Brachial plexus injury in Los Angeles is one of the most devasting nerve injuries of the upper extremity whereby an individual loses both sensation and motor control of the shoulder joint, elbow, and hand function depending on which nerve roots are injured. What is the Brachial plexus? The brachial plexus is a series of major nerves that comes from cervical spine levels C5, C6, C7, C8, and T1 levels. The anatomy of the brachial plexus is normally divided into 5 segments (1) Roots, (2) Trunk, (3) Divisions, (4) cords, and (5) Terminal branches. In the posterior neck, the nerves exit the spine foraminal and form roots that travel between two muscles, the anterior and middle scalene muscles. These nerves join to form trunks, the upper, middle, and lower trunks, and then divide into the anterior and posterior divisions as it travels from the neck to the chest level. These nerves travel under the clavicle bone as it enters the chest level. In the upper chest, the nerves travel intimately with the major blood vessels called the subclavian artery and vein. At this level, the nerves form cords and start to divide into terminal branches. Along the brachial plexus path from the neck to the chest, it also gives off smaller motor nerve branches that innervate the anterior as well as anterior chest muscles.
Brachial Plexus Injury
Los Angeles
What is the Brachial Plexus?
What is a Brachial Plexus Injury?
A brachial plexus injury in Los Angeles is a devasting life-changing injury. Historically, brachial plexus injury has been treated with amputations or benign neglect. Fortunately, recent advances in microsurgery techniques have significantly improved outcomes for patients with brachial plexus injury.
What is the Most Common Mechanism of Nerve Disruption in Brachial Plexus Injury?
The mechanisms of brachial plexus injury are classified into avulsion versus rupture type of injury, and close versus open injury.
Avulsion injury is when the nerve roots are torn from the spinal cord. The second is the rupture of the nerve which occurs after the nerve exits from the spinal cord.
Avulsion injury – the nerve roots avulsed from the spinal cord. In the acute phase, the nerve has a coiled spring-like structure. In the chronic phase, the distal end of the nerve forms a fusiform neuroma. Avulsion injury is rarely acutely treated. It requires reimplantation of the nerve root back to the spinal cord. There are a few reported series of nerve root reimplantation to the spinal cord that show a modest functional return of muscle contraction.
Rupture of the brachial plexus nerve is caused by traction of the nerve trunk/divisions/or cords after it exits the spinal cord, resulting in brachial plexus injury in Los Angeles. The nerve recoils and both ends will form a neuroma. During this process, the nerve is severely injured and bruised. Rupture-type injury is more favorable since it is amendable to repair. We have extensive experience and data on nerve grafting with excellent motor recovery in patients.
Close versus open injury
Close brachial plexus injury – The majority of brachial plexus is close injury. This happens when the nerve is injured but there is no opening in the skin over the site of injury. This is the type of injury seen in motorcycle and bicycle injuries.
Open injury of the brachial plexus is when there is an actual cut in the skin at the site of the nerve as in a stab wound or laceration injury. Interestingly most gunshot wound type of injury is classified as a close injury due to the fact the path of the bullet is unpredictable, and it is more likely the deficit nerve injury is due to thermal injury from the bullet trajectory.
What causes Brachial Plexus Injury?
Brachial plexus injury in Los Angeles is also commonly known as burner and Stinger. It occurs when the neck suddenly or violently flexes away from the shoulder joint and the brachial plexus nerves become pinched. It is also more common in a person with a narrow spinal canal.
- Blunt trauma: such as falls or motor vehicle accidents/bike 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. This is commonly seen in head and neck radiation for the treatment of cancers.
Many patients with brachial plexus are male patients in their 20s, average 28 years old. The most common cause of brachial plexus injury is motorcycle accidents (79%), followed by firearm injuries (4.1%), car accidents (3.8%), and lastly bike injuries & sports injuries (3.2%).
What are the Symptoms of Brachial Plexus Injury?
The symptoms of burner and stinger include a sudden intense burst of pain that radiates from the neck to shoulder, and arm, and may reach the hand/fingers. It also accompanies a burning sensation. It can result in numbness and weakness in the shoulder/arm and hand.
Common Symptoms of brachial plexus injury in Los Angeles
- Burst of pain radiating down to the neck/shoulder, arm, and hand
- Burning sensation in the arm or hand
- Numbness and weakness in shoulder/arm/forearm/hand
- Inability to control or move the shoulder, arm, wrist, or hand. (picture of a patient with brachial plexus injury)
Your symptoms depend on where along the length of the brachial plexus the injuries occur and how severe they are.
Brachial plexus injury pain can be mild to severe, and temporary to chronic, depending on the type and extent of the injury. For instance, a simply stretched nerve may hurt for a week or so, but a ruptured nerve can cause serious, long-term pain that might require physical therapy and potentially surgery.
How do you diagnose brachial plexus injury?
If you have symptoms of brachial plexus injury also known as Burner and stinger, you should be referred urgently to a plastic surgeon or hand surgeon who specializes in the treatments of peripheral nerve and brachial plexus injuries. Time is of the essence. Once you are seen by a specialist, a thorough physical exam is performed documenting the sensory and motor deficits in the affected extremity. This will allow for a preliminary diagnosis of the level of brachial plexus injury in Los Angeles.
Additional diagnosis studies including
- X-ray of the neck and affected extremity (shoulder joint, clavicle, arm, forearm, and hand)
- MRI with contrast of the brachial plexus to visualize the nerves of the brachial plexus.
- Electromyogram (EMG) and nerve conduction will be administered to look at the electrical conduction of the nerves and muscle motor end plates activity. These two important studies will be administered 6 weeks from your time of injury and repeated every few months to follow the progress of your nerve recovery.
Treatments of Brachial Plexus Injury
Most brachial plexus injuries may heal on their own, especially in patients with neuropraxia type of injury. During the recovery process, you should see a physical therapist or hand therapist to help with exercises that can help regain of muscle function and maintain mobility of the joints.
Non-surgical Treatment of Brachial Plexus Injury
Recovery from this complex injury includes physical therapy at the beginning and the end of a surgical injury. Physical therapy not only helps with maintaining joint mobility, but it also stimulates and maintains muscle bulk during the nerve recovery process. It can also help with pain management.
Surgical Treatment of Brachial Plexus Injuries
Injuries that fail to recover on their own will require surgical treatment. Surgical procedures to address brachial plexus injury in Los Angeles include
1. Nerve exploration – Explore the affected brachial plexus to determine the injured affected nerves
2. Nerve repair – Reconnecting a torn nerve.
3. Nerve graft – using a person’s healthy nerve to reconnect an injured nerve that cannot be repaired directly without undue tension. Sometimes, your surgeon may elect to use a cadaver nerve also known as an allograft to reconnect the injured nerve
4. Nerve transfer – Transfer a nerve of less important function to the damage nerve to restore a more important function of the arm, wrist or hand functions.
5. Functional muscle transfer – muscle from the thigh or the back can be move to the arm to restore function in the shoulder, elbow or hand.
6. Tendon transfer – tendon from one part of the hand can be transferred to restore function in another part of the hand.
Before & After
Brachial Plexus Injury FAQs
After a brachial plexus surgery, what can I do to help it heal faster?
To facilitate a quicker recovery from the surgery for your brachial plexus injury in Los Angeles, follow your surgeon’s post-operative instructions diligently:
- Engage in regular physical therapy to regain strength and mobility.
- Maintain a balanced diet to support tissue repair.
- Avoid smoking or excessive alcohol consumption, as they can hinder healing.
- Ensure adequate rest and stress management for a faster recovery.
Should I wait to see if a brachial plexus injury heals naturally before looking into surgery?
The decision to wait for a brachial plexus injury to heal naturally or opt for surgery depends on the severity and type of injury. Mild cases may improve without surgery, but please consult the experts at the Nerve Institute for a thorough evaluation and diagnosis. We can assess the severity of the situation and make appropriate recommendations — timely intervention can prevent permanent damage and maximize your chances of recovery.
How successful is surgery for brachial plexus injuries?
The success of surgery for a brachial plexus injury in Los Angeles varies based on the injury’s type and severity, as well as the patient’s age and overall health. Generally, early intervention and a comprehensive rehabilitation plan can yield favorable outcomes. Please consult our skilled surgeons to discuss your individual prognosis and treatment plan.
What are the signs that a child may have a brachial plexus injury?
Common signs of a brachial plexus injury in infants include limited arm movement, a limp or weak arm, and a lack of reflexes in the affected arm. During childbirth, excessive pulling or pressure on the baby’s head or shoulders can lead to these injuries. Prompt evaluation and treatment are essential to ensure the best possible outcome for the child.
Is surgery for brachial plexus injury done under general or local anesthesia?
Brachial plexus surgery is typically performed under general anesthesia. This ensures that the patient is completely unconscious and pain-free during the procedure. General anesthesia allows the surgical team to work safely while the patient remains comfortably asleep.
Timing of Surgical Intervention
Nerve regeneration is very slow (1mm/day) and motor end plates in the muscle degenerate (1%/week). Therefore, early surgical intervention for brachial plexus injury in Los Angeles is very important to restore muscle function. The earliest surgical intervention is recommended between 3 to 6 months from the time of injury for the best functional outcome.
