BRACHIAL PLEXUS LEGION
What is it?
The brachial plexus is the network of nerves that sends signals from your spine to your shoulder, arm and hand. A brachial plexus injury occurs when these nerves are stretched, compressed, or in the most serious cases, ripped apart or torn away from the spinal cord.
The brachial plexus controls movement and sensation in the entire arm and hand so a a traumatic brachial plexus injury that involves sudden damage to these nerves may cause weakness, loss of feeling, or loss of movement in the shoulder, arm, or hand.
Some brachial plexus injuries are minor and will completely recover in several weeks, but severe brachial plexus injuries can leave your arm paralysed, with a permanent loss of function and sensation.
In severe cases surgical procedures such as nerve grafts, nerve transfers or muscle/tendon transfers can help restore some function. Recovery can take many months or years and is dependent upon the commitment of the person to their rehabilitation programme.
How does it happen?
The network of nerves is fragile and can be damaged by pressure, stretching, or cutting.
Traction: Known as a stretch injury, is one of the mechanisms that cause brachial plexus injury, such as a motorcycle accident. The nerves of the brachial plexus are damaged due to a pull and stretch in the space between the shoulder and neck which widens forcefully.
Impact: Heavy
impact to the shoulder causing injury to the brachial plexus is the second most common reason. Some forms of impact that affect the injury to the brachial plexus are
shoulder dislocation,
clavicle fractures, hyper-extension of the arm and a heavy knock sustained on the top of the head pressing down and crushing the nerves.
Complications
There are some conditions which can place pressure onto the brachial plexus such as a tumour, arthritis, immune system conditions, exposure to radiation. Sometimes there is no cause found for the condition.
In severe cases where the nerves have been pulled or severed from their root, the person can experience lasting pain and paralysis in the arm affected. Occasionally the nerves in the face are also affected.
There is no doubt that it can be life changing and has a huge impact on quality of life, career choices, relationships and independence.
The treatment for it usually involves surgery to graft a good nerve, transfer a nerve to keep the muscles working or a tendon transfer to replace the affected muscle.
Surgical options
It is important to determine which nerves are stretched or torn versus those that are avulsed (pulled out of the spinal cord completely). If nerves are avulsed, the surgeon can operate earlier instead of giving time for recovery, knowing that these injuries will not recover on their own.
Reconstructive surgery for complete brachial plexus injuries generally consists of a combination of nerve grafting and nerve transfer procedures. The treatment for each patient will be determined according to his or her individual condition.
Patients can undergo surgery within three to four months after the injury. In order to provide for the best recovery, it is often important that the patient receive Hand therapy before the surgery to keep the joints mobile and to learn to recruit the nerves that will be transferred and, after the surgery, to learn to use the muscles that are now run by different nerves.
Treatment
Injury to the brachial plexus is very complex. It requires a multidisciplinary team of Doctors, surgeons, physiotherapists and occupational therapists to look at your condition from lots of angles. Together the team will develop a picture of your motor function, sensory function and your ability to adapt to loss of movement. They will then work with you to decide how to help improve your circumstances and when to intervene. As rehabilitation afterwards can take many months, you can expect your hospital team to support you and guide you through the phases of your treatment programme.
Treatment at Hand Kinetics
At Hand Kinetics, our occupational therapists can offer additional support. We can look at your ability to perform daily activities pre and post surgery and can advise you how to prepare for surgery and how to retrain functional movement afterwards.
As treatment requires a multidisciplinary team, we can liaise with your hospital team to keep them up to date with your progress and functional outcomes.
Please talk to our principal therapist at Hand Kinetics to discuss your specific needs and shoulder problem before making an appointment and we will be happy to discuss treatment options with you.
Hand Kinetics Telephone: 0044 28 417 72301
www.handkinetics.com
contactus@handkinetics.com
