The brachial plexus refers to a network of nerves branching from the spinal cord in the neck that gives feeling and movement to the shoulder, elbow and hand. Injuries to this area range from minor and temporary to catastrophic often with permanent limitations in movement and sensation.
The most common cause of injury in adults is trauma from motorcycle and car accidents where the nerves are stretched. Sharp, cutting injuries and gunshot wounds are also seen frequently. In babies, birth stretch injuries are the most common.
Early referral to a specialist comfortable treating these injuries is critical to maximize the ability to recover. Just like in the case of a heart attack “time is muscle”. If nerve signals cannot be restored to the muscle by approximately a year from injury, often that muscle’s function will be lost.
The physician caring for these injuries will conduct a thorough history and likely several examinations to determine the exact location of the injury. CT or MRI images and Nerve Conduction Studies (NCS/EMG) will also be ordered to determine the extent and location of the injury.
Depending on the extent of the injury and the time elapsed from the injury, surgery may be recommended to repair the nerves. Often nerve grafts are used to bridge the gap left by damaged nerves. Transferring nerves from one that is working to one that is not working also can help improve function. If too much time has elapsed or too many nerves are injured, then procedures such as tendon transfers or joint fusions may be recommended to help restore function and decrease pain.
Pain and emotional distress are often associated with these injuries, and patients are encouraged to seek pain management consultation and obtain psychologic assistance to cope with the pain and stress of these injuries.
Written by: Michael D. Riggenbach, M.D.