Brachial plexus injury

A brachial plexus injury in adults may involve each individual root and can result in:

• avulsion (the root is torn from the spinal cord)
• rupture (a tear at root level)

The most common symptoms of brachial plexus injury include:

• weakness or numbness
• loss of sensation
• paralysis
• pain

Neuropathic pain might mean that the root is torn from the spinal cord. It usually feels like stabbing, crushing, burning and tingling. If there is an electric sensation down the arm when the side of the neck is tapped (Tinel's sign), an urgent nerve repair operation is carried out. Nerve repairs are more successful carried out soon after the injury.

Your consultant will discuss your symptoms with you and help to make a diagnosis. If you've been in an accident, the diagnosis will be performed urgently. They will conduct a physical exam on all nerve groups controlled by the brachial plexus and look at the whole upper limb for symptoms. If they suspect brachial plexus injury, they might order the following:

• MRI of the neck, chest and spine to help locate the injury
• CT scan; here, dye is injected into the spinal cord and neck to display avulsion injuries
• electrodiagnostic test; these can highlight nerve damage weeks of an injury, showing the full extent of the nerve degeneration

Urgent surgery may be performed when there's been trauma and there's a Tinel’s sign (an electric sensation shooting down the arm). This means there's a good chance that the nerve can be saved.

In less urgent cases, surgery may be recommended if the nerve isn't healing on its own. Your surgeon will either reattach both sides of a severed nerve (nerve repair) or use a nerve from somewhere else in your body (nerve graft) to guide the existing nerve fibres and help them grow into the muscle. The process of the nerve healing itself takes time and your doctor may recommend physiotherapy to prevent joint and muscle stiffness.