Brachial Plexus Injury Risk factors
Brachial Plexus Injury Nonsurgical Treatment
Brachial Plexus Injury Surgical Treatment
Brachial Plexus Injury Recovery
Overview
The brachial plexus is a network of intertwined nerves that control movement and sensation in the arm and hand. A traumatic brachial plexus injury involves sudden damage to these nerves, and may cause weakness, loss of feeling, or loss of movement in the shoulder, arm, or hand.
The brachial plexus begins at the neck and crosses the upper chest to the armpit. Injury to this network of nerves often occurs when the arm is forcibly pulled or stretched.
Mild brachial plexus injuries may heal without treatment. More severe injuries may require surgery to regain function of the arm or hand.
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Types of Brachial Plexus Injuries
Brachial plexus birth injuries are often categorized according to the type of nerve injury and the pattern of nerves involved. There are four types of nerve injuries.
Stretch (neurapraxia)
Rupture
Avulsion
Neuroma
Brachial Plexus Injury Symptoms
Symptoms depend on where along the length of the brachial plexus the injuries occur and how severe they are. Injuries to nerves that root higher up on the spinal cord, in the neck, affect the shoulder. If nerves that originate lower in the brachial plexus are injured, the arm, wrist and hand are affected.
Common symptoms of brachial plexus injuries are:
Brachial plexus injury pain can be mild to severe, and temporary to chronic, depending on the type and extent of the injury. For instance, a simple stretched nerve may hurt for a week or so, but a ruptured nerve can cause serious, long-term pain that might require physical therapy and potentially surgery.
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When to see a doctor
Brachial plexus injuries can cause permanent weakness or disability. Even if yours seems minor, you may need medical care. See your doctor if you have:
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Causes of Brachial Plexus Injury
Damage to the upper nerves that make up the brachial plexus tends to occur when your shoulder is forced down while your neck stretches up and away from the injured shoulder. The lower nerves are more likely to be injured when your arm is forced above your head.
These injuries can occur in several ways, including:
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Brachial Plexus Injuries Diagnosis
A health care provider will examine the hand and arm and test for sensation and function to help diagnose a brachial plexus injury.
These are other diagnostic tests often used:
These tests may be repeated every few weeks or months to allow your doctor to monitor your progress.
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Brachial Plexus Injury Risk factors
Participating in contact sports, particularly football and wrestling, or being involved in high-speed motor-vehicle accidents increases your risk of brachial plexus injury.
Complications
Given enough time, many brachial plexus injuries in both children and adults heal with little if any lasting damage. But some injuries can cause temporary or permanent problems, such as:
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Brachial Plexus Injury Nonsurgical Treatment
Many injuries to the brachial plexus will recover spontaneously without surgery over a period of weeks to months, especially if they are mild. Nerve injuries that heal on their own tend to have better functional outcomes. If your doctor believes that the injury has a good potential for recovery without surgery, he or she may delay procedures and simply monitor your injury.
The process of the nerve healing itself takes time and your doctor may recommend physical therapy to prevent joint and muscle stiffness.
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Brachial Plexus Injury Surgical Treatment
Surgical treatment is typically recommended when the nerves fail to recover on their own or fail to recover enough to restore necessary function to the arm and hand. It is important to note that depending upon the severity of the injury, even surgery may not be able to return the arm or hand to preinjury abilities.
Considerations
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Surgical Procedures
Several surgical techniques are used to treat nerve injury, depending upon the type of injury and the length of time that has passed since the injury.
In most procedures, an incision is made near the neck above the collarbone. If the injury extends down the brachial plexus, another incision at the front of the shoulder may be required. To repair or reconnect nerves, surgeons often use high-powered microscopes and small, specialized instruments.
A tendon transfer is a type of surgery in which the tendon of a functioning muscle is cut and sewn into a nonfunctioning muscle tendon to restore a specific motion or motor function.
In a free-functioning muscle transfer, a muscle from one part of the body is moved to the injured area, along with its tendon, artery, vein, and nerve. Each of these structures is connected to the corresponding structures of the injured area in order to restore motion or motor function.
Brachial Plexus Injury Recovery
The patient must do several things to keep up muscle activity and prevent the joints from getting stiff. Your doctor may recommend therapy to keep these joints flexible. If the joints become stiff, they will not move even after muscles begin to work again, like a hinge that has rusted.
When a sensory nerve has been injured, the patient must be extra careful not to burn or cut fingers while there is no feeling in the affected area. During nerve recovery, the brain may not interpret the new nerve signals properly, and a procedure called sensory re-education may be needed to optimize muscle control and feeling in the hand or fingers. Your doctor will recommend the appropriate therapy based on the nature of your injury.
Factors that may affect results after a brachial plexus injury include patient age and the type, severity and location of the injury. Though these injuries will result in lasting problems for the patient, care by a hand surgeon and proper therapy can maximize function.
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