Description

The brachial plexus is the bundle of nerves that sends signals from the spinal cord to the shoulder, the arm and the hand. A brachial plexus injury occurs when these nerves are stretched, squeezed, or in the most serious cases, ripped apart or torn away from the spinal cord.

Minor brachial plexus injuries, called stingers or burners, are common in contact sports, such as football. Sometimes babies get the injuries of the brachial plexus when he is born. Other health problems, such as inflammation or tumors, which can affect the brachial plexus.

The most severe brachial plexus injuries happen during the car or motorcycle accidents. Bad brachial plexus injuries can leave the paralyzed arm, but surgery can help.

Symptoms

The symptoms of a brachial plexus injury can differ depending on the severity of the injury is and where it is located. Usually only one arm is affected.

Less serious injuries

Minor damage often occurs during contact sports, such as football or wrestling, when the nerves of the brachial plexus is stretched or squeezed. These are called stingers or burners. Some of the symptoms are:

  • A sensation like an electric shock or a burning sensation shooting down the arm.
  • Numbness and weakness in the arm.

These symptoms usually last only a few seconds or minutes, but in some people the symptoms can last days or more.

More-serious injury

More serious symptoms occur when there is an injury that seriously damaged or even ruptures or tears the nerves. The most severe brachial plexus injury is when the root of the nerve is cut or torn from the spinal cord.

The symptoms of serious injuries can include:

  • Weakness or not being able to use certain muscles in the hand, the arm or the shoulder.
  • Loss of sensation in the arm, including the shoulder and in the hand.
  • Intense pain.

When to see a doctor

Brachial plexus injuries can cause lasting weakness, or disability. Even if yours seems minor, you may need medical attention. Consult with your healthcare provider if you have:

  • Burners and stingers that keep coming back, or symptoms that do not go away quickly.
  • The weakness in the arm or hand.
  • The neck pain.
  • The symptoms in both arms.

Causes

Injuries of the brachial plexus in the upper part of the nerves to happen when the shoulder is forced down on one side of the body and the head is pushed towards the other side in the opposite direction. The bottom of the nerves are more prone to injury when the arm is forced above the head.

These injuries can occur in many ways, including:

  • Contact sports. Many soccer players have been burners or stingers. These are caused when the nerves of the brachial plexus is stretched beyond its limit during the clashes with other players.
  • Birth. Newborns may have injuries of the brachial plexus. This is more common in babies with high birth weight, a lot of work and a bottom-first, also called a breech presentation. If a baby's shoulders get stuck in the birth canal, brachial plexus palsy is more likely. Most often, the upper part of the injured nerves. This is called Erbs palsy.
  • Injury. Many of the injuries — including motor vehicle accidents, motorcycle accidents, falls and gunshot wounds — can damage the brachial plexus.
  • Tumors and cancer treatments. The tumors can grow on its own. Rarely, they may form due to a health condition, such as neurofibromatosis, or after radiation treatment.

Risk factors

Contact sports, especially football and wrestling, or be in high-speed motor-vehicle accidents, increases the risk of injury to the brachial plexus.

Complications

Many minor brachial plexus injuries will heal with time, with few or no problem. But some injuries can cause short-term or long-term problems, such as:

  • The stiffness in the joints. If you have hand or arm paralysis, the joints can get stiff. This can make it difficult to move, even if you are able to use the hand or the arm again. For that reason, your health care professional may suggest a course of physical therapy during your recovery.
  • Pain. This is caused by damage to the nerves and may be for life.
  • Numbness. If you lose feeling in your arm or hand, you are at risk of burns or injury to yourself without knowing it.
  • The muscle atrophy. Nerves grow slowly and may take many years to heal after injury. During that time, the non-use of the muscles can cause them to break down.
  • Permanent disability. How well you recover from a serious injury to the brachial plexus can depend on many things, such as your age and the type, location and severity of the injury. Even with the surgery, some people have muscle weakness or paralysis that lasts for the rest of their lives.

Prevention

Despite an injury to the brachial plexus can't always be avoided, you can take steps to reduce your risk of complications after an injury:

  • For yourself.If you can't use the hand or arm for a short time, daily range-of-motion exercises and physical therapy can help to prevent stiffness of the joints. Avoid burns or cuts, as you can not feel if you have numbness. If you are an athlete with an injury to the brachial plexus, your healthcare provider may suggest that you use padding to protect the area of sports.
  • For your child. If your child has a brachial plexus palsy, it is important to exercise your child's joints and muscles that work every day. You can start when your baby is just a couple of weeks old. This helps stop the joints to become permanently stiff. It also keeps your son to work the muscles strong and healthy.

For yourself. If you can't use the hand or arm for a short time, daily range-of-motion exercises and physical therapy can help to prevent stiffness of the joints. Avoid burns or cuts, as you can not feel if you have numbness.

If you are an athlete with an injury to the brachial plexus, your healthcare provider may suggest that you use padding to protect the area of sports.

Diagnosis

To diagnose your condition, your healthcare provider checks your symptoms and do a physical exam. To know the severity of your injury to the brachial plexus is, you may need one or more of the following tests:

  • X-ray. An x-ray of the shoulder and neck can show fractures or other injuries.
  • Electromyography (EMG). During an EMG , a healthcare provider puts a needle electrode through your skin into various muscles. The test evaluates the electrical activity of your muscles when they contract and when they are at rest. You may feel a little pain when the electrodes are placed in, but the majority of the people can finish the test without much hassle.
  • Nerve conduction studies. These tests are performed as part of the EMG . That measure how fast and how well the electrical signals that travel along the nerves. This provides information about the way in which the nerve is working.
  • Magnetic resonance imaging (MRI). This test uses a powerful magnetic field and radio waves to take detailed images of the organs and tissues in the body. Can show you what the damage of the brachial plexus after an injury. You can also display any artery damage in the limb, which is important for the reconstruction. New types of high-resolution magnetic resonance imaging , such as magnetic resonance neurography or diffusion tensor imaging, may be used.
  • The computed tomography (CT) myelography. The ct scan uses a series of X-rays to create images of the body. CT myelography uses dye injected during a lumbar puncture to look for problems in the spinal cord and nerve roots. This test is sometimes done when the magnetic Resonance does not give enough information.

Treatment

The treatment depends on many factors, such as severity of the injury, type of injury, time since injury, and other existing conditions.

The nerves that have just been stretched can heal on their own.

Your health care team may suggest physical therapy to keep the joints and muscles to function correctly, maintain the range of motion and prevent stiffness in the joints.

The surgery is often the best option for the serious injuries of the nerves. In the past, surgery was sometimes delayed, to see if the nerves that was going to heal on their own. However, the new research shows that delaying surgery for over 2 to 6 months, it could make the repair less successful. New imaging techniques can help your health care team to decide if the surgery may be more beneficial.

Nervous tissue grows slowly, so that it can take several years before you see the final results of the surgery. During the recovery, you can do exercises to keep your joints flexible. Splints can be used to keep the hand from curling inward.

Types of surgery

  • Neurolysis. This procedure is used to release the nerve from scar tissue.
  • The repair of the nerve. This directly implies the repair of nerve injuries by sharp objects, like knives. Rarely, this can be done when the nerve fibers are stretched.
  • Nerve graft. A nerve graft using the nerves in other parts of the body to replace the damaged part of the brachial plexus. This creates a bridge to the new growth of the nerve over time.
  • Nerve transfer. When the nerve root has been torn from the spinal cord, the surgeons often wear the least important of the nerves that are still working and connected to a nerve that is most important, but it doesn't work. This allows for the regrowth of the nerve.
  • Muscle transfer. In the transfer of muscle, the surgeon removes a less important muscle or tendon from another part of the body, such as thighs, transfers to the arm, and re-connect the nerves and the blood vessels of the muscle.

The control of pain

Severe brachial plexus injuries can cause extreme pain. The pain has been described as a debilitating, severe, crushing feeling or a constant burning. This pain goes away within a period of three years for most people. If the medicine may not control your pain, your health care team may suggest surgery to interrupt the pain signals coming from the damaged part of the spinal cord.

Preparing for your appointment

Many tests may be used to help diagnose injury of the brachial plexus. When you make your appointment, be sure to ask if you need to prepare for these tests. For example, you may need to stop taking certain medications a few days or avoid the use of lotions on the day of the test.

If possible, bring a family member or friend. Sometimes it can be difficult to remember all information that you receive during an appointment. Someone who goes with you may remember something that you've forgotten or lost.

Other tips to get the most out of your appointment are:

  • Write down all your symptoms, including the manner in which you were injured, how long you have had your symptoms and if they have gotten worse over time.
  • Make a list of all the medicines, vitamins, and supplements you are taking.
  • Do not hesitate to ask questions. Children and adults with brachial plexus injuries have many options for the restoration of movement. Be sure to ask your healthcare team about all of the possibilities available to you or your child. If you run out of time, ask to speak with a nurse or a member of your care team a call later.
Symptoms and treatment of the injury of the Brachial plexus