Brachial Plexus Nerve Injury

What is Brachial Plexus Nerve Injury?

The brachial plexus is a network of nerves that control movement and sensation in the shoulder, arm, and hand. A brachial plexus nerve injury occurs when these nerves are stretched, compressed, or torn, leading to weakness, numbness, or even paralysis in the affected limb.

This type of injury can result from trauma, birth complications, or medical conditions that affect nerve function. The severity varies from minor nerve stretching to complete nerve rupture or avulsion (where the nerve is pulled out from the spinal cord).

Causes of Brachial Plexus Nerve Injury

Birth-Related Injuries (Obstetric Brachial Plexus Palsy – Erb’s Palsy)
Occurs when excessive force is applied to the baby’s head and neck during delivery.
More common in difficult or prolonged labor, breech births, or large babies.
Traumatic Injury (Most Common Cause in Adults)
Motorcycle and car accidents – Sudden impact can stretch or tear the nerves.
Sports injuries – High-impact sports like football or wrestling can damage the brachial plexus.
Falls or direct blows – Trauma to the neck and shoulder can stretch the nerve network.
Gunshot or stab wounds – Penetrating injuries can directly damage nerves.
Tumors and Infections
Tumors or cysts in the neck or armpit region can press on the brachial plexus.
Certain infections can cause inflammation, leading to nerve damage.
Inflammatory and Autoimmune Conditions
Parsonage-Turner Syndrome – A rare inflammatory disorder that affects the brachial plexus, causing sudden severe pain and weakness.

Types of Brachial Plexus Injuries

Neuropraxia (Stretch Injury) – Mildest Form
The nerve is stretched but not torn.
Typically heals on its own within a few weeks to months.
Common in sports injuries or mild trauma.
Rupture – Severe Injury
The nerve is partially or completely torn but still connected.
Surgical repair may be needed.
Avulsion – Most Severe Form
The nerve is torn from the spinal cord.
Requires complex surgical intervention like nerve grafting or muscle transfer.

Symptoms of Brachial Plexus Nerve Injury

Symptoms depend on the location and severity of the nerve damage.

Mild Injury Symptoms (Stretch or Partial Tear)
Weakness in the shoulder, arm, or hand.
Numbness or tingling in the arm.
Burning or electric shock-like pain.
Severe Injury Symptoms (Complete Tear or Avulsion)
Complete loss of movement and sensation in the arm.
Severe, constant pain.
Muscle atrophy (wasting of muscles due to lack of nerve supply).
Drooping eyelid (Horner’s syndrome) in some cases.

Diagnosis of Brachial Plexus Injury

A detailed examination and diagnostic tests are required to determine the severity and exact location of nerve damage.

Physical Examination
The doctor will assess muscle strength, reflexes, and sensation in the affected arm.
Specific tests check for muscle weakness and nerve dysfunction.
Imaging Tests
MRI (Magnetic Resonance Imaging) – Provides detailed images of the brachial plexus and detects nerve damage.
CT Myelogram – A specialized scan using contrast dye to visualize nerve roots.
Nerve Conduction Studies (Electromyography – EMG)
Measures electrical signals in muscles and nerves to assess damage.

Treatment Options for Brachial Plexus Injuries

Treatment depends on the severity of the nerve injury.

Non-Surgical Treatment (For Mild Injuries)
Physical Therapy – Helps maintain muscle strength and prevent joint stiffness.
Pain Management – Includes medications like NSAIDs, nerve pain relievers, and physiotherapy.
Bracing or Splinting – Supports the affected limb to prevent further damage.
Surgical Treatments (For Severe Nerve Damage)
If the nerves are severely damaged and do not recover within 3–6 months, surgery may be necessary.

a) Nerve Grafting
A damaged section of the nerve is replaced with a healthy nerve graft from another part of the body.
Helps restore nerve function over time.
b) Nerve Transfer Surgery
When the original nerve is too damaged, a healthy nerve from another area is connected to restore function.
Often used for avulsion injuries.
c) Muscle or Tendon Transfer
If nerves cannot be repaired, a muscle or tendon from another part of the body is transplanted to improve movement.

3. Rehabilitation and Long-Term Recovery
Occupational therapy helps patients regain arm and hand movement.
Electrical stimulation is sometimes used to keep muscles active while nerves recover.
Surgical follow-ups ensure proper nerve healing.

Prognosis and Recovery

The outcome depends on the severity of the injury and the timing of treatment.

Mild injuries (neuropraxia) may recover fully in a few months.
Moderate injuries (nerve rupture) may require surgery but still have a good prognosis.
Severe injuries (avulsion) may result in permanent disability, though surgery can improve function.
Factors That Influence Recovery
✔ Early diagnosis and treatment lead to better outcomes.
✔ Physical therapy and rehabilitation help restore function.
✔ Severe injuries may take years for nerves to regrow and heal.

Complications of Brachial Plexus Injury

Without proper treatment, the following complications can occur:

Permanent weakness or paralysis of the arm.
Chronic pain due to nerve damage.
Joint stiffness and muscle wasting.
Psychological effects, including frustration and depression due to loss of function.

Prevention of Brachial Plexus Injuries
While not all injuries can be prevented, certain precautions can reduce the risk:

✔ Proper protective gear – Wear helmets and protective padding in contact sports.
✔ Safe driving habits – Avoid high-impact motorcycle and car accidents.
✔ Prenatal care – Ensures proper delivery techniques to prevent birth injuries.
✔ Early medical intervention – Treat minor nerve injuries before they worsen.

Brachial plexus injuries can range from mild nerve stretching to severe paralysis of the arm. Early diagnosis, physical therapy, and surgical interventions can significantly improve outcomes. If you or a loved one experience symptoms like weakness, numbness, or loss of arm movement, seek medical help immediately.

More than ninety percent of patients with brachial plexus injuries require medical treatment alone. However, in cases where severe nerve damage occurs, advanced procedures such as nerve grafting or transfers may be needed. These evaluations typically involve MRI scans and nerve conduction studies by an expert neurologist or neurosurgeon.

If you are facing this situation, please consult Dr. Aditya Gupta for further evaluation and treatment.