Overview
What Is The Brachial Plexus ?
The brachial plexus is a network of nerves that originate near the neck and shoulder. These nerves begin at the spinal cord in the neck and control the hand, wrist, elbow, and shoulder . Nerves are the electrical wiring system in all people that carry messages from the brain to the rest of the body. A nerve is like an electrical cable wrapped in insulation.
Motor nerves carry messages from the brain to muscles to make the body move. Sensory nerves carry messages to the brain from different parts of the body to signal pain, pressure, and temperature. The brachial plexus has nerves that are both motor and sensory.
Types Of Injuries
Injuries to the Brachial Plexus can involve :
- Tearing the nerve from the spinal cord (an avulsion)
- Tearing the nerve but not at the spinal cord ( a rupture)
- Scar tissue where an injured nerve has tried to heal putting pressure on the nerve and disrupting signals to the muscles ( a neuroma)
- Stretching but not tearing of the nerve where the nerve is able to heal itself (a praxis).
This a temporary condition where the muscle regains complete function. Denervated muscle can cause imbalances resulting in muscular and skeletal deformities in the elbow and shoulder. Also, the development of the affected arm can be compromised resulting in a shorter limb.
Injuries to the Brachial Plexus can result in full to partial paralysis of one or both arms with a temporary or, when the nerve cannot completely heal, a life time injury. While compromising muscle function and the ability to grasp, extend, and reach with the affected limb, the injury can also affect physical appearance.
What Happens When The Brachial Plexus Is Injured ?
The network of nerves is fragile and can be damaged by pressure, stretching, or cutting. Stretching can occur when the head and neck are forced away from the shoulder, such as might happen in a fall off a motorcycle. If severe enough, the nerves can actually avulse, or tear out of, their roots in the neck. Pressure could occur from crushing of the brachial plexus between the collarbone and first rib, or swelling in this area from injured muscles or other structures.
Injury to a nerve can stop signals to and from the brain, preventing the muscles of the arm and hand from working properly, and causing loss of feeling in the area supplied by the injured nerve. When a nerve is cut, both the nerve and the insulation are broken. Pressure or stretching injuries can cause the fibers that carry the information to break and stop the nerve from working, without damaging the cover.
When nerve fibers are cut, the end of the fiber farthest from the brain dies, while the insulation stays healthy. The end that is closest to the brain does not die, and after some time may begin to heal. If the insulation was not cut, new fibers may grow down the empty cover of the tissue until reaching a muscle or sensory receptor.
Some brachial plexus injuries are minor and will completely recover in several weeks. Other injuries are severe enough that some permanent disability involving the arm can be expected.
How Is Brachial Plexus Treated ?
Many brachial plexus injuries can recover with time and therapy. The time for recovery can be weeks or months. When an injury is unlikely to improve, several surgical techniques can be used to improve the recovery. To help decide which injuries are likely to recover, your physician will rely upon multiple examinations of the arm and hand to check the strength of muscles and sensation. Additional testing, such as an MRI scan, or CT scan/myelography, may be used to visually evaluate the brachial plexus. A Nerve Conduction Study/Electromyogram (NCS/EMG), a test that measures the electrical activity transmitted by nerves and muscles, may also be performed. In some cases, repair of the nerves or transfer of undamaged nerves from other areas of the body can be performed. In other cases, transfer of functioning muscles (tendon transfer) to take over areas of lost function can be performed.
Medical Treatment
Brachial plexus injuries are treated with neurosurgery to repair damaged nerves (primary surgery), surgeries to transfer tendons and muscles thereby improving functionality (secondary surgery), physical therapy (PT) to improve strength and range of motion, and occupational therapy (OT) to deal with issues of every day living.
Surgical Treatment
Primary surgeries are usually performed 5-12 months after the injury when it is apparent that the damaged nerves are unable to heal themselves. Secondary surgeries are typically done when skeletal and muscular development has matured to the point where surgical intervention has been demonstrated to be beneficial. This may occur in ages from toddler to adult depending on the injury and the proposed procedure.
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