Brachial Plexus Neck and Shoulder Injury
Written by Andrew Sarski on July 30, 2013
The brachial plexus describes the nerves that exit the cervical spine and pass down to the shoulder and arm. There are five major nerves that comprise the brachial plexus: C5, C6, C7, C8 and T1, with C meaning cervical or neck, and T meaning thorax or chest. These nerves pass under the skin in the neck and axilla (the area directly under the joint where the shoulder connects to the arm), where they are susceptible to serious injury. The C5 nerve controls the rotator cuff muscles and shoulder function, the C6 nerve controls the flexing of the arm at the elbow, C7 partially controls wrist flexion and the triceps, and C8/T1 controls hand movements. Brachial plexus injuries can result in serious limitations in movement, often accompanied by pain and possibly even paralysis. Unfortunately, the treatment required for brachial plexus injuries can result in costly medical bills, and recovery can can take a year or more of the patient’s life. If you have suffered from a brachial plexus injury caused by another person or party, such as in a car accident, contact a personal injury attorney to discuss your compensation options.
Causes and Symptoms of Brachial Plexus Injuries
When the arm and neck are pulled away from one another forcibly, such as during falls, car accidents or motorcycle accidents, the brachial plexus nerves can become stretched or torn. If the force is severe enough, these nerves may even be forced away from the spinal cord where they originate. Damage to the brachial plexus nerves can cause symptoms like numbness, pain, and weakness in the shoulder, arm and hand, described as pins and needles, a burning sensation, or crushing. During traumatic brachial plexus injuries, several patterns of injury can occur, the most common of which is known as Erb’s palsy. Erb’s palsy affects mostly the C5 and C6 nerves, preventing patients from lifting their arms or flexing at the elbow, potentially leading to severe atrophy. Another type of brachial plexus injury affects the C8/T1 nerves, resulting in hand weakness and pain, and the most severe brachial plexus injury causes complete paralysis of the arm.
Brachial Plexus Injury Diagnosis
Diagnosis of a brachial plexus injury involves imaging of the spine with either MRT or CT myelography, in order to determine whether the nerves have detached from the spinal cord. Electrical testing can also help guide treatment and predict outcome, although this method should not be performed until three weeks after the injury, and direct imaging of the brachial plexus is usually not helpful with currently available techniques. After sustaining a brachial plexus injury, it is important that patients seek medical attention from a physician who specializes in examining, diagnosing and treating this particular type of injury.
Treatment for Brachial Plexus Injuries
During the first three months following a brachial plexus injury, patients are typically observed for spontaneous recovery, as some patients regain some function during this time. Surgery is usually not performed immediately after the injury occurs because delicate nerves that may have spontaneously recovered could be injured with premature surgery. During this three-month period, pain is controlled aggressively and the patient undergoes physical therapy. If paralysis remains after three months and electrical testing does not indicate an early recovery, the next step is usually exploratory surgery.
Brachial Plexus Surgery
Surgery for brachial plexus injuries is usually scheduled between three and six months after surgery, after which the chance of successful surgery becomes less and less likely. Brachial plexus surgery entails one or more of the three following procedures:
- Erb’s palsy repair for shoulder/elbow weakness
- Isolated nerve transfers
- Complete brachial plexus reconstruction
During surgery, recovering nerves are protected while injured, non-functional nerves are exposed and examined with a microscope and intraoperative electrical testing. If possible, injured nerves are repaired or replaced during this procedure, giving them the opportunity to regenerate, which progresses about one inch per month. Unfortunately, this slow process means that, even after successful surgery, it can six to 12 months before regenerating nerves reach their target muscle, allowing movement to occur.
Complications and Prognosis for Brachial Plexus Injuries
Regardless of how well the surgery goes, the chance of recovery for brachial plexus injuries is somewhat uncertain. The success of brachial plexus surgery depends on a number of factors, including the type of injury, the age of the patient, the nerves that are injured, the timing of repair, and the motivation of the patient. On average, there is a 50% chance that surgery for each nerve will result in movement returning, although this number may be as high at 90% for certain nerves and injuries. Unfortunately, complications may occur during brachial plexus treatment, which may include:
- Wound infections
- Damage to arteries and veins going to the arm, possibly leading to loss of the limb
- Additional numbness near the chest or neck
- Trouble breathing after surgery due to new diaphragm weakness, air compressing the lung, or fluid on the lung
- Additional paralysis
Recovery from Brachial Plexus Treatment
During the first two weeks after surgery, brachial plexus patients wear a sling to protect the arm and allow the wound to heal. One week after surgery, the patient will visit the surgeon to have the wound examined and to have sutures removed. After about two weeks, physical therapy will be prescribed, the first three months of which will concentrate on shoulder and elbow range of motion. Immediately after surgery, paralysis is typically the same; when movement eventually returns though, strengthening exercises are performed to promote normal movement. Overall, recovery from brachial plexus injuries typically takes one year or longer.
Personal Injury Lawyers for Brachial Plexus Injuries
Brachial plexus injuries can severely alter a patient’s quality of life, possibly resulting in limited movement or paralysis in the shoulder, arm, elbow or hand. If you or a loved one has experienced complications associated with a brachial plexus injury that was caused by a slip and fall accident, a motor vehicle accident, or another type of accident, contact a personal injury attorney for legal advice. You may have grounds to file a personal injury lawsuit against the negligent party in order to pursue financial compensation for your injuries, medical bills, lost wages, and pain and suffering.