What is a brachial plexus injury?

Better yet, what is the brachial plexus?…

In a nutshell, the brachial plexus is a complex web of nerves. These nerves stem from our spinal cord in the neck, or cervical spine, and continue to travel outward and down into our axilla, or armpit region. These nerves will then continue to branch and travel down the entire upper extremity, or arm.

Now that we have a basic idea of what the brachial plexus is, let’s consider its role in the body, potential injuries that can occur to this nerve network, how this might affect us, and a glance into recovery.

Role of the Brachial Plexus

So, what exactly does the brachial plexus do?

The majority of nerves in this network are responsible for innervating both the sensation and musculature of the arm, or upper extremity. This is how we can feel different temperatures and other sensations in the arm. It’s also how we initiate and activate the muscles in the arm, in order to move the way we want and need to.

The brachial plexus is formed by 5 nerve roots. These are from the anterior rami of the spinal nerves that run between C5-T1. The following are the 5 nerves created from the brachial plexus:

1.   Musculocutaneous nerve

2.   Axillary nerve

3.   Median nerve

4.   Radial nerve

5.   Ulnar nerve

Smaller nerves then branch off from these larger nerves.

We won’t go into the whole anatomy, but it’s a pretty complex system!

Potential Causes of a Brachial Plexus Injury

How does one injure their brachial plexus? There are a few possible scenarios to consider.

First off, you could experience an over-stretching injury to the brachial plexus. This is more formally called neuropraxia. Similar to overstretching our other soft tissues, such as our muscles, tendons and ligaments, the nerves can be susceptible to an excessive stretching force. This could be from a traction-type force or compression injury to this region.

Next, you could experience something more severe, such as the rupture of part of the brachial plexus. This could be compared to more of a severe tear, which will more likely be caused by a trauma of some kind.

One of the most severe injuries would be a complete tearing away of the nerve root from the spinal cord, otherwise known as an avulsion injury. This would, again, be related to a more severe trauma or injury directly to this area.

If you have had a surgery near or around this region, and scar tissue develops on or around the brachial plexus, you could develop what is called a brachial plexus neuroma.

A less common problem, but still something to consider, is brachial neuritis. This issue can cause a more sudden onset of dysfunction in the region of the brachial plexus for some unknown reason. While it’s possible to potentially connect this issue to a recent trauma, injury or surgery, again, the cause is more likely than not unknown.

While the exact cause of these various types of brachial plexus injuries will vary, the following are common causes to consider:

• Contact sports
• Direct or blunt force trauma
• Childbirth for a newborn
• Surgery
• Cancer and/or cancer treatments
• Fall

Signs and Symptoms of a Brachial Plexus Injury

The general signs and symptoms of a brachial plexus injury will vary. This usually depends on the cause, severity and specific location of the injury within the brachial plexus.

Keep in mind that multiple nerves are included in the brachial plexus, so which nerves are involved in your injury will also determine the exact location and type of symptoms you may experience.

Generally speaking, the following signs and symptoms can be present at varying degrees of intensity and exact onset:

• Weakness or paralysis of the arm/hand
• Decreased or loss of sensation in the arm/hand
• More severe pain in any region along the upper extremity
• A lack of control or coordination when trying to use the arm or hand

Another friendly reminder that how quickly these symptoms come on and how severe they are very much depends on the cause of the injury itself. Like with most things, no two people are the same.

Treatment and Recovery from a Brachial Plexus Injury

First and foremost, if you ever experience any of the above signs of symptoms, see a medical professional immediately.

It’s incredibly important to have a thorough examination performed ASAP, in order to determine if this is truly a brachial plexus injury or decide if there is something else possibly occurring, such as a stroke, which would also require immediate medical attention.

Once your provider has appropriately examined, tested and determined that you do indeed have a brachial plexus injury, then they can discuss recommended and necessary treatment options with you.

If your initial cause of injury and subsequent symptoms are milder and not considered an emergency, then non-surgical options are usually considered. This may include simply allowing adequate rest and time for the injured area to heal on its own. The amount of time needed could take weeks or months, depending on the severity of the injury, but normally less time would be needed for milder symptoms. Your provider may also recommend physical or occupational therapy to further assist you in recovery back to your prior level of function.

If the cause of the brachial plexus injury and the symptoms that follow are more serious, you may require surgical interventions. This is especially true if the injury has caused other problems in nearby regions, such as disruption or damage to nearby circulatory vessels (veins and arteries), muscles, ligaments and tendons.

Possible surgical techniques may include consideration of the following:

• Nerve repair or graft
• Surgical removal of scar tissue around the damaged nerve/s
• Nerve transfer
• Muscle or tendon transfer

As previously mentioned, the length of time to recover from a brachial plexus injury depends on the cause, severity of symptoms, and treatment approach indicated. Nerve healing can be a bit slow, so it’s not uncommon to anticipate a few months of healing or longer for more moderate to severe injuries.

While most brachial plexus injuries can completely heal and allow you to make a full recovery over time, it’s important to consider more severe injuries may potentially cause long-term damage and/or restrictions. This could prevent you from regaining full sensation or strength in the affected arm, contribute to muscle wasting or atrophy, create issues with chronic pain to some extent, and so on.

The above possible complications are not necessarily the norm. It’s all dependent on each individual.

The most important thing to remember, like with any injury to the body though, is that the sooner you seek treatment, the better your outcomes normally are.