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Brachial plexus injury

Medically reviewed by Drugs.com. Last updated on Mar 27, 2024.

Overview

The brachial plexus is the group of nerves that sends signals from the spinal cord to the shoulder, arm and hand. A brachial plexus injury happens when these nerves are stretched, squeezed together, or in the most serious cases, ripped apart or torn away from the spinal cord.

Minor brachial plexus injuries, called stingers or burners, are common in contact sports, such as football. Babies sometimes get brachial plexus injuries when they're born. Other health issues, such as inflammation or tumors, may affect the brachial plexus.

The most serious brachial plexus injuries happen during car or motorcycle accidents. Bad brachial plexus injuries can leave the arm paralyzed, but surgery may help.

Symptoms

Symptoms of a brachial plexus injury can differ depending on how serious the injury is and where it's located. Usually only one arm is affected.

Less severe injuries

Minor damage often happens during contact sports, such as football or wrestling, when the brachial plexus nerves get stretched or squeezed together. These are called stingers or burners. Some of the symptoms are:

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

More-serious injuries

More-serious symptoms happen when an injury seriously damages or even tears or ruptures the nerves. The most serious brachial plexus injury is when the nerve root is cut or torn from the spinal cord.

Symptoms of serious injuries can include:

When to see a doctor

Brachial plexus injuries can cause lasting weakness or disability. Even if yours seems minor, you may need medical care. See your healthcare provider if you have:

Types of nerve damage

Part of the spine (on left) shows how nerve roots connect to the spinal cord. The most serious types of nerve injuries are an avulsion (A), where the nerve roots are torn away from the spinal cord, and rupture (C), where the nerve is torn into two pieces. A less serious injury is stretching (B) of the nerve fibers.

Causes

Brachial plexus injuries in the upper nerves happen when the shoulder is forced down on one side of the body and the head is pushed to the other side in the opposite direction. The lower nerves are more likely to be injured when the arm is forced above the head.

These injuries can happen in many ways, including:

Risk factors

Playing contact sports, especially football and wrestling, or being in high-speed motor vehicle accidents increases the risk of brachial plexus injury.

Complications

Many mild brachial plexus injuries heal over time with few to no issues. But some injuries can cause short-term or lasting problems, such as:

Prevention

Although a brachial plexus injury can't always be avoided, you can take steps to reduce your risk of complications after getting hurt:

Diagnosis

To diagnose your condition, your healthcare professional checks your symptoms and does a physical exam. To know how serious your brachial plexus injury is, you may need one or more of the following tests:

Treatment

Treatment depends on many factors, such as the seriousness of the injury, the type of injury, the length of time since the injury and other existing conditions.

Nerves that have only been stretched may heal on their own.

Your healthcare team may suggest physical therapy to keep the joints and muscles working properly, maintain range of motion, and prevent stiff joints.

Surgery is often the best option for serious nerve injuries. In the past, surgery was sometimes delayed to see if the nerves would heal on their own. However, new research shows that delaying surgery by more than 2 to 6 months could make the repair less successful. New imaging techniques can help your healthcare team decide when surgery would be most beneficial.

Nerve tissue grows slowly, so it can take many years before you see the final results of surgery. During recovery, you can do exercises to keep your joints flexible. Splints may be used to keep the hand from curling inward.

Types of surgery

Pain control

Serious brachial plexus injuries can cause extreme pain. The pain has been described as a debilitating, severe, crushing feeling or a constant burning. This pain goes away within three years for most people. If medicine can't control the pain, your healthcare team might suggest surgery to interrupt the pain signals coming from the damaged part of the spinal cord.

Nerve graft

Nerve tissue can be taken from other parts of the body to replace the damaged parts of the brachial plexus nerves.

Nerve transfer

Nerve transfers are most helpful for serious brachial plexus injuries, called avulsions. An avulsion happens when the nerve root has been torn out of the spinal cord. Nerve transfers also may be used to speed up muscle recovery. Because the nerve reconstruction is often close to the muscle, nerve recovery may be faster and better than it is with other techniques.

Muscle transfer

If the arm muscles are weak from lack of use, a muscle transfer may be needed. The most used donor muscle is in the inner thigh. A section of skin and tissue attached to the donor muscle may also be removed. This skin flap can help the surgeons check whether the muscle is getting enough blood after it has been transferred to its new location.

Preparing for an appointment

Many tests may be used to help diagnose brachial plexus injuries. When you make your appointment, be sure to ask whether you need to prepare for these tests. For example, you may need to stop taking certain medicines for a few days or avoid using lotions the day of the test.

If possible, bring a family member or friend. Sometimes it can be hard to remember all the information you're given during an appointment. Someone who goes with you may remember something that you forgot or missed.

Other tips for getting the most from your appointment are:

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