Brachial Plexus Injury—An Overview
The group of nerves that run from the neck to the arm is called the brachial plexus. These nerves control the arm’s muscle strength and sensation. A brachial plexus injury (BPI) stems from the nerves being overstretched or torn, and affects movement and feeling in the arm and wrist.
There are five types of brachial plexus injury:
- Contusion – the brachial plexus is bruised
- Stretching – the nerves are stretched too far
- Rupture – the nerve tears into more than one piece
- Penetrating injury – something penetrates and cuts or tears the brachial plexus
- Avulsion – a severe nerve injury in which the nerve is pulled apart from the spinal cord
What Are The Symptoms Of A Brachial Plexus Injury?
Brachial plexus injury symptoms vary according to the type of injury, as well as its location. The usual symptoms of a brachial plexus injury are pain, weakness or numbness, paralysis, and loss of feeling in the affected limb. You may also see muscle changes that cause movement problems or pain in your child’s arm or shoulder. Many young athletes report a feeling of burning or stinging. If your child is injured while playing sports, they may complain of a burning feeling down the arm, inability to use the hand, arm, or shoulder, or complete lack of movement there. Pain may be severe in BPIs that originate at the spinal cord level, and it can last a long time. If left untreated, the symptoms may become permanent.
What Are The Causes Of A Brachial Plexus Injury?
The common causes of brachial plexus injury are shoulder trauma (from contact sports or accidents), as well as tumors or inflammation. Depending on the situation, the symptoms may be mild and resolve quickly; however, some trauma can cause severe injury.
This is also the potential for newborn babies to suffer a brachial plexus injury during a difficult delivery when the baby’s shoulder gets stuck in the birth canal. Most babies (two-thirds) recover fully within three or four months. However, if the nerve injury is severe, the baby may have permanent damage to their arm and hand function.
Contact Sports
If your child participates in contact or collision sports, be aware that the causes of most minor brachial plexus injuries are from contact sports, when the head moves in the opposite direction as the shoulder. This happens from a hit to the head or downward traction (pulling) of the shoulder, which stretches the nerve roots on the contact side or compresses them on the opposite side.
The result of a sports BPI is often called a “burner” or “stinger”; your child may experience sudden shooting pain and numbness in these instances. Many children and teens who play football and rugby suffer from them, sometimes due to improper tackling or blocking techniques. In fact, these injuries are quite common in contact sports. The good news is that many symptoms subside within 24 hours. Stingers can also happen in basketball, wrestling, ice hockey, some track & field events, and martial arts.
Trauma
Car, motorcycle or biking accidents and significant falls are also causes of severe brachial plexus injuries. These traumatic events can lead to paralysis of the affected arm following sudden, violent traction (pulling force) of the arm. Traumatic traction occurs when someone falls and dislocates a shoulder or fractures the upper arm bone that connects the shoulder and shoulder blade to the elbow.
Other types of trauma that cause brachial plexus injury are:
- Crushing and penetrating injuries – such as a stabbing or an accident in which glass shards penetrate the nerves
- A condition called thoracic outlet syndrome – the nerves in the space between the collarbone and first rib are compressed, causing numbness in the fingers or pain in the shoulder and/or neck
How To Prevent Brachial Plexus Injuries
There is no set way to prevent brachial plexus injuries. As noted above, improper blocking and tackling techniques in football can cause them—so as a parent, you’ll want to talk to your child’s trainer or coach to make sure they are promoting proper techniques on the field. Padding or protective clothing can also help prevent brachial plexus injury when playing sports.
If your teen is now driving, of course following the rules of the road will help them avoid motor accidents (and a possible BPI).
If your child has suffered a brachial plexus injury, you can reduce the risk of aggravating it. For example, if numbness is a symptom, make sure your child avoids getting cuts or burns they might not feel. Exercising the joints and muscles daily at home also helps prevent permanent stiffness and keeps muscles strong.
How To Treat Brachial Plexus Injuries
The goal of any brachial plexus injury treatment is to restore your child’s arm or hand function and improve their range of motion and arm strength. At TPOC, we strongly recommend coming in for an assessment right away if this injury is suspected, so that our pediatric orthopedists can evaluate the severity and develop a treatment plan.
Although mild brachial plexus injuries usually heal without treatment, more severe injuries may require surgery. Minor stretching of the nerve will likely improve with rest and perhaps a splint; more severe brachial plexus injuries that result in rupture or avulsion may call for surgery to repair the nerve and restore function and movement.
It is important to keep the muscles and soft tissue in the joints flexible; therefore, we may prescribe physical therapy for the arm, shoulder, elbows, wrist, hand, and fingers on the affected side. In some cases, occupational therapy for the upper extremities may be prescribed, as well.
Surgeries to treat major brachial plexus injuries are reconstructive nerve surgery (nerve graft or nerve transfer), soft tissue (tendon or muscle) transfer, and bone reconstructive surgery. Since the best outcomes for nerve surgery are within six months of injury, scheduling that procedure may be urgent to promote your child’s healing. Soft tissue surgeries may still have good results after that time frame if symptoms persist. Bear in mind that nerves heal slowly after surgery, so full recovery takes a long time. Post-surgical physical therapy will keep the joints and muscles limber.
Bring Your Child To Tpoc If You Suspect Brachial Plexus Injury:
Our pediatric orthopedists treat children from newborns to older teens and will conduct a thorough exam to determine if the pain, numbness, or loss of movement is due to a brachial plexus injury. We will recommend the next steps, both non-surgical and surgical, depending on the severity of your child’s injury. We offer urgent care visits for acute injuries in our Cedar Knolls office.
