Brachial Plexus Injury

Brachial plexus injuries are caused by excessive stretching, tearing, or other trauma to a network of nerves from the spine to the shoulder, arm, and hand. Symptoms may include a limp or paralyzed arm, loss of muscle control in the shoulder, arm, hand, or wrist, and lack of feeling or sensation in the arm or hand. Injuries often occur secondary to vehicular accidents, sports injuries, gunshot wounds, or surgeries; many brachial plexus injuries happen during birth, if the baby’s shoulders become impacted during the birth process (called shoulder dystocia), causing the brachial plexus nerves to stretch or tear.

Some brachial plexus injuries may heal with little or no treatment. Many children improve or recover by 3 to 4 months of age; physical and occupational therapies are usually employed, especially range of motion. Some who appear to be recovered at 3-4 months of age will have secondary issues months or years later.

Treatment for brachial plexus injuries includes occupational or physical therapy and, in some cases, surgery. The site and type of brachial plexus injury determine the prognosis. For avulsion (tears) and rupture injuries there is no potential for recovery unless surgical reconnection is made in a timely manner. For neuroma (scarring) and neuropraxia (stretching) injuries the potential for recovery is more encouraging. Most patients with neuropraxia injuries recover a significant amount of function.

The major area of concern to most people with brachial plexus injures is often management of pain, which can be chronic and extreme, and which does not generally respond well to many painkillers.

Those with a birth related brachial plexus injury vary widely regarding pain. Some experience no pain, as their sensation is diminished; others are hypersensitive to pain as well as to any stimulus. Some may eventually experience pain on the unaffected side because they chronically overuse their uninjured arm for everyday activities.

According to the United Brachial Plexus Network, obstetrical injuries of this sort are not reported to the Centers for Disease Control; therefore, many cases are incorrectly diagnosed or referred to as Erb's Palsy.

Sources: United Brachial Plexus Network, Brachial Plexus Palsy Foundation, National Institute of Neurological Disorders and Stroke.