Brachial Plexus Injury

Your hands, arms and shoulders receive signals from the spine through a network of nerves called the brachial plexus. An injury will occur when these nerves are compressed, stretched or in serious cases torn or ripped apart from the spine. People who participate in contact sports like football are more likely to suffer brachial plexus injuries. Babies can also sustain this type of injury during birth. The worst of brachial plexus injuries result from auto and motorcycles accidents. A serious injury will leave you with a paralyzed arm without sensation and functionality.

What Causes Brachial Plexus Injury?

Injury of the upper nerves that form the brachial plexus occurs when your shoulder is forced down while your neck stretches upwards away from the shoulder. Whenever your arm is forced to go over your head, the lower nerves are likely to get injured. There are a number of ways this can happen:

  • Contact sports: most contact sport players experience burners or stingers that are caused by the stretching of the brachial plexus past their limit upon collision with other players.
  • Trauma: most types of trauma including motorcycle accidents, car accidents, and fall wounds can lead to a brachial plexus injury.
  • Inflammation: inflammation is likely to destroy the brachial plexus. A rare condition referred to as Parsonage-Turner syndrome causes brachial plexus inflammation without trauma, and ends up paralyzing some arm muscles.
  • Tumor: benign or cancerous tumor can grow or put pressure on the brachial plexus or extend to the nerves, leading to injury of the brachial plexus.
  • Radiation treatment: brachial plexus injuries can occur as a result of radiation treatment.

Brachial Plexus Injuries in Newborns

The most common cause of injury to the brachial plexus in babies is the use of excessive force during delivery and labor as well as over-stretching. In most cases, the delivery is difficult and stressful, often characterized by use of birth-assistance tools like vacuum extraction tools and forceps.

Other causes of infant brachial plexus include maternal obesity, underdeveloped muscles in the neck, maternal diabetes, large infant size and weight, or breech delivery. In some cases, the baby sustains an injury of the brachial plexus because the doctor uses improper force or pressure when delivering the baby by hand. Injuries to the brachial plexus can also be caused by contractions. When labor is prolonged and the baby is stuck in the birth canal, contractions can exert force on the baby’s shoulder, upper arms and head, resulting in tearing, bruising and even fractures in rare cases.

What Are the Symptoms of Brachial Plexus Injury?

Types of Injury

The severity of injury varies based on the force applied on the nerves and the type of injury. You can also hurt a number of nerves of the brachial plexus in varying severity.

  • Stretch. This occurs when the nerve is mildly stretched out. In most cases it will heal on its own or with the help of simple non-surgical treatments.
  • Rupture. This occurs as a result of a forceful stretch that causes the nerve to partially or completely tear. In some cases these injuries require surgery to repair the damage.
  • Avulsion. This is the most severe type of brachial plexus injuries. The root of the nerve is completely torn from the spine. This type of injury might not be reparable through surgery.

Symptoms

  1. Minor injuries

They are referred to as burners or stingers and may have the following symptoms:

  • A burn sensation and the feeling of electric shock rushing through your arm
  • Weakness and numbness in the arm

These symptoms will be felt for some seconds or minutes but some people experience them for days or longer.

  1. Severe injuries

Symptoms of rupture or avulsion of the brachial plexus include:

  • Severe pain
  • Total lack of motion and sensation in the arm. This includes your hand and shoulder
  • Inability or weakness to use some shoulder, arm or hand muscles

When to Visit Your Doctor

When a brachial plexus injury is left untreated, it can lead to permanent weakness or disability. Even the injuries that seem minor need medical attention. Call your doctor when you experience:

  • Symptoms in lower and upper limbs
  • Symptoms in both arms
  • After a trauma, total paralysis occurs in the upper extremity
  • Weakness in any part of the arm after a trauma
  • Weakness in the arm or hand
  • Recurrent stingers and burners

How Is Brachial Plexus Injury Treated?

Non-Surgical Treatment

In most cases, mild injuries will heal on their own without surgery. This can take a week to months. When the nerves heal on their own, the functional outcomes are always better. If the doctor believes you have a chance of healing without surgery, he might delay the operation and watch your healing progress. Nerve healing takestime, so the doctor may advise you to go for physical therapy to avoid muscle and joint stiffness.

Surgery

Depending on how long you have had the injury and the type of the injury, the surgeon might suggest one of the following surgical techniques:

  • Nerve repair: this procedure is done immediately after a sharp laceration to the nerve, for example a knife wound. The surgeon reattaches the torn edges of the injured nerve.
  • Nerve graft: this procedure requires a healthy nerve to be taken from a different part of the body and stitched between the 2 edges of the torn nerve. The purpose of the transplanted nerve is to direct nerve regrowth and eventually reinstate nerve signals that will power the paralyzed muscles.
  • Nerve transfer: if there no functional nerve stumps present in the neck, this procedure is performed. A healthy donor nerve is taken from another part of the body and reconnected to the damaged nerve.
  • Tendon and muscle transfers: when the first trip to the doctor is delayed for more than a year after the injury, nerve reconstruction surgery outcomes are normally very poor, and reconstruction of the tendon or muscle is a better option in this case.

Rehabilitation

Nerve regeneration takes place quite slowly (about 1mm per day), and for this reason it normally takes patients months to heal after a brachial plexus injury. During healing, your therapist will help train you to use the uninjured arm for daily activities. Specific exercise is recommended for the fingers, wrist, elbow and shoulder to avoid muscle atrophy, contractures and stiffness. Your physical therapist can also advocate for assistive devices like a supportive bracing or splinting. This will help support the joints and limb. To prevent swelling which could lead to joint contractures and pain, compression gloves as well as sleeves are helpful. The pain can also be managed by taking pain medication, assistive devices and therapy. Healthy coping skills are needed to help make life adjustments.

 
 
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