What's a brachial nerve injury and how is it treated? We just got word that our brother-in-law was in an accident and that's what happened to him.
A nerve plexus refers to the entire group of nerves as they first start out with several main branches that divide to form a much larger number of nerve groups. The brachial plexus starts at the neck but travels under the clavicle (collar bone) and down the arm.
These nerves provide both sensation (pain, temperature, touch, vibration) and motor function (muscle contraction) for the entire upper extremity including the shoulder, arm, wrist, and hand.
Traumatic injuries of the brachial plexus refer to stretching, avulsion, or rupture of a group of nerves that come from the spinal cord in the neck. Avulsion tells us the nerve root is torn from the spinal cord where it attaches. Rupture refers to a complete tear across the nerve dividing it into two or more parts. The upper part is still attached to the spinal cord.
Brachial plexus injuries are usually caused by some type of trauma such as a car accident, fall onto an outstretched arm (especially if the head and face are turned away from that side), and stretching or pulling on the hand, wrist, or forearm. Gunshot wounds, knife lacerations, and other blunt open injuries are also likely causes of nerve avulsion or rupture.
Surgery is often needed to reconstruct the nerve. The surgeon must choose among several different approaches, each with their own specific surgical techniques. When there is a clean cut through the nerve, it is possible to stitch the two ends of the nerves back together in what is referred to as a direct repair.
But most of the time, there are multiple nerves that involve both sensory and motor function. In these cases, it may be necessary to perform nerve grafting, nerve transfers, or even muscle transfers. The nerves used depend on the location of the primary (main) nerve injury and the muscles (motion) affected.
Brachial plexus injuries can be complex, difficult to treat, and devastating for the patient. Every effort must be made to establish a correct diagnosis (which nerve is affected, location of the lesion, severity of the lesion) in order to plan treatment specific to that problem. Recent advances in the surgical repair and reconstruction of traumatic brachial plexus injuries has opened up treatment options and improved results.
Raymond A. Pensy, MD. Traumatic Brachial Plexus Injuries. In Current Orthopaedic Practice. September/October 2010. Vol. 21. No. 5. Pp. 462-466.
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