The brachial plexus is a network of nerves that conducts signals from the spine to the shoulder, arm, elbow, wrist, hand and fingers that allow movement and sensation. Damage to the nerves from inflammation, tumors, stretching, tearing or other trauma is considered a brachial plexus injury.
Most pediatric BPIs occur during the birthing process. Other causes of BPIs include motor vehicle accidents, sports injuries and gunshot wounds.
The most severe type of injury is avulsion. Avulsion is caused when the nerve root is pulled out from the spinal cord. If only part of the nerve is pulled, an incomplete form of avulsion can occur. If a nerve is stretched, there can be a transient disruption of the insulation surrounding the nerve fibers. This form of injury (Neuropraxia) recovers over hours to days. In a more severe stretch injury, there is disruption (axonotemsis) of the internal electricity carry fibers (axons). These fibers have to regenerate or grow back down to their target muscles or area of skin. This process of re-growth occurs at approximately one inch per month. In more severe stretch injuries there can be disruption of the internal nerve environment that then scars and prevents much of the re-growth of fibers. This leads to formation of a neuroma, or tangle of nerve fibers. There is little recovery of function and management should include surgical repair of the nerves. A very severe stretch injury can cause the nerve to split and a complete rupture is present. There is no hope of recovery without surgical repair.
Damage to the upper nerves that make up the brachial plexus tends to occur when your shoulder is forced down while your neck stretches up and away from the injured shoulder. The lower nerves are more likely to be injured when your arm is forced above your head.
These injuries can occur in several ways, including:
- During birth. In babies, the brachial plexus nerves in the shoulder are vulnerable during birth. Injury to the brachial plexus is fairly common in newborns, occurring in one to two births per 1,000. Larger babies in difficult vaginal deliveries are particularly prone to this injury, as are babies with high birth weight, breech presentation or prolonged labor. If an infant's shoulders get wedged within the birth canal, there is an increased risk of a brachial plexus palsy. Most often, the upper nerves are injured, a condition called Erb's palsy.
- Contact sports. Many football players experience burners or stingers, which can occur when the nerves in the brachial plexus get stretched beyond their limit during collisions with other players.
- Trauma. Several types of trauma — including motor vehicle accidents, motorcycle accidents, falls or bullet wounds — can result in brachial plexus injuries.
- Tumors and cancer treatments. Tumors can grow in or along the brachial plexus, or put pressure on the brachial plexus or spread to the nerves. Radiation treatments to the chest may cause damage to the brachial plexus.
Our team of experts at the Brachial Plexus and Peripheral Neve Clinic are well-versed in all types of brachial plexus and peripheral nerve injuries, from birth injuries to acute flaccid myelitis to radiation treatment complications. We provide interdisciplinary care, combining the expertise of multiple medical and surgical clinicians to produce the best outcomes and create an individualized treatment plan for each patient.
Our team includes:
- Occupational therapy
- Orthopedic surgery
- Plastic surgery
Because brachial plexus and peripheral nerve injuries could result in permanent damage if not treated as soon as possible, early intervention is key to regaining function.
Our treatment options include:
Non-surgical Treatment Options: Occupational therapy and physical medicine are always part of the recovery process. The Kennedy Krieger Institute not only offers traditional therapies, but also the opportunity to receive intensive activity-based restorative therapies (ABRT) to maximize the recovery and neurodevelopmental processes which lead to function and development of adequate and efficient motor patterns.
Surgical Treatment Options: The degree of functional impairment and potential for recovery depends on the mechanism, type, complexity of the brachial plexus injury, and time from injury. The most important decision your surgeons will make is determining if and when surgical intervention should occur.
Surgical Treatment for Acute Flaccid Myelitis (AFM): For children who have been diagnosed with acute flaccid myelitis (AFM), nerve transfer surgery is an option for improving function in an affected area. Our clinic offers evaluation for nerve transfer surgery by peripheral nerve surgeons at The Johns Hopkins Hospital, which is adjacent to Kennedy Krieger.
Examples, Subsets and Synonyms for Brachial Plexus Injury:
- Brachial Plexus Palsy
- "Burners" or "Stingers" (usually associated with sports-related brachial plexus injuries)
- Erb's Palsy (upper trunk injury)
- Erb-Duchenne Palsy
- Horner's Syndrome (when facial nerves are also affected)
- Klumpke's Palsy (lower trunk injury)\Obstetrical Brachial Plexus Injury
- Parsonage-Turner Syndrome (inflammation of the brachial plexus)
Learn more about brachial plexus treatments and evaluations at The Brachial Plexus Clinic at Kennedy Krieger Institute.