Brachial Plexus Injury Treatment

While some brachial plexus injuries are minor and heal completely without medical intervention, others are so severe they cause permanent disability in the arm.

At The Department of Neurosurgery at Rutgers Health and RWJBarnabas Health, our team of board-certified neurologists, neurosurgeons and other medical specialists will ensure you receive the highest-quality care for brachial plexus injuries. We utilize state-of-the-art research and advanced technology to accurately diagnose and treat brachial plexus injuries, examining each patient carefully to determine an individualized treatment plan.

If you have suffered from recurrent burning, stinging, or weakness in one or both arms, especially after direct trauma to the shoulder area, even if it seems minor, you may need medical attention. If severe, a brachial plexus injury can cause permanent disability and may require surgical intervention to preserve existing function.

Contact The Department of Neurosurgery at Rutgers Health and RWJBarnabas Health about treatment for your brachial plexus injury.

What Is the Brachial Plexus?

To understand brachial plexus injuries and the disabilities they can cause, it helps to know the function of the brachial plexus itself. This network of 5 intertwined nerves extends from the spinal cord in the neck and travels down the arms. The nerves control the shoulder, elbow, wrist and hand muscles, providing sensation in the arms and hands. There is a brachial plexus on both sides of the body.

The fives anatomic sections of the brachial plexus, any of which may be injured, include:

• Spinal nerves

• Trunk

• Divisions

• Cords

• Branches

Types of Brachial Plexus Injuries and Their Symptoms

Brachial plexus injuries are categorized by the level of nerve damage the patient suffers.

A less severe brachial plexus injury is neuropraxia. This injury is caused when the nerves are stretched mildly, and may heal on its own or require conservative, nonsurgical treatment to improve/restore normal function.

The more severe brachial plexus injuries include:

• Rupture: A part of the nerve is torn from a forceful stretch, causing it to tear partially or fully. These injuries are sometimes repairable through surgical treatment.

• Avulsion: This occurs when the nerve root is completely separated from the spinal cord, and causes severe weakness, or even the inability to use certain muscles in the upper extremity. As the most severe type of brachial plexus injury, avulsion requires expert medical care to preserve existing arm function and reduce nerve pain

• Brachial plexitis: Also called Parsonage-Turner syndrome, this rare condition is idiopathic, meaning there is no identifiable source. This causes inflammation of the brachial plexus, even though there was no previous trauma to the area.

Brachial Plexus Injury Symptoms

Depending on the severity and precise location of an individual’s brachial plexus injury, symptoms vary. In general, an injury to the brachial plexus cuts off some or all communication between the spinal cord and the entire affected upper extremity, including the arm and hands, causing loss of sensation.

Minor brachial plexus injuries often repair on their own, and if they require any treatment, it is usually in the form of rest, ice, relaxation, and over-the-counter pain relievers. More severe brachial plexus injuries can cause permanent problems, including muscle atrophy, numbness, and chronic burning/stinging pain. The individual’s specific injury type, location, and severity affect the patient’s prognosis for a good treatment outcome. However, certain patients may still be permanently disabled even after surgical treatment.

In general, all brachial plexus injuries include some degree of the following symptoms:

• Good control of the fingers, but minimal if any control over the shoulder and elbow muscles

• An individual can use his/her arm, but has little or no control over their fingers

• Some patients have a completely limp arm with no sensation or motor functions

• Some patients are affected in both arms.

Complications

Although there are no long-term studies explaining how the unaffected arm’s brachial plexus is impacted, or the function of the compensating arm in general, patients face common problems because it supports the majority of life functions and work. A lifetime of the arm not affected with the brachial plexus injury can cause overuse and repetitive stress syndrome. The extent of the injury of the affected arm directly impacts the damage the patient may incur over time.

Causes of Brachial Plexus Injuries

The brachial plexus nerves can be damaged by stretching, compression, and cutting. In the most severe cases, they are torn away from the spinal cord.

Some of the most common causes of brachial plexus injuries include:

• Contact sports: Football players who describe a burning, stinging pain in their arms are experiencing symptoms because the nerves in the brachial plexus have been stretched beyond their capacity during collision with another player.

• Trauma: Car accidents, falls, knife wounds, surgery-complications, and even bullet wounds can cause the brachial plexus to rupture or tear.

• Tumors and cancer treatments: Tumors can grow along the brachial plexus and put pressure on the nerves. Radiation therapy to the chest can also damage the brachial plexus.

• Birth injuries: During childbirth, very large infants, as well as those in the breech position, are at an increased risk of brachial plexus injuries. Babies are more likely to suffer from brachial plexus injuries if their delivery was an emergency and the baby had to be forcibly pulled out. The reason is usually because the baby’s neck has flexed severely in one direction.

Brachial Plexus Injury Diagnosis

A brachial plexus injury is diagnosed through diagnostic imaging tests, such as a magnetic resonance imaging (MRI) scan or computerized tomography (CT) scan, which can allow your neuroradiologist to better view the nerve structures. Your neurologist may order a nerve conduction study or electromyogram to determine nerve function and electrical activity, as well to help determine a treatment plan.

Brachial Plexus Injury Treatment

Treatment depends on the location of the brachial plexus injury and its severity, as well as the length of time elapsed since the injury occurred. If the injury involves stretched nerves that have not ruptured, the patient may recover without treatment, except perhaps physical therapy, which can improve or maintain range of motion and prevent joint stiffness.

Surgical Treatment

Within 8 weeks of the injury, the brachial plexus nerves should be repaired for the optimal result, as surgeries that occur later have lower success rates. Nerve tissue grows very slowly, taking several years before the full benefit is noticeable. During recovery, physical therapy is useful to help keep the joints flexible. A splint is also used to keep the hand stable and prevent is the injury from progressing.

Surgical treatments may include:

• Nerve graft: The area where the brachial plexus is damaged is then removed with sections of nerves harvested from other parts of the body and then grafted to the injured area(s). It can successfully improve arm function.

• Nerve transfer: If the patient has nerve avulsion (where the nerve root is torn away from the spinal cord), a less important nerve that still functions can be used to connect it to a non-functional nerve.

• Muscle transfer: This procedure involves a neurosurgeon removing a less important muscle or tendon, usually one in the thigh, and transfering it to the affected arm. The nerves and blood vessels supplying the arm are reconnected.

Post-Surgical Care

After brachial plexus repair surgery, the patient must be diligent with aftercare. Pain control is one of the more serious concerns, as these injuries can be debilitating and cause constant burning pain. Some patients are more likely to develop arthritis in the affected shoulder, arm, and hand due to previous overuse of the injured brachial plexus.

Request an appointment online now or call 833-656-3876.