Brachial Plexus

Brachial PlexusThe “brachial plexus,” a set of nerves,  controls many of the sensations and movements in the arms, shoulders and parts of the chest. Beginning at the spinal cord and ending at the fingertips, these nerves are important to everyday tasks. When they are injured, serious problems can arise. Learning more about it is the first step to understanding and caring for these nerves.

What is Brachial Plexus?

The brachial plexus refers to a specific network that comprises five different major nerves. These nerves act as the “middle man” for communication between the spine and the shoulders, arms and hands. The nerves run from your spinal cord, from the bones of your neck, shoulders, arms and fingertips. Parts of the bundle can even be found running over the upper portion of the ribs. In this case, it would facilitate respiration.

The brachial plexus is defined by its roots, divisions, cords and branches. Each section of the brachial plexus needs to be fully functional. Otherwise, you may have symptoms of numbness or localized pain. Typically, these symptoms will be felt within the arm or fingers and require a doctor’s attention.

When and how can these nerves become damaged?

Brachial plexus injuries are caused by stretching or tearing of the nerves. This can occur after general trauma or during difficult deliveries.  The upper nerves are damaged when the neck and shoulder separate. The lower nerves become damaged after the arm is unnaturally yanked or forced above the head.

For example, if an infant does not easily fit through the birth canal, he or she could experience shoulder dystocia during childbirth. This may lead to a brachial plexus injury because of the stretching within the neck and stress on the nerves.

Mothers who are of small stature are at risk for this type of birth, which can occur in up to .01 percent of all deliveries. A child’s brachial plexus may also come into contact with the mother’s pelvic bone during delivery. The force of that collision may crush and damage the nerves (this scenario is much less common than shoulder dystocia). A child may even get this type of injury during difficult or emergency C-sections.

Types of Brachial Plexus Injuries

The four main kinds of brachial plexus injuries include:

Neurapraxia

This is the least severe and most common type of injury. Our bodies can handle a great deal of stress before lasting damage occurs. In this case, the nerve has been stretched, causing discomfort. It will likely return to its original position on its own. This may take several months and be uncomfortable.

This injury can happen at any given spot along the brachial plexus. Exact symptoms (like numbness, burning or general pain) may vary. Once the nerve is back in place, there will likely not be lasting effects or lingering tension.

Erb’s Palsy  

This type of palsy refers to a specific part of the brachial plexus at the top of the neck. It supports the arm and supports flexibility. Symptoms will normally affect the top part of the arm. Those with Erb’s Palsy typically have better range of motion toward the fingers. Symptoms can include sore or numb arms, as well as problems gripping objects and completing general tasks.

Neuroma

This occurs when scar tissue is left over after the nerve heals from being stretched. The tissue that develops will put extra pressure on the nerve. Those who experience it will feel the same symptoms as those with neuropraxia. However, they may need further treatment to regain movement.

Klumpke’s Palsy

Just as Erb’s Palsy affects the upper portion, Klumpke’s Palsy affects the lower portion. These nerves are connected to the lower trunk of the brachial plexus. When they’re injured, they cannot send the proper signals for movement and flexibility. These roots control the muscles in the forearm and hand. Symptoms include hand deformity with numbness, weakness and lack of motion. It’s one of the easier conditions to spot because those who have it generally flex their fingers into the shape of a claw. The wrist may face either upward or outward.

Common condition’s caused by Brachial Plexus

The most common condition is neurapraxia, which can last for up to a few months. Pain may be more intense with strenuous movement. It’s important to treat the muscles with extra care during this time. Healing time will depend on the person’s body and the severity of stretching.

What are the nerves and how do they work

These nerves refer to the four lower cervical nerves and the first thoracic nerves. They’re found within the armpit, rib and neck, and they branch out from the spinal cord. These nerves supply the sensations that will be felt by nerve fibers in the shoulder, arm, hands and chest.

There are five major roots, three trunks and various branches composed of smaller nerves.  Each nerve is associated with different functions of the body. This is why one person with an injury may feel searing, burning pain, while another feels  nothing at all.

The superior trunk is necessary for proper shoulder movements. Another nerve, called the “subclavian,” controls the movement of the ribs during breathing. These nerves are very concentrated and important to normal development in the chest, arms and shoulders.

Five major nerves typically damaged in a birth injury?

Musculocutaneous

Located in the upper arm and between the biceps, ending at the elbow. It controls many of the motor functions of the arms (as opposed to sensory).

Axillary

The axillary nerve, located around the armpit, drives functions within the deltoids (where your arm meets your shoulders).

Median  

The median nerve is found in the upper part of the arm and controls the motions of the wrist. It is the primary damaged nerve in carpal tunnel syndrome.

Radial

The radial nerve is also found within the upper arm, but it controls the forearm and triceps.

Ulnar

The ulnar nerve is located in the forearm and hand. It is responsible for sensations in certain fingers, the palm and the underside of the forearm.

Typically, during a birth injury, the upper part of the body is affected. This is true in cases of shoulder dystocia, or when the baby is breech and her or his arms are stretched in traumatic ways.

It is possible for the trauma to cause compression or general damage to the lower portion as well. When all five nerves are damaged, it’s referred to as “global palsy.”

What injuries occur when nerves are damaged?

The most typical injury is pain in the affected portions of the arm. Patients describe it as a burning or searing pain. Numbness and temporary paralysis in affected areas are also common. Infants may have difficulty forming a fist or turn their arm inwards involuntarily.

The worst type of injury is “avulsion.” This will not only damage the nerves but also the skin that surrounds them. In some cases, there will be a partial or complete loss of function in the arm for a lifetime.

Minor injuries may clear up entirely with no formal treatment. Nerves are naturally resilient. They are meant to withstand a certain amount of pressure that comes from trauma, causing only temporary discomfort.

What are the causes of a Brachial Plexus injury?

There could be several contributors to this injury, including:

  • A difficult delivery
  • Use of forceps
  • Weight of the mother and child
  • Positioning of the baby
  • Long labors

Later in life, this injury is generally caused by trauma or major illness. A fall or accident can damage nerves as the neck moves away from the shoulder. Localized pressure on the nerves in either children or adults and swelling or tissue damage can interfere with normal signals.

People may experience this from extreme incidents. Being pinned in a car or under a heavy object can lead to this injury. Everyday activities like high-contact sports can also cause problems.

The severity of the tear determines the exact symptoms. There is always some element of tension or impact on the nerves.

Brachial plexus injury symptoms can also be caused by excessive pressure on the nerves. A fracture in the bones, tumors of any kind or general inflammation can all contribute. This injury can also occur when a doctor does a routine reduction, such as for a shoulder dislocation.

Symptoms of Brachial Plexus

Palsy” is a general word given to damage to the nerves, but it’s not always a lifelong condition. The amount and severity of symptoms depend on the exact nature of the injury. Symptoms can include the following:

  • General pain
  • Severe pain
  • Lack of Moro reflex (which protects infants if dropped)
  • Contractions in the arm
  • Claw-shaped hand
  • Full or partial numbness
  • Full or partial paralysis

Brachial Plexus Therapy Options

Physical therapy is the most recommended form of treatment for minor to moderate cases. Along with proper rest, it can clear up minor nerve damage entirely. Physical therapy will keep the joints and muscles in the shoulders and the arm active. It will hopefully steadily increase the range of motion over time. When damage is more severe, patients may need a combination of surgery and physical therapy. Therapy is usually the best treatment options for most cases.

While many cases clear up with no treatment at all, there may still be reason to get a professional’s advice if you think your child may have this injury.

Brachial Plexus Surgery Options

Yes, and it’s important to discuss it with your doctor as early as possible. For infants affected by brachial plexus palsy, the surgery should be completed around six-months. Otherwise, surgery can put the infant at risk for permanent loss of function. Several surgeries can help with brachial plexus palsy:

Nerve Graft

In this surgery, doctors remove the damaged portion and replace it with nerves that were taken from other parts of the body.

Nerve Transfer

Once a nerve tears from the spinal cord, there is no way to reattach it. However, surgeons can connect different (less vital) nerves that are attached to the spinal cord to the one that was ripped away.

Muscle Transfer

This surgery will transfer muscle from another part of the body (normally the leg) and place it into the arm in an effort to reconnect the nerves.
Infants and children may have a combination of the first two surgeries for best results. However, it may take years to find out just how successful a surgery is since nerve tissue grows extremely slowly.

Brachial Plexus Prognosis

The prognosis is good for most people. Physical therapy and surgery can reverse the effects entirely for many infants. Normally, symptoms for infants will disappear completely between 3 and 6 months of age — often with no special treatment or care at all.

However, there are cases where the injured will sustain a lifelong loss of function. Parents can prevent this by watching children’s movements from an early age. Any limitations when making a fist or moving the shoulders should be brought to a doctor. These types of handicaps can reduce a child’s self-esteem or increase frustration as they attempt to perform normal tasks.

Clinical Trials

Most trials directly related to brachial plexus injury treatment are performed on animals. Plenty of today’s most lucrative clinical trials are related to general nerve damage or on parts of the body that are associated with the brachial plexus.

Current treatments do seem to be accepted by both patients and doctors. However, nerves are an extremely important part of the body, which means there will always be continued research to either heal or replace those that have been damaged.

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