Brachial Plexus Injury


Different factors can influence the recovery of the injured nerve. To know which nerves were affected and the type of injury (if the nerve was torn from its root, whether it was cut or stretched) can give you an idea of which path to follow in recovery and direct the treatment.

Less serious injuries usually happen when the nerve is stretched / pulled or compressed, but does not "break". In these cases, the nerves may or may not recover on their own. Nerve recovery is quite variable, and can take up to a few years according to the severity of the injury.

More severe lesions may involve nerve rupture, loss of continuity, and pulling, also called avulsion, when the nerve is pulled out by its root in the spinal cord. In these cases it is possible to repair by surgery.

The time elapsed between the injury and the surgery is a factor that greatly influences the recovery of the nerves and consequently of the movements. Therefore, it is important that the diagnosis and examinations are done quickly. Still, there are cases where nerves cannot be repaired.

In general, surgeries are performed within 6 to 12 months after the injury. Nowadays it is agreed that the sooner the surgery is performed, greater the chances of success are. Performing surgery before 6 months is recommended, but the best time is established by clinical examination and neurophysiological examinations.

The most frequently performed surgeries are nerve grafts (surgical procedure used to transplant tissues) and nerve transfers.

Other types of operations are possible at a more advanced stage (months or even years after the injury), but in general they are not primarily aimed at nerve recovery but rather to assist in the use of remaining motor function (muscle and tendon transfers, arthrodesis, and others).

Each type of surgery works as below:

Nervous graft – When the nerve is ruptured, the extremities of the nerve may become severed and must be severed so that the nerve can be repaired/reconnected. For the repair to be done, grafts taken from other nerves (of a leg nerve, for example) are used.

The graft will serve as a guide for damaged nerve growth, a process that can be quite slow, which makes the recovery time often long.

Nerve transfer – In this case, an uninjured nerve of the plexus itself (when possible) or a nearby region, is directly attached to the injured nerve to restore motor function of the affected nerve. Intensive physiotherapeutic training is required to relearn how to move the arm with the new nerve connection

After surgery, the upper limb is usually immobilized for a period of 4 to 6 weeks. Immobilization is an important care because surgery is a delicate procedure where the nerves are reattached and the repair site can rupture again if there is too much movement. Immobilization time is required for nerve repair to take place.

The precise time will be determined by the clinical staff. Always follow the recommendations of the clinical staff and do NOT remove the immobilization without medical advice.

The use of slings and other related devices, supports the injured arm and serves to guarantee immobilization when necessary.

Slings and support devices help in order to maintain the correct position of the arm and shoulder and prevent unwanted movements. Overall, the time your arm will need to be immobilized will depend on the severity of the injury and recovery from other injuries that may be associated, such as shoulder dislocation and fractures of the arm bones.

Many patients feel more comfortable and safe using slings, but remember that it is important to avoid disuse and atrophy of muscles and stiffness of joints. Ask your caregiver what movements you can do during restraint and include these movements in your routine.

Some recommendations on the use of slings:

  • After surgery: Do not remove immobilization until directed by your physician doctor.
  • Always notice the color and sensations of your hand and fingers. If you notice a bluish tinge, tingling, prickling sensation or swelling, contact a physician doctor immediately.
  • If possible, move your hand, fingers and wrist regularly. Take pain medications as directed by your physician doctor.
  • Sleep with your belly up. Use extra pillows to support the upper limb.
  • Do not use accessories such as bracelets, bracelets, and rings on your injured arm.
  • Do not use enamel on the nails on the side of the injury as it may disrupt the color of the hand.

WARNING: Always follow the medical advices.

Pain is both a physical and an emotional experience. It acts as a warning sign that warns us that something is wrong. Acute pain is a sudden and rapid event, lasting from a few hours to a few weeks. Chronic pain is persistent and has a longer duration (greater than 6 months or longer than the expected time to cure an injury). Most individuals with traumatic injury to the brachial plexus experience pain, and it may become chronic.

Pain can be separated into two types: nociceptive pain and neuropathic pain.

Nociceptive pain is caused by the presence of a painful stimulus (for example, a wound or a superficial burn, fractures or muscle contracture). This type of pain has the function of alerting about an imminent danger or about the appearance of injuries or damages in the body and usually it improves with the recovery of the injury and/or injury.

The neuropathic pain, in its turn, originates in the injury of the nerve fibers. The characteristics of neuropathic pain are very peculiar, like the sensation of "burning", painful cold and electric shock, and can be accompanied by tingling, needling, numbness and itching.

Treatment of neuropathic pain may involve more potent analgesic medications and also medications used for other conditions such as depression and epilepsy.

Physiotherapy after a traumatic injury of the brachial plexus aims to recover the sensory and motor functions of the individual and avoid or minimize joint deformities and muscle alterations, such as muscle shortening and atrophy, aiming for greater independence and better quality of life.

Physiotherapeutic treatment should be started early. For surgical cases, the approach is still important in the preoperative period. Physiotherapy aims recovering muscle strength, restoring or maintaining joint mobility and flexibility of muscles, preventing deformities and postural changes, improving pain and training of day to day activities that are compromised.

Brachial plexus injury is an experience that can bring many changes to life. There may be changes in the general health condition, such as the appearance of insomnia, fatigue, loss of appetite, gain or loss of weight, and also changes in daily activities (walking, eating, dressing, using the bathroom, housework)

These factors also include psychosocial issues such as decreased self-esteem, anxiety about treatment, changes in the body, loss of control and independence on day-to-day activities, concentration and memory problems, problems with libido, frustration, anger and guilt.

It is important to seek help in dealing with these and other issues.

Psychotherapy is a joint work in which one is helped to explore and manage one's personal life privately and confidentially. Psychological counseling can help deal with reactions to diagnosis, as well as family and personal issues.