Treatment. Brachial Plexus Injury

Brachial plexus injury diagnosis

In order to confirm a brachial plexus injury diagnosis, your physician will take your medical history, review your symptoms and complete a physical examination. To determine the severity of your injury, one or a combination of the following tests may be ordered:

• Electromyography (EMG): This study tests the activity of the muscles both when they are at rest and when they are contracting. It is performed by inserting an electrode into different muscles through the skin. Some people feel a little discomfort when the electrodes pass through the skin, but most patients tolerate the test without much pain.
• Nerve conduction studies: Typically, these studies are completed with the EMG. They test the speed of conduction in the nerves when a current passes through them. This tells the doctor if the nerves are functioning correctly.
• Magnetic resonance imaging (MRI): Through the use of a powerful magnetic field and radio waves, this test can produce very detailed pictures of your body. It can show the doctor how much damage has been caused by an injury. An MRI can determine if a nerve has been completely torn from the spinal cord and can also assess how well the blood vessels in the area are functioning. 
• Computerized tomography (CT) myelography: This is a scan that uses x-ray technology to produce cross-sectional views of the affected area. A contrast dye is injected to produce an image of the nerve roots and spinal cord that can provide additional information needed by the physicians. 

Brachial plexus injury treatment

The treatment of a brachial plexus injury depends on many factors. These include the type of injury, the severity of the injury, how much time has elapsed since the injury, and other existing patient health conditions. If the nerves have only been stretched and not torn, they may heal without treatment.

Sometimes physical therapy is recommended to make sure the muscles don’t become weak, and the joints don’t become stiff while the nerves are healing.

In some cases, scar tissue forms as healing take place. In order to improve the nerve’s function, this extra tissue must be surgically removed. Nerves that have been torn or cut or that have large amounts of scar tissue often need to be surgically repaired.
In order to regain muscle function, brachial plexus injury surgery for the repair of nerves should be completed within three to six months of the injury. Chances of surgery being able to improve muscle function decrease if surgery does not occur within six months.

Brachial plexus injury surgery

• Nerve graft: This surgery is completed to restore function to the arm. The injured portion of the brachial plexus is replaced with portions of nerves harvested from other places in your body.  
• Nerve transfer: If one or two nerve roots have been torn away from the spinal cord, less important nerves that are still attached can be put in their place. This surgery is sometimes combined with a nerve graft. It can sometimes take years to recover after surgery on the nerves because nerve tissue grows very slowly. As patients recover from brachial plexus injury surgery, they must follow an exercise program to make sure their joints remain flexible. Splints are sometimes worn to prevent the hand from contracting inward.
• Muscle transfer: If the muscles in the arm atrophy or deteriorate, it may be necessary to perform a muscle transfer. In this procedure, a muscle or tendon is taken from another part of the body and transferred to the arm.

Pain control

Severe brachial plexus injuries cause pain that has been described by patients as a continual burning or as a crushing pain. Immediately following the injury, narcotic analgesics, such as codeine, are often used. Anticonvulsants and antidepressant medications are often used to treat nerve pain, and muscle relaxants can also provide pain relief.

Transcutaneous electrical nerve stimulation (TENS) is a device that is sometimes used in the treatment of pain. Electrodes are attached to the skin, and electrical impulses are delivered to nerve pathways through these electrodes to help eliminate pain.

Brachial plexus injury complications prevention 

Brachial plexus injuries cannot usually be prevented, but you can help reduce the risk of complications after an injury has occurred by taking the following steps:

• For yourself: 
  • If you cannot use your arm or hand, exercise it every day to prevent stiffness in the joints. Ask your doctor about physical therapy to help you plan an exercise program.
  • Practice extra safety precautions, especially in the kitchen and bathroom. You may not be able to feel if you are being burned or cut if your hand, fingers, or arm are numb. 
  •  If you have already had injuries to your brachial plexus and you still participate in sports activities, consider wearing specific protective equipment or padding to protect yourself against further injuries.
• For your child: 
  • If your child has Erb’s palsy, exercise his or her joints and muscles daily from the time your baby is approximately three weeks old. This will help keep your child’s joints flexible and the muscles healthy and strong.