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Brachial Plexus Injury

What is a brachial plexus injury?
The brachial plexus is the anatomical term for the group of nerves running from the neck and along the shoulder. A brachial plexus injury affects the nerves in the shoulder, elbow, forearm, wrist, and fingers.  This may affect the ability to feel and touch objects and to move parts of the shoulder, elbow, wrist, hand, and fingers. A brachial plexus injury may lead to burning pain or tingling in the shoulder, elbow, forearm, wrist or finger.

How do brachial plexus injuries occur?
Brachial plexus injuries can occur from any type of accident or trauma, but most often occur after car accidents, motorcycle accidents, ATV accidents, falls, or injuries such as stabbing or gunshot wounds.

How are brachial plexus injuries evaluated?
The doctor who evaluates patients with brachial plexus will typically start with a very detailed interview and physical examination. After an initial period of observation and repeat physical examinations, most doctors will request electrical studies to get an additional sense of which nerves and muscles are affected and how severely they are affected.

Other tests (such as MRI or CT scans) may be ordered depending on the case. Once the doctor has reviewed the collective information, he or she will discuss the overall treatment plan.

How are brachial plexus injuries treated?
There are several possible ways to treat these types of injuries. The treatment depends on the severity of the injury. A consultation with an orthopedic hand surgeon is recommended to evaluate and recommend the right type of treatment. During that evaluation, here are some things she or he may recommend:

  • Observation (to determine if the nerves will recover on their own)
  • Physical therapy to strengthen muscles and keep joints limber
  • Surgery to repair or reconstruct the nerves and ultimately improve muscle function

The types of treatment available may be different based on how long it has been since the injury.

How do I know if brachial plexus surgery is necessary?
That decision will be made after a careful discussion with the surgeon. Please call our office at 314-514-3500 to request an appointment.

In most cases, a period of time should be dedicated to observation to see what type of recovery occurs on its own. This time window will depend on the type of injury.

What types of surgery are considered?
The type of surgery will depend on many factors that should be discussed with an orthopedic hand surgeon. Below, please find a summary of the different types of surgeries available. A combination of these surgeries are often used to help restore function.

  • Direct repair – in some cases, a direct nerve repair is possible.
  • Nerve grafting – the non-working portion of the nerve is removed and replaced with a segment of nerve from another part of the body.
  • Nerve transfers – part of a working nerve is “borrowed” to serve the function of an injured nerve.
  • Scar tissue removal and nerve decompression - the scar surrounding from the nerve is removed and the nerve is decompressed from any tight surrounding tissues.
  • Muscle transfer - healthy and working muscle (with its own blood supply and nerve supply) can be transferred from another part of the body (such as the back or thigh) to the injured arm to help with providing motion.
  • Tendon transfer - healthy and working tendons can be transferred within the arm to help with motion of joints that are close by.

Is timing important?
YES. This is why it is important to be seen by a surgeon who specializes in brachial plexus injuries, even if it seems too early to consider surgery. It’s important that any surgical intervention is done in a timely manner.

The exact time frame will depend on the type of injury – it is ideal that the patient begin a relationship with a surgeon who has expertise in treating brachial plexus injuries within a few weeks or months after the injury. This is especially important if the treating doctor thinks the injury is not recovering sufficiently.

Seeing a surgeon does not mean that he or she will recommend surgery, but it is often helpful to get their opinion on the treatment options as time passes.

How quickly do patients return to a normal life?
Brachial plexus injuries are life-altering, traumatic injuries that create a “new normal” for patients. Recovery typically takes several months to several years.

Every patient and every injury are different, so an honest discussion about expectations for recovery (both how much recovery and how long it will take) with the surgeon is important.

Do I need a referral from a physician?
In most cases, a referral is not required. However, it is also recommended that patients check with their insurance company by calling the number on the back of the insurance card.

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