What Is a Brachial Plexus Injury? Symptoms and Treatment

The brachial plexus is a bundle of nerves that allows us to sense the senses and control the movements of the arm and hand. Due to trauma, these nerve fibers can be injured suddenly; shoulder, arm and hand movements may weaken, paralysis may develop, sensation may decrease or disappear.

The brachial plexus starts from the neck and continues from the upper end of the chest to the armpit. It may be injured if the arm is forcibly pulled or stretched. Mild brachial plexus injuries can heal with physical therapy and time without the need for surgery. More severe injuries may require surgery to restore arm and hand function.

Anatomy

The brachial plexus consists of five nerve roots emerging from the neck level of the spinal cord. These are C5, C6, C7, C8 and T1 nerve roots. There are two separate brachial plexuses that go to the right and left arm. The brachial plexus is the rearrangement of nerve roots to form peripheral nerve fibers going to the arm and hand. Each nerve has a unique function. For this reason, the symptoms that occur according to the nerves affected by the injury also differ. The reorganization of nerves among themselves is analyzed anatomically in five different parts: spinal nerve, trunk, division, cord and branch. Injury may occur in one or more parts.

Reasons

Most brachial plexus injuries are caused by forceful pulling or stretching of the arm. Events such as falling, traffic accident (most often in motorcycle accidents), stabbing, gunshot wounds can cause this. Infants may develop brachial plexus palsy at birth. Radiotherapy used to treat tumors and cancer can also damage the brachial plexus.

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Damage Severity

  • Strain (neuropraxia): The nerve is slightly stretched. It can get better on its own or with physical therapy.
  • Rupture: A stronger stretch can lead to partial or complete rupture of the nerve. Sometimes it can be repaired with surgery.
  • Avulsion: It is the most serious brachial plexus injury. Nerve roots break from the spinal cord. It may not even be corrected with surgery.

Upper Truncus Damage

If the angle between the shoulder and the neck increases forcibly, for example, falling on the shoulder with the head turned to the opposite side, upper trunk damage may occur. As a result, loss of strength in the arm, inability to bend at the elbow; Sensation loss may occur in the shoulder, outer part of the arm and thumb.

Lower Truncus Damage

Lower trunk damage can occur if the angle between the arm and the chest is forcibly increased. In these patients, although shoulder and elbow function is preserved, hand function is lost. Over time, the fingers may take on a claw-like appearance. Loss of sensation can be seen in the little finger and ring finger.

Felci Pan-Plexus

In very severe trauma, nerves and trunks can be damaged at all levels. Paralysis of the entire arm and hand may develop.

Firearm Injuries

Lead can hit the nerve directly, causing damage, or more often, the shock waves created by high-velocity lead in the tissue can stretch and damage the nerve. Damage caused by the shock wave can heal on its own over time.

Sharp-Piercing Injuries

Direct damage to the nerve as a result of a knife injury often requires surgical intervention.

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Traumas that cause brachial plexus injury often also cause damage to other tissues. Arterial and vein injury, fractures, collapse in the lung, bleeding into the chest cavity or into the lung, spinal fracture, spinal cord injury , traumatic brain injury may occur together.

Brachial Plexus Injury Symptoms

Muscle weakness, loss of sensation, paralysis, pain are the main symptoms. The location of the symptoms varies depending on the nerve affected. As a result of damage to nerve fibers, difficult to treat pain that can be felt in different ways such as burning, stinging, tingling, electrification, called neuropathic pain, may occur. Neuropathic pain can persist for a very long time.

examinations

Examination findings allow to identify the damaged nerves to a large extent. However, imaging methods such as X-ray, CT, MRI and EMG are used to make a clearer diagnosis, to determine the degree of damage and possible additional injuries. EMG is a method of assessing nerve and muscle function by inserting a needle into the muscles and recording their electrical activity. On EMG, changes related to nerve damage are first detected 3-4 weeks after injury. Then, the nerve recovery can be followed by repeating the EMG every 2-3 months.

Operation

If it is not possible for the nerves to heal on their own, surgery may be recommended. However, in severe damage, recovery may not be possible even with surgery. In the surgery, the broken nerve fibers can be stitched together under the microscope. Sometimes, a piece of nerve (graft) taken from another part of the body can be used to join two broken nerves. The graft guides the ruptured nerve to re-extend starting from the spinal cord. A healthy nerve root is required for grafting. If this is not the case, nerve transfer surgery can be performed. In nerve transfer, the healthy nerve fiber, which is considered less functionally important, is cut and a branch is connected to the damaged nerve, which is considered more important.

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People more than 12 months after the initial injury benefit little from nerve remodeling surgery. Instead, tendon or muscle transfer surgeries may be beneficial.

Physiotheraphy

Physical therapy may be sufficient in mild brachial plexus injuries. While nerve recovery takes place over time, joint and muscle stiffness is prevented in physical therapy, and exercises for functional functions are performed. Nerve healing can take months or even years.

Physical therapy is also very important for the recovery process after surgery. Since nerve growth occurs at an average rate of 1 mm per day, no difference may be seen in the first months after the surgery. During this period, it is necessary to keep morale high and not lose motivation. Special exercises are performed to prevent stiffness of the shoulders, elbows, wrists and fingers. Joints can be supported with orthoses such as shoulder straps and wristbands. Compression gloves can be used to reduce hand edema. Occupational therapy teaches how to reuse the arm and hand in daily tasks. With sensory reeducation therapy , it can be helped to regain deteriorated sensory sensations. Physical therapies such as TENS and warming treatments can be applied to relieve pain.

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