The damage occurs when 1 or more nerves are pulled, stretched, compressed, or torn. The nerve injury can be an avulsion pulled away from the spinal cord , a stretch pulled but not torn , or a rupture stretched with a partial or complete tear. Often, the nerves closer to the neck are damaged when the shoulder is forced down and the nerves closer to the armpit are more likely damaged when your arm is forced upward or above your head.
The injury occurs when the arm is forcibly pulled or stretched downward and the head is pushed to the opposite side. Interestingly, brachial plexus insult can also occur in an idiopathic unknown cause fashion after inflammation of the nerves. For most brachial plexus injuries, only one side is usually affected and depending on the severity and location, the signs and symptoms vary. For example, the minor damage caused by a burner or stinger can produce an electric shock or burning sensation shooting down the arm and numbness and weakness in the limb.
The symptoms can last a few seconds or they can last for days. Traumatic brachial plexus injuries can present with partial or complete motor and sensory paralysis of the arm, shooting pains in the affected arm, and an inability to use all or selected muscles on the affected side. These injuries can be transient and slowly resolve over time or can persist for longer periods leading to permanent damage. If you experience a serious injury, such as an avulsion, you may become unable to use certain muscles in your shoulder, arm, or hand.
You may experience severe pain or lose feeling and the ability to move the limb. Acute injuries to the brachial plexus often warrant close follow-up with a medical professional. Mean delay until surgery was 5 months range, months. Two patients had C5 paralysis, 2 had C5-C6 paralysis, 2 had C5-C7 paralysis, and 5 had complete 5-level injuries. Outcome parameters included active range of motion ROM in degrees, a modified British Medical Research Council mBMRC scale for muscle strength, and electromyographic motor unit configuration and recruitment pattern.
The brachial plexus is the network of nerves that sends signals from your spinal cord to your shoulder, arm and hand. A brachial plexus injury occurs when these nerves are stretched, compressed, or in the most serious cases, ripped apart or torn away from the spinal cord. Minor brachial plexus injuries, known as stingers or burners, are common in contact sports, such as football. Babies sometimes sustain brachial plexus injuries during birth.
Other conditions, such as inflammation or tumors, may affect the brachial plexus. The most severe brachial plexus injuries usually result from automobile or motorcycle accidents. Severe brachial plexus injuries can leave your arm paralyzed, but surgery may help restore function. The brachial plexus is the network of nerves that send signals from your spine to your shoulder, arm and hand.
A cross section of spine on left shows how nerve roots are connected to the spinal cord. The most severe type of nerve injury is an avulsion A , where the nerve roots are torn away from the spinal cord. Less severe injuries involve a stretching B of the nerve fibers or a rupture C , where the nerve is torn into two pieces. Signs and symptoms of a brachial plexus injury can vary greatly, depending on the severity and location of your injury. Usually only one arm is affected. Minor damage often occurs during contact sports, such as football or wrestling, when the brachial plexus nerves get stretched or compressed.
These are called stingers or burners, and can produce the following symptoms:. These symptoms usually last only a few seconds or minutes, but in some people the symptoms may linger for days or longer. Shoulder dystocia occurs when the shoulder is temporarily stuck under the pubis during delivery, and can result in brachial plexus injury. The severity of these injuries can vary widely. Some children with brachial plexus birth injuries recover spontaneously, and most children will regain all or most of their normal function through physical and occupational therapy.
A smaller group will require surgical intervention to achieve good function. Early diagnosis and treatment can improve long-term results. 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. 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. A health care provider will examine the hand and arm and test for sensation and function to help diagnose a brachial plexus injury. These tests may be repeated every few weeks or months to allow your doctor to monitor your progress.
Some people, particularly babies with a brachial plexus birth injury or adults with neuropraxia, recover without any treatment, though it can take as long as several weeks or months for the injury to heal. Certain exercises can help with healing and function, but more severe injuries may require surgery. Prompt examination by a health care provider is essential after any suspected brachial plexus injury.
Mild brachial plexus injuries respond well to a combination of nonsurgical treatment options. Your doctor may recommend one or all of the following:. Brachial plexus injuries that fail to heal on their own may require surgery to repair the damage. Nerve tissue grows and heals slowly, so it can take months to years to see the results of brachial plexus surgery.
Brachial plexus surgeries should take place within six months of injury for the best chance at recovery. Procedures your surgeon might recommend include:. Our experts at the Johns Hopkins Peripheral Nerve Surgery Center are well-versed in all types of brachial plexus injuries, from birth injuries to radiation treatment complications.
We use a holistic approach, creating an individualized treatment plan for each patient. In infants, if no improvement is seen after three months of occupational therapy, consulting a pediatric neurologist and pediatric neurosurgeon can help determine if your child can benefit from other interventions or surgery. Up to 1 in 10 babies with brachial plexus injury will require some level of surgery. Prompt intervention is important. If the injury occurred during birth, the best time for surgery is when your child is between 4 and 9 months, as waiting longer than a year can limit the level of function a surgery might restore.
Because nerves heal slowly, brachial plexus injury recovery can take several weeks to months, depending on the severity. During this time, regular physical therapy appointments to prevent muscle atrophy and contractures are often necessary. You may also need regular checkups with your neurologist to watch the progress and healing of a brachial plexus injury, as well as to manage any pain.
Checkups are especially important for babies, and may be needed for as long as two years as the injury heals. For severe brachial plexus injuries, prompt surgical treatment could be needed to attempt to regain function.
Without it, you might have a permanent disability and be unable to feel or use your arm or hand. If you have a brachial plexus injury resulting in a lack of feeling, take special care when dealing with hot items, razors, knives or other objects that could harm you.
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