The brachial plexus is a giant bundle of nerves that stems from the nerve roots in the cervical (neck) and upper torso sections of the spinal cord, creating a network that connects to the nerves in the arm. These significant nerves manage the motions of your wrists, hands, and arms, allowing you to raise your arm, grab items, or type on a keyboard. From the roots, the brachial plexus nerves branch and fuse through the shoulder and down the arm, classified into a few separate sections, which are the trunks, divisions, cords, and branches. These different sections do not function differently but help explain the complexity of the brachial plexus.
In addition, the brachial plexus ends in five nerve branches that extend down the arm, such as:
- Axillary nerve – This helps the shoulder rotate and enables the arm to lift away from your body.
- Musculocutaneous nerve – This helps flex the muscles in the upper arm, at both the shoulder and elbow.
- Median nerve – The median nerve enables movement in the forearm and parts of the hand.
- Radial nerve – This controls various muscles in the upper arm, elbow, forearm, and hand.
- Ulnar nerve – The ulnar nerve allows for great motor control of the fingers.
Brachial plexopathy (brachial plexus injury) occurs when the arm is pulled down on one side of the body and the head is pushed to the other side. Pulling the arm forcibly overstretches it and suddenly you may notice your entire arm feels weak. This weakened feeling can go away after a few minutes, although it may continue for days. Most people injure the brachial plexus in a wide variety of ways.
It may either be compressed or cut in a serious vehicle accident or other trauma. If the nerves are torn away from the spinal cord, the result could be permanent paralysis of the arm and hand. Athletes who participate in high-impact sports, such as wrestling or soccer have injured themselves in this type of way, as well as people who have experienced blunt traumas or even gunshot wounds.
Causes & Symptoms of Brachial Plexopathy
Brachial plexopathy is a type of peripheral neuropathy which refers to damage to a single nerve or a group of nerves. As mentioned earlier, the brachial plexus is an area where nerves from the spinal cord branch into the arm nerves. The nerves of the brachial plexus then run from your lower neck through your upper shoulders. Therefore, brachial plexus injuries can occur in many ways, such as the types below:
Brachial plexus rupture
In a brachial plexus rupture, a forceful stretch causes the nerve to tear, either partially or completely. This is a more serious injury than other brachial plexus injuries. Ruptures can cause weakness in the shoulder, arm, or hand and can even make certain muscles unusable. Depending on the severity and location of the rupture, these injuries can often be repaired with surgery.
Also known as Parsonage-Turner syndrome, this is a progressive disorder of the nerves of the brachial plexus. This syndrome causes sudden, severe shoulder and upper arm pain and progresses from pain to weakness, muscle loss, and even loss of sensation. This syndrome typically affects the shoulder and arm, however, it can affect the legs and diaphragm.
Brachial plexus neuroma
Brachial plexus neuroma is scar tissue that forms as the brachial plexus attempts to repair itself. This scar tissue can result in a painful knot on one of the nerves. This only occurs when you are going through surgery.
Brachial plexus avulsion
A brachial plexus avulsion happens when the root of the nerve is fully separated from the spinal cord. This injury is normally caused by trauma, such as a vehicle or motorbike accident. Because it is difficult and usually impossible to reattach the root to the spinal cord, avulsions can lead to permanent weakness, paralysis, and loss of feeling.
Symptoms depend on where along the length of the brachial plexus the injuries occur and how severe they are. Therefore, the common symptoms linked to brachial plexopathy include:
- Inability to control or move the shoulder, arm, wrist, or hand.
- An arm that hangs (limping).
- Numbness or loss of feeling in the hand or arm.
- Burning, stinging or severe, and sudden pain in the shoulder or arm.
Who gets Brachial Plexopathy?
In severe cases, brachial plexopathy injuries result from motor vehicle accidents, especially motorbike accidents. Severe injury can also be the result of a gunshot or knife wound or a fall from a great height.
Furthermore, an infant may sustain brachial plexus injury during difficult childbirth. This type of injury can occur if the baby’s neck is stretched to one side. After your child experiences a brachial plexopathy injury, he or she may develop either of the following conditions below:
- Erb’s palsy – This condition often affects the upper portion of the brachial plexus. A child usually has weakening involving the muscles of the shoulder and biceps.
- Klumpke’s palsy – Klumpke’s palsy involves the lower roots of the brachial plexus. It usually affects the muscles of the hand, although almost never occurs in babies or children.
- Horner’s syndrome – This condition can lead a child to have ptosis (drooping eyelid), miosis (smaller pupil of the eye), and anhydrosis (diminished sweat production in part of the face).
- Total plexus involvement – Total plexus involvement affects all five nerves of the brachial plexus. Your children may also be unable to move their shoulder, arm, or hand.
How Does Brachial Plexopathy Affect You? How Serious is it?
Such longer-term complications that are caused by brachial plexopathy are quite numerous and include:
- Reduced stamina and balance
- Discrepancies in limb length
- Impaired bone growth
- Joint dysfunction
Muscle atrophy, which is the shrinking of muscle tissue, could also result from brachial plexus injuries because of reduced muscle movement and disruption to the nerve supply. With sufficient nerve supply, however, muscle mass may increase with exercise.
Also, a reduced supply of nerves also has an impact on regular muscle movement, even without muscle atrophy. Brachial plexopathy alters the movement and biomechanics of the body, limiting dexterity, range of motion, and the structure and formation of the joints in the affected limb. The result is abnormal movement, and wear patterns could develop over the years, increasing the risk of osteoarthritis.
Another known complication that plays a role in brachial plexopathy is scoliosis. This is a rare condition that can also occur due to this type of injury. Oftentimes, scoliosis is so severe that surgery is required.
Recommended Treatment & Rehabilitation for Brachial Plexopathy
If your doctor suspects symptoms linked to brachial plexopathy, he or she will perform a thorough physical examination to determine the cause of the injury and rule out other conditions alongside. Your doctor will examine all nerve groups controlled by the brachial plexus to identify the specific location of the nerve injury and its severity.
The pattern by which nerves from the brachial plexus manage various muscles of the arm and hand will assist your doctor in identifying potential sites of nerve injury. After a physical exam has been done, your doctor may order additional imaging tests to get a clearer view of the condition that is affecting your brachial plexus, such as:
This imaging test creates a clear image of dense structures, like bones. X-rays of the neck, chest, shoulder, and arm are precisely taken to rule out associated fractures.
Computed Tomography (CT) scan
This test is usually performed at least 3-4 weeks after the injury to allow any potential blood clots in the area of the nerve root to dissolve.
These tests measure nerve conduction and muscle signals. They are important evaluation tools due to the higher success rate of confirming the diagnosis. It is used to locate the nerve injury, characterize its severity, and assess the rate of nerve recovery. This test is normally done 3-4 weeks after the injury, as it allows any nerve degeneration that may occur to become detectable.
After a diagnosis has been done, physiotherapy may be further advised. A physiotherapist will design a treatment program specific to your condition and goals. These are performed to prevent or reduce joint contractures, maintain, or improve muscle strength, and increase daily activities to encourage participation. Therefore, treatments include:
Passive and active stretching
Your physiotherapist will assist you in performing gentle stretches to increase joint flexibility (range of motion) and prevent or delay contractures (tightening) in the arm.
Improving your strength
Your therapist will teach you exercises and perform activities to maintain or increase arm strength. He or she will identify certain tasks that promote strength. As your brachial plexus heals, your physiotherapist will identify higher-demanding activities that will continue to strengthen your arm and hand.
Your physiotherapist might use a variety of modalities (intervention techniques) to improve muscle function and movement. Electrical stimulation is sometimes applied to gently stimulate the nerve signal to the muscle. Flexible tape can be applied over specific muscle areas to help guide proper muscle movement or promote relaxation. Constraint-induced movement therapy (CIMT) may also be applied to the non-affected arm to gently limit its use and encourage the use of the affected arm.
Weakness of the shoulder muscles can lead to the unsupported weight of the arm slowly pulling down on the shoulder causing partial dislocation (subluxation). Therefore, your physiotherapist will advise you to wear a custom or off-the-shelf brace (orthosis) to avoid contracture of the fingers, thumb, wrist, or elbow. Some orthoses are to be used only at nighttime to keep the limb in a certain position or they can be used during the day to help complete tasks.
Below are some examples of exercises for you to try. The exercises may be recommended to reduce symptoms linked to brachial plexopathy:
Hold a dumbbell in your hand while kneeling on a bench with the opposite leg. Next, bend forward and place your arm on the bench to support your body weight. Lift your affected arm until your upper arm is parallel to the ground with your elbow bent and hand pointed toward the ground. Keeping your elbow by your side, straighten your arm until your elbow is straight, hold this position for 2-3 seconds, then repeat 3-4 times a day.
Rubber band stretches
Wrap a rubber band around your fingers. Then, spread your fingers apart and hold for 2-3 seconds. Slowly bring them back together and repeat 10 times a day.
Stand up straight and squeeze your shoulder blades together. Holding a dumbbell in your hand, turn your thumb toward the ceiling. Next, lift your arm out to the side until it is parallel to the ground. Finally, hold for 2-3 seconds, then slowly lower back down before repeating this method 3-4 times a day.
Alternative & Homeopathic Treatment for Brachial Plexopathy
Most cases of brachial plexopathy require some type of treatment to help manage the initial pain levels, such as one of a combination of the following:
- Pain medications – such as non-steroidal anti-inflammatory drugs (NSAIDs) or nerve pain medications may be recommended on a short-term basis for severe pain.
- Rest – Specifically avoiding movements of the affected arm and shoulder may avoid worsening the pain.
- Ice/heat application – Applying ice may help reduce inflammation, while applying heat later in the process may help facilitate blood flow to the painful area and loosen stiff muscles.
- TENS unit – This device sends electrical signals via wires to electrodes that are attached to the skin on sticky pads. The ultimate goal is for the electrical signals to interfere with and reduce the pain signals being sent to the brain.