Brachial Plexus Injury

What it is

The brachial plexus is a network of nerves that starts at the spinal cord in the neck and travels into the arm. Its nerves control the muscles of the shoulder, elbow, wrist, and hand, and carry sensation back to the brain. An injury can affect any or all of these functions.

What causes it

• Stretching: the head and neck forced away from the shoulder, as in a motorcycle or car accident. In newborns, it can happen during delivery if the shoulder gets stuck (brachial plexus birth injury).
• Pressure: from a fracture, dislocation, bleeding, or a tumor near the nerves
• Cuts: from sharp objects, gunshot wounds, or, rarely, surgery nearby

Symptoms

• Numbness, pins and needles, or trouble sensing where the arm is
• Weakness, or in severe injuries a limp arm
• Pain, sometimes shooting down the arm

Diagnosis

A careful examination of strength and sensation throughout the arm, imaging such as MRI, CT, or myelography, and nerve studies (EMG/NCS), often repeated over weeks to months to track recovery.

Treatment

The most important first step is evaluation by a physician experienced in treating brachial plexus injuries. Most patients need a combination of:

• Observation: mild injuries may recover on their own, with repeated examinations to track recovery
• Therapy: to prevent stiff joints while muscles recover, strengthen them as they return, and help with pain
• Surgery: for severe injuries or those that do not recover, including clearing scar tissue from the nerves (neurolysis), nerve repair, nerve transfers, and tendon transfers. More than one surgery may be needed.

Recovery

Recovery depends on which nerves are injured, the type and severity of the injury, and your age. Some minor injuries recover completely in weeks, while severe injuries can cause permanent disability despite the best treatment. Younger patients tend to recover faster and more completely. Timely evaluation gives the best chance of maximizing function.