Brachial plexus injuries
DEFINITION
The brachial plexus is the network of nerves that sends signals from your spine to your shoulder, arm and hand. A brachial plexus injury occurs when these nerves are stretched, compressed, or in the most serious cases, ripped apart or torn away from the spinal cord.
Minor brachial plexus injuries, known as stingers or burners, are common in contact sports, such as football. Babies sometimes sustain brachial plexus injuries during birth. Other conditions, such as inflammation or tumors, may affect the brachial plexus.
The most severe brachial plexus injuries usually result from auto or motorcycle accidents. Severe brachial plexus injuries can leave your arm paralyzed, with a loss of function and sensation. Surgical procedures such as nerve grafts, nerve transfers or muscle transfers can help restore function.
CAUSES
Damage to the upper nerves that make up the brachial plexus tends to occur when your shoulder is forced down while your neck stretches up and away from the injured shoulder. The lower nerves are more likely to be injured when your arm is forced above your head. These injuries can occur in several ways, including:
- Contact sports. Many football players experience burners or stingers, which can occur when the nerves in the brachial plexus get stretched beyond their limit during collisions with other players.
- Difficult births. Newborns can sustain brachial plexus injuries when there are problems during birth, such as a breech presentation or prolonged labor. If an infant’s shoulders get wedged within the birth canal, there is an increased risk of a brachial plexus palsy. Most often, the upper nerves are injured, a condition called Erb’s palsy. Total brachial plexus birth palsy occurs when both the upper and lower nerves are damaged.
- Trauma. Several types of trauma — including motor vehicle accidents, motorcycle accidents, falls or bullet wounds — can result in brachial plexus injuries.
- Inflammation. Inflammation may cause damage to the brachial plexus. A rare condition known as Parsonage-Turner syndrome (brachial plexitis) causes brachial plexus inflammation with no trauma and results in paralysis of some muscles of the arm.
- Tumors. Noncancerous (benign) or cancerous tumors can grow in the brachial plexus or put pressure on the brachial plexus or spread to the nerves, causing damage to the brachial plexus.
- Radiation treatment. Radiation treatment may cause damage to the brachial plexus.
SYMPTOMS
Signs and symptoms of a brachial plexus injury can vary greatly, depending on the severity and location of your injury. Usually only one arm is affected.
Less severe injuries
Minor damage often occurs during contact sports, such as football or wrestling, when the brachial plexus nerves get stretched or compressed. These are called stingers or burners, and can produce the following symptoms:
- A feeling like an electric shock or a burning sensation shooting down your arm
- Numbness and weakness in your arm
- These symptoms usually last only a few seconds or minutes, but in some people may linger for days or longer.
More-severe injuries
More-severe symptoms result from injuries that seriously injure or even tear or rupture the nerves. The most serious brachial plexus injury (avulsion) occurs when the nerve root is torn from the spinal cord.
Signs and symptoms of more-severe injuries can include:
- Weakness or inability to use certain muscles in your hand, arm or shoulder
- Complete lack of movement and feeling in your arm, including your shoulder and hand
- Severe pain
When to see a doctor
Brachial plexus injuries can cause permanent weakness or disability. Even if yours seems minor, you may need medical care. See your doctor if you have:
- Recurrent burners and stingers
- Weakness in your hand or arm
- Weakness in any part of the arm following trauma
- Complete paralysis of the upper extremity following trauma
- Neck pain
- Symptoms in both arms
- Symptoms in upper and lower limbs
It’s important to be evaluated and treated within six to seven months after the injury. Delays in treatment may compromise outcomes of nerve surgeries.
