The brachial plexus is a complex network of nerves that extends from the spinal cord within the neck through the axilla (armpit) and supplies nerves to the chest, shoulder and arm. In general, brachial plexus injuries are caused by trauma that affects the region of the neck and shoulder. This trauma can result from motorcycle or auto accidents, falls, lacerations or other injuries or medical conditions.
Partial injuries most commonly occur in the upper part of the brachial plexus and result in paralysis of shoulder and elbow function. The arm is left hanging at the side, but hand function is usually preserved.
Previously, these injuries had a poor prognosis and required extensive grafting procedures. Surgeons now use a number of nerve transfers â€” in which a less essential nerve or nerve section is "transferred" to restore function in a more crucial nerve â€” to treat patients with these injuries. This new strategy restores useful function in a fraction of the time that was required for recovery from the grafting procedures.
However, itâ€™s important that patients see a surgeon relatively soon after the accident or injury. Surgeons generally prefer to schedule operations within three to four months after the injury, but can operate earlier if an avulsion (a condition in which a nerve is pulled out of the spinal cord) is found on MRI or myelogram. Patients should avoid waiting for more than a year to undergo an operation to treat any nerve or brachial plexus injury.
When the brachial plexus is completely injured, patients have no function at all in their extremity. They generally can neither feel nor move their arm.
With these injuries, it is important to determine which nerves are scarred or torn versus those that are avulsed (pulled out of the spinal cord). If nerves are avulsed, the surgeon can operate earlier instead of giving time for recovery, knowing that these injuries will not recover on their own. Special studies can be used to determine whether nerves are avulsed and grafts can be used with nerves that are scarred or torn.
Reconstructive surgery for complete brachial plexus injuries generally consists of a combination of nerve grafting and nerve transfer procedures. The treatment for each patient will be determined according to his or her individual condition.
Patients can undergo surgery within three to four months after the injury. In order to provide for the best recovery, it is often important that the patient receive physical therapy before the surgery to keep the joints mobile and to learn to recruit the nerves that will be transferred and, after the surgery, to learn to use the muscles that are now run by different nerves.