Brachial Plexus Injuries

Brachial Plexus Clinic

Treatment for Brachial Plexus Injury

The brachial plexus is a network of nerves that control the muscles and sensations in the shoulders, arms and hands. These nerves originate at the neck and continue into the shoulder, where individual nerves branch out into the arms and hands.

Injury to the brachial plexus occurs when these nerves are damaged at the neck or shoulder level. The injury is usually caused by stretching, tearing or other trauma to the nerves. One or more of the nerves in the brachial plexus may be injured.

Causes of Injury

In children, the most common brachial plexus injuries occur at birth, when the brachial plexus is injured in a baby’s shoulder during delivery. About one or two babies out of 1,000 will have a brachial plexus injury when born, and about 10 percent of these babies will need surgery. In adults, the most common causes of injury to the brachial plexus include motor vehicle crashes, sports injuries, industrial accidents, falls and severe over-extension of the arm.

An injury may result in numbness or tingling, pain, weakness, limited movement and paralysis in the shoulder, arm and hand. Left untreated, muscles associated with the damaged nerves will atrophy (waste away). If a person waits too long for treatment, the muscle will become permanently dysfunctional.

Diagnosing Brachial Plexus Injury

Brachial plexus injuries are diagnosed by a thorough examination of muscle function and sensation. It takes a physician experienced in treating many brachial plexus injuries to notice subtle changes in muscle function. In addition, electrical testing of the muscles and nerves is done to determine the severity and location of the injury. This testing is done with an electromyogram (EMG) to test the muscles along with nerve conduction velocity (NCV) and evoked potential to test the nerves. Imaging of the neck and shoulder using X-rays, computed tomography (CT) and magnetic resonance imaging (MRI) may be done as well.

There are four types of nerve injuries:

Praxis — a nerve is damaged but not torn
Neuroma — scar tissue that grows around an injured nerve after the nerve has tried to heal itself
Rupture — a nerve is entirely torn at a point beyond where it attaches to the spinal cord
Avulsion —a nerve is entirely torn from the spinal cord

Treating Brachial Plexus Injury

Because injury to the brachial plexus can destroy arm function, timing is important for diagnosing and treating these injuries. Following diagnosis, patients are monitored over a period of time to see if the function has returned in their hand, arm and shoulder. During this time, the patient may undergo physical and/or occupational therapy. If it is determined that there is insufficient improvement, surgery may be needed. The best results for surgical repair are obtained within one year of the injury.

Few hospitals in the country have the expertise to evaluate and repair brachial plexus injuries. In the Brachial Plexus Clinic at Froedtert & the Medical College of Wisconsin and at Children’s Hospital of Wisconsin, multidisciplinary teams specialize in the evaluation and treatment of a variety of brachial plexus injuries.

Highly trained plastic surgeons specializing in hand surgery and microsurgery repair brachial plexus injuries, with an aim of repairing damaged nerves and restoring maximum function to the arm. Surgery is performed under high magnification using a special microscope (microsurgery), instruments and techniques to repair the very small structures of the brachial plexus.

Brachial plexus repairs may involve one or more microsurgery procedures:
- Neurolysis — removal of scar tissue surrounding a nerve
- Nerve graft — removal of a piece of nerve from another part of the body to bridge a severed nerve
- Nerve transfer — moving nerves from an uninjured portion of the brachial plexus to restore motor or sensory functions to a paralyzed muscle
- Muscle transfer — moving an expendable muscle along with its nerve and blood supply to a damaged area to restore function to the elbow, wrist and hand
Neurologists work with surgeons to perform electrophysiological studies on adult patients before and during surgery to assess nerve conduction activity and the extent of the injury.
Specialized physical and occupational therapists work with each patient to maximize their functional recovery after surgery. They use specific range-of-motion exercises to prevent the muscles and joints from tightening, and re-educate and strengthen the muscles to restore function.