Brachial Plexus Injury

Brachial plexus injuries affect the peripheral nerves that carry movement and sensory signals between the spinal cord and the shoulder, arm, and hand. These injuries can cause pain, weakness, numbness, or even paralysis in the affected arm and hand.

With broad and deep clinical experience, backed by current research and investigations conducted at UT Southwestern Medical Center, we are defining a wider range of effective nonsurgical and surgical treatment options for patients. Our faculty members publish their work in high-impact scientific journals and present their work worldwide.

What Is a Brachial Plexus Injury?

The brachial plexus is a network of nerves on each side of the body that connects the central nervous system to the shoulder, arm, and hand. These nerves can be injured when stretched, compressed, or otherwise damaged.

Most minor brachial plexus injuries heal well, even without treatment. Some nerve injuries require noninvasive treatments, and severe injuries often require surgery to help restore function.

What Causes Brachial Plexus Injuries?

Most brachial plexus injuries are caused by physical trauma. Damage to the upper brachial plexus nerves often occurs when the shoulder is forced down while the neck is stretched up and away from the shoulder. The lower brachial plexus nerves are more likely to be injured when an arm is forced above the head.

Causes of brachial plexus injury include:

• Contact sports
• Damage from radiation treatments to the chest
• Difficult births: High birth weight, breech presentation, or prolonged labor increase a newborn’s risk of brachial plexus injury, especially if the infant's shoulders get wedged within the birth canal.
• Major trauma, such as motor vehicle accidents, falls, or bullet wounds
• Medical trauma: A nerve may be cut during a surgical procedure, damaged by an injection, or damaged by the positioning of the body during surgery.
• Tumors that grow in or along the brachial plexus or that otherwise put pressure on the brachial plexus

What Are the Types of Brachial Plexus Injuries?

There are several types of brachial plexus injuries, which are categorized according to how the nerves are damaged and the severity of the damage.

Burners and stingers – brachial plexus neuropraxia: The nerves are stretched or compressed to the point of injury. These injuries are called burners or stingers because the main symptom is a burning or stinging sensation. They can also feel like an electric shock.

• Compression neuropraxia is the most common form and generally occurs in older people. The brachial plexus nerve root is compressed, usually by the rotation of the head.
• Traction neuropraxia is less common and tends to develop in adolescents and young adults, especially those who play contact sports. This injury occurs when the nerve is pulled.

Brachial plexus rupture: The nerve is torn, either partially or completely. Ruptures can cause severe pain, weakness, or paralysis in the shoulder, arm, or hand.

Brachial plexus avulsion: The root of the nerve is completely separated from the spinal cord. More severe than ruptures, avulsions often cause severe pain and can lead to permanent weakness, paralysis, and loss of feeling.

Brachial plexus neuroma: Nerve tissue that has been injured, such as from a cut during surgery, forms a painful knot of scar tissue called a neuroma.

Brachial neuritis: Also called Parsonage-Turner syndrome, brachial neuritis is a rare, progressive disorder that causes sudden, severe shoulder and upper arm pain that leads to weakness, muscle loss, and even loss of sensation. This syndrome usually affects the shoulder and arm, but it can also affect the legs and diaphragm.

Brachial plexus injury at birth (obstetric brachial plexus injury): Injury to the brachial plexus occurs in one to two newborns per 1,000. Larger babies in difficult vaginal deliveries are particularly prone to this injury, as are babies of mothers who have diabetes. These injuries can vary widely in severity and take one of two forms:

• Erb’s palsy: A common injury of the upper brachial plexus nerves, causing numbness and loss of motion around the shoulder and an inability to flex the elbow, lift the arm, or bring objects to the mouth.
• Klumpke’s palsy: A less common injury that affects the lower brachial plexus, leading to loss of motion or sensation in the wrist and hand.

How Are Brachial Plexus Injuries Diagnosed?

Prompt examination and diagnosis of brachial plexus injury is an important part of successful treatment. Diagnosis usually begins with a physical exam of the hand and arm to test for sensation and function.

Other diagnostic tests often include:

• An X-ray of the neck and shoulder area
• Imaging tests, such as magnetic resonance imaging (MRI) or a computed tomography (CT) scan, to detect injury to the nerves of the brachial plexus
• Electrodiagnostic tests, such as nerve conduction studies and electromyography, to determine the severity of damage to the median nerve

These tests may be repeated every few weeks or months to monitor progress after treatment.

How Are Brachial Plexus Injuries Treated?

Brachial plexus injuries don’t always need treatment. Some people, particularly babies with a birth injury or people with burners and stingers, recover most or all of their sensation and function without any treatment, though it can take weeks or months for the injury to heal.

When treatment is necessary, UT Southwestern specialists offer a team approach. A patient’s care team includes a peripheral nerve specialist as well as doctors and medical professionals in plastic surgery, neurosurgery, neurology, internal medicine, pain management, occupational therapy, physical therapy, and rehabilitation, as needed.

Each patient’s treatment plan is based on that person’s specific health conditions, needs, and goals. The sooner treatment begins after an injury, the better the chance of successful treatment.

Nonsurgical Treatment for Brachial Plexus Injuries

Mild brachial plexus injuries usually respond well to a combination of nonsurgical treatment options, including:

• Assistive devices such as braces, splints, and compression sleeves
• Corticosteroid creams or injections or other medications to help manage pain during healing
• Occupational therapy to restore practical skills such as dressing and cooking, in cases that involve severe muscle weakness, numbness, and pain
• Physical therapy to learn exercises that can help restore function in the arms and hands and improve range of motion and flexibility in stiff muscles and joints

Brachial Plexus Surgery

Brachial plexus injuries that are severe or fail to heal on their own may require surgery. The experienced specialists at UT Southwestern are experts in the latest, most effective surgical techniques, including:

• Innovative microsurgical techniques to improve painful conditions involving the wrist, elbow, and shoulder
• Groundbreaking nerve reconstruction, such as nerve transfers and grafts to achieve better functional recovery over a shorter period of time
• Surgery to move or disconnect sensory nerves that cause pain
• Surgery to reconstruct nerves that have been severed as a result of trauma, tumor removal, or birth-related brachial palsy

UT Southwestern surgeons make sure patients who need surgery understand what to expect for recovery and whether physical or occupational therapy will be needed after surgery.

Follow-Up Care

Because nerves heal slowly, brachial plexus injury recovery can take several weeks to months. During this time, regular physical therapy and checkups help to monitor healing progress and manage any pain. Follow-up checkups are especially important for babies and may be needed for up to two years.

UT Southwestern surgeons make sure patients are prepared for postoperative care and physical therapy, so the results of the surgery are as positive as possible.