Definition of Brachial plexus injury
A brachial plexus injury is an injury to the brachial plexus — the network of nerves that sends signals from your spine to your shoulder, arm and hand.
A brachial plexus injury occurs when these nerves are stretched, compressed or, in the most serious cases, torn. This can happen when your shoulder is pressed down forcefully while your head is pushed up and away from that shoulder; a direct contact hit also can compress these nerves.
Brachial plexus injuries are common in contact sports such as football, but they can also result from auto or motorcycle accidents or falls. Babies sometimes sustain brachial plexus injuries during birth. Other conditions, such as inflammation or tumors, may affect the brachial plexus.
Minor injuries may get better on their own, but severe brachial plexus injuries require surgical repair.
Symptoms of Brachial plexus injury
Signs and symptoms of a brachial plexus injury can vary greatly, depending on the severity and location of your injury. Usually only one arm is affected.
Less severe injuries
Minor damage often occurs during contact sports, such as football or wrestling, when the brachial plexus nerves get stretched or compressed. Known as stingers or burners, these injuries can produce the following symptoms:
- A feeling like an electric shock or a burning sensation shooting down your arm
- Numbness and weakness in your arm
These symptoms usually last only a few seconds or minutes, but in some people may linger for days or longer.
More-severe symptoms result from injuries that seriously injure or even tear or rupture the nerves. The most serious brachial plexus injury (avulsion) occurs when the nerve root is torn from the spinal cord.
Signs and symptoms of more-severe injuries can include:
- Weakness or inability to use certain muscles in your hand, arm or shoulder
- Complete lack of movement and feeling in your arm, including your shoulder and hand
- Severe pain
When to see a doctor
Brachial plexus injuries can cause permanent weakness or disability. Even if yours seems minor, you may need medical care. See your doctor if you have:
- Recurrent burners and stingers
- Weakness in your hand or arm
- Weakness in any part of the arm following trauma
- Neck pain
- Symptoms in both arms
- Symptoms in upper and lower limbs
Damage to the upper nerves that make up the brachial plexus tends to occur when your shoulder is forced down while your neck stretches up and away from the injured shoulder. The lower nerves are more likely to be injured when your arm is forced above your head. These injuries can occur in several ways, including:
- Contact sports. Many football players experience burners or stingers, which can occur when the nerves in the brachial plexus get stretched beyond their limit during collisions with other players.
Difficult births. Newborns can sustain brachial plexus injuries when there are problems during birth, such as a breech presentation or prolonged labor.
If an infant’s shoulders get wedged within the birth canal, the force used to pull the baby free also can damage the nerves in the brachial plexus. Most often, the upper nerves are injured, a condition called Erb’s palsy. Total brachial plexus birth palsy occurs when both the upper and lower nerves are damaged.
- Trauma. Several types of trauma including motor vehicle accidents, motorcycle accidents, falls, animal bites or bullet wounds can result in brachial plexus injuries.
- Inflammation. Inflammation may cause damage to the brachial plexus. A rare condition known as Parsonage-Turner syndrome (brachial plexitis) causes brachial plexus inflammation with no apparent shoulder injury.
- Tumors. Noncancerous (benign) or cancerous tumors can put pressure on the brachial plexus or spread to the nerves, causing damage to the brachial plexus.
- Radiation treatment. Radiation treatment may cause damage to the brachial plexus.
Participating in contact sports, particularly football and wrestling, or being involved in high-speed accidents increases your risk of brachial plexus injury.
Complications of Brachial plexus injury
Given enough time, many brachial plexus injuries in both children and adults heal with no lasting damage. But some injuries can cause temporary or permanent problems:
- Stiff joints. If you experience paralysis of your hand or arm, your joints can stiffen, making movement difficult, even if you regain use of your limb. For that reason, your doctor is likely to recommend ongoing physical therapy during your recovery.
- Pain. This results from nerve damage and may become chronic.
- Loss of feeling. If you lose feeling in your arm or hand, you run the risk of burning or injuring yourself without knowing it.
- Muscle atrophy. Slow-growing nerves can take several years to heal after injury. During that time, lack of use may cause the affected muscles to break down (degenerate).
- Permanent disability. How well you recover from a serious brachial plexus injury depends on a number of factors, including your age and the type, location and severity of the injury. Even with surgery, some people experience permanent disability, ranging from weakness in the hand, shoulder or arm to paralysis.
Preparing for your appointment
A number of tests may be used to help diagnose the type and severity of brachial plexus injuries. When you make your appointment, be sure to ask whether you need to prepare for these tests. For instance, you may need to stop taking certain medications for a few days or avoid using lotions the day of the test.
Other suggestions for getting the most from your appointment include:
- Write down all your symptoms, including how you were injured, how long you’ve had your symptoms and whether they’ve gotten worse over time.
- Make a list of all medications, vitamins and supplements that you’re taking.
If possible, take along a family member or friend. Sometimes it can be difficult to absorb all the information you’re given during an appointment. Someone who accompanies you may remember something that you forgot or missed.
This is especially important if your child has a brachial plexus injury. For most babies, the injury heals on its own without any lasting damage, but children who don’t show improvement in the first three to six months of life may require surgery. This means parents face some difficult decisions, and it’s often helpful to have a friend or family member who can offer advice and support.
- Don’t hesitate to ask questions. Children and adults with brachial plexus injuries have several options for restoring lost function. Be sure to ask your doctor about all the possibilities available to you or your child. If you run out of time, ask to speak with a nurse or have your doctor call you later.
Tests and diagnosis
To diagnose your condition, your doctor will review your symptoms and conduct a physical examination.
To help diagnose the extent and severity of a brachial plexus injury, you may have one or more of the following tests:
- Electromyography (EMG). During an EMG, your doctor inserts a needle electrode through your skin into various muscles. The test evaluates the electrical activity of your muscles when they contract and when they’re at rest. You may feel a little pain when the electrodes are inserted, but most people can complete the test without much discomfort.
- Nerve conduction studies. These tests are usually performed as part of the EMG, and measure the speed of conduction in your nerve when a small current passes through the nerve. This provides information about how well the nerve is functioning.
Magnetic resonance imaging (MRI). This test uses powerful magnets and radio waves to produce detailed views of your body in multiple planes. It often can show the extent of the damage caused by a brachial plexus injury.
This test may be used to determine if a nerve has been severed completely from your spinal cord. This test can also be used to assess the status of arteries that are important for the limb or for reconstruction of it.
New methods of high resolution MRI, known as magnetic resonance neurography, may be used.
Computerized tomography (CT) myelography. In CT myelography, a computerized tomography (CT) scan is conducted that uses a series of X-rays to obtain cross-sectional images of your body.
CT myelography uses a contrast material, injected during a spinal tap, to produce a detailed picture of your spinal cord and nerve roots during a CT scan. This test is sometimes performed when MRIs don’t provide adequate information.
Treatments and drugs
Treatment depends on several factors including the severity of the injury, the type of injury, the length of time since the injury and other existing conditions.
Nerves that have only been stretched may recover without further treatment.
Your doctor may recommend physical therapy to keep your joints and muscles working properly, maintain the range of motion, and prevent stiff joints.
The healing process sometimes forms scar tissue that must be removed surgically to improve the nerve’s function. Surgical repair is often required for nerves that have significant surrounding scar tissue or that have been cut or torn.
Surgery to repair brachial plexus nerves should generally occur within three to six months after the injury. The chances of improved function after surgery drop if nerve surgery occurs more than six months after the injury, as the muscles may not recover their function.
Types of surgery
- Nerve graft. In this procedure, the damaged part of the brachial plexus is removed and replaced with sections of nerves cut from other parts of your body. This helps restore your arm’s function.
Nerve transfer. When the nerve root has been torn from the spinal cord, surgeons often take a less important nerve that’s still attached to the spinal cord and attach it to the nerve that’s no longer attached to the spinal cord. Surgeons sometimes may transfer two nerves to attach to two different nerves.
In some cases, surgeons may perform this technique at a level close to the targeted muscle in an effort to speed up recovery rather than doing a repair (nerve graft) farther from the muscle.
Sometimes doctors may perform a combination of nerve graft and nerve transfer.
Nerve tissue grows slowly, about an inch a month, so it can take several years to fully recover after surgery. During the recovery period, you must keep your joints flexible with a program of exercises. Splints may be used to keep your hand from curling inward.
- Muscle transfer. Muscle transfer is a procedure in which your surgeon removes a less important muscle or tendon from another part of your body and transfers it to your arm. This may be necessary if your arm muscles deteriorate.
Pain from the most severe types of brachial plexus injuries has been described as a crushing sensation or a constant burning. Drugs such as codeine sulfate are generally used immediately after the injury. Antidepressant, anticonvulsant and muscle relaxant medications also can be helpful.
Pain control and a device called transcutaneous electrical nerve stimulation (TENS) sometimes provide relief. TENS involves using electrodes attached to your skin to deliver electrical impulses to nearby nerve pathways to help control and relieve pain. In extreme cases, surgery may be necessary.
Although damage to your brachial plexus often can’t be prevented, you can take steps to reduce the risk of complications once an injury has occurred:
For yourself. If you temporarily lose the use of your hand or arm, daily range of motion exercises and physical therapy can help prevent joint stiffness.
Avoid burns or cuts, as you may not feel it if you’re experiencing numbness.
If you’re an athlete who has experienced several injuries to the brachial plexus area, your doctor may suggest you wear specific padding to protect the area during sports.
- For your child. If you’re the parent of a child with Erb’s palsy, it’s important that you exercise your child’s joints and functioning muscles every day, beginning when your baby is about 3 weeks old. This helps prevent the joints from becoming permanently stiff and keeps your child’s working muscles strong and healthy.