Brachial plexus injury it is when the brachial plexus gets to be injured, a network of nerves that emits signals from the spinal cord to the shoulder, arms, and hands. When compression or stretching of these nerves is practiced wrongly, it might result in an injury.
It also happens, in the most severe cases, when these nerves are torn away or ripped apart from the spinal cord. Brachial plexus injury is among the most devastating injuries a person can endure. This post sheds light on the diagnosis, treatment, and rehabilitation of this serious condition.
Symptoms of brachial plexus injury
The symptoms of the brachial plexus injury may vary as it depends on the severity and location. Minor injuries may occur during contact sports. The symptoms of a less severe brachial plexus injury include numbness and weakness in the arm and a burning sensation down the arm. In many of the cases, the symptoms may last a few seconds or minutes but may take longer in some people.
Serious injuries can cause even more severe symptoms such as intense pain, weakness or inability to use certain muscles in the shoulder, arm, or hand, and complete lack of movement and feeling from shoulder to hand.
Diagnosis of brachial plexus injury
While sometimes brachial plexus injuries heal on their own, more severe cases do not. When left untreated, these injuries can cause complications such as pain, stiff joints, numbness, muscle atrophy, and permanent disability.
It is necessary to see a doctor if a patient is experiencing recurrent burners and stingers, neck pain, weakness in the arm or hand, and symptoms in both arms.
The doctor will start with the physical exam and ask about the symptoms the patients experience. In order to undergo a precise diagnosis and rule out other problems, the doctor generally orders various diagnostic tests. These include:
- Imaging tests – computed tomography (CT) as well as computed tomographic myelography (CTM) help, evaluate the extent of the nerve injury. A doctor may order CT when MRI doesn’t provide enough information. Right after the injury, blood clots form at the affected site, and they become noticeable in myelography. That’s why CT myelography is best performed three to four weeks after the injury. On the other hand, MRI can depict more lesions apart from root injuries. Besides these, imaging tests like X-rays are also used to determine whether a patient has fractures or other injuries.
- Histamine test – rarely performed nowadays and involves histamine injection to get more information about the type and extent of the injury.
- Electrodiagnostic tests – an integral component of the preoperative and intraoperative evaluation. Healthcare professionals use tests such as electromyography (EMG) and nerve conduction velocity studies to diagnose the injury, pinpoint the lesions, determine the severity of the injury, and perform differential diagnoses. The main objective of EMG and nerve conduction studies is to evaluate the electrical activity of muscles when they’re at rest and contract or how well the nerves are functioning.
Treatment of brachial plexus injury
The exact treatment of brachial plexus injury depends on the severity and type of the injury, the length of time since it occurred, and other factors. Subtle stretching of the nerves usually doesn’t require treatment. More serious injuries require physical therapy or surgery.
The main objective of the treatment is to maintain the range of emotion of the affected arm, hand, or shoulder but also to strengthen the remaining functional muscles. Proper treatment also aids in pain management. Pain can be very intense in patients with brachial plexus injury.
In most cases, a combination of different approaches works best. Nonsurgical options for the treatment of brachial plexus injury include pain-relieving medications, corticosteroid creams or injections, and assistive devices such as compression sleeves. While helpful for alleviating pain, nonsurgical options don’t treat the injury itself. That’s why they’re not the only treatment approach for this injury.
Surgical procedures performed within six months after the injury have the highest success rates. Several types of surgeries can help patients with brachial plexus injury. These include:
- Neurolysis – frees up the nerve from scar tissue.
- Nerve graft – is the removal of the damaged part of the brachial plexus. Once removed, the damaged part is replaced by nerve sections taken from other parts of the body.
- Neurotization (nerve transfer) – taking a less important functioning nerve and connecting it to a more important but dysfunctional nerve. This surgical approach is performed in cases when the nerve root is torn from the spinal cord.
- Muscle transfer – similar process as neurotization, but instead of nerves, muscle is transferred.
Besides the abovementioned surgeries, healthcare professionals may recommend tendon transfer and arthrodesis, a fusion of two or more bones.
Rehabilitation for brachial plexus injury
Rehabilitation for brachial plexus injury is challenging and relatively unexplored. In addition to medications and surgery, physical therapy is a crucial aspect of managing brachial plexus injury. This is certainly for the cases of patients who undergo surgery, but it’s also recommended for persons with less severe injuries.
The exact physical therapy program depends on the severity of the injury. The main objective of physiotherapy is to help patients develop flexibility, strength, coordination, and stamina. At the same time, physical therapy helps maintain a range of emotions, provides functional training, assists in pain control, and aids the management of chronic edema through massage therapy, education, and compression garments.
Rehabilitation for brachial plexus injury requires a lot of patients. It’s a long-term process that takes a year or more, not weeks.
Besides exercise therapy and other conventional physiotherapy methods, alternative methods are also available. These include biofeedback, pain neuroscience education, and TENS (transcutaneous electrical nerve stimulation). Well-structured rehabilitation program helps patients with brachial plexus injury alleviate pain, move more easily, and improve their quality of life.
Since every injury is different, programs may vary from one person to another.
It’s useful to emphasize that rehabilitation is useful for all persons with brachial plexus injury, even if they don’t need surgery.
The success of a rehabilitation program depends on the patient’s cooperation. Lack of cooperation may increase disability. For that reason, patients with brachial plexus injury may also need psychological help. For example, regular therapy sessions could help patients cope.
As their mental health improves, they are more likely to cooperate and stick to the recommended program. The therapy enables patients to overcome a common obstacle caused by negative thoughts and emotions, making them firmly believe they will not get better.
Brachial plexus injury is becoming increasingly prevalent. Considering the amount of pain that patients experience, brachial plexus injury is one of the most devastating injuries. Fortunately, it is manageable. Everything starts with a precise diagnosis that involves a physical exam and imaging tests. The healthcare professional recommends the best treatment based on the type and severity of the injury.
A combination of medications, assistive devices, and surgery works best. Rehabilitation is the cornerstone of recovery, regardless of whether patients need surgery or not. The exact program varies from one patient to another, but its main objective is to increase flexibility, strength, endurance, and range of motion. Psychological management may also be necessary for patients with this injury.