Brachial Plexus Injury

What is a Briachial Plexus injury?

A Brachial Plexus Injury is the result of severe or prolonged compression on the network of nerves that conduct signals from the spine to the shoulder, arm, hand and fingers. Although an injury of this nature can occur at any age and at anytime, 1 in a 1000 babies are born with this condition, which is also known as Erb's Palsy. Symptoms include a limp or paralysed arm, or a distinct lack of muscle control in the upper limb.

There are four types of Brachial Plexus Injury:

i. Avulsion: a severe injury in which the nerve is torn from the spine
ii. Rupture: where the nerve is torn, but not at the spinal attachment
iii. Neuroma: where scar tissue has healed around the nerve and tear injury
iv. Neuropraxia: the most common injury in which the nerve is damaged but not torn  

Why does a Brachial Plexus injury occur?

The Brachial Plexus is a large bundle of nerves formed by nerves that exit the spinal cord of the neck and travel into the arm below the collarbone (clavicle) meeting the nerves that exit high in the neck and into the hand and fingers. This bundle is situated exactly between where the neck joins the shoulder.

If abnormal pressure is exerted on the Brachial Plexus for a prolonged length of time it has the potential to compress a large number of nerves in one go, a matter that can have a far reaching effect on the sensation and function of the shoulder, wrist, hand and fingers.

The reasons for this condition developing are not always fully understood, although the majority of those suffering with this condition are newborn babies, particularly those who have endured a difficult or elongated labour. This condition is therefore seen more in large babies born to women of a small build, especially where the size of the babies shoulders obstruct or delay the progress of delivery through the birth canal.

How is a Brachial Plexus injury treated without surgery?

Neuropaxia Brachial Plexus Injuries are likely to heal in 90% of cases without any treatment and many babies improve or recover by 3 to 4 months of age with just the aid of physiotherapy.

How is a Brachial Plexus injury treated with surgery?

A surgical procedure to repair an Avulsion or ruptured nerve or nerves will always be required to reconnect severed nerves as they do not have a natural capability to unite of their own accord. A surgical repair of this type is more likely to be successful the earlier after injury it is performed.

Surgical intervention is aimed at reconnecting or decompressing any severed or compressed nerves and restoring sensation and normal movement to the affected limb. However, in some severe cases a weakness in mobility and function may always be apparent.

This procedure is typically carried out under general anaesthetic and will take around an hour to perform dependant on the complexity of the surgery. 

What is the recovery like?

Once a patient is fully recovered from the effects of anaesthetic they are normally quickly encouraged to be as active and mobile as possible to avoid limb and joint stiffness and other complications such as Deep Vein Thrombosis (DVT) from developing. It is therefore normal for patients to perform gentle postoperative exercises with guidance from a physiotherapist on the day of surgery and for parents to be instructed on how to perform specific physiotherapy exercises on their child's effected limb before discharge.

Over the next three months parents will be expected to work on improving their child's limb function through a dedicated and progressive upper limb physiotherapy regime which will be mainly conducted at home in order to limit the chance of muscle contraction or muscle wasting.

Your Consultant Surgeon will assess your child's stability and range of movement after 6 weeks and then again after three months to evaluate how successful your child's Brachial Plexus Repair procedure has been. Parents should expect a continuous and full physical recovery to take around six to twelve months to achieve.

Are there any risks associated with Brachial Plexus surgery?

Brachial Plexus Surgery of this type is considered a specialist and complex procedure to perform successfully. It is therefore very important that all candidates or parents are fully aware of both the benefits and risks of undertaking such specialist surgery.

The importance of a full consultation to discuss your condition with a specialist upper limb orthopaedic surgeon in relation to these risks cannot therefore be over emphasised.

How do I find out if I am a suitable candidate for Brachial Plexus surgery?

Surgical Advisor will be delighted to help you find a leading expert in Brachial Plexus surgery to consult with. Your surgeon will carry out a thorough evaluation of your condition and provide you with a comprehensive explanation of the most appropriate surgical solution.
 
Our Expert Consultant Orthopaedic Surgeons are most carefully selected and recommended because they understand the importance of the decision you are making when contemplating complex shoulder surgery and because of their specialist upper limb surgical expertise. Throughout your consultation you will therefore be encouraged to ask as many questions as you wish and to take your time in making a decision to proceed with any recommended treatment.

To ensure that patients are comfortable with any recommendations or advice given in their consultation, all patients are asked to go away after a consultation and think through all the information they have received. If for whatever reason you are still not sure about the best course of action and wish to have further dialogue with your surgeon, you will not be expected to pay for a second consultation appointment.

How do I make a consultation appointment?

For further advice on how to make an appointment to consult with an expert upper limb orthopaedic surgeon: 

Please call Surgical Advisor on: 0870 41 41 41 2
Or email us by clicking on: advice@surgicaladvisor.com