Types and Symptoms of Brachial Plexus Injury | Neurology

Brachial Plexus Injury

What is brachial plexus injury?

A brachial plexus injury is a collection of nerves that arise from the spinal cord in the neck and travel from the arm. These nerves control muscles in the shoulder, elbow, wrist, and arm, as well as feeling in the hand. Some brachial plexus injuries are small and fully heal in several weeks. Other injuries are serious enough and can cause permanent deformity of the hand.

The brachial plexus can be injured in many ways: under pressure, strain, or over long distances. Cancer or radiation treatment can cut or damage nerves. Sometimes brachial plexus injuries occur in babies during delivery.

Alternate name

  • Brachial plexus lesion

Types of brachial plexus injury

Types of brachial plexus injury include:

Avulsion: The origin of the nerve is completely separated from the spinal cord (the most serious type).

Rupture: The nerve is torn, but not at the spinal insertion.

Neuroma: Scar tissue around the injured area increases, putting pressure on the injured nerve and preventing the nerve from sending signals to the muscle.

Neurapraxia: The nerve was stretched and damaged, but not torn.

Brachial plexitis: It is a rare syndrome and no cause can be identified. This is also known as Parsonage-Turner syndrome.

Risk factors

Factors that may increase your risk include: 

  • Shoulder dystocia (the baby’s shoulder holding restricted on the mother’s pelvis)
  • Maternal diabetes
  • Large gestational size
  • Difficult delivery needing external assistance
  • Prolonged labor
  • Breech presentation at birth
  • Above half of brachial plexus injuries have no identified risk factors

Causes of brachial plexus injury

Damage to the upper nerves that make up the brachial plexus causes your neck to move further and further away from the injured shoulder when your shoulder is forced down. Lower nerves are more likely to be injured when your hand is forcibly placed on your head.

Common causes of brachial plexus injury include:

Brachial plexus injury is mild and can occur:

  • Brachial plexitis (swelling of the brachial plexus for strange cause)
  • A cyst (the benign sac that contains fluid, air, or other materials)
  • Damage to the brachial plexus during birth
  • Infection in the shoulder, arm, or hand
  • Inflammation in the shoulder, arm, or hand
  • Nerve injury
  • Shoulder injury

Serious causes of brachial plexus injury include:

In severe cases of brachial plexus injury, the nerve can be severed from the spinal cord (a condition called avulsion) or severely compressed. The causes of brachial plexus injury cannot be resolved abruptly:

  • Autoimmune inflammatory disorder
  • Surgery
  • Traumatic injury
  • Tumor

Symptoms of brachial plexus injury

Depending on the severity and location of the injury, the symptoms of brachial plexus injury vary from person to person. Brachial plexus injuries affect just one arm.

Minor symptoms include:

People often undergo minor brachial plexus injuries while performing contact sports – soccer, hockey, or wrestling.

At times any of these symptoms can be difficult:

  • Loss of sensation
  • Muscle weakness
  • Numbness or tingling
  • Redness, warmth, or swelling
  • Reduction in limb flexibility
  • Shoulder, arm, hand, or finger pain
  • Soreness
  • Tingling or different unusual feelings in the shoulder, arm, or hand

Symptoms of moderate to severe injuries

A more severe injury can lead to significant weakness and, in more severe cases, complete paralysis of one or more muscles in the hand. If all the nerves in the brachial plexus are severely damaged, the entire arm from the shoulder to the fingers can also be paralyzed. These more serious injuries can include severe pain or even a full sensation from the injury.

Diagnosis of brachial plexus injury

A brachial plexus injury is diagnosed with a complete history and physical examination. It is necessary to see a doctor who practices in examining, diagnosing, and treating an injury within the first few weeks of an accident or incident.

After an exam, your doctor may order tests to discover the location and severity of your injury.

The brachial plexus may have one or more of the following tests to help determine the severity of the injury:

  • Electromyography (EMG) and nerve conduction studies
  • Magnetic resonance imaging (MRI)
  • Computerized tomography (CT) scans
  • Myelography
  • Angiogram

Treatment for brachial plexus injury

Each injury is unique and the two are not identical. It is very difficult to estimate the abrupt recovery rate, and it is important to follow experts such as the University of Michigan Interdisciplinary Treatment Team to make appropriate recommendations when necessary. The likelihood of a sudden recovery depends on the extent and severity of the injury.

Non-surgical treatment

As mentioned above, some damage to the brachial plexus during childbirth is very rare, and in most cases, the injury is mild. Mild stretching or moderate amount, usually the kind of injury that doesn’t require much treatment. Most babies born with this condition recover naturally as nerves heal over a period of three to six months.

Babies with mild to moderate nerve damage with marked paralysis can benefit from physical therapy as the nerves heal. Physical therapy includes movement movements, muscle building and strengthening exercises, gentle massage, and joint mobilization.

Aquatic therapy can also help some children, such as neuromuscular electrical stimulation, which uses a mild electrical current to stimulate muscle movement.

Surgery

The degree of functional impairment and the likelihood of recovery depends on the mechanism, type, severity of the injury, and the time elapsed since the injury. The most important decision your surgeons make is deciding when and when to perform surgery. The exact time and type of surgery are different for each patient. Therefore, it is important to assess in advance how the patient will view all of their treatment options.

Complications

For acute brachial plexus injuries, immediate surgical treatment is required to regain function. Without it, you may have a permanent disability and will not be able to use your arm or arm.

If you have a brachial plexus injury due to a lack of sensation, you should be especially careful when handling hot objects, razors, knives, or other objects that may damage it. This injury stops you from undergoing any other injury to the affected area, so you may not notice that you are suffering.

Prognosis

Brachial plexus injury depends on the severity of the nerve damage. For most babies, weakness is mild and heals within three to six months after birth. In these cases, the child should not experience any symptoms after the nerves have healed. For more serious injuries, including those in which the nerves are torn, more treatment is needed, including surgery to repair the damaged nerves.

When to contact the doctor

Brachial plexus injuries can cause constant instability or disability. Even if yours seems small, you may need medical attention. Consult your doctor if you have:

  • Recurrent burners and stingers
  • Weakness in your hand or arm
  • Neck pain
  • Symptoms in both arms

Departments to consult for this condition

  • Department of Neurology

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