The brachial plexus is the set of nerves that makes the communication between the arms and brain. Everything that happens to our arm, like the sensations and movements of the shoulders, elbows, forearms, wrists and hands depend on the health and situation of the brachial plexus.
Nerves are like a cord made up of many clustered fibers (resembling an electric cord). These "cables" carry and bring information from the brain and spinal cord to the arm. It is from these messages that the movements are produced and the sensations are perceived.
The brachial plexus carries information to the brain that allows us to identify objects that touch the skin, perceive different temperatures or perceive stimuli that can cause pain, which is important to protect the arm from an injury, for instance.
In addition, the execution of movements - from the simplest, such as raising one's arm, to the most delicate and complex, such as hand movements - depends on these nerves. The traumatic injury of the brachial plexus is characterized by a compromise of this set of nerves and consequently of these abilities.
The main causes of the traumatic injury of the brachial plexus are traumas related to traffic accidents involving cars, motorcycles, public transport, bicycle and pedestrians - more than 80% of the injuries are due to motorcycle accidents. Accidents at work, home, sports, and injuries to the neck and shoulder can also cause this kind of injury.
If you have had any trauma affecting your shoulder, neck, arm, hand, and any of the following signs on your arm and / or hand, seek medical advice for a full examination as soon as possible:
- Weakness or lack of control of movements.
- Paralyzed or weak arm and/or hand.
- Sensitivity changes, such as tingling, numbness, shock and pain, or lack of sensitivity.
- Swelling, increase or decrease in sweating.
The signs and symptoms will depend on the location, type and severity of the injury. The clinical examination is the best tool to identify such injuries, and for cases like this you will be referred to a neurologist or neurosurgeon. The clinical examination also evaluates the history of the trauma and the patient's complaints. Physical evaluation is also performed, where, through specific tests, the strength (movements) and the sensitivity of the shoulder, arm and hand will be examined. However, it is quite common for other tests to be performed to help identify and/or confirm and detail the injury. This information is particularly important in planning the next steps in your rehabilitation. The most used exams are Electromyoneurography (ENMG) and Magnetic Resonance Imaging.
Traumatic injuries of the brachial plexus are varied, and can affect the set of nerves in different ways. Symptoms and even treatment will depend on the location and severity of the injury.
Below, the types of injuries that occur most frequently:
- Upper body injury (C5 and C6) - mainly affects the movements and sensitivity of the shoulder and elbow. Movements such as lifting and opening the arm, and bending the elbow become difficult or even impossible. They can be extended lesions, affecting also the middle trunk (C7). In such cases, the movements of stretching the elbow and lifting the wrist will also be affected.
- Injury to the lower torso (C8 and T1) - mainly affects the movements and the sensitivity of the hand and the wrist. Movements such as opening and closing the hand, folding and opening the fingers, and folding the wrist are all affected.
- Complete injury (C5 to T1) - affects the movements and the sensitivity of every arm and hand. Complete paralysis may occur or some movement may be difficult, depending on the severity of the injury.
- Bijos, P.; Guedes, F. Plexo Braquial. Ed. DiLivros – 1ª Edição.
- Silva, J.S.B., Silva, P.G., Gazzalle, A. Lesões do Plexo Braquial. Revista da AMRIGS, Porto Alegre, 54 (3): 344-349, 2010. Can be accessed by link: www.amrigs.org.br/revista/54-03/019-540_lesoes_do_plexo.pdf
- Mello Junior,J.S., Souza, T.C.R., Andrade, F.G.,Castaneda, L, Baptista, A.F. Nunes Sá, K., Vargas, C.D, Gomes, M.M. Guede, J.F. Martins, J.V. (2012) Perfil Epidemiológico de Pacientes com Lesão Traumática do Plexo Braquial avaliados em um Hospital Universitário no Rio de Janeiro, Brasil, 2011. Rev Bras Neurol, 48 (3): 5-8, 2012
- Flores, LP (2006). Estudo epidemiológico das lesões traumáticas de plexo braquial em adultos. Arq. Neuro-Psiquiatr. vol.64 no.1 São Paulo Mar. 2006
- For more information on chronic pain, visit the group called "Pesquisa em Dor" (Portuguese for "Pain Research"): http://pesquisaemdor.com.br/
