Frequently Asked Questions
What is the Brachial Plexus?
The brachial plexus is a network of nerves. It conducts signals from the spine to the arm and hand. These signals cause the arm and hand muscles to move. It also provides feeling for the hand and arm.
What Causes Brachial Plexus Injuries?
Adult brachial plexus injuries are often the result of high impact trauma such as a motorcycle injury, motor vehicle accident or sporting injury. Tumors, compression or irradiation therapy can also damage the brachial plexus.
Most pediatric (obstetric) brachial plexus injuries happen during birth. Many babies with birth palsy are larger than average at birth, had a prolonged labor, or breech delivery. About 45% are associated with shoulder dystonia. About 2 or 3 babies in 1,000 suffer brachial plexus injuries at birth.
How Do We Diagnose Birth Palsy at Wake Forest Baptist?
Patients with brachial plexus injuries are affected in different ways. Brachial plexus injuries are usually discovered, at birth or shortly after injury, by an inequality of upper arm movement or suspicion because of the type of delivery or trauma.
Erb's Palsy is the most common type of obstetric palsy and involves C5 and C6 nerve roots. There is an inability to abduct the shoulder, externally rotate the arm, and to turn the forearm outward. The hand and wrist are spared. In contrast, Klumpke's Palsy is much less common. It involves C8 - T1 nerve roots and will have an inability to flex the wrist or grasp. Some patients have no muscle control and no feeling in the entire arm or hand due to the entire plexus involvement.
The initial evaluation should occur as early as possible following injury. When evaluation is delayed beyond 6 to 9 months, treatment options are limited, although will still be valuable in maximizing the recovery. The diagnosis is based on a thorough medical history and physical examination. Studies including x-ray, MRI, CT, EMG will also be utilized to assist the physician to locate the injury and to identify the severity of the nerve damage.
How Do We Treat Brachial Plexus Injuries at Wake Forest Baptist?
The treatment for each child or adult is highly individualized based on the age, the type and severity of the injury. Immediately after injury, therapy and exercises should be emphasized to keep the muscles and joints flexible.
Some patients show improvement or recover within 3 to 6 months of the injury. These patients are typically treated with exercises and physical therapy to improve range of motion, muscle strength and to prevent joint stiffness and deformity.
Surgery may be indicated if spontaneous recovery has not occurred within several months. The purpose of surgery is to improve the arm function. Nerve surgery, if required, is most effective when it is done early and should ideally occur within 6 months and typically not later than one year.
By using microsurgical techniques, surgeons can repair the individual nerves of the brachial plexus to improve nerve regeneration and to restore some hand and arm functions. This may include nerve repair, release of the nerve from scar tissue (neurolysis), placing nerve grafts across the damaged nerves, or "nerve transfer" (neurotization) to sew an adjacent, functioning nerve into an irreparably injured nerve in an attempt to restore function in a paralyzed muscle. Late surgery may be done to release the contracted muscles, to reduce a dislocated shoulder, to correct a bony deformity (osteotomy) and to transfer muscles or tendons to rebuild the hand functions.