To know about a brachial plexus injury, we need to first know as to what is brachial plexus? The brachial plexus forms a complex setup of nerves the function of which is to send signals from the spine to the hand and shoulder. A brachial plexus injury is said to occur when these setup of nerves are these nerves are stretched or torn. This can happen when the shoulder is pressed down and the head is pushed away from the shoulder. These injuries commonly occur with contact sports but may also occur with MVAs or falls. Some infants incur brachial plexus injury during birth. Medical conditions like inflammation or tumors can affect these nerves. If the injury is very small then generally it gets better without any treatment but serious injuries require surgery.
Symptoms of Brachial Plexus Injury
The symptoms of a brachial plexus injury depend upon the location and whether the injury incurred is severe or not.
In The Case Of a Small Injury Which Can Occur With Contact Sports the Following Symptoms Can Be Observed
- Electric shock sensation shooting down the hand.
- Numbness and weakness of the hand.
Generally they happen only for a matter of minutes but for some people they can last longer.
In The Case Of Severe Injuries Occurring As A Result Of the Nerves Being Torn, the Symptoms That Can Be Observed Are
- Inability to use shoulder and elbow muscles.
- The inability to use the fingers
- Lack of motion and sensation of the arm.
- Excruciating pain
Causes of Brachial Plexus Injury
As discussed above, injury to the nerves occur when the shoulder is forced down and the neck is moved away from the shoulder causing the nerves to stretch causing injury to the nerves.
Brachial Plexus Injury Can Result In the Ways Illustrated Below
- Contact Sports: The injury occurs when the nerves are stretched beyond their capacity in the case of colliding with other players while playing thus injuring the brachial plexus nerve.
- Difficulty with Birth: Infants suffer from this injury due to problems during delivery. For example, if there is a breech presentation or prolonged labor. In this scenario, the baby's shoulder gets stuck in the birth canal and the nerves may get injured in order to get the shoulder free.
- Trauma: MVAs can also cause brachial plexus injury.
Diagnosis of Brachial Plexus Injury
The following investigations are carried out for the diagnosis of a brachial plexus injury
- EMG/Nerve Conduction Tests: This test is used to check the state of the nerves. Needle electrodes are put into the muscles and the test provides data on the response of the muscle with stimulation of the nerves. The nerve conduction study gives data on how fast the impulses are passed through the nerve.
- MRI: MRI gives us information on the extent of the damage, if any, to the brachial plexus nerves.
- CT Myelogram: In this contrast is injected to view the spinal cord and the nerve roots in detail to identify any damage in injury.
Treatment of Brachial Plexus Injury
Minor stretching of the nerve gets cured by itself but in the case of severe injury surgery is required in order to improve the function of the nerves.
The Forms of Surgery That Are Conducted For Severe Cases of Brachial Plexus Injury Are As Following
- Nerve Graft: This procedure deals with the removal of injured area of the brachial plexus and replacing them with nerves from other parts of the body
- Nerve Transfer: This procedure is done when the nerve is completely torn from the spinal cord. A redundant nerve which is still connected to the spinal cord is taken and is used as a bridge between the spinal cord and the nerve that is completely cut off from the spinal cord.
- Muscle Transfer: This is a procedure in which a redundant muscle is moved from some other part of the body into the area of the brachial plexus.
Since there is excruciating pain from this injury, pain control becomes important. Opioid medications are typically used immediately after the injury to control pain. TENS unit is also used for pain control.