Overview
The brachial plexus is a network of intertwined nerves that control movement and sensation in your arm and hand. A brachial plexus injury involves sudden damage to these nerves, which may cause pain, weakness, loss of feeling, or loss of movement in your shoulder, arm and/or hand.
The brachial plexus begins at your neck and crosses your upper chest to your armpit. Injury to this network of nerves often happens when your arm is forcibly pulled or stretched or your head and neck are forcibly pulled away from your shoulder.
Mild brachial plexus injuries may heal without treatment, but more severe injuries may require surgery to regain function in your arm or hand.
Babies can experience brachial plexus injuries while in the uterus or during delivery. This injury is called neonatal brachial plexus palsy (NBPP).
What is the brachial plexus?
The brachial plexus consists of five nerves that branch off from your spinal cord at your neck and conduct signals from your spinal cord to your shoulder, arm and hand. You have a brachial plexus on each side of your body.
In the medical world, a plexus is a bundle of intersecting nerves, blood vessels or lymphatic vessels in the human body. “Brachial” means “relating to the arm or to a structure resembling the arm.” (The brachial artery, for example, is the main vessel supplying blood to the muscles in your upper arm and elbow joint.) Thus, the brachial plexus is a bundle of nerves that run from your spinal cord down into your arm.
The plexus connects these five nerves with the nerves that provide sensation to your skin and allow movement in the muscles of your arm and hand.
Each of the five nerves in the brachial plexus has a specific function, such as stimulating muscles or carrying sensory information, like temperature and touch, from your hand to your brain.
Because each nerve has a different function, the location of the nerve injury and the type of nerve injury within the plexus determines the symptoms you experience and the type of treatment you may need.
What are the brachial plexus nerves?
There are five nerves in your brachial plexus, each with a different function. These nerves work together to complete movements and sensations in your arms and hands:
- Axillary nerve: It activates the deltoid and teres minor muscles to move and stabilize your shoulder.
- Median nerve: It flexes the muscles in your forearm and hand, including wrist and finger muscles. It also helps you feel sensations in your palm, thumb, index finger, middle finger and part of your ring finger.
- Musculocutaneous nerve: It moves the muscles in your upper arm, including your biceps brachii, coracobrachialis and brachialis muscles. It helps your elbow flex and your forearm turn.
- Radial nerve: It activates the muscles in the back of your arm and forearm to move your elbow and wrist. It helps you feel on the back of your hand and your thumb, index finger, middle finger and half of your ring finger.
- Ulnar nerve: It moves muscles in your hand and forearm to help you make hand movements. It allows feeling in part of your ring and little (pinky) finger.
What are the types of brachial plexus injuries?
Brachial plexus injuries vary greatly in severity, depending on the type of injury and the amount of force involved. You can injure several different nerves of your brachial plexus in varying severity from the same event.
The main types of brachial plexus injuries include:
- Stretch (neuropraxia): This happens when a brachial plexus nerve mildly stretches, which damages the protective covering of the nerve. This causes problems with nerve signal conduction but doesn’t always result in damage to the nerve underneath. It may heal on its own or require simple, nonsurgical treatment methods such as physical therapy to return to normal function.
- Rupture: This happens when a more forceful stretch of a brachial plexus nerve causes it to tear partially or fully. These types of injuries can often be repaired with surgery.
- Avulsion: This is the most severe type of brachial plexus injury. It happens when the nerve root tears away from your spinal cord. These types of injuries require surgery to regain function.
What’s the difference between cervical radiculopathy and a brachial plexus injury?
While cervical radiculopathy and a brachial plexus injury have similar symptoms, they are different conditions.
Cervical radiculopathy (also known as “pinched nerve”) is a condition that results in neurological dysfunction caused by compression and inflammation of any of the nerve roots of your cervical spine (neck). Neurological dysfunction can include radiating pain, muscle weakness and/or numbness.
While cervical radiculopathy results from compression and inflammation, a brachial plexus injury more commonly happens due to tearing or overstretching the nerves in the plexus.
Brachial plexus injuries often involve multiple nerve roots and there’s usually an absence of neck symptoms, such as neck spasms and pain, unlike with cervical radiculopathy.
Who gets brachial plexus injuries?
Anyone at any age can experience a brachial plexus injury, including babies during delivery.
These injuries are most common in people assigned male at birth between the ages of 15 and 25.
How common are brachial plexus injuries?
Researchers don’t know exactly how many brachial plexus injuries happen to children and adults each year, but the number seems to be increasing. More participation in high-energy sports and higher rates of survival from high-speed motor vehicle accidents may be reasons why the number of these injuries is growing.
Approximately 70% of traumatic brachial plexus injuries result from traffic accidents, of which 70% involve motorcycles or bicycles.
Neonatal (infant) brachial plexus injuries are a common type of birth injury. There are 2 to 3 cases for every 1,000 births.
Symptoms
When to see a doctor
Complications
- High blood pressure.
- Diabetes.
- Heart failure.
- Some types of heart valve disease.
Prevention
- Control high blood pressure, high cholesterol and diabetes.
- Don't smoke or use tobacco.
- Eat a diet that's low in salt and saturated fat.
- Exercise at least 30 minutes a day on most days of the week unless your health care team says not to.
- Get good sleep. Adults should aim for 7 to 9 hours daily.
- Maintain a healthy weight.
- Reduce and manage stress.
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