Brachial plexus injuries are some of the more devastating injuries. Road traffic accidents due to a two wheeler accidents are the overwhelming cause of these injuries. Damage to this plexus can lead to a totally weak upper limb. The treatment for these injuries involves careful clinical examination, appropriate investigations at the correct time and timely surgery.
What are brachial plexus?
The set of nerves that supply and control the hand are called brachial plexus .The brachial plexus is a group of five major nerves that together supply the upper limb. They are generally injured during normal delivery of a larger baby if the mother is diabetic .and in normal adults it can be due to injury or any other trauma to the nerve plexus.
The brachial plexus is a nerve bundle that begins in the spine in the neck region. This region of the spine is called the cervical spine and is made of seven vertebrae. Each vertebra is abbreviated according to its numerical order in the cervical spine. The abbreviations are C1 through C8. So, the first vertebra in the cervical spine, which is the vertebra closest to the skull, is called C1 and the second is C2, and so on .
The brachial plexus begins at C5 and travels through the rest of the neck vertebra (C6 through C8). It then proceeds through the first vertebra (T1) in the thoracic region, or rib cage region, then moves under the collar bone, through the underarm, and into the arm.
If you have damage to the brachial plexus, you can experience problems, such as pain or weakness in the shoulder, elbow, wrist, or hands. If severe enough, you may not be able to use your arm. The injury may occur due to:
- Birth if the baby’s neck or shoulder was abnormally stretched during delivery
- Traumatic injury, such as a motor vehicle accident
- Pressure from tumors in the area
- Radiation therapy
- Exposure to toxins, chemicals, or drugs
in the case of an older child with a brachial plexus injury, from a gunshot wound, motor vehicle accident or other injury, it’s important to see them as early as possible after injury. Lung, brain or spinal cord injuries may require stabilization at the referring hospital prior to transfer. A detailed examination of the sensory and motor function of the arm is performed. Depending on the level and nature of the injury, nerve grafting or nerve transfers may help in improving recovery.
The symptoms of injury are:
- Diminished reflexes in any part of the arm
- Diminished sensation in any part of the arm
- Weakness in the shoulder, elbow, wrist, or hand
- Inability to move at any of these joints
- Tingling, burning, pain, or abnormal sensations
Usually in cases of closed injury (such as car crashes), we would not perform surgery until three months after the injury. In these cases, electrical studies (EMG) can be quite helpful, as well as MRI, CT and diaphragm ultrasound. If there is an open injury then surgical exploration and nerve grafting with or without nerve transfers may be warranted before three months.
The pattern of injury will dictate the type of surgery that has to be performed. Necrolysis, nerve repair, nerve grafting, nerve transfers, muscle transfers and free functional muscle transfers are some of the commonly done surgeries for this condition.
The most important factor in the resolution of brachial plexus injuries is time. Injured nerves will often repair themselves well enough to allow full use of the arm.
There are surgical options such as:
2. Nerve grafting:
3. Tendon transfer :this is done by using tendons which hold muscle on bone
The final conclusion after surgery along with physiotherapy we would expect almost normal functioning of hand and shoulder.