Brachial plexus injury

Damage to the upper nerves that make up the brachial plexus tends to occur when the shoulder is forced down while the neck stretches up and away from the injured shoulder. The lower nerves are more likely to be injured when the arm is forced above the head.

These injuries can occur in several ways, including:

• Contact sports. Many football players experience burners or stingers, which can occur when the nerves in the brachial plexus get stretched beyond their limit during collisions with other players.
• Difficult births. Newborns can sustain brachial plexus injuries. These may be associated with high birth weight, breech presentation or prolonged labor. If an infant's shoulders get wedged within the birth canal, there is an increased risk of a brachial plexus palsy. Most often, the upper nerves are injured, a condition called Erb's palsy.
• Trauma. Several types of trauma — including motor vehicle accidents, motorcycle accidents, falls or bullet wounds — can result in brachial plexus injuries.
• Tumors and cancer treatments. Radiation treatment to the chest or neck may cause tumors to grow in or along the brachial plexus, or put pressure on the brachial plexus or spread to the nerves. Radiation treatment to the chest may cause damage to the brachial plexus.

Participating in contact sports, particularly football and wrestling, or being involved in high-speed motor-vehicle accidents increases the risk of brachial plexus injury.

Given enough time, many brachial plexus injuries in both children and adults heal with little if any lasting damage. But some injuries can cause temporary or permanent problems, such as:

• Stiff joints. If you experience paralysis of the hand or arm, the joints can stiffen. This can make movement difficult, even if you eventually regain use of the limb. For that reason, your provider is likely to recommend ongoing physical therapy during your recovery.
• Pain. This results from nerve damage and may become chronic.
• Numbness. If you lose feeling in the arm or hand, you run the risk of burning or injuring yourself without knowing it.
• Muscle atrophy. Nerves regrow slowly and can take several years to heal after injury. During that time, lack of use may cause the affected muscles to break down.
• Permanent disability. How well you recover from a serious brachial plexus injury depends on a number of factors, including your age and the type, location and severity of the injury. Even with surgery, some people experience permanent muscle weakness or paralysis.

Although damage to the brachial plexus often can't be prevented, you can take steps to reduce the risk of complications once an injury has occurred:

• For yourself. If you temporarily lose the use of the hand or arm, daily range-of-motion exercises and physical therapy can help prevent joint stiffness. Avoid burns or cuts, as you may not feel them if you're experiencing numbness.

  If you're an athlete who has experienced injuries to the brachial plexus area, your provider may suggest you wear specific padding to protect the area during sports.

• For your child. If you're the parent of a child with a brachial plexus palsy, it's important that you exercise your child's joints and functioning muscles every day, beginning when your baby is just a few weeks old. This helps prevent the joints from becoming permanently stiff and keeps your child's working muscles strong and healthy.

To diagnose your condition, your provider will review your symptoms and conduct a physical examination. To help diagnose the extent and severity of a brachial plexus injury, you may have one or more of the following tests:

• X-ray. An X-ray of the shoulder and neck can tell the provider if you have fractures or other associated injuries.
• Electromyography (EMG). During an EMG, your provider inserts a needle electrode through the skin into various muscles. The test evaluates the electrical activity of the muscles when they contract and when they're at rest. You may feel a little pain when the electrodes are inserted, but most people can complete the test without much discomfort.
• Nerve conduction studies. These tests are usually performed as part of the EMG, and they measure the speed of conduction in the nerve when a small current passes through the nerve. This provides information about how well the nerve is functioning.
• Magnetic resonance imaging (MRI). This test uses a powerful magnetic field and radio waves to produce detailed views of the body in multiple planes. It often can show the extent of the damage caused by a brachial plexus injury and can help assess the status of arteries that are important for the limb or for its reconstruction. New methods of high-resolution MRI, known as magnetic resonance neurography, may be used.
• Computerized tomography (CT) myelography. Computerized tomography uses a series of X-rays to obtain cross-sectional images of the body. CT myelography adds a contrast material, injected during a spinal tap, to produce a detailed picture of the spinal cord and nerve roots during a CT scan. This test is sometimes performed when MRIs don't provide adequate information.

Several tests may be used to help diagnose the type and severity of brachial plexus injuries. When you make your appointment, be sure to ask whether you need to prepare for these tests. For instance, you may need to stop taking certain medications for a few days or avoid using lotions the day of the test.

If possible, take along a family member or friend. Sometimes it can be difficult to absorb all the information you're given during an appointment. Someone who accompanies you may remember something that you forgot or missed.

Other suggestions for getting the most from your appointment include:

• Write down all your symptoms, including how you were injured, how long you've had your symptoms and whether they've gotten worse over time.
• Make a list of all medications, vitamins and supplements that you're taking.
• Don't hesitate to ask questions. Children and adults with brachial plexus injuries have several options for restoring lost function. Be sure to ask your provider about all the possibilities available to you or your child. If you run out of time, ask to speak with a nurse or have your provider call you later.