Brachial plexus injury

Diagnosis

Several tests may be needed following a physical examination to confirm the diagnosis of brachial plexus injury and to verify for other injuries. The tests include:

• X-ray: This will provide the doctor with images of bones and soft tissues. The images can reveal fractures or other problems on the shoulder, chest, arm, and neck.
• Magnetic resonance imaging (MRI). MRI can provide very clear images of the organs and structures inside your body. This test can demonstrate the amount of the damages produced by a brachial plexus injury and can aid in determining the health of arteries crucial for the limb or its repair. Magnetic resonance neurography, a new form of high-resolution MRI, could be used.
• Computerized tomography (CT) myelography. When MRIs do not provide enough information, this test is often used. A CT myelogram scan uses X-rays and computers to create images of structures within the body by injecting a specific dye around the spinal nerves. This imaging test is regarded as the most reliable for detecting spinal nerve avulsion injury.
• Electromyography (EMG): This is a diagnostic test that will help assess the health and function of the nerves and muscles. During the procedure, a needle electrode is inserted through the skin into several muscles. It will measure the electrical activity of the muscles while they contract and when they are at rest. An EMG may be advised if patients experience symptoms such as muscle weakness, numbness, or tingling.
• Nerve conduction studies: This is one of the electrodiagnostic exams that measure nerve conduction and muscle signals. This indicates how well the nerve is working. Typically, these examinations are conducted along with an EMG.

Treatment

The appropriate treatment for a brachial plexus injury is influenced by the type and severity of nerve injury, which nerves were damaged, the duration of time since the injury, if there were other injuries and other significant factors.

Minor brachial plexus injuries may recover without surgery within weeks to months. If the healthcare practitioner believes that the injury has a high chance of healing without surgery, they may wait to observe how it recovers before recommending surgery.

Surgical therapy is often recommended for brachial plexus injuries that do not recover sufficiently to restore vital function to the arm and hand. The surgery is usually performed within six months of the damage. Success rate is significantly reduced if performed after that timeframe.

Physical therapy may be recommended by the doctor to ensure that the joints and muscles are operating properly, preserve mobility, and avoid stiff joints.

An occupational therapist can assist the patient on how to use the unaffected arm for daily tasks such as eating and personal hygiene.

Nerves recover slowly. As a result, recovering from a brachial plexus injury takes time. It is possible that the benefits or improvement will take for several months.

Types of surgery

A healthcare specialist may use different methods to treat brachial plexus injuries. Common surgical treatments include:

• Neurolysis: This procedure involves decompressing the nerve by removing the scar tissue around the nerve.
• Nerve graft: The surgeon will stitch a healthy nerve from another region of the body between the two ends of a lacerated (severed) nerve. This acts as a bridge for fresh nerve development to occur throughout time. It will serve as a framework, supporting the wounded nerve ends while they repair.
• Nerve transfer: This surgery is performed by cutting and reconnecting a healthy donor nerve to the wounded nerve in order to provide a signal to a paralyzed muscle. This creates a path for fresh nerve development. This is often done when a nerve root is torn from the spinal cord.
• Muscle transfer: In this procedure, a transplanted muscle is connected to the nerves and blood arteries that supply the muscle. A minor healthy muscle or tendon from another region of the body, usually the thigh, is often extracted for muscle transfer.

Pain control

People with severe brachial plexus injuries may experience pain within three years. Drugs are often prescribed to relieve the pain. If the condition does not improve, the doctor may recommend a surgical procedure to block pain signals from the injured section of the spinal cord. The pain is often reported as a crippling, terrible crushing sensation or a continual burning sensation.