Brachial plexus and peripheral nerve injuries prevent the nerves from carrying signals between the brain and muscles. Over time, the muscles can become weak and lose function.
The brachial plexus is a group of nerves that begin in the spinal cord of the neck and travel to the shoulder and down the arm to the wrist and hand. These nerves are part of the peripheral nervous system, which includes the motor and sensory nerves that connect the spinal cord and brain to the rest of the body.
These nerves can be damaged when they are stretched, pinched or cut. The most common conditions are:
- Brachial plexus injuries at birth. If a baby’s shoulders get stuck in the birth canal during a vaginal birth, the brachial plexus nerves can be stretched and injured. This can make it difficult to move the arm or flex the arm muscles. This injury happens in 1.5 of every 1,000 births.
- Brachial plexus trauma injuries. These nerves also can be damaged in a fall from a bicycle or ATV, in a motor vehicle accident or from a sports injury.
- Thoracic outlet syndrome. This condition is more common in adolescents. It occurs when an abnormal growth from a rib or the spinal column puts pressure on the brachial plexus nerves, causing lack or movement and pain in the arm.
Other conditions that affect the peripheral nervous system and can cause problems with movement include:
- Neurofibromatosis a condition causes tumors to form on peripheral nerves.
- Horner syndrome affects the optic nerves and causes asymmetrical pupils in the eyes. It often indicates other peripheral nerve problems.
- Entrapment syndromes are a group of conditions like carpal tunnel, where the muscles and ligaments that surround a nerve become tight, restricting or putting pressure on the nerve.
Symptoms of Brachial Plexus & Peripheral Nerve Injuries
The extent of the damage caused by nerve injury to the brachial plexus and peripheral nerves can vary from minor to severe depending on the type of injury. Symptoms include:
- Loss of feeling
- Difficulty moving the entire arm
- Problem bending the arm at the elbow
- Trouble making a bicep
- Pain when lifting the arm
- General pain
Diagnosis of Brachial Plexus & Peripheral Nerve Injuries
Doctors at Riley at IU Health use different tests to diagnose a nerve injury to the brachial plexus or peripheral nerves.
These tests include:
- Physical exam. The doctor and also sometimes a physical therapist will examine your child and will watch how he or she moves and uses the arm or other injured area.
- Electromyography (EMG) test. An EMG measures the health of muscles and their nerves and to looks for areas where electrical signals may be blocked.
- Magnetic resonance imaging (MRI). This imaging test can spot structural abnormalities in the muscles and nerves.
- Ultrasound. This test uses sound waves to create images of the tissues in the should to check for shoulder dislocation.
Doctors use the test results and work with you to create the best care plan for your child’s specific condition.
Treatment for Brachial Plexus & Peripheral Nerve Injuries
Treatment for Brachial Plexus & Peripheral Nerve Injuries
The cause of your child’s brachial plexus or peripheral nerve injury will determine his or her treatment options. We use a multidisciplinary approach to treating these injuries. Our rehabilitation specialists collaborate with our neurosurgeons and plastic surgeons to determine the right care.
Whenever appropriate, we use physical therapy as first-line care. This is often the best treatment when nerves are stretched and they tend to heal with time.
If stretched nerves do not improve after nine months or they were cut, pinched or torn away from the spinal cord, further treatment may be necessary. Between 20 percent and 30 percent of these injuries require surgery.
Our goal is to restore function to the damaged nerves and muscles.
Surgical treatment options include:
- Primary nerve repair. Doctors can repair or replace damaged nerves.
- Jump grafts. The injured piece of nerve is removed and a working nerve from the leg is used to repair it.
- Direct nerve transfer. A branch of a nearby working nerve is plugged into the damaged nerve. This creates a short circuit and restores function.
- Secondary repair. A plastic surgeon can transfer working muscles to part of a damaged limb to give movement to paralyzed muscles.
- Rehabilitation. Physical and occupational therapy are important before and after surgery to build strength, retrain the body and brain to use injured muscles and regain as much function as possible.
Key Points to Remember about Brachial Plexus & Peripheral Nerve Injuries
Key Points to Remember about Brachial Plexus & Peripheral Nerve Injuries
- The brachial plexus is a group of nerves in the shoulders and arms that is part of the peripheral nervous system.
- Brachial plexus injuries at birth occur in 1.5 of every 1,000 births.
- Thoracic outlet syndrome is when abnormal ribs or spinal column growths injure brachial plexus.
- Most brachial plexus birth injuries heal with time and physical therapy.
- Between 20 percent and 30 percent of these nerve injuries require surgery.
Support Services & Resources
Support Services & Resources
Visit the following sites to find out more about how brachial plexus and peripheral nerve injuries are diagnosed and treated.
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
The American Academy of Pediatrics provides information about the diagnosis and treatment of brachial plexus injuries.
This clinical website provides health information from physicians about neonatal brachial plexus injuries.