Have you ever suddenly felt numbness, weakness, or pain in your arm? Sometimes you can feel this discomfort from your shoulder all the way down to your fingers. It's really scary when something like this happens, isn't it? So today we're going to talk about one possible cause of these symptoms. That is damage to the nerve network called the Brachial Plexus.
What is the Brachial Plexus?
Simply put, the brachial plexus is a collection of nerves that run from your neck to your armpit and down your arm. It's like a bunch of little cables connected together. These nerves control the movement and sensation of your shoulder, arm, hand, and fingers. For example, if your arm is suddenly jerked, or your head and neck are jerked to one side and your shoulder is jerked to the other, this network of nerves can be damaged. A minor injury may heal without treatment. However , if the damage is more serious, surgery may be needed to restore the function of your arm . This condition can also occur in young babies, especially in the womb or at birth. We call it `(Neonatal Brachial Plexus Palsy - NBPP)`.
What nerves are in the Brachial Plexus?
Now let's look at how the Brachial Plexus is formed. This network is formed by five main nerves that start at the neck of your spine and come out of there. Just like a river branches off, these nerves also branch off and spread throughout the arm. In medicine, `(Plexus)` refers to a collection of nerves, blood vessels, or lymph vessels that are connected together like this. The word `(Brachial)` means 'related to the arm'. So the brachial plexus is a group of nerves that run to the arm.
Each of these five nerves has a specific function. Some stimulate muscles, while others carry sensations like heat and touch to the brain. The symptoms you experience and the treatment you need will depend on which nerve is damaged and the nature of the damage.
Five main nerves are involved:
- Axillary nerve: Helps with shoulder movement and stability.
- Median nerve: Helps flex the muscles of the forearm and hand, and flex the wrist and fingers. It is also important for sensation in the palm, thumb, index, middle, and ring fingers.
- Musculocutaneous nerve: Helps to activate the muscles of the upper arm (e.g., biceps) and bend the elbow and turn the forearm.
- Radial nerve: It helps to extend the elbow and wrist by activating the muscles on the back of the hand and forearm. It also helps to feel the thumb, index finger, middle finger, and half of the ring finger on the back of the hand.
- Ulnar nerve: It controls the muscles of the hand and forearm and helps with fine movements of the hand. It is also involved in sensation in part of the ring finger and little finger.
What are the types of Brachial Plexus disorders?
These brachial plexus injuries can occur in a variety of ways, depending on how severe the injury is. Several nerves in this network can be damaged to varying degrees in a single incident.
- Stretch / Neuropraxia: This is when a nerve is pulled slightly. This can damage the protective covering around the nerve. This can disrupt the transmission of nerve signals, but in most cases, there is no significant damage to the underlying nerve. This condition may resolve on its own , or it can be treated with simple treatments such as physical therapy.
- Rupture: This is when a nerve is pulled too hard and suddenly partially or completely tears. These injuries can often be repaired with surgery .
- Avulsion: This is the most serious type . This is when the nerve root separates from the spinal cord. These injuries usually require surgery to restore function.
Is this different from cervical radiculopathy?
Some people may think this is something like ``Cervical Radiculopathy / Pinched Nerve''. Although the symptoms are somewhat similar, these two conditions are actually different.
Cervical Radiculopathy is a condition that occurs when a nerve root that comes from the vertebrae in the neck becomes compressed or inflamed. This can cause symptoms such as neck pain and stiffness in the neck muscles.
However, a brachial plexus injury is usually caused by a pinched or torn nerve. This often involves multiple nerve roots and is less likely to cause neck symptoms (pain, stiffness) like in cervical radiculopathy.
Who gets this condition? How common is it?
In fact, this brachial plexus disorder can occur in anyone of any age, regardless of gender. Newborn babies are also at risk of developing this condition when they are born.
However, it is most commonly seen among young men between the ages of 15 and 25 .
It's hard to say exactly how many people develop the condition each year, but researchers say the number is increasing. This could be due to factors such as the increase in participation in high-energy sports and the increase in the number of people surviving high-speed car accidents.
Just think, 70% of brachial plexus injuries from accidents like this are caused by traffic accidents . And 70% of those accidents are motorcycle or bicycle accidents! That means we understand how careful we need to be when we're on the road, right?
If we talk about this disorder (Neonatal Brachial Plexus Palsy) in newborns, on average, only 2-3 children per 1000 births can see this condition.
What are the symptoms?
The symptoms of this disorder vary depending on the type of nerve that is damaged and the nature of the damage. These symptoms may occur in conjunction with other injuries.
The main symptoms seen in adults and children:
- The hand seems to be hanging lifelessly.
- A condition like paralysis of the arm or hand.
- Difficulty controlling the hand, arm, or wrist.
- Numbness or loss of feeling in the hand or wrist.
- Pain in the hand, palm, or wrist.
Symptoms seen in newborn babies:
- Loss of any movement in the baby's upper arm, lower arm, or hand.
- Loss of the Moro reflex/startle response on the affected side (i.e., the baby does not use the hand when startled).
- The baby is holding his arm against his body, extended at the elbow.
- Decreased grip strength on the affected side.
What are the causes of brachial plexus disorders?
There are several main reasons why this brachial plexus nerve network can be damaged.
1. Forceful Trauma
Often, the upper part of this nerve network is damaged when your shoulder is pressed down, and your neck and head are pulled up and to the side by your shoulder. Think of it like a motorcycle accident .
The lower part of the nerve network is more likely to be damaged if your arm is suddenly pulled hard above your head.
Examples of such accidents are:
- High-speed vehicle accidents, especially motorcycle accidents .
- Falls.
- A direct blow from something that is not sharp (e.g. in a fight).
- Concussions (often minor injuries, also called ``burners'' or ``stingers'') occur in some sports.
- Injuries caused by a sharp weapon (e.g., a stab wound) or bullet wounds (ballistic trauma).
2. Tumors
Sometimes tumors can develop within or along the brachial plexus, or they can be caused by tumors that put pressure on it.
Breast cancer and lung cancer are the main types of cancer that affect the brachial plexus.
In addition, cancers such as lymphoma and melanoma can spread to the lymph nodes in the armpit and affect this nerve network.
3. Inflammation
When our bodies are attacked by germs like viruses or bacteria, or when we are injured, our immune system is activated. Inflammatory cells are released. Although this is necessary, sometimes this immune system can go haywire and attack healthy tissue. Or, the response to a germ can become too much and damage the body's tissues.
In a rare condition called `Parsonage-Turner Syndrome` (also called `(Brachial Neuritis)`), inflammation of the brachial plexus occurs without any obvious shoulder injury. It begins with severe pain in the shoulder or arm, followed by weakness and numbness.
4. Injuries at birth
Newborn babies can suffer damage to their brachial plexus, either from trauma while they are in their mother's womb or during a difficult birth. This is called ``Neonatal Brachial Plexus Palsy (NBPP)``. The following conditions can occur:
- When the baby's head comes out and the shoulders come out, the head and neck are pulled to one side (this is also called `(Shoulder Dystocia)`).
- Due to the baby's shoulders being pulled during a head-first delivery.
- In a breech delivery, pressure is placed on the baby's raised arms.
How do you recognize this? What tests are done?
If you have these symptoms, a doctor will examine you carefully to see if this is a brachial plexus injury or if there are other injuries. This is because most of the time, these injuries are caused by serious accidents, and there may be other injuries as well.
The doctor will examine each group of nerves connected to the brachial plexus to try to determine exactly where the damage has occurred and how severe it is .
If a newborn baby shows these symptoms, a doctor will check to see if the baby can move their arms and legs and if they have the Moro reflex.
To accurately diagnose this condition and check for other problems, a doctor may perform several tests, such as:
- X-rays: These can clearly see solid objects like bones. X-rays are taken of the neck, chest, shoulders, and arms to check for fractures.
- CT Myelogram Scan: This involves injecting a special fluid around the spinal nerves and using X-rays and a computer to create clear images of the inside of the body. This is considered the best test to see if a nerve root has come loose from the spinal cord (`(Avulsion)`). Some doctors may also do an MRI scan in addition to this, or instead of this.
- Electrodiagnostic exams: These include tests called `(Electromyogram - EMG)` and `(Nerve Conduction Studies)`. These measure the way nerve signals travel and signals in muscles. These tests can confirm a brachial plexus injury, locate the site of the injury, determine the severity of the injury, and assess the rate of nerve healing. The initial exam is usually done 3-4 weeks after the injury. Then, it is repeated in 2-3 months to see if the nerve is healing.
If a newborn baby has these symptoms, an X-ray may be done to see if their collarbone is broken. This is because there is a condition called ``Pseudoparalysis'', in which the baby cannot move their arm because of a broken bone and pain, not nerve damage.
What are the treatments?
Because this type of brachial plexus injury usually occurs after a serious accident, many people also have other serious injuries . For example, blood vessel damage, fractures of the shoulder, arm, back or ribs, a collapsed lung, spinal cord damage, or brain injury. Therefore, the medical team will first treat these life-threatening injuries before starting treatment for the brachial plexus injury.
When treating this, neurologists, neurosurgeons, hand surgeons, physical therapists, occupational therapists, and your family doctor (Primary Healthcare Provider) work together as a team.
There are two main treatment methods: non-surgical treatment and surgical treatment.
Nonsurgical treatment
Most brachial plexus injuries, especially minor ones, heal without surgery within a few weeks to a few months . Nerve injuries that heal on their own often have good results in terms of muscle and nerve function.
If your doctor thinks there is a good chance that you will recover without surgery, he may wait until the wound heals before considering surgery.
Your doctor may recommend physical therapy to keep your joints and muscles from getting stiff while your injury heals. You will also need to rest your arm and shoulder and avoid strenuous activities.
Surgical treatment
If the nerve does not heal on its own, or if it does not heal well enough to regain the necessary function of the hand and wrist, doctors recommend surgery.
The most important thing is to know that, depending on the severity of the injury, even after surgery, you may not have the same function in your hand or wrist as you had before the injury, or you may not have the full function .
Neurosurgeons use a variety of methods to treat nerve injuries, depending on the type of injury, its severity, and how long it has been present.
- Nerve repair: In this procedure, the surgeon reattaches the torn edges of a broken nerve. This is done quickly for sharp cuts, such as a knife cut.
- Nerve graft: In this procedure, the surgeon takes a healthy nerve from another part of your body and sews it between the two ends of the damaged nerve. This healthy nerve graft acts as a scaffold, helping the two damaged nerve ends grow together.
- Nerve transfer: This surgery is performed when there is not enough functional nerve tissue in the neck to be transplanted. In this procedure, the surgeon cuts a healthy donor nerve and connects it to the injured nerve. This allows the nerve to send signals to the paralyzed muscle.
Treatment for newborn babies
If a newborn baby has a minor brachial plexus injury, a doctor may recommend massaging the baby's arm and doing range-of-motion exercises.
If the damage is severe, or if it doesn't heal within the first few weeks, the baby may need to be referred to a pediatric neurosurgeon. If the baby's strength doesn't improve within 3-9 months, they may consider surgery.
Are there any complications in surgery?
As with any surgery, these surgeries can carry some risks. For example:
- Problems related to anesthesia.
- Infection.
- Excessive bleeding.
In addition, if you have other pre-existing medical conditions (e.g. diabetes, high blood pressure), your risk of developing the following complications may be increased:
- Chronic pain (`(Chronic pain)`).
- Blood clots.
- Heart attack.
- Stroke.
How long does it take to heal?
Nerves heal very slowly . Therefore, it takes time to recover from a brachial plexus injury. You may not see any improvement for several months.
The most important thing is to have a positive attitude and commit to your treatment plan.
An occupational therapist can help you learn to do everyday tasks (like eating and washing yourself) with your unaffected hand.
You will also need to continue physical therapy to keep your shoulders, elbows, wrists, and fingers from becoming stiff and to prevent muscle atrophy.
If the function of your hand and/or wrist has not fully returned to the way it was before the injury, it is also very important to have good mental strength and adaptability to make the necessary changes in your life (job, daily activities).
What things increase the risk of this?
There are several factors that increase the risk of developing this brachial plexus disorder:
- Playing certain sports, especially contact sports (e.g. football, rugby, wrestling).
- Reckless driving and speeding.
Always be careful about safety when playing sports and driving and try to avoid accidents like this.
Factors that increase the risk of newborn babies developing this condition (Neonatal Brachial Plexus Palsy - NBPP):
- Breech delivery.
- Obesity of the mother.
- Being a larger than average baby.
- Difficulty in removing the baby's shoulders after the baby's head comes out (Shoulder Dystocia).
What will happen in the future? (Prognosis)
Your prognosis (or prognosis) after this injury depends on several factors:
- The type and severity of nerve damage (`(Avulsion)`, tear, traction).
- What do you mean by damaged nerves?
- Do you have any other injuries?
- How quickly you received treatment after being injured.
- How committed you are to physical therapy and other recovery treatments.
In cases of avulsion and rupture, there is usually no possibility of regaining muscle function and function unless the nerve is reattached in a timely manner through surgery .
Most people with nerve stretch (neuropraxia) injuries regain 90% - 100% of their nerve function without surgery .
Most babies born with this condition recover completely within 3-4 months . The outlook for babies who do not recover within this time is not very good. In such cases, they may have suffered a nerve avulsion.
When should I see a doctor?
If you have had a brachial plexus injury, you will need to meet with your medical team regularly to monitor the healing and function of your nerves throughout your recovery.
Also, if you have a rehabilitation plan, you should meet with your physical therapist regularly. It is very important to participate in these treatments with dedication to achieve the best results.
Nerves take time to heal. After a brachial plexus injury, especially after surgery, the recovery period is often long. A rehabilitation program to regain physical abilities requires a lot of dedication. Although this can be a bit challenging, it is important to keep a positive attitude . Ask for help from your friends and family. Your doctors are also ready to help you and give you the best treatment plan.
Finally, remember this.
So, the brachial plexus disorder we talked about today is a serious condition that can affect the function of our arms and hands.
- This is mainly due to accidents, tumors, inflammatory conditions, and birth defects .
- If you experience symptoms such as numbness, weakness, pain, or loss of control in your hand , you should definitely see a doctor .
- There are treatments, but recovery takes time and a lot of dedication . Physiotherapy is your best friend on this journey.
- Some causes (especially accidents) can be prevented. Always be mindful of safety.
- If a newborn baby's arms are not moving, tell a doctor immediately.
I hope this information is helpful to you. If you have had a similar experience, don't worry. With proper medical advice and treatment, you too can overcome this condition.
` Brachial Plexus, Brachial Plexus Injury, Nerve Disorders, Numbness in the Hand, Loss of Hand, Nerve Injury, NBPP
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