Ask a Doctor: Brachial Plexus Injuries

Hand surgeon Ryan Zimmerman, MD answers your questions about brachial plexus injuries.

What is the brachial plexus? 

The brachial plexus is a complicated web of nerves located near the base of your neck and top of your shoulder.  Typically, five nerves from the spinal cord at your neck weave together and eventually form the nerves for your shoulder, arm and hand.

How do brachial plexus injuries happen?

Brachial plexus injuries usually happen due to a stretching injury across the nerves.  Most of the time, the nerves get stretched but stay connected.  In severe cases, the nerves can tear. There are a few common ways for brachial plexus injuries to happen.  In newborns, the injury can occur during birth, This is more likely if the baby gets stuck during delivery.  During sports, tackles or collisions can cause a stretch injury.  This is commonly referred to as a “stinger” or “burner.”  In car or motorcycle accidents, the brachial plexus can be stretched by the force of the impact.

What are the symptoms of a brachial plexus injury?

Each injury is unique, and the symptoms are due to the exact nerves that get stretched and how badly they get stretched.  Many patients with brachial plexus injuries describe “electrical” or shooting pains that can run all the way down to the hand.  Numbness and weakness are also common.  The numbness can range from a slight funny feeling to total numbness. Weakness can range from mild loss of strength to total inability to move the shoulder, elbow, or hand.

How is a brachial plexus injury diagnosed?

Nerve injuries are often difficult to diagnose with pictures and imaging. In cases of traumatic injuries, X-rays are typically used to look for breaks or dislocations in bones and to also make sure there are no injuries to the neck or chest.  A brachial plexus injury is mainly diagnosed by a doctor’s exam, where sensation and strength throughout your shoulder, arm and hand is carefully checked.  Based upon a number of factors, nerve studies (tests that look at how well nerves conduct electricity), a CT scan or MRI may be ordered to learn more about a specific injury.

How is a brachial plexus injury treated?

Initially, most injuries are watched for several weeks to see if the nerves recover on their own.  During this time, it’s important to keep any weak joints from getting stiff and make sure that numb areas are not accidentally burnt or cut.  If the nerves don’t recover on their own, surgery may be recommended.  The surgery recommended is determined by which nerves are injured and can involve moving, repairing or grafting nerves and tendons.

What is the typical outcome?

In many cases, good or complete recovery can occur on its own over weeks to months, often taking 6 months or more to recover.  In more severe cases, there may be permanent loss of sensation and strength.  Unfortunately, recovery from a brachial plexus injury can be unpredictable.

Ryan Zimmerman, MD is a Hand, Shoulder and Elbow Surgeon and Greater Chesapeake Hand to Shoulder and the Curtis National Hand Center. 

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