Brachial Plexus: Injuries, Causes, and Resources

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What is the Brachial Plexus

The brachial plexus is a plexus or network of nerves appearing in the neck and axilla or armpit. The brachial plexus starts at the scalene muscles of the neck, moves under the clavicle also known as the collarbone until it reaches the axilla. It is formed at the lower fourth cervical and first two thoracic spinal nerves. These nerves supply the areas of the chest, shoulders and arms. Traction is the stretching of the nerves. In the case of a brachial plexus injury, the traction is a traumatic or excessive stretching, often resulting in lesions.

Types of Brachial Plexus Injuries

There are a few types of brachial plexus injuries, with brachial plexus traction injury being the most common. Research indicates that traction injuries occur most often in young adults, often men. Motor vehicle accidents, with a high incidence of motorcycle injuries, appear to be the primary cause of such severe injury. Contact sport, particularly resulting from tackling maneuvers, often in football, provide another typical possibility of a brachial plexus injury occurring. A violent fall from a significant height may be another culprit, as well as inflammation, and in some cases tumors. Brachial plexus injuries have been noted as common in childbirth deliveries, with the infant experiencing the injury during the birth process.

The type of injury, the severity of the lesion, and the speed at which it is attended to and treated, are factors determining the viability and possibility of healing and restoration. The pain can be dramatic and can cause extreme difficulty for the injured person. Medical reports have used the term catastrophic as a description for brachial plexus traction injury.

When excessive stretching, known as traction, occurs in the brachial plexus the nerves may be torn in the process. The crucial factor in terms of recovery has to do with whether there is root avulsion of the nerve. Avulsion refers to a nerve root being severed from the spinal cord. The medical term for this situation is preganglionic root avulsion. As the cells of the sensory nerves are cut or pulled off from the spinal cord, there is little chance of recovery. Surgical reconstruction is likewise limited. In the case of the cell bodies still being connected there is a level of continuity which facilitates the surgical reconstruction or healing process.

Symptoms of a Brachial Plexus Injury

Less-severe injuries
Known as “stingers” or “burners,” these injuries can produce the following symptoms:

1. A feeling like an electric shock or a burning sensation shooting down your arm
2. Numbness and weakness in your arm

These symptoms usually last only a few seconds or minutes, but in some people may linger for days or even longer.

More-severe injuries
The most serious brachial plexus injury (avulsion) occurs when the nerve root is torn from the spinal cord.

Signs and symptoms of more-severe injuries can include:

1. The ability to use your fingers, but little to no control of your shoulder and elbow muscles
2. The ability to use your arm but not your fingers
3. Complete lack of movement and feeling in your arm
4. Severe pain

Technically what happens when brachial plexus traction takes place is that there is a violent traumatic movement of the head and neck from the ipsilateral shoulder, the shoulder on the same side of the body. The shoulder is depressed and the neck is forced into flexing in a sudden lateral motion away from the corresponding side of the body. The force of the traction can result in the nerve injuries described above, with the lesions or ruptures being severe. A traction injury may also be accompanied by a vascular injury. Together with standard advanced trauma life support actions, a medical team dealing with an injury trauma will check the associated injury possibilities. It is essential to rule out a cervical fracture, prior to treating for brachial plexus or shoulder-girdle injury.

As the brachial plexus is the nerve network serving most of the muscles of the upper limbs, injury can cause the complete demobilization of the upper body. When these nerves are damaged by brachial plexus injuries the nerve signals from the spine to the shoulder, arm and head are affected. Patients may present with pain of varying degrees in the neck and shoulder, a feeling of heaviness and weakness, and diminished pulse rate. Nerve damage may create a lack of muscle control, paralysis of the arm or loss of sensation.

Test to Determine If You Have a Brachial Plexus Injury

1. Electromyography: This test checks the health of the nerves that help move your muscles.

2. Nerve conduction studies. These measure how quickly impulses are conducted through a nerve.

3. Magnetic resonance imaging (MRI). An MRI uses radio waves and a powerful magnetic field to visualize structures in your body.

4. Computerized tomography (CT) myelography. A myelogram is a type of X-ray that uses a contrast material, injected during a spinal tap, to produce a detailed picture of your spinal cord and nerve roots.

Who is At Risk For Getting a Brachial Plexus Injury

Participating in contact sports, particularly football and wrestling, or being involved in high-speed accidents increases your risk of brachial plexus injury.

The National Institutes of Health stresses that for brachial plexus injuries causing avulsion and rupture there is no potential for surgical reconstruction unless the injury is treated immediately. Physical therapy may be prescribed as an additional recovery treatment.

Brachial plexus injuries may also be caused by compression between the clavicle and first rib, direct blows or other penetrating injuries.

Complications That Can Occur From A Brachial Plexus Injury

1. Stiff joints: If you experience paralysis of your hand or arm, your joints can stiffen even if you regain use of your limb.

2. Pain: This results from nerve damage and may become chronic.

3. Loss of feeling: If you lose feeling in your arm or hand, you run the risk of burning or injuring yourself without knowing.

4. Muscle atrophy: Slow-growing nerves can take several years to regenerate. During that time, lack of use may cause the affected muscles to degenerate.

5. Permanent disability: Even with surgery, some people experience permanent disability, ranging from weakness in the hand, shoulder or arm to paralysis.

Resources about Brachial Plexus Injury

Mayo Clinic Information about Brachial Plexus Injury

Nih.gov Information about the Brachial Plexus including: What are Brachial Plexus Injuries?, Is there any treatment?, What is the prognosis?, What research is being done?, Clinical Trials, and Organizations

Medscape Information

Resource by Will

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