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Brachial Plexus Injury

What is the brachial plexus?

The brachial plexus is a complex network of intertwined nerves located on each side of the neck and around the shoulder. These nerves work together to provide movement and feeling of the shoulder, arm, and hand.

What can cause a brachial plexus injury?

There are many causes of brachial plexus injury, most commonly being a form of trauma:

  • Shoulder dislocation: Since the shoulder is located so closely to the brachial plexus, a dislocation can cause these nerves to be stretched and injured.
    • Erb's palsy: When a baby's shoulder is dislocated during a vaginal birth, this can cause Erb's palsy, also known as a brachial plexus birth palsy. An Erb's palsy presents the same as a brachial plexus injury and is worked-up in a similar manner. Most infants with this injury recover very well without intervention and are able to live a normal life. The most important treatment for these infants is physical/occupation therapy, with the goal to keep the babies' joints loose while the nerves are recovering.
  • Penetrating injuries: A gunshot wound or stab wound to the shoulder area may damage or completely cut a nerve of the brachial plexus.
  • Other common causes: Anytime the arm is forcefully pulled or stretched, motor vehicle collisions, or motorcycle accidents.

What are the symptoms of a brachial plexus injury?

The brachial plexus is made up of 3 different sections known as "trunks" or "cords." The symptoms of a brachial plexus injury depend on which section of the brachial plexus is injured.

  1. Upper trunk/lateral cord: This section is made up of the C5 and C6 nerve roots. These nerve roots are responsible for the movement of your shoulder, elbow flexion, and wrist extension. These nerve roots are responsible for the feeling along your outer arm and palm side of your thumb.
  2. Middle trunk/posterior cord: This section is made up of the C7 nerve root. This nerve root is responsible for the movement of your elbow extension and wrist flexion. This nerve root is responsible for the feeling along the back of your arm, and top and bottom of your index and middle fingers.
  3. Lower trunk/medial cord: This section is made up of the C8 and T1 nerve roots. These nerve roots are responsible for the movement of your fingers and hand grip. These nerve roots are responsible for the feeling along the inside of your arm and your ring and pinky fingers.

How is ulnar nerve entrapment​ diagnosed?

How is a brachial plexus injury treated?

Nonsurgical

Nerves heal very slowly. If the nerves are stretched, we first want to give the nerves time to heal on their own prior to any surgical intervention. Nerves recovering on their own is always preferred over surgical intervention. During this time, physical/occupational therapy is very important to keep the joints in the shoulder, arm, and hand loose to prevent contracture. Over the counter medications for symptom control (NSAIDs, acetaminophen), and/or prescription medications for symptom control (gabapentin, Lyrica, steroids) can also be used.

Surgical

If the nerve is transected (completely cut), surgery to repair the nerve as soon as possible is indicated. If the nerve is stretched, surgery is considered about 6 months following the injury if the nerves have not recovered on their own. We know if the nerve is completely cut versus stretched based on the results of the testing (EMG, imaging).