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      Overview

      The brachial plexus is a system of five core nerves housed within the shoulder. It controls the back and forth signaling that occurs between the spine and the arms and hands. The greater network of nerves connected to the brachial plexus begins at the nerve root at the top of the neck and flows through the shoulder all the way down to the hands. As part of this network, the brachial plexus is responsible for both movement and sensory signaling (innervation) and activity for the arm, wrist, and hand.

      Since the brachial plexus is a network of nerves, injuries that can impact it won’t always occur directly to the shoulder. Neck, back, and spine trauma can also impact the functioning of the brachial plexus.

      Minor brachial plexus injuries can cause temporary discomfort, but often heal well, with the patient regaining 90 to 100 percent of the arm’s natural strength and functionality. If the nerve damage is more acute, surgery may be required to treat the impacted nerve(s) and restore as much of the arm’s original mobility and sensation as possible. If you have experienced recent neck or shoulder trauma, watch for signs of a brachial plexus injury and contact the team at the Institute for Advanced Reconstruction for a diagnostic consultation.

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      Brachial Plexus Injury Symptoms

      Damaged nerves can manifest in a number of different sensations and effects to the connected area of the body. Nerve pain is often described as a sharp, burning sensation. The worse the damage to the nerve is, the further the pain can radiate to adjacent areas of the body. Nerve damage can also create a weakness to the impacted area and subsequent body parts to which the nerve controls sensory and movement communication. In severe cases this can lead to a loss of mobility to fingers, hands, or the entire arm (paralysis).

      Watch for these signs of nerve damage and reach out to a medical professional if the pain becomes debilitating or you start to notice a weakening or loss of functioning in the hands, wrist or arms:

      • Lessened or lost dexterity of the hand or individual fingers
      • Numbness or loss of sensation in the arm or hand
      • Loss of use of part or all of the arm, wrist, or hand
      • A jolting, shock sensation immediately after a fall or blunt force to the shoulder or neck
      • Persistent or worsening burning sensation that radiates from any part of the shoulder or arm
      • The arm is hanging limp
      • A burning pain that radiates from the shoulder, arm, or wrist

      Causes & Risk Factors

      As a network of nerves, injuries to the brachial plexus can result from any damage or blockage that creates a disturbance to the nerve fibers. This could include small abrasions or complete tears to the nerve. It also includes swelling, scar tissue, or tumors that smother the nerve fibers in the brachial plexus. Below is a list of brachial plexus injury causes:

      • Injury at birth (Obstetric brachial plexus injury) - Occurs in 0.1%-0.2% of births and comes in two forms - Erb’s palsy and Klumpke’s palsy. Some cases resolve spontaneously, most involve physical therapy to regain full functionality, and some rare cases will require surgery to repair limb function.
      • Traumatic force to the neck or shoulder - Falls, impact injuries, car accidents can disrupt nerve functionality in the neck, shoulder, and arm.
      • Sports injuries - “Stingers” are especially common in football and hockey.
      • Piercing injuries (stab or gunshot wounds) - Severed or damaged nerves in the shoulder will result in distrurbed communication between the arm and the brain, creating excess pain or a loss of mobility.
      • Surgical trauma - Nerve fibers can be accidentally clipped or severed during an operation, which will result in lessened or lost ability to use part or all of the arm.
      • Cancer and/or tumors - Tumors can swell in inconvenient locations of the body, resulting in the invasion of brachial nerve pathways, potentially disturbing the use of the arm.
      • Radiation therapy - Enough radiation can damage nerve tissue, eventually leading to a loss of sensation or mobility of the shoulder, upper arm, elbow, forearm, wrist, or hand.

      Diagnosing a Brachial Plexus Injury

      To diagnose a brachial plexus injury, your doctor will conduct a physical examination and review your symptoms and medical history. To help identify the severity of your injury, your doctor may also use one of the following diagnostic tools:

      • X-rays
      • MRI
      • CT scan
      • Nerve conduction study
      • Electromyogram
      These tests will also determine the type of brachial plexus injury you may have, such as:
      • Brachial Plexus Neuropraxia: Nerves that are stretched to the point of excess, leading to an injury.
      • Brachial Plexus Rupture: The complete or partial tear of a brachial plexus nerve.
      • Brachial Plexus Neuroma - The scar tissue that develops as the body attempts to heal a cut or abrasion.
      • Brachial Neuritis (Parsonage Turner syndrome): A very rare condition that impacts nerve function.
      • Brachial Plexus Avulsion: Similar to a rupture, but more severe.
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      Brachial Plexus Injury Treatments

      Treating nerve tissue requires a very sensitive and often procedural approach. In mild cases of brachial plexus injuries, the affected arm may return to its full functionality naturally. The greater the damage to the nerve fibers, the more likely surgical intervention will be required. Brachial plexus injury treatment may include medication and physical therapy.

      If surgical intervention is necessary, your doctor may recommend one or more of the following:

      • Brachial Plexus
      • Decompression and Neurolysis
      • Nerve Transplant
      • Nerve Transfer
      • Grafting Surgery

      In severe cases involving paralysis, brachial plexus injury treatment may be a gradual process, rather than an event. Multiple surgeries may be required to return mobility and then sensitivity to the arm. 

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