function by re-routing a muscle that still functions in the area
- Joint fusions can be used to stabilize certain joints to a better functioning position
Brachial plexus injuries are extremely complex, and it may take months to years to recover. When you come in for your consultation, one of our surgeons will educate you about your condition and create a personalized treatment plan to allow for the best possible outcome.
