Brachial Plexus Injury: Types, Causes, Diagnosis and Treatment

There are numerous ways to harm the brachial plexus, including pressure, tension, and excessive stretching. Radiation therapy or cancer treatment also has the potential to harm the nerves. Babies can occasionally sustain brachial plexus injuries during birth.

Injury to the brachial plexus prevents the arm, wrist, and hand from communicating with the spinal cord in whole or in part. You might not be able to utilize your arm or hand as a result. A common side effect of brachial plexus injuries is complete loss of sensation.

Depending on the area of the nerve that is affected and the amount of the injury, a brachial plexus injury can range in severity. While some people regain function and sensation, others can have lifelong limitations.

Types Of Brachial Injury

The severity of the injury and the way the nerves are hurt are used to classify brachial plexus injuries.

• Neuropraxia- Stretch of the Brachial Plexus occurs when the nerves are stretched to the point of damage. Compression and traction are the two basic mechanisms through which this injury happens. 
  • The brachial plexus nerve root is squeezed in a compression injury, most often as a result of head rotation. The most prevalent type is compression neuropraxia which  typically affects older persons.
• Traction neuropraxia- It is brought on by the nerve being dragged, usually downward. Compression neuropraxia is more common, despite the fact that teenagers and young adults are more prone to this injury.
• These injuries are typically referred to as "burners" or "stingers" in the brachial plexus depending on whether the major symptom is a burning or stinging sensation. An electric shock could also be experienced.
• Brachial Plexus Abrasion- When the brachial plexus ruptures, the nerve is violently stretched and either completely or partially tears. The harm is more severe than neuropraxia. After fractures, the shoulder, arm, or hand may become weakened, and some muscles may even lose their usefulness. These injuries might result in significant discomfort in addition to modest pain.
• Neuroma of the Brachial Plexus- Scar tissue may occasionally occur when nerve tissue is damaged, such as after a cut during surgery, as the nerve works to heal itself. This type of painful knot on a brachial plexus nerve is referred to as a neuroma, which is a type of scar tissue.
  • Surgery is used to remove the damaged nerve tissue from brachial plexus neuromas. For the purpose of preventing the development of another neuroma, the surgeon then either caps the nerve or connects it to another nerve.
• Neuropathy in the Arms- Sudden, acute pain in the shoulder and upper arm is a symptom of this illness, which also causes muscle weakness, atrophy, and possibly loss of sensation.
• Brachial Neuritis- Brachial neuritis, also known as Parsonage-Turner syndrome, is a rare, progressive condition that affects the brachial plexus nerves. This syndrome starts with sudden, intense shoulder and upper arm pain and develops to weakening muscle atrophy and even loss of feeling. 
  • This syndrome typically impacts the shoulder and arm, although it can also impact the legs and diaphragm. Although the exact etiology of brachial neuritis is unknown, it may be linked to an immunological reaction brought on by infections, trauma, childbirth, or other circumstances.
• Avulsions are more painful than ruptures and are more serious. Avulsions can result in persistent weakness, paralysis, and numbness since it is challenging and frequently impossible to reattach the root to the spinal cord.

Causes Of Brachial Plexus Injury During Birth

The brachial plexus nerves in the shoulder are particularly susceptible in newborns. One to two deliveries per 1,000 result in brachial plexus injury, which is a reasonably common birth injury. Newborns of women with diabetes and larger newborns who experience challenging vaginal births are particularly vulnerable to this damage.

Large newborns may have a higher chance of suffering brachial plexus injuries during delivery. The brachial plexus nerves beneath the baby's shoulder may be harmed if the head is stretched away from it. 

Brachial plexus injuries can also occur in babies born in the breech position (the bottom end comes out first) and in women whose labors are especially protracted.

Shoulder dystocia, which can harm the brachial plexus, happens when the shoulder becomes momentarily trapped under the pubis during delivery.

There are typically two types of brachial plexus damage during birth:

• Erb's Palsy- It presents as a  common lesion to the upper brachial plexus which results in numbness, loss of motion, and also the inability to elevate an arm, flex the elbow, or bring things closer to the mouth.
• Klumpkes Palsy- A less frequent injury affecting the lower brachial plexus, Klumpke's palsy causes loss of sensation and/or motion in the wrist and hand, including the inability to move the fingers.

There is a considerable range in the severity of these injuries. With physical and occupational treatment, the majority of children with brachial plexus birth injuries will restore all or most of their full function. However, some children do heal on their own. In order to obtain good function, a smaller group will need surgery. Long-term outcomes can be enhanced by early detection and intervention.

Causes Of Brachial Plexus Injury In Adults

 Brachial plexus injuries in adults can result from many different things, such as:

• Blunt trauma- incidents like slips and falls or car crashes.
• Sports- related injuries are common, especially in contact sports like football.
• As a result of a gunshot, the nerves are torn through or very near.
• Medical trauma-  the cutting of a nerve during surgery, the injury caused by an injection or the positioning of the body during surgery.
• Cancer- The brachial plexus is invaded by a tumor.
• Radiation therapy- The nerves are damaged as a result of radiation treatment.

Diagnosis Of Brachial Plexus Injury

In order to determine whether a brachial plexus injury has occurred, a medical professional will examine the hand and arm and perform tests to assess sensation and function.

Several additional diagnostic procedures include these:

• An X-ray of the neck - It helps to diagnose any fractures or any  other injuries to the bone or the tissues that surround the brachial plexus nerves.
• A brachial plexus injury may be visible through imaging tests like an MRI or CT scan, during which contrast dye may be administered.
• The nerve conduction study and the electromyogram are two tests that use needle electrodes to measure electrical activity and nerve function.
• For the purpose of allowing your doctor to track your development, these tests could be repeated every few weeks or months.

Treatment Of Brachial Plexus Injury

The degree of the injury, the type of injury, how long it has been since the injury, as well as any underlying conditions, all influence how it will be treated.

Only stretched nerves may heal on their own without additional medical care.

To keep the muscles and joints flexible, maintain range of motion, and prevent stiff joints, your doctor could advise physical therapy.

Brachial plexus nerve repair surgery should often be done within six months after the initial injury. Less successful surgeries are performed when that time has passed.

The full benefits of surgery may not become apparent for several years since nerve tissue grows slowly. You must follow an exercise regimen during the healing process to maintain your joints mobile. The hand could be prevented from moving by splints.

• Neurolysis. The goal of this technique is to release the nerve from scar tissue.
• Nerve Grafting. The injured brachial plexus portion is removed during this treatment, and pieces of nerves from other regions of the body are used to replace it. Over time, new nerves can sprout on this bridge.
• Transfer of Nerves. When a nerve root has been severed from the spinal cord, surgeons frequently join a less significant nerve that is still functioning with a more significant nerve that is no longer functioning. For the growth of new nerves, this acts as a bypass.
• Transfer of Muscle. During a muscle transfer, your surgeon will cut a less significant muscle or tendon from another area of the body, generally the thigh, transport it to the arm, and then reattach the nerves and blood arteries that nourish the muscle.
• Reducing pain
• The most severe brachial plexus injuries can cause pain that is incapacitating, extremely crushing, or persistently burning. For the majority of people, this pain disappears after three years. If painkillers are unable to relieve it, your doctor may advise surgery to cut off the pain signals coming from the injured area of the spinal cord.

Complications Of Brachial Plexus Injury

Many brachial plexus injuries in both children and adults recover with little to no long-term effects when given ample time. However, some wounds might result in either short- or long-term issues, such as:

• Stiff Joints- The joints may become stiff and even if you eventually regain the use of the leg, this can make movement challenging. Because of this, your doctor could advise continuing physical therapy as you recuperate.
• Pain- This is brought on by nerve injury and may last a long time.
• Numbness- There is a high risk of  burning yourself or hurting yourself without realizing it if you lose feeling in your arm or hand.
• Muscle Wasting-  After an injury, nerves regenerate slowly and may take several years to recover. Lack of use during that time may lead the damaged muscles to degenerate.
• Permanent Disability- The kind, location, and severity of the damage, as well as your age, all affect how successfully you recover from a significant brachial plexus injury. Some patients still have paralysis or persistent muscle weakness after surgery.

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