The brachial plexus is the nerve plexus of the entire upper limb. Shoulder injury occurring due to accidents, sports injuries and birth injuries can cause nerve injury in the region and result in brachial plexus palsy. Brachial plexus injury can give rise to severe impairment of hand functions.
Brachial Plexus – Nerve Plexus of Upper Limb
Five pairs of spinal nerves arising in the neck region (cervical spinal nerves) run into the upper limb, providing nerve supply to all its muscles. Before they can enter the upper limb, these nerves undergo complex intertwining to form what is called the brachial plexus, the nerve plexus for the upper limb.
The nerves arising from the brachial plexus control sensation and movement of the entire shoulder girdle, arm, forearm, hand and fingers. Brachial plexus injury or damage to parts of it can result in disability of the upper limb.
Brachial Plexus Palsy – Causes
Shoulder injury can cause brachial plexus injury as the plexus is located in the axilla or armpit. Some of the causes of brachial plexus injury are:
- birth injury
- shoulder trauma
- tumors
- inflammation
Birth Injuries and Brachial Plexus Palsy
Brachial plexus injuries sometimes occur in infants, mostly due to birth injuries. The commonest cause is shoulder dystocia, where there is obstructed labor because the infant’s shoulder comes in the way of delivery. Shoulder dystocia can occur in big babies.
Birth injuries resulting in brachial plexus palsy can also occur due to forceps delivery and very rarely with caesarean section. The cause for nerve injury in all these situations is the stretching of the brachial plexus nerves due to traction on the shoulder.
Shoulder Injury and Brachial Plexus Palsy
In adults, the most common cause of brachial plexus palsy is trauma to the shoulder, which occurs in high velocity sports injuries and motor vehicle accidents, especially bike accidents. Brachial plexus injuries are common in contact sports like football and rugby. Penetrating injuries like gun shots and direct violence or blows to the region can also be the cause.
Shoulder trauma as a result of fall from a height, especially when a person falls on one side, can also cause brachial plexus injury. Again, in all these situations, what occurs is a violent traction of the head and neck away from the shoulder. The result is that the nerves of the brachial plexus, located in the shoulder region, are stretched or violently wrenched, damaging them.
The severity of the injury depends on the type or degree of damage sustained by the nerves, the location of the injury and the number of nerves or roots involved.
Brachial Plexus Injury Symptoms
The symptoms of brachial plexus injury can range from mild pain to severe disability depending on the extent of injury. Typically, the symptoms of brachial plexus lesions are:
- shoulder pain
- weakness of the upper limb
- heaviness of the upper limb
- sensory disturbances like tingling or burning
Physical examination of the upper limb for sensation and range of movements will usually confirm or rule out brachial plexus injury and even help pinpoint the level of injury. Brachial plexus damage often occurs with associated damage to blood vessels. There may also be multiple injuries to other organs.
Treatment of brachial plexus injury also depends on the severity of the damage. While some sufferers require multiple surgeries, others improve with physical therapy. For a good prognosis, timely diagnosis and intervention are of the utmost importance.
Sources:
Birche R. Surgical Disorders of the Peripheral Nerves. 1st ed. Churchill Livingstone,1998
Lakshmi Ananth - Lakshmi Ananth is a practising ENT, head and neck surgeon and has faculty position at a medical college. She is specially interested in ...
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