Brachial Plexus: What Is It Exactly
Each of the five parts of the brachial plexus , ends in a peripheral neuron that provides sensation to the arm, shoulder and hands. These roots create a network of connections as they travel up the spine to reach the upper limbs. These connections make it more reliable for impulses to reach the hands and arms. If one part of the spinal cord is injured or damaged, multiple signals can be sent from the same area. If youre in the area, visit the best San Diego Physical Therapy Clinic.
Where Does The Brachial Plexus Originate
The brachial plexus passes from the neck to the axilla and supplies the upper limb. It is formed from the ventral rami of the 5th to 8th cervical nerves and the ascending part of the ventral ramus of the 1st thoracic nerve. Branches from the 4th cervical and the 2nd thoracic ventral ramus may contribute.
What Are The Symptoms Of Brachial Plexus Birth Injury
When a newborn has brachial plexus injury they may experience:
- muscle weakness or paralysis in the affected arm or hand
Usually, the baby is not in much pain, probably because infants nerves behave differently from adults. Roughly, just 4 percent seem to experience severe pain. If a fracture accompanies the BPBP, the baby will experience some discomfort from the fracture, but not usually intense pain. And any fractures the baby may have will probably heal quickly in about 10 days.
This is in contrast to an adults traumatic brachial plexus injury caused by accident or sports impact. In these cases, pain from brachial plexus injury is acute and disabling, as is pain from any accompanying fractures.
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What Tests Will Be Done To Diagnose A Brachial Plexus Injury
Your healthcare provider may perform several tests to help diagnose a brachial plexus injury and to check for other possible injuries. These tests include:
- X-rays: This imaging test creates clear pictures of dense structures, like bone, using small safe amounts of radiation. Youll likely get X-rays of your neck, chest, shoulder and arm to rule out associated bone fractures, especially since brachial plexus injuries typically happen from traumatic injuries.
- Computed tomography myelogram scan: A CT myelogram scan shows structures inside your body by using X-rays and computers to produce images with a special dye injection around your spinal nerves. Providers consider this imaging test the most reliable test for detecting spinal nerve avulsion injuries. Some providers may also use magnetic resonance imaging instead of, or in addition to, a CT scan.
- Electrodiagnostic exams: These tests, which include electromyograms and nerve conduction studies, measure nerve conduction and muscle signals. They can confirm the diagnosis of a brachial plexus injury, locate the nerve injury, reveal its severity and help assess the rate of nerve recovery. Your provider will likely do a baseline electrodiagnostic exam three to four weeks after your injury. This allows any nerve degeneration that may happen to become detectable. Your provider will then repeat the exam two to three months after the initial exam and then repeatedly over time to assess whether the nerves are recovering.
How Is It Diagnosed
Brachial plexus injuries are often apparent at birth because the infant’s arm is limp or unusually stiff. Diagnosis of the injury requires a careful physical examination by a specialist to determine which nerves have been affected, and the severity of the injury. The examination will include physical observation of the arm, and may be repeated several times over many months to assess muscle and nerve recovery. Sometimes special tests may be completed as part of the examination, such as an electromyogram that reveals the extent of muscle damage caused by the nerve injury. A nerve conduction study may be used to determine how far signals are transmitted along the nerves. Other scans may be recommended to assess the damage to the nerves, or to look at the shoulder-joint position, which may be affected by muscle weakness.
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Physical Therapy Protocol For The Management Of Obstetric Brachial Plexus Palsy
Samah Saud Alharbi*
King Faisal Specialist Hospital & Research Center, Riyadh 11211, 3354, MBC 45, Saudi Arabia
*Corresponding Author :Samah Saud AlharbiKing Faisal Specialist Hospital & Research Center, Riyadh 11211, 3354, MBC 45, Saudi Arabia, Tel: 00966114647272-32977 0096654134520 E-mail:
Received: 24-10-2018 Accepted: 8-11-2018 15-11-2018
Citation:Alharbi SS Physical Therapy Protocol for the Management of Obstetric Brachial Plexus Palsy. J Physiother Rehabil 2:2.
Causes Of Brachial Plexus Injuries In Adults
In adults, brachial plexus injuries have a range of causes, including:
- Blunt trauma: such as falls or motor vehicle accidents.
- Athletic injuries: especially from contact sports like football.
- Gunshot wounds: a bullet tears through or close to the nerves.
- Medical trauma: a nerve is cut during a surgical procedure, or damaged by an injection or the positioning of the body during surgery.
- Cancer: a tumor invades the brachial plexus.
- Radiation therapy: radiation treatment in the area damages the nerves.
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Brachial Plexus Birth Injury Treatment
In infants, if no improvement is seen after three months of occupational therapy, consulting a pediatric neurologist and pediatric neurosurgeon can help determine if your child can benefit from other interventions or surgery. Up to 1 in 10 babies with brachial plexus injury will require some level of surgery.
Prompt intervention is important. If the injury occurred during birth, the best time for surgery is when your child is between 4 and 9 months, as waiting longer than a year can limit the level of function a surgery might restore.
What Is A Brachial Plexus Injury
The brachial plexus can be injured in many different ways from pressure, stress or being stretched too far. The nerves may also be cut or damaged by cancer or radiation treatment. Sometimes, brachial plexus injuries happen to babies during birth.
Brachial plexus injuries cut off all or parts of the communication between the spinal cord and the arm, wrist and hand. This may mean that you cant use your arm or hand. Often, brachial plexus injuries also result in total loss of sensation in the area.
The severity of a brachial plexus injury varies, depending on the part of the nerve that is injured and the extent of the injury. In some people, function and feeling returns to normal, while others may have lifelong disabilities because they cant use or feel a part of their arm.
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Can This Injury Or Condition Be Prevented
All pregnant women should seek good prenatal care, including a test for gestational diabetes. Mothers with gestational diabetes tend to have larger babies. The larger the baby, the higher the chance of brachial plexus injury during delivery. Attentive care during labor and delivery is extremely important. Specific positioning of the mother during the delivery may improve the infant’s movements through the birth process the delivery health care provider may be able to suggest the most helpful positions. The use of equipment to assist in delivery also has been associated with brachial plexus injury. Some parent advocate groups recommend that families consider the birth environment if the mother has known risk factors associated with brachial plexus injury. A birthing facility with the ability to quickly adapt to complications may prevent or diminish shoulder dystocia . Having a difficult delivery and shoulder dystocia with one baby increases the likelihood of a brachial plexus injury with a subsequent baby. Expectant parents should discuss prior birth experiences with their delivery health care provider to develop a strong birth plan that minimizes risk.
Upper Extremity Rehabilitation For Traumatic Brachial Plexus Injuries
This course begins with an in-depth overview of the anatomy and mechanics of traumatic brachial plexus injury, possible nerve transfers, and delves into evaluating and monitoring the progress of recovery. Additionally, it highlights treatment priorities and techniques that may be helpful in the rehabilitation of this patient population. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.
Course created on February 6, 2020
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What Are The Long
For severe brachial plexus injuries, prompt surgical treatment could be needed to attempt to regain function. Without it, you might have a permanent disability and be unable to feel or use your arm or hand.
If you have a brachial plexus injury resulting in a lack of feeling, take special care when dealing with hot items, razors, knives or other objects that could harm you. A brachial plexus injury can keep you from feeling any other injury to the affected area, so you may not notice that youre hurt.
Some brachial plexus injuries can result in Horners syndrome, a disorder in which certain nerves of the sympathetic nervous system are damaged. This syndrome can lead to a drooping eyelid, overly constricted pupil and decreased facial sweating on one side of the face. There is no specific treatment for Horners syndrome, but sometimes treating its underlying cause may help to alleviate symptoms.
Chronic pain can also result from a brachial plexus injury, especially without prompt treatment. Its important to work with your neurologist and physical therapist to find ways to help manage any pain.
Brachial plexus injuries due to trauma often occur with other injuries to the neck and shoulder area, including bone fractures and shoulder dislocation. All aspects of an injury should be addressed for the best chance at recovery.
Causes Of Brachial Plexus Injuries
Brachial plexus injury caused during childbirth when nerves are stretched. Brachial plexus injuries may be related to the birthing process, when the nerves get pulled during delivery. Many of these babies recover well without needing surgery. Nevertheless, it is still important for them to be followed by a medical team early after the injury to monitor their recovery and ensure that additional treatment is not needed. Children treated at CHOP for brachial plexus injuries that happened during delivery are followed closely with regular office visits and occupational therapy sessions.
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Brachial Plexus Injury Causes
There are several ways the brachial plexus can be injured. The cause of brachial plexus injury often varies depending on age.
Brachial plexus injury in infants is relatively common and referred to as obstetric brachial plexus injury. These injuries occur in about 2 births per 1,000 and are so common because infantsâ nerves are sensitive to injury during birth. There are several factors that may increase the risk of obstetric brachial plexus injury, including:
- High birth weight of the baby
- A difficult vaginal delivery, like a long labor
- A breech birth
Brachial plexus injuries in adults range from mild to severe. Injury severity often depends on how the injury happened. Milder injuries often happen because of contact sports like football. More severe injuries may be caused by intense trauma, like trauma from a serious car accident. Injuries to other parts of the body, like fractures or herniated discs, can also cause a secondary injury to the brachial plexus.
Cancer and cancer treatments may also cause injury to the brachial plexus. Tumors on the brachial plexus or its nerves can cause compression, and some cancer treatments, like radiation, can cause unintended harm to this nerve bundle.
Tactile And Visual Stimulation
It is important to provide stimulation to the affected arm to match the stimulation received by the unaffected arm. You can do this by rubbing different textures over it and by taking the palm of the affected hand to the face and mouth. It is also important to bring the affected hand into the childs line of vision.
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Surgical Options To Treat Brachial Plexus Injuries
by Deb Balzer, Mayo Clinic
Severe damage to the brachial plexusthe group of nerves that control the movements of your hands, arms and wristscan leave your entire hand and arm paralyzed.
Dr. Shelley Noland, a Mayo Clinic hand and peripheral nerve surgeon, has more on surgical options to treat brachial plexus injuries.
As nerves exit the spinal cord and enter the arm, they form what is called the brachial plexus.
“This collection of nerves powers the entire arm and hand, so it provides all of the motor function to the arm and hand, and all the capabilities of the arm and hand are powered by the brachial plexus,” says Dr. Noland.
Damage to these nerves needs to be cared for in a timely manner to avoid problems. Dr. Noland says if too much time has passed, then the options become more limited for repair and reconstruction.
The most common surgical options are nerve reconstruction, nerve repair, nerve grafting and nerve transfers.
“We treat brachial plexus injuries primarily through the use of what’s called a nerve transfer. And a nerve transfer can be thought of as rewiring the injured nerves with good nerves that are nearby and functioning, but also expendable,” says Dr. Noland.
Postoperative rehabilitation or physical therapy are crucial to healing.
How Is A Brachial Plexus Injury Treated
Since brachial plexus injuries are typically caused by traumatic, forceful events, many people have additional injuries. These may include:
- Artery or vein injuries.
There are two main types of treatment for brachial plexus injuries: nonsurgical and surgical.
Nonsurgical treatment of brachial plexus injuries
Many brachial plexus injuries will heal without surgery over a period of weeks to months, especially if theyre mild. Nerve injuries that heal on their own tend to have better outcomes in terms of muscle and nerve function.
If your healthcare provider thinks that the injury has a good potential for recovery without surgery, they may wait to see how your injury heals before considering surgery.
Your provider may recommend physical therapy as your injury heals to prevent joint and muscle stiffness. Youll also likely need to rest your arm and shoulder and avoid strenuous activities.
Surgical treatment of brachial plexus injuries
Healthcare providers typically recommend surgical treatment for brachial plexus injuries when the nerves dont heal on their own or dont recover enough to restore necessary function to your arm and hand.
Its important to know that depending on the severity of the injury, surgery may not be able to return your arm or hand to its abilities before the injury.
Neurosurgeons use several different techniques to treat nerve injuries, depending on the type and severity of the injury and the amount of time that has passed since the injury.
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How Common Are Brachial Plexus Injuries
Researchers dont know exactly how many brachial plexus injuries happen to children and adults each year, but the number seems to be increasing. More participation in high-energy sports and higher rates of survival from high-speed motor vehicle accidents may be reasons why the number of these injuries is growing.
Approximately 70% of traumatic brachial plexus injuries result from traffic accidents, of which 70% involve motorcycles or bicycles.
Neonatal brachial plexus injuries are a common type of birth injury. There are 2 to 3 cases for every 1,000 births.
What Kind Of Physical Therapist Do I Need
All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:
- A physical therapist who is experienced in pediatrics and brachial plexus injuries. Many hospitals dedicated to the care of children will have special brachial plexus centers with experienced pediatric physical therapists. You may want to work with the physical therapist at the specialty center and the physical therapist in your local area, who will work with you and your child in the home, school, or community environments.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in pediatric physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to brachial plexus injuries.
- A team approach. Experienced pediatric physical therapists understand the importance of working with other health care professionals to maximize outcomes for children with brachial plexus injuries.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
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Fastest Nerve Injury Recovery
Brachial Plexus Injury is found in children as well as in adults.
We at Physioline can help you recover from this problem in turn improving the functionality and quality of life.
Lets Understand this condition
The brachial plexus is formed from the spinal nerves or roots, the coalescence of the ventral and the dorsal rootlets as they pass through the spinal foramen. The dorsal root ganglion contains the cell bodies of the sensory nerves the cell bodies for the ventral nerves lie within the spinal cord.
Typically, the brachial plexus is formed from C5-T1 in some cases with there is a contribution from C4 or T2 . All nerve supply to the upper extremity passes through this plexus. The brachial plexus starts at the scalenes, courses under the clavicle, and ends at the axilla. It is typically composed of 5 roots, 3 trunks, 6 divisions , 3 cords and terminal branches.
The common mechanism for traction injuries of the brachial plexus is violent distraction of the entire forequarter from the rest of the body. These injuries usually result from a motorcycle accident or a high-speed motor vehicle accident. A fall from a significant height may also result in brachial plexus injury, either traction type or from a direct blow penetrating injuries and low- or high-velocity gunshot wounds also are seen.
The initial patient evaluation should occur as early as possible following injury, or as soon as stabilization after the trauma permits.