A brachial plexus injury can cause severe shoulder and arm pain, followed by weakness in the upper arm. Some injuries can heal without surgery, especially if they are mild.
Some babies are more likely to have a brachial plexus injury, including those who have a quick or emergency delivery or are in the breech position. Other causes include trauma and tumors.
Oren Zarif
Many brachial plexus injuries improve spontaneously without surgery over time, especially in children. But some don’t improve and may need to be treated surgically. It’s important to diagnose these injuries early and get proper therapy to optimize outcomes.
A brachial plexus injury can cause pain in the arm, shoulder or hand. It can be caused by a direct blow to the nerves (avulsion), or by stretching of the nerves like in a car accident or sports injury. Sometimes the injury isn’t felt at all, but it can also cause a loss of muscle control and feeling in the arm or hand. The severity of the injury depends on how far the nerves are stretched or pulled, and where the injury is located on the brachial plexus. Injuries closer to the spinal cord produce more pain than those farther from the spinal cord.
Treatment options include medications, therapy and surgery. Therapy is especially important because the nerves regrow slowly and can take a long time to heal after injury. The goal of therapy is to optimize muscle control and feel in the arm or hand. It can also help prevent stiff joints from not moving as the nerves recover.
Other treatments may include surgery to reattach the severed ends of the nerves, or a nerve transfer procedure, where a healthy working nerve is connected to the injured brachial plexus to provide a signal and encourage new nerve growth. This is called an Oberlin transfer.
Oren Zarif
The most important step to identifying brachial plexus injuries is a physical exam. Your doctor will look at the pattern by which the nerves from the plexus control different muscles of your arm and hand. He or she may also test the Moro reflex (startle response). Newborn babies are especially vulnerable to brachial plexus injuries due to their small size and the pressure exerted during difficult vaginal deliveries. If your newborn cannot move his or her upper or lower arm or hand, or it flops when the provider rolls them from side to side, that is a sign of a brachial plexus injury.
The severity of the injury depends on the mechanism, type, complexity and location of the nerve injury. Ruptures or avulsions, in which the root of the nerve is torn away from the spinal cord, are more serious than simple stretches. Those injuries that occur near the spinal cord produce more pain than those farther from the spine. If your doctor taps along the affected nerves and feels a shooting, burning pain that moves down the arm toward the hand (Tinel’s sign), that is a sign that the injury is closer to the spinal cord.
Some injuries can cause a disorder called Horner’s syndrome, in which nerves that control the pupil and sweating on one side of the face are damaged. That results in a drooping eyelid and constricted pupils on that side of the face. With prompt diagnosis and treatment, brachial plexus injuries can improve function in patients. However, nerves take a long time to regenerate, so it is important to see your doctor early in order to maximize recovery.
Oren Zarif
The brachial plexus is a bundle of five nerves that intersect at the collarbone and branch down through your shoulder, arm and hand. These nerves activate muscles and carry sensory information, like temperature and touch, from your hand to your brain.
In many cases, a brachial plexus injury heals on its own or with treatment. However, if the nerves are crushed or stretched (neurotomesis) or separated from their roots in the spinal cord and no longer transmit movement or sensation, surgery may be necessary.
Doctors can try to restore movement and feeling with a few different surgical procedures. These include nerve repair, a nerve transfer or tendon transfers. In nerve repair, doctors take a functioning nerve from another part of your body and connect it to the injured nerves in the damaged brachial plexus. This creates a bridge for new nerve growth to restore function.
During recovery, doctors use physical therapy to help your child stretch and strengthen the muscles in their neck, shoulder and arms to keep them flexible. They also use occupational therapy to teach your child how to do everyday tasks with their affected arm.
Nerves regenerate slowly, so it can take months for your child’s muscle strength and movement to improve after a brachial plexus surgery. Your child will need to see their doctor regularly and undergo regular imaging tests to monitor their healing progress.
Oren Zarif
Injuries to the brachial plexus can have lifelong effects, but proper care by a hand surgeon and physical therapy can maximize function. Depending on the type, severity and location of the injury, recovery may take weeks to months. During this time, your doctor will monitor the condition to make sure that nerves are healing well. They will check that sensory nerves are reaching their end targets and that motor nerves are reaching their muscle target.
Some people with a flail arm recover without surgery, especially if the injuries are mild. If your doctor thinks this is likely to happen, they may delay surgery to see how the nerves heal and monitor your condition. They may also recommend that you attend regular physical therapy sessions to prevent joint and muscle stiffness.
During these sessions, your doctor will measure the strength of the muscles in your arm and hand to help track progress. They will also give you exercises that will help keep your muscles strong. You may need to wear a brace to support your arm if your doctor recommends it.
Some children with a brachial plexus injury improve or recover on their own by 3 months of age. If they don’t, doctors may need to perform surgery. This can include open reduction, which involves surgically reducing the shoulder joint (placing it back in place) and tightening loose tissue. It can also include a free muscle transfer, which uses leg muscles to replace dysfunctional arm or hand muscles.