Brachial plexus injuries refer to injuries involving the brachial plexus in the neck region, resulting in weakness or the loss of movement in the affected shoulder, elbow, and/or hand following an accident.
The brachial plexus is a complex network of nerves that transmits signals from the spinal cord to the shoulder, arm, and hand, controlling their movement and sensations. This network originates in the neck and extends through the upper chest to the armpit.
Typically, brachial plexus injuries occur when the arm experiences forceful stretching, pulling, or injury during an accident. This condition is more commonly observed in males aged between 15-25 years.
When the nerves responsible for transmitting and receiving signals are compressed, stretched, torn, or severed due to an accident, it can lead to weakness, numbness, or loss of movement in the affected shoulder, arm, or hand. A practical illustration of this is when a person becomes unable to lift their hand from the elbow or shoulder joint, loses grip strength, or struggles to hold objects after an accident.
To avoid delays in treatment due to lack of awareness, patients should consult Plastic Surgeons with expertise in managing Brachial Plexus injuries. Dr. Amit Agarwal, with over 14 years of experience in this field, specializes in Brachial Plexus injury management.
If there is no improvement within 3 weeks of the accident, several diagnostic investigations are recommended:
The brachial plexus consists of five cervical nerves: C5, C6, C7, C8, and T1. Patients can correlate their injury type with their specific symptoms and weaknesses. Brachial plexus injuries can be categorized into:
1) Partial Brachial Plexus Injuries (Upper Arm Type, Lower Arm Type)
a) Upper arm type (C5, C6 with or without C7 injuries)- Upper arm type injury will present with deficits in
If C7 is involved, there will be a variable weakness in elbow, wrist, and finger extension (straightening of elbow, wrist, and finger joints).
b) Lower arm type (C8, T1 injuries), very less common. Lower arm-type injury will present with
2) Complete Brachial Plexus Injuries (Total Arm Type)
Total arm-type injury will have a complete loss of movements in the hand, forearm, and arm, with loss of sensation as well.
The upper brachial plexus (C5, C6) is more prone to stretching or rupturing in the neck region, while the lower brachial plexus (C8, T1) tends to avulse or detach from the spine.
Once the patient has recovered from other injuries, they should undergo regular physiotherapy and self-examination as described earlier. If there is no improvement within 3 months, nerve transfer surgery is recommended as the primary treatment for brachial plexus injuries.
The time elapsed between the accident and surgical intervention plays a crucial role in the outcome of brachial plexus injuries. Immediate surgery is performed in cases of sharp open injuries, while blunt closed injuries are observed for the first 2-3 months to allow for potential spontaneous recovery. Surgery can still be effective within 9 months to 1 year of injury, but the chances of recovery decrease with time. After 1 year, specific muscle and tendon transfers are considered instead of nerve transfer surgery.
Treatment for Brachial Plexus Injuries depends on the time elapsed since the accident.
A) If the intervention occurs within one year of the accident, nerve transfers or nerve repair are performed.
B) For cases more than one-year post-accident, muscle or tendon transfers are advised. The specific procedure is determined by whether the injury is complete or partial.
Less than 1 year of Injury:
More than 1 year of Injury:
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