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According to the National Center for Biotechnology Information, roughly 1 to 2 babies per 1000 suffer brachial plexus injury during birth. The brachial plexus is injured in about 1% of multi-trauma victims. Tragic motorcycle accidents and winter accidents regard for roughly 5% of similar injuries. The risk of long-term brachial plexus injury percentage from birth is nearly 30 percent.
Is what I said about brachial plexus going right over your head? You may not know what a brachial plexus is. In layman’s terms, brachial plexus injury is an injury to the nerves in the shoulder that runs from the lower cervical spine to the arm.
If you play sports, you may have experienced sudden stretching to your neck as a result of a fall or hit. You may have experienced arm or finger weakness after the fall. You might be wondering why I have arm weakness if I haven’t hit my arm or fingers. The arm weakness could have betided as a result of your neck strain, which caused a partial or complete tear to the C5 to T1 nerve roots or the parts of the brachial plexus.
Have you ever seen a child or an adult with arm weakness? Do you know why this is so? People can injure the network of nerves in the shoulder during sports, motorcycle accidents, or during birth. Since they transmit movement and signals from the spinal cord to the arms and fingers, any injury to these nerves can beget pain, weakness or numbness in the arms and fingers.
Before delving into the complications of brachial plexus injury, let’s get familiar with the anatomy of brachial plexus nerves.
Anatomy of Brachial Plexus
The cervical nerves from C5 to C8, as well as the first thoracic nerve from T1, are intertwined and branch out to the arms and fingers. These five nerve roots join and diverge after exiting the cervical spine, forming ‘…three trunks, six divisions (three anterior and three posterior), three cords, and five branches.’ The five branches are the musculocutaneous nerve, axillary nerve, radial nerve, median nerve, and ulnar nerve. These nerves control the motor activities in the upper extremity muscles and disseminate the signals from the spinal cord down to the fingertips. Going through the given picture will give a clear idea.
Causes of Brachial Plexus Injury
As we have seen in the beginning, multiple factors could cause brachial plexus injury. Let’s go through them.
- Sports activities: Competitors in contact sports such as boxing, wrestling, football, ice hockey, or hockey might experience significant stretching at neck while colliding with other participants. You may get a disastrous brachial plexus injury from a fall. This sudden and powerful blow to the neck and shoulder might result in an unfavorable consequence such as brachial plexus damage.
- Birth injury: Since their muscles and nerves are delicate, newborns might sustain brachial plexus damage during delivery. Not every delivery is risk-free. In certain situations, the baby’s shoulder may become trapped inside the mother’s pubic cavity, owing to the child’s enormous weight, lengthy labor, breeched state of the infant in the womb, or inappropriate dilation of the pubic bones. When a doctor or nurse pulls the baby out by holding the head, the brachial plexus might be injured.
- Cancer or cancer treatments: Cancerous or tumorous development in the area of the brachial plexus can have a harmful impact on the nerves. Radiation therapy for cancer can harm brachial plexus nerve fibres in some circumstances.
- Traumatic accidents: Any type of traumatic event can harm the brachial plexus. Motorcycle accidents, bicycle accidents, slips and falls, automobile accidents, and even gunshots can cause nerve damage.
- Surgeries: When procedures on the neck or shoulder are performed, the brachial plexus nerves may be inadvertently injured. In rare circumstances, surgical scars can thicken and injure the brachial plexus.
- Laceration and gun shot: The cut or laceration with a knife or razor would cut the brachial plexus nerves partially or completely. Such torsions would cut down the transmission of the nerve impulses from reaching the brain. This may end up in loss of sensation or movement. When the bullet pierces through the shoulder, it can damage the brachial plexus.
Brachial Plexus Injury Symptoms
The symptoms of a brachial plexus nerve injury differ depending on the nerve and the side of the damage. Brachial plexus injury causes pain, weakness or numbness, loss of feeling, and loss of movement in the arm from the neck. The protracted agony caused by brachial plexus avulsion (full nerve root torsion) would be unbearable. More intense pain would result from injuries closer to the cervical spine. The most severe injuries will result in upper-extremity paralysis.
Brachial Plexus Injury Types
- Avulsion: When nerve roots are torn apart completely from the spinal cord, brachial plexus avulsion occurs. This is the most severe condition among all brachial plexus injuries. Surgery is used to repair the damages.
- Rupture: When the brachial plexus nerves are compressed or stretched, there are chances for them to be torn partially or completely. This kind of injury can result in pain, weakness, numbness, or even complete loss of movement.
- Neuroma: The thickening of the nerves after injuries from the scar tissue is called a neuroma. These thickened nerves can become a painful knot causing symptoms in some cases.
- Neuritis: The inflammation of the nerves due to injuries, infection or autoimmune diseases is called neuritis. Pain, numbness, and weakness can be caused by neuritis. Pain medications or surgery can be needed to cure that.
- Neurapraxia: Due to compression or traction, the nerves will be stretched to an extent to cause injury. This is called neuropraxia.
- Erb’s palsy: It is an upper plexus palsy in the C5-6. Sometimes it includes C7 too. When the brachial plexus nerves are injured during the delivery or have a forceful impact on the shoulder and neck, there will be loss of movement or weakness in the shoulder, arm, and fingers.
- Klumpke’s palsy: It is a lower plexus palsy involving C8-T1. Sometimes this may include C7 too. When the brachial plexus nerves are scarred, stretched, or torn due to an injury that occurred at the time of the childbirth, this paralysis occurs.
- Global palsy: Global palsy is the extreme condition in the brachial plexus injury during childbirth. Though it is somewhat similar to the Erb’s palsy, the victim loses the movement in the whole arm as if a complete paralysis to the shoulder, forearm, wrist, hand, and fingers. Because the torsion occurs in all nerve roots from C5 to T1.
- Horner syndrome: It is an illness caused by the torsion in the sympathetic nerve fibers in the brachial plexus. It can cause ptosis (drooping eyelids), miosis (smaller pupil size), hypochromic iridis (lighter pigmentation in the eye) and anhidrosis (dryness of the eye) on the affected side. It can also be caused by injury to the aorta or tumor in the nervous system.
Complications of Brachial Plexus Injury
As we’ve seen with the symptoms, the dangers vary depending on which nerve is affected. Most of the milder nerve injuries will be healed on their own. The majority of people who have been affected can regain 90 to 100 percent of their usual arm functions. However, in the case of severe injuries, treatment should be sought as soon as possible. Delay in treatment might result in long-term problems, such as loss of sensation or movement in the affected arm.
If your kid has a brachial plexus injury after birth, you should seek therapy within six to eight months. The baby’s chances of survival will be more in this stage. In the first six weeks, a birth injury may heal on its own. Those who do not heal will require substantial treatment in the initial stage itself.
Since a brachial plexus injury can cause people to lose sensation, you must be particularly cautious while handling sharp objects like knives, razors, or hot items. You may not be aware of an injury because you lack the sensation of touch.
For some patients, long-term pain in the affected side is a possibility. In severe circumstances, the affected upper limb will be paralyzed from the shoulder to the fingers.
Diagnosis of Brachial Plexus
The doctors examine the neck, shoulders, arms, wrists, hands, and fingers to determine where the weakness is. They can identify brachial plexus damage by examining motor strength and range of motion and gathering symptoms and medical history.
Imaging examinations such as X-rays, CT scans, and MRI scans are used to diagnose brachial plexus injuries. The imaging studies also reveal the sort of brachial plexus injury that has occurred. Electromyograms will be performed on a regular basis to track how well the treatments are working. The time it takes for an electrical impulse to go from the neck to the hands is measured with a nerve conduction study to assess treatment and recovery progress.
Treatment for Brachial Plexus Injury
Over-the-counter pain relievers such as Acetaminophen and Ibuprofen are used to treat brachial plexus injuries in the neck, shoulder, arm, wrist, hands, and fingers.
Casts may be used on a regular basis to increase range of motion and ensure joint alignment. The cast will be removed after the progress has been verified, allowing the limb to move freely.
A splint may be needed on occasion, particularly in the case of kids, to ensure that the damage heals properly. The children might not be as careful as they should be in keeping their hands immobilised to aid recuperation. The splint must be worn depending on the severity of the injury and the amount of time required for healing.
Exercises for Brachial Plexus Injury
Physical therapy is used to increase flexibility in the joints, arm, hands, wrists, and fingers. Some brachial plexus injury workouts include lateral raises, biceps and wrist extension curls, triceps kickbacks, grip strengthening exercises, aquatic therapy, free weights, and resistive band stretches. Home workout plans will be introduced in addition to this. Electrical impulses are used to stimulate nerve fibres via transcutaneous electrical nerve stimulation (TENS). Occupational therapies can be used in conjunction with these to improve daily activities such as dressing, bathing, and so on.
Surgeries for Brachial Plexus
Surgery should be performed as soon as possible following the damage. Surgery that is postponed will not produce better results. Because nerve growth is slow, the surgery’s results will take months or years to show. Exercise routines should be continued even after surgery to ensure a full recovery. Splints or casts may be utilized following surgery in some circumstances. Let’s look at the various procedures used to treat brachial plexus injuries.
Decompression and Neurolysis of the Brachial Plexus: Neurolysis is the process of removing scar tissue in order to relieve pressure on the damaged nerves. Only if the nerve is compressed, this can be done.
Nerve graft: If the nerve is injured to the point where it can no longer transfer signals to the brain, resulting in arm paralysis, surgery to graft the nerves will be performed. The injured part of the brachial plexus nerve is surgically removed, and nerves from the patient’s donor site are subsequently implanted to encourage nerve growth.
Nerve transfer: If a nerve ceases to function completely, a nearby less important nerve is attached to the non-functioning one to allow the transmission of messages to continue uninterrupted. The upper limb’s movement and function can be recovered in this way. This method can be used to transfer the medial pectoral nerve, intercostal nerve, musculocutaneous nerve, and other nerves.
Muscle/tendon transfer: Muscles or tendons will be extracted from other parts of the body, such as the thigh, and fastened to the location where the muscle or tendon is damaged, assuring blood circulation. The paralysed tendon or muscle will be stimulated by the new tendon or muscle, allowing it to regain its lost motions.
When the brachial plexus is injured, it can result in excruciating agony. As we’ve seen throughout this blog, upper-limb paralysis has a negative impact on the quality of life. Therapy and procedures can help restore motion, but only if they are started on time. Only a small percentage of the injuries would respond to treatment to a 90 percent. Others would not be able to regain their entire range of motion or arm movement. Neuromodulation or ablative techniques might be required for them. Therefore, never ignore the birth injuries, or a violent stretch to the neck or shoulder.