Brachial Plexus Injuries

Injuries to the arm nerve network in the neck-axilla region that cause weakness, numbness, and paralysis in the arm.

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Peripheral Nerve Surgery

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1Overview

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What is this Condition?

The brachial plexus is a nerve network that exits from the neck, passes through the axilla, and extends to the arm and hand, providing movement and sensation to the arm. Damage to this network is called brachial plexus injury. Most commonly occurs from motorcycle and traffic accidents, sports injuries, and penetrating wounds; in infants, it develops during difficult labor. The presentation ranges widely from mild numbness and weakness to complete paralysis of the arm. Depending on the location of the damage, there are patterns affecting the shoulder and elbow (upper type) or the hand and fingers (lower type). Recovery depends on the type and severity of damage; mild injuries may recover completely, while severe injuries with nerve root avulsion from the spinal cord may result in permanent deficits. Early evaluation and follow-up at experienced centers is important.

Symptoms

Weakness in moving the shoulder and/or elbow (upper type injury)

Weakness in the hand and fingers, inability to perform fine tasks (lower type injury)

In severe injury, complete immobility and flaccid hanging of the arm

Numbness in the arm and hand, loss of sensation

In some cases, severe neuropathic pain

Drooping of the ipsilateral eyelid and constriction of the pupil (may indicate severe nerve root avulsion)

Diagnosis Methods

Diagnosis begins with injury history and detailed examination; which muscles are weak and the distribution of sensory loss indicate the location of the damage. EMG and nerve conduction studies are performed to assess the condition of the nerves and severity of the injury; these tests are usually more informative several weeks after the injury. MRI is used to determine whether the nerve root has avulsed from the spinal cord and to identify causes of compression; CT and special imaging are used if necessary.

Treatment Methods

Treatment is determined based on the type and severity of the injury. In mild injuries (temporary damage due to stretching), physical therapy and follow-up are usually sufficient; preventing joint stiffness and protecting muscles are essential. In cases with expectation of recovery but no improvement within a certain period, or in severe injuries with nerve rupture, surgical options are evaluated: neurolysis (removal of adhesions around the nerve), nerve grafting, nerve transfer (transferring a functioning nerve to the damaged area), or late-stage tendon/muscle transfer. Timing of surgery is important; delay may reduce the chances of success. Intensive rehabilitation is required throughout the process.

Physical therapy and rehabilitation (preventing joint stiffness, protecting muscles)

Neurolysis (removal of adhesions around the nerve)

Nerve grafting or nerve transfer (transferring a functioning nerve to the damaged area)

Late-stage tendon/muscle transfer for functional restoration

References

Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023:579.
Winn HR, ed. Youmans and Winn Neurological Surgery. 6th ed. Elsevier; 2011:2484-2500.
Comprehensive Neurosurgery Board Review. 2nd ed. New York: Thieme; 2020.

This content is based on academic sources and is for general information only; individual assessment requires a medical examination.

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Brachial Plexus Injuries

Peripheral Nerve Surgery

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What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

References

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