Brachial plexus injury

Your arm hangs alongside your torso; you cannot raise it, bend your elbow, or move your hand despite trying very hard. In addition, there is extensive loss of sensation and burning, stabbing pain that does not go away. This is not a ‘strain that will go away on its own.’ It may be a serious injury to the brachial plexus, the place from which the entire upper limb receives its nerve supply.

What is actually happening?

A nerve works like a bundle of electrical wires: some fibers carry signals from the brain to the muscles, telling them to move, while others carry sensation back. The brachial plexus is the junction where all these wires emerging from the spinal cord at neck level cross and mix before branching into individual nerves in the upper limb. When this one area is injured, a large area or the entire limb immediately loses function, rather than just one finger or movement.

The plexus is formed by nerve roots from C5 to Th1. Its upper part controls shoulder movement and elbow flexion, while its lower part controls hand function and the small muscles of the hand. Which roots are affected and to what extent determines whether weakness involves the shoulder, elbow, hand, or the entire limb.

The injury most often occurs through a sudden pull when the head and shoulder are stretched in opposite directions. The nerve may then be torn, but in the most severe case the root is pulled directly out of the spinal cord, like a wire ripped from a socket together with its contacts. Such an injury cannot simply be stitched back together and requires a different reconstructive treatment.

How can you recognize it?

• paralysis of the entire limb or part of it, for example a drooping shoulder, inability to bend the elbow, or a nonfunctioning hand,
• characteristic positioning of the limb in an upper plexus injury, with the arm held against the body and rotated inward
• loss or marked weakening of sensation over a large area of the hand, forearm, or entire limb,
• severe, burning, stabbing neuropathic pain, especially pronounced when a nerve root has been avulsed,
• drooping of the eyelid and constriction of the pupil on the injured side (Horner syndrome), signaling that the root has been torn from the spinal cord,
• progressive muscle wasting and thinning of the limb as more time passes after the injury.

Why you should not wait

A nerve that has been severed or avulsed cannot restore its continuity on its own. The muscles that received movement commands through it gradually atrophy, and the longer the signal is absent, the more irreversible the wasting becomes, until movement can no longer be recovered even after good nerve regeneration.

Regeneration progresses slowly, and the path the signal must travel from the brachial plexus to the arm muscles is long. That is why every month counts: the earlier we restore conduction, the more time remains before the muscles atrophy permanently. When a root has been avulsed, direct suturing is impossible and the signal must be transferred from another functioning nerve (nerve transfer); such operations have a time window after which they lose effectiveness. Waiting closes off further treatment options.

How we help

We begin with a detailed examination of sensation and the strength of individual muscle groups to determine which roots have been affected and at what level. We supplement this with ultrasound and EMG and ENG tests assessing conduction; if root avulsion is suspected, we also perform magnetic resonance imaging to show the injury at the root’s origin near the spinal cord.

In milder injuries without interruption of nerve continuity, observation is usually sufficient, and follow-up EMG examinations show the progress of spontaneous regeneration. When nerves are trapped in scar tissue, we surgically release them from the surrounding adhesions. In a rupture, we restore continuity with microsurgical suturing and replace any defect with a nerve graft. When a root has been avulsed from the spinal cord and there is nothing to suture, we transfer signals from a functioning, less important nerve to the one responsible for the limb’s most important functions. In selected cases, when much time has passed since the injury, we restore movement by transferring tendons or fusing a joint in a functional position.

There is one goal: a hand that can feel and follow commands again.

Book a consultation

If your hand has lost sensation or stopped moving after an injury, do not wait, because time is decisive in brachial plexus injuries. Make an appointment for a consultation. We will determine which parts of the plexus are damaged and tell you what treatment is needed.