A brachial plexus injury can cause weakness and loss of sensation or control in the shoulder, arm and hand. This makes it hard to lift the arm, hold objects or use your hand. It can also cause reduced or no sensation in the arm and fingers.
At Banner Health, our team of specialists is dedicated to helping you understand this condition and find the best treatment options tailored to your needs.
What is a brachial plexus injury?
The brachial plexus is a group of nerves that controls movement and sensation in the shoulders, arms and hands. It enables you to raise your hand, play an instrument, throw a ball and detect a hot surface.
The brachial plexus consists of five main nerves that begin at the neck and across the upper chest to the armpit. Each of the five nerves has a specific function:
- Axillary nerve: Helps lift the arm away from the body and provides feeling to the skin over the shoulder.
- Musculocutaneous nerve: Controls the muscles in the front of the upper arm for bending the elbow and feeling in part of the forearm.
- Radial nerve: This nerve extends down the back of the arm and into the hand. It controls the muscles that straighten the elbow, wrist and fingers including the thumb and provides sensation to the back of the hand.
- Median nerve: This nerve runs down the middle of the arm into the hand, controlling the gripping muscles and providing feelings to the palm and fingers.
- Ulnar nerve: Travels down the inner side of the arm, controlling most hand muscles and providing sensation to the pink and part of the ring finger.
A brachial plexus injury occurs when the nerves are stretched, compressed or torn. Depending on the location of the nerve injury, it can cause problems such as loss of sensation, weakness or total loss of function along with pain in the arm and hand.
Types of brachial plexus injuries
Different kinds of brachial plexus injuries can range from mild to very serious:
- Stretch injury (neuropraxia): This happens when the nerve gets stretched but isn’t torn. It’s the mildest type of injury. Most sports-related brachial plexus injuries fit into this category. A tumor may also cause a stretch injury as it grows by putting pressure on the nerves. With a stretch injury you might have weakness or loss of sensation in your arms for a while, but in most cases, it usually gets better on its own. However, surgery may be needed if the injury is caused by a tumor.
- Torn nerve (rupture): This injury is more serious because the nerve is cut (or torn). Many cases of penetrating trauma, like stabbings, can cause this type of injury. Surgery to repair the cut nerve may be necessary. Along with nerve repair, some cases may also require tendon or nerve transfer surgeries to help improve function.
- Nerve pulling from the spine (avulsion): The most serious brachial plexus injury happens when the nerve is pulled completely away from the spinal cord. This causes a total loss of movement and sensation in the arm. These injuries are severe, and surgery cannot fix the damage. However, other procedures like tendon and nerve transfer surgeries may be used to help restore some function to the affected arm and hand.
What causes brachial plexus injury?
These injuries can happen for many reasons:
- Motor vehicle injuries: Sudden impacts during a car crash (specifically a motorcycle crash) can cause severe stretching or nerve damage.
- Sports injuries: Activities like football or wrestling can lead to these injuries due to falls or rough contact.
- Birth injuries: During delivery, sometimes excessive pulling can injure the baby’s brachial plexus. Two forms of brachial plexus injury at birth are Erb’s palsy and Klumpke’s palsy.
- Falls: Falling for a height or landing awkwardly can stretch or compress the nerves.
- Gunshot wound: A bullet that tears through or close to the nerves can cause damage.
- Tumors: A malignant or benign tumor near the brachial plexus or radiation therapy in the area may damage the plexus.
Symptoms of brachial plexus injury
The symptoms can vary depending on the severity of the injury. Common signs include:
- Loss of sensation: You might not be able to feel anything in your hand or arm.
- Weakness: You may find it hard to lift your arm or grasp objects.
- Pain: Some people experience burning, stinging or severe pain in their shoulders or arms.
- Limited range of motion: You may not be able to move your arm or hand as freely as before.
- Partial or total loss of motor functions: Paralysis or loss of muscle control in your arm, hand or wrist can occur.
If you notice these symptoms, see your health care provider. Early diagnosis and treatment can improve your chance of recovery.
Diagnosis of brachial plexus injuries
Your health care provider will ask you about your symptoms and do a physical exam. They will check your physical strength, range of motion and sensation in your arm and hand.
Your provider may order imaging tests to see how serious your injury is. You may need one or more of the following tests:
- X-rays: These are used to check for broken bones or fractures near the neck, collar bone and shoulder that might be pressing on or injuring the nerves.
- MRI (magnetic resonance imaging): An MRI provides detailed images of the soft tissues, including nerves, muscles and tendons. This can help identify nerve damage or pinched nerves.
- ElectroMyoGraphy (EMG): This is a study that is done by an expert neurologist. This study may help to determine the level of the injury and its severity and be used to monitor the injury and its progress. It can also help the surgeons to determine what kind of surgical treatment may be needed along with MRI guidance.
What is the best way to treat a brachial plexus injury?
The best way to treat a brachial plexus injury depends on the type and severity of the injury. Treatment options can range from nonsurgical approaches to more invasive options like surgery.
Nonsurgical treatments
For mild injuries, especially stretch injuries (neuropraxia), the nerves can heal on their own with time. Your provider may take a “wait-and-see” approach, monitoring the nerve to ensure it heals without surgery.
Nonsurgical treatments are often recommended in these cases. Your provider may recommend one or all of the following:
- Physical therapy: This is important to maintain strength and range of motion in the affected shoulder, arm and hand. Physical therapy can prevent muscle stiffness and help regain function as the nerves heal.
- Medication: Over-the-counter (OTC) medications, like ibuprofen or acetaminophen, may help manage discomfort. For more severe pain, your provider may prescribe stronger pain relievers or recommend nerve blocks. Nerve blockers relieve pain by blocking the signals sent from the injured nerves.
- Occupational therapy: When you have severe muscle weakness, numbness or pain, an occupational therapist can help you work on practical skills like dressing, cooking or typing on the computer.
- Assistive devices: Braces and splints can help support the arm or hand during recovery, stabilize the affected limb and prevent further injury.
- Pain management assistance: An expert anesthesiologist can help you manage the severe pain cause by a plexus injury by using a carefully controlled combination of medications.
Surgical treatments
If nonsurgical treatments don’t provide relief or if the injury is severe, surgery may be necessary. Some surgical options include:
- Nerve repair: In this procedure, the damaged nerve is sewn back together.
- Nerve grafting: If the nerve is torn, surgeons can replace the damaged part with a nerve from another area of the body or tissue from another person (allograft). This may allow the injured nerve to grow back and restore function over the time.
- Nerve transfer: Whether or not the nerve is repaired, surgeons can sometimes redirect a functioning nerve from another muscle (unaffected by the injury) to the damaged nerve to help restore movement. For example, they might use a nerve that controls the wrist muscles and attach it to the nerve controlling the biceps to help restore movement in the elbow.
- Tendon transfer: Surgeons may move tendons from healthy muscles to help restore lost functions in the upper limb. For example, they might use a tendon from the wrist flexor to help with finger extension.
- Free muscle transfer: Some extreme cases may need more complex reconstruction. A functional muscle (including its own blood vessels and nerves) may be taken and relocated to the place where the functions are missing. For example, a leg muscle might be moved to the forearm to restore the function of the muscles that allow you to bend your fingers.
Your provider and surgeon will discuss the best options for the specific type of injury.
Outlook for a brachial plexus injury
The outlook for brachial plexus injuries varies depending on the severity. Mild injuries often heal with physical therapy within a few months, allowing many people to regain full or near-full function.
However, it may take longer to recover from severe injuries, especially those requiring surgery. Some people may have permanent weakness or loss of feeling might remain.
Early treatment greatly improves the chances of a better recovery.
Brachial plexus injuries and their related symptoms are different from person to person, so it’s important to have treatment that is tailored specifically to your needs.
Preventing brachial plexus injuries
While not all injuries can be prevented, there are steps you can take to reduce your risk:
- Practice safe driving habits: Always buckle up when in a vehicle, obey motor vehicle laws and never operate under influence. Pay special attention when riding a motorcycle and assume drivers can’t see you.
- Follow workplace safety regulations: It’s important to obey all safety regulations and guidelines while at work.
- Use protective gear: If you participate in contact sports, wearing proper protective gear can help prevent injuries.
- Stay fit: Maintaining a strong and flexible body can help you avoid falls and other accidents.
- Be careful during activities: Always be aware of your surroundings to prevent falls or awkward movements.
Banner Health is here to help
At Banner Health, we understand how difficult it can be to deal with a brachial plexus injury. Our team provides comprehensive care to help you recover. We offer physical therapy, reconstructive surgical options and support throughout your recovery journey.
Please contact us if you have questions or need help with a brachial plexus injury. Your health is our priority, and we are here to help you every step of the way.
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