Brachial Plexus injury demystified

What is the Brachial Plexus?
The Brachial Plexus is the name given to the network of nerves as they leave the neck on the way to servicing the shoulder, arm and hand. These nerves are responsible for all shoulder, elbow, wrist and hand movements as well as feeling to these areas. Nerve also also have other functions such as sweating, getting goose bumps & hairs standing up when you are cold and knowing where your joints are positioned- even when you can't see them.

What is a Brachial Plexus injury?
Injury to the Brachial Plexus is when there is a change in the normal continuity of a part of a nerve or several nerves in the Brachial Plexus. The damage to the nerve results in disruption or stopping of the nerve messages as they travel from the spinal cord to the arm. 

Symptoms of Brachial Plexus Injury 
As a result of the messages being blocked or stopped the muscle will not get usual messages from the brain. And without the usual messages from the brain, the muscles will not be able to move properly; they may be weak or lack movement all together.
In the same way (but back to front) the messages that our skin give us about feeling; temperature, vibration, texture, will not get to the brain as usual. As the messages from the skin won't be able to travel along injured parts of the nerve where the damage has occurred. Therefore, following Brachial Plexus Injury a person will likely have altered, decreased or no feeling in the part of the arm that is usually serviced by the nerves that are damaged.
People may experience other symptoms as a result of nerve damage, including; decreased sweat, and therefore slippery hands which can lead to dropping items. Or when it is cold notice a lack of goosebumps and the hairs not standing up. Hair and nail growth in the injured arm and hand may change. And sometimes the involved hand can look a different colour to the other, for example a mottled appearance, or paler or more blue or red in tone.

Types of Brachial Plexus injury 
Damage to the Brachial Plexus can occur due to a traumatic injury or non-traumatic damage;

• Non-traumatic due to a condition such as Parsonage Turner Syndrome, compression on the nerve such as neuroma or the presence of an extra rib or unusual anatomy or an obstetric related palsy.
• Traumatic injury- direct result from contact or traction trauma, for example due to a fall from height, a motor vehicle accident or contact sport

Whether the symptoms are traumatic or otherwise, the degree to which someone experiences symptoms will be directly related to the amount of nerve damage sustained. Nerve damage is classified into the following categories;

• Stretch (neuropraxia) - where the nerve is stretched and usually the symptoms are temporary and the nerve heals on its own with 100% improvement expected within hours to months without an operation
• Rupture - where the nerve has undergone a forceful stretch which results in a tear in nerve fibers. This can involve part of the nerve or the full width of the nerve. Surgery may be required to repair ruptured nerves and speed recovery. Full return of function can occur, but will depend upon the degree of the rupture and number of nerves involved and is not guaranteed.
  
• Avulsion - the nerve root is torn from the spinal cord. This usually occurs as a result of high speed / force injury. An operation will be required to regain any nerve return. This is the most severe type of Brachial Plexus Injury and usually requires intensive therapy intervention.

Some injuries are transient, that is, symptoms are temporary and full recovery will be anticipated within weeks to months. Other injuries will result in permanent loss of movement and feeling to some or all upper limb muscles, leaving operation/s the only option to regain movement.