Brachial Plexus Injury
Also known as: Brachial Plexus Palsy, Erb's Palsy, Klumpke's Palsy, Obstetrical Brachial Plexus Palsy (OBPP), Traumatic Brachial Plexus Injury
Brachial plexus injury refers to damage to the brachial plexus, a network of nerves that originates in the neck and shoulder and provides motor and sensory function to the arm, hand, and fingers. These injuries can range from mild stretches to complete avulsion of the nerve roots from the spinal cord. The severity and location of the injury determine the extent of functional impairment.
Imagine your arm is like a puppet controlled by strings (nerves) from your neck. If those strings get stretched or broken during birth or an accident, your arm might not move as well. Doctors can sometimes fix the strings with surgery or help you learn to use your arm better with exercises.
Signs & Symptoms
- Weakness or paralysis in the arm or hand
- Loss of sensation in the arm or hand
- Pain in the shoulder, arm, or hand
- Limited range of motion in the shoulder, arm, or hand
- Muscle atrophy
- Numbness or tingling in the arm or hand
- Horner's syndrome (in severe cases involving nerve root avulsion)
- Claw hand deformity (in Klumpke's palsy)
Treatment Options
Observation and Physical Therapy
MODERATELY EFFECTIVEOccupational Therapy
MODERATELY EFFECTIVEMicrosurgical Nerve Repair
MODERATELY EFFECTIVENerve Grafting
MODERATELY EFFECTIVENerve Transfer
MODERATELY EFFECTIVEMuscle Transfer
MODERATELY EFFECTIVEBotulinum Toxin (Botox) Injections
MODERATELY EFFECTIVEPain Management (medications, nerve blocks)
SUPPORTIVEDiagnosis
- Physical examination
- Neurological examination
- Electromyography (EMG)
- Nerve conduction studies (NCS)
- Magnetic resonance imaging (MRI)
- Computed tomography (CT) myelography
- Ultrasound
History
Descriptions of brachial plexus injuries date back to the late 18th century. Guillaume Benjamin Amand Duchenne described obstetrical brachial plexus palsy in the mid-19th century, and Wilhelm Heinrich Erb further characterized the upper plexus injury. Augusta Déjerine-Klumpke described the lower plexus injury. Surgical techniques for nerve repair and reconstruction have evolved significantly over the past century, improving outcomes for patients with brachial plexus injuries.
Recent Breakthroughs
Advanced Imaging Techniques for Brachial Plexus Injury Assessment
Improved MRI protocols, including diffusion tensor imaging (DTI), are enhancing the ability to visualize and assess the extent of nerve damage in brachial plexus injuries, leading to more precise surgical planning.
Expanded Use of Nerve Transfers in Brachial Plexus Reconstruction
Nerve transfer techniques, involving the transfer of functioning nerves to reinnervate paralyzed muscles, are showing promising results in restoring upper extremity function in patients with severe brachial plexus injuries.
Development of Novel Biomaterials for Nerve Grafting
Researchers are developing new biomaterials and nerve conduits to improve nerve regeneration and functional outcomes following nerve grafting procedures in brachial plexus injury repair.