Brachial Plexus Injuries

The Brachial Plexus is an extremely complex network of nerves that starts from the spinal cord at the level of the neck and gives innervation to the entire upper extremity, both for motion and sensation.

Trauma Related Paralysis

Paralysis of the brachial plexus in adults occurs mainly secondary to high velocity trauma. The most common cause is motor-vehicle accidents (cars, motorcycles, snowmobiles, etc.). Often, the patient may suffer other injuries that may be life threatening and need to be treated in an emergency basis i.e. vessel injuries, bone injuries, head injuries, abdominal and chest injuries.

Even if the brachial plexus injury is not life threatening, it can result in complete or partial paralysis of the entire upper arm and loss of sensation. This is obviously a devastating injury for the function of the patient. The patient with a diagnosed brachial plexus injury must be evaluated as soon as possible, because the shorter the time period between the traumatic event and the time treatment starts, the better the chance for the patient to regain function in his arm.Therefore the referral to the brachial plexus specialist should be done sooner, rather than later.

The reconstruction of the torn nerve elements in a patient with brachial plexus paralysis is usually staged. If the injury is very severe, at least two operations are required to reconnect the injured nerves. Often secondary operations are needed to transfer muscles from the legs to the affected arm in order to restore a missing function. The patient usually stays in the hospital for two or three days after the surgery and then is discharged. Postoperatively, the arm is immobilized in a brace. Following removal of the brace, in six to eight weeks, physical therapy commences. Usually, the operations are spaced so we can see what function has been regained in the arm and then formulate a plan for the next step of reconstruction.