Brachial Plexus Injuries, Symptoms and Treatment
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Brachial Plexus And Injuries

Dr.Surya Rao Poodipeddi profile Authored by Dr.Surya Rao Poodipeddi on 30 Dec 2014 - 11:31.

The brachial plexus is a network of nerves running from the spine that supplies the skin and musculature of the upper limb.These nerves from the spine are formed by the ventral rami of the lower four cervical nerves and first thoracic nerve roots (C5-C8, T1). It proceeds through the neck, the axilla (armpit region) and into the arm.

The spinal cord is an extension of the brain stem which descends downwards into the spinal canal. The spinal cord traverses from the base of the skull through the openings in the 24 vertebrae starting from the cervical region down to the sacral region. Each vertebra has two openings on its sides through which the spinal cord sends one branch of nerves to each side that forms the brachial plexus on either side.

Each branch that comes out from one vertebra joins with the branch from the vertebra down below. The combined branch joins again with the branch emerging from vertebra below. And the combined network of branches from all the seven cervical vertebrae constitutes the Brachial Plexus one for each side, supplying nerves to the muscles in the upper limb of the corresponding side.

To sum, up the brachial plexus is a network of nerves.It conducts signals from the spine to the arm and hand. These signals cause the arm and hand muscles to move. (Brachial means arm, and plexus refers to a network of nerves).

Brachial Plexus Injuries: A brachial plexus injury (Erb's Palsy) is a nerve injury. The nerves that are damaged control muscles in the shoulder, arm, or hand. Any or all of these muscles may be paralyzed. Injuries to the brachial plexus in children presents in different ways. Some of the examples of injuries affecting children are as follows:

  • Some children lose control over their muscles and have no feelings in the arm or hand.
  • Some children can move their arms but have little control over the wrist or the hand.
  • In some cases a child can use his hands well but cannot use the shoulder or elbow muscles.

Although an injury can occur any time, most brachial plexus injuries in children happen at birth. Many such children are usually larger than average at birth (large babies). However, a newborn of any size including premature babies can have these injuries. About 1 or 2 percent babies account for such injuries during birth. From these, about 1 in 10 such children might require treatment. The common line of treatment in such cases is either exercise and surgery or both.

Brachial plexus injuries may present in four different types:

  • An avulsion causing a tear in the nerve from the spine.
  • A rupture may tear a nerve at a lace other than its attachment to the spine.
  • A neuroma while trying to heal may leave a scar around the injury leading to pressure on the injured nerve, resulting in the disability to conduct  signals to the muscles.
  • Praxis is a case in which the nerve has been damaged but not torn which might heal on its own. Children with this type of injury show good prognosis where one can expect improvement in 2 to 3 months.

One or more nerves may be involved in injuries to the brachial plexus. Surgery may help a child with brachial nerve injury. A pediatric neurosurgeon can help a child with such injuries and be able to restore some functions to the affected muscles. Surgery is more effective when done in a patient between the ages of 5 and 12 months. It may not prove successful if done after one year of age.

Treatment approach:

Exercise is an important step that can help in cases of injuries to brachial plexus. Exercise helps in improving the tone of the muscles leading to better range of movements in an affected muscle. These exercises are called range of motion exercises. Any muscle when not used properly may become loose and inactive, more so, when affected due to such injuries. Therefore,constant exercises over a length of period will go a long way to help restore, tone and help in a range of movements. An occupational or physiotherapist can provide the suitable guidance in doing various exercises and help recover.

Symptoms:

Any injury to the plexus results in the following symptoms.

  • Limp or paralysis of the arm.
  • Lack of muscle control in the arm or hand.

The presentation of symptoms as paralysis or weakness in muscles or loss of control in a particular muscle or group of muscles, depends on the extent and severity of involvement of the nerves.

The type and site of involvement determines the prognosis. For avulsion and rupture injuries there is no potential for recovery unless surgical reconstruction is done on time. Cases due to neuroma and /or neuropraxia have greater potential for recovery varies.Majority of such cases end up with complete recovery over a period of 2 to 3 months. There’s a ray of hope for those with brachial plexus injuries, due to the extensive research being conducted on finding a cure and also avoiding it.

*Disclaimer: This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.