Brachial plexus injuries are among the most devastating injuries, causing significant loss of function and the ability to perform tasks of daily living and in the workplace. They often occur as a result of motorcycle accidents, industrial trauma, or a heavy fall with stretching of the neck.
Early diagnosis and treatment makes a huge difference in eventual outcome.
The brachial plexus is a complex group of nerves that come from the spinal cord in the neck and travel down the arm. These nerves control the muscles of the shoulder, elbow, wrist and hand, and provides feeling in the arms.
These nerves can be damaged by stretching, pressure or cutting. Stretching can occur when the head and neck are forced away from the shoulder, such as during a car accident or a fall off a ladder at work. If the force is severe enough, the nerves can tear out of the spinal cord in the neck. Pressure could occur from the crushing of the brachial plexus between the collarbone and first rib, which can happen during a fracture or dislocation. Swelling in this area from excessive bleeding or injured soft tissues can also cause an injury.
Minor brachial plexus injuries usually completely heal in several weeks, and other injuries are severe enough that they could cause permanent residuals such a loss of function and chronic pain. Early intervention and recent advances in microsurgical reconstruction have greatly improved outcomes.
The more severe injuries or those not caught right away may require reconstructive surgery. Nerve reconstructive surgery is ideally performed within the first 3-6 months after acute injury to permit optimal recovery, allowing time for the regenerating nerves to connect with paralyzed muscles before dense scarring develops. In injuries that occurred more than six months ago, new techniques have enabled surgeons to transfer working muscles with their blood and nerve supply from distant parts of the body, enabling lost elbow flexion and shoulder motion to return.
However, the recovery process is slow –measured in months and years rather than weeks and months. Muscle takes between 6-12 months to recover and then work toward the return of strength and mobility needs to be progressive. State-of-the-art techniques like electric stimulation, biofeedback and pool therapy may be employed to help with the recovery process.
Most brachial plexus injuries are extremely complex because of the myriad of nerves which control function and feeling in the arm. The outcome is generally dependent upon:
Looking at medical developments throughout the last three decades, there have been significant developments in the management of these injuries, which include a better understanding of the anatomy, advances in diagnostic modalities, incorporation of intra-operative nerve stimulation techniques and more liberal use of nerve grafts. Additionally, current microsurgical techniques have resulted in increased functionality of the upper plexus injuries. As research continues, we can expect to see less pain and disability associated with brachial plexus injuries.
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