Neurosurgical Diseases and Disorders (A-L) / Brachial Plexus Injury

General Information

• The brachial plexus lies in the neck and consists of a group of combining nerve roots that eventually divide again to form peripheral nerves.
• These nerves are responsible for movement and sensation in the shoulders, arms, forearms and hands, and some muscles of the back and chest.

Symptoms and diagnosis

• Symptoms of injury to the nerves of the brachial plexus vary depending upon which nerves are affected. Diagnosis depends on the symptoms.
  • Upper plexus lesion
    • The condition is caused by prolonged pulling on the arm at birth (Erb-Duchenne paralysis) or falls on the shoulder.
    • Paralysis in the deltoid, supraspinatus and infraspinatus muscles causes weak shoulder, while paralysis in the biceps and brachoradialis prevents movement of the elbow.
  • Posterior cord lesion
    • The condition causes paralysis of the following muscles: deltoid (shoulder), triceps (straightens the elbow), extensor carpi radialis and ulnaris (straightens wrist), and extensor digitorum (straightens fingers).
    • The injury prevents patients from straightening the affected arm, forearm and hand.
  • Lower plexus lesion
    • Caused by forced outstretch of the shoulder and arm at birth (Klumpke's paralysis) or trauma, the condition causes paralysis of certain hand muscles.
    • Symptoms include a claw hand, sensory loss in the lower trunk, and Horner's syndrome. Symptoms of the syndrome include drooping eyelid, contracted pupils, absence of sweating and receding eyeball.
  • Complete brachial plexus injury
    • The condition results in a completely paralyzed arm with no sensation.

Treatment

• Most injuries cause maximum symptoms at the time of the injury.
• Vascular injury can cause worsening of symptoms and needs to be addressed quickly to prevent ongoing deterioration.
  Treatment depends on the type of injury:
  • Laceration
    • Nerves damaged by clean, sharp, relatively fresh lacerations, such as those from a knife wound, should be surgically reconnected within 72 hours.
    • Penetrating injuries with severe or complete loss of sensation should be explored as soon as the primary wound heals.
  • Gunshot wounds
    • Gunshots usually damage the nerves dues to the vibratory effect of the bullet and rarely divide the nerves.
    • Surgery is of little benefit to these lesions and chances of full or partial recovery is small.
  • Stretching
    • Injuries related to stretching of the nerves will usually recover spontaneously within four months.
    • Injuries with symptoms that continue after four to six months should be investigated surgically.