The brachial plexus is a network of nerves that runs from the bones in your neck into your shoulders. You have a brachial plexus on each side of your body.
A brachial plexus injury stretches or compresses the nerves in your shoulder, arm, and hand. Usually, only one side is affected. Symptoms of a brachial plexus injury can vary from person to person, depending on the severity and location of the injury.
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What Is a Brachial Plexus Injury?
The brachial plexus is the network of nerves around your neck that sends signals from your spine to your shoulders, arms, and hands.
Injury to the nerves of the brachial plexus occurs when they are cut, stretched, or compressed.
In severe cases, trauma or impact can completely tear the nerves away from the spinal cord, leaving your arm paralyzed.
What causes a brachial plexus injury?
The nerves in the brachial plexus are well-protected. It takes a lot of force to hurt them.
Injuries mostly happen after major trauma or impact — such as a motorcycle or car crash, stabbing, or gunshot wound.
Other causes include:
- Contact sports.
- Falls or other accidental injuries.
- Other medical conditions, including tumors and inflammation.
- Radiation from cancer treatments.
Newborn babies can also sustain brachial plexus injuries during childbirth.
Brachial plexus injury risk factors
There are no specific risk factors for brachial plexus injuries. While they usually occur after serious accidents, such as car crashes, other medical conditions can also affect the brachial plexus.
Complications of brachial plexus injury
Many less severe brachial plexus injuries heal with time. If a severe brachial plexus injury is left untreated, it may lead to joint stiffness or permanent loss of feeling or arm movement.
How common are brachial plexus injuries?
Brachial plexus injuries are rare, affecting just over one out of every 100 trauma patients. But the risk jumps to nearly one in 20 for people in motorcycle or snowmobile crashes. They often occur along with other major injuries and can be severe, especially when the damage is above the collarbone (near the neck).
In newborns, brachial plexus injuries affect up to four babies per 1,000 births. A common cause is shoulder dystocia, a rare but serious emergency during vaginal deliveries. It happens when the baby's shoulders get stuck after their head has been delivered, usually because their front shoulder is caught behind their mother's pubic bone. Most cases cannot be predicted or prevented.
What Are the Signs and Symptoms of Brachial Plexus Injuries?
Symptoms of a brachial plexus injury can vary from person to person, depending on the severity and location of the injury. Most often, brachial plexus injuries affect only one arm. Symptoms include loss of feeling or loss of movement in your shoulder, arm, or hand.
What are brachial plexus injury symptoms?
Car or motorcycle accidents — or other high-impact injuries — may tear or rupture the nerves of the brachial plexus.
In serious cases, the impact can actually tear the nerve root away from the spinal cord. This is a condition known as an avulsion.
Traumatic brachial plexus injury symptoms include:
- Lack of movement or feeling in the arm, including the shoulder and hand.
- Severe pain.
- Weakness or inability to use muscles in the hand, arm, or shoulder.
When should I see a doctor about my brachial plexus injury symptoms?
Brachial plexus injuries can cause permanent weakness or disability. If you suspect you have a brachial injury, contact a physician.
How Do You Diagnose a Brachial Plexus Injury?
Serious brachial plexus injuries are more likely to heal properly if treated within six months of the injury.
Your doctor will ask you questions about your medical and health history and will perform an extensive physical exam. They will also order imaging tests to help diagnose the injury.
Tests to help diagnose the severity of a brachial plexus injury may include one or more of the following:
- Angiogram.
- Computerized tomography (CT) scans.
- Electromyography (EMG) and nerve conduction studies.
- Magnetic resonance imaging (MRI).
- Myelography.
- Nerve tests.
- X-rays.
How Do You Treat a Brachial Plexus Injury?
Nonsurgical brachial plexus injury treatment
Less severe brachial plexus injuries often heal with rest alone, as there is no surgical treatment that can improve upon the recovery.
If the injury is mild or less severe, your doctor may prescribe:
- Exercises, which can be supervised by a physical therapist.
- Rest.
- Wearing an arm or shoulder brace.
Surgical brachial plexus injury treatment
When do you need surgery for a brachial plexus injury?
If severe scar tissue forms, you may need surgery to remove it and restore nerve function.
Brachial plexus surgery
If the injuries are severe and natural healing is unlikely, surgery can help restore function. These surgeries are usually performed by plastic surgeons because of the reconstructive techniques required.
They include:
- Joint fusion — Putting joints in a better position.
- Nerve repair — Reconnecting nerves, sometimes with grafts.
- Nerve transfers — Connecting less important working nerves to injured ones.
- Tendon or muscle transfers — Moving less important working tendons or muscles.
Recovery after surgery
Nerves heal slowly. It can take one to two years to see how well your arm works. Sometimes, you may have a second surgery to further improve the use of your arm. Exercises can help with your recovery after surgery.
How effective is treatment?
If your injury is severe, it’s may not be possible to completely heal your arm. But either through healing over time, or surgery, your arm can become more useful.
