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The brachial plexus are an important network of intertwined nerves responsible for the motor function of all of the muscles of the upper arms. This means the brachial plexus aids in controlling movements and sensations in the arm and hand. Brachial plexus injuries occur when the arm is forcefully pulled or stretched. Before speaking on these injuries though, let's explore the anatomy of this complex area.
Comprising the last 4 cervical nerve roots in the neck ( C5-C8) and the first thoracic (T1) nerve root, the brachial plexus is a component of the peripheral nervous system. This system makes up a network of 43 pairs of motor and sensory nerves which connect the brain and spinal cord (the central nervous system) to the entire human body.
Having trauma of any kind occur to a brachial plexus can be very difficult to diagnose. It is common in most cases that abnormal pain occurs because of a communication problem between the nerves and brain. This should not be confused with "phantom pain". The awkward feelings of burning, electrical shock or nerve misfires are a result of dysesthesia. A Greek word with prefix "dys", meaning "not-normal" and "aesthesis", which means "sensation", Dysesthesia can occur intermittently or be continuous.
If you are having disturbing sensations or pain that won’t go away, you shouldn’t assume it's due to dysesthesia. See your primary care physician or neurologist. All other causes for pain should be examined and ruled out first.
The brachial plexus begins at the neck and crosses the upper chest to the armpit. There are five anatomic sections of the brachial plexus.
- Roots
- Trunks
- Divisions
- Cords
- Branches
Mnemonics for brachial plexus components are plenty. The one I find works best is; really tired drink coffee black.
Yes, there is a brachial plexus on each side of the body 😊
In Latin brachial means “arm” and plexus means “braid”
In Latin brachial means “arm” and plexus means “braid”
Roots merge C5 and C6 to establish the upper trunk, C7 continuously forms the middle trunk, and C8 along with T1 merge to establish the lower trunk. Each trunk then splits in two, to form six divisions. These then regroup to create the three cords or large fiber bundles. The branches form off the cords into terminal branches of the brachial plexus. These are the musculocutaneous, axillary, radial, median and ulnar nerves which all have specific sensory, motor and proprioceptive functions.
Brachial plexus injuries vary greatly in severity, depending upon the type of injury and the amount of force placed on the plexus.
- Stretch (Neuropraxia): When the nerve is mildly stretched, it may heal on its own or require simple, nonsurgical treatment methods to return to normal function.
- Rupture: A more forceful stretch of the nerve may cause it to tear partially or fully. These types of injuries can sometimes be repaired with surgery.
- Avulsion: In this most severe brachial plexus injury, the nerve root has been torn from the spinal cord. These types of injuries may not be repairable with surgery.
Many events can cause the injury, including birth (ERb's palsy), falls, motor vehicle collisions, knife and gunshot wounds, and most commonly, motorcycle collisions. Injury to this mesh of nerves often occurs when the arm is forcibly pulled or stretched (One to two of every 1,000 babies are injured when an infant's neck is stretched to the side during a difficult delivery). Because brachial plexus injuries are typically caused by high-energy, forceful events, many patients have additional injuries. These may include artery or vein injuries, fractures to the shoulder or arm, rib fractures, a collapsed lung, bleeding into the lungs or chest cavity, spine fractures, spinal cord injury, and traumatic brain injury.
A positive mindset and the support of family, friends, and healthcare professionals are vital for recovery and rehabilitation. Patients with brachial plexus injuries must be evaluated and treated within an appropriate timeframe, typically within 6 to 7 months after injury. The longer a muscle is without nerve input, the less likely it is that the muscle will function normally in the future.
What can be done?
What can be done?
Treatment is different for everybody. Getting advise from others going through similar injuries is recommended. It will take trial and error as well as patience to find the best solution for you. As an example the medications for treating dysesthesia include:
- CBD
- Over-the-counter pain relievers
- Anti-seizure agents such as gabapentin (Neurontin), pregabalin (Lyrica), carbamazepine (Tegretol), and phenytoin (Dilantin)
- Anti-anxiety agents such as duloxetine hydrochloride (Cymbalta) and clonazepam (Klonopin)
- Tricyclic antidepressants such as amitriptyline (Elavil), nortriptyline (Pamelor) and desipramine (Norpramin)
- Tramadol (Ultram, ConZip, Ryzolt), especially for burning sensations
- Lidocaine or capsaicin patches
- The antihistamine hydroxyzine (Atarax)
Persistent dysesthesia can also interfere with your life in a number of ways, such as:
- Skin or scalp irritation or infection due to scratching, itching or rubbing
- Daytime fatigue due to difficulty sleeping
- Inability to perform routine everyday tasks
- Avoiding social outings, which can lead to isolation
- Irritability, anxiety or depression
It is extremely important if you do incur a brachial plexus injury that you have a strong support system. Overworking an unaffected arm can cause strains or sprains which really make daily activities difficult.
The process of the nerve healing itself takes time (nerve regeneration occurs at a rate of approximately 1 mm/day). A doctor will likely recommend physical therapy to prevent joint and muscle stiffness. Exercises will maintain the range of motion in the shoulder, elbow, wrist, and hand. This will prevent the joint from becoming permanently stiff or extreme muscle atrophy.
Surgical treatment is typically recommended when the nerves fail to recover on their own or fail to recover enough to restore necessary function to the arm and hand. It is important to note that depending upon the severity of the injury, even surgery may not be able to return the arm or hand to pre-injury abilities.
Prevention
Prevention
Severe injuries to the brachial plexus are very debilitating and frustrating for those suffering from them. Prevention is likely the only way to assure one doesn't suffer from this terrible condition. Wearing safety equipment for possible accidents is important however even those safety measures may not be enough during a high speed impact.
Always ride safe and don't drink and drive. This includes bicycling and riding scooters! 😉
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