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Brachial plexus injury

A brachial plexus injury is an injury to the brachial plexus — the network of nerves that sends signals from your spine to your shoulder, arm and hand.

A brachial plexus injury occurs when these nerves are stretched, compressed or, in the most serious cases, torn. This can happen when your shoulder is pressed down forcefully while your head is pushed up and away from that shoulder; a direct contact hit also can compress these nerves.

Brachial plexus injuries are common in contact sports such as football, but they can also result from auto or motorcycle accidents or falls. Babies sometimes sustain brachial plexus injuries during birth. Other conditions, such as inflammation or tumors, may affect the brachial plexus.

Minor injuries may get better on their own, but severe brachial plexus injuries require surgical repair.

Symptoms Causes Risk factors Complications Prevention

Signs and symptoms of a brachial plexus injury can vary greatly, depending on the severity and location of your injury. Usually only one arm is affected.

Less severe injuries

Minor damage often occurs during contact sports, such as football or wrestling, when the brachial plexus nerves get stretched or compressed. Known as stingers or burners, these injuries can produce the following symptoms:

  • A feeling like an electric shock or a burning sensation shooting down your arm
  • Numbness and weakness in your arm

These symptoms usually last only a few seconds or minutes, but in some people may linger for days or longer.

More-severe injuries

More-severe symptoms result from injuries that seriously injure or even tear or rupture the nerves. The most serious brachial plexus injury (avulsion) occurs when the nerve root is torn from the spinal cord.

Signs and symptoms of more-severe injuries can include:

  • Weakness or inability to use certain muscles in your hand, arm or shoulder
  • Complete lack of movement and feeling in your arm, including your shoulder and hand
  • Severe pain

When to see a doctor

Brachial plexus injuries can cause permanent weakness or disability. Even if yours seems minor, you may need medical care. See your doctor if you have:

  • Recurrent burners and stingers
  • Weakness in your hand or arm
  • Weakness in any part of the arm following trauma
  • Neck pain
  • Symptoms in both arms
  • Symptoms in upper and lower limbs

Damage to the upper nerves that make up the brachial plexus tends to occur when your shoulder is forced down while your neck stretches up and away from the injured shoulder. The lower nerves are more likely to be injured when your arm is forced above your head. These injuries can occur in several ways, including:

  • Contact sports. Many football players experience burners or stingers, which can occur when the nerves in the brachial plexus get stretched beyond their limit during collisions with other players.
  • Difficult births. Newborns can sustain brachial plexus injuries when there are problems during birth, such as a breech presentation or prolonged labor.

    If an infant's shoulders get wedged within the birth canal, the force used to pull the baby free also can damage the nerves in the brachial plexus. Most often, the upper nerves are injured, a condition called Erb's palsy. Total brachial plexus birth palsy occurs when both the upper and lower nerves are damaged.

  • Trauma. Several types of trauma including motor vehicle accidents, motorcycle accidents, falls, animal bites or bullet wounds can result in brachial plexus injuries.
  • Inflammation. Inflammation may cause damage to the brachial plexus. A rare condition known as Parsonage-Turner syndrome (brachial plexitis) causes brachial plexus inflammation with no apparent shoulder injury.
  • Tumors. Noncancerous (benign) or cancerous tumors can put pressure on the brachial plexus or spread to the nerves, causing damage to the brachial plexus.
  • Radiation treatment. Radiation treatment may cause damage to the brachial plexus.

Participating in contact sports, particularly football and wrestling, or being involved in high-speed accidents increases your risk of brachial plexus injury.

Given enough time, many brachial plexus injuries in both children and adults heal with no lasting damage. But some injuries can cause temporary or permanent problems:

  • Stiff joints. If you experience paralysis of your hand or arm, your joints can stiffen, making movement difficult, even if you regain use of your limb. For that reason, your doctor is likely to recommend ongoing physical therapy during your recovery.
  • Pain. This results from nerve damage and may become chronic.
  • Loss of feeling. If you lose feeling in your arm or hand, you run the risk of burning or injuring yourself without knowing it.
  • Muscle atrophy. Slow-growing nerves can take several years to heal after injury. During that time, lack of use may cause the affected muscles to break down (degenerate).
  • Permanent disability. How well you recover from a serious brachial plexus injury depends on a number of factors, including your age and the type, location and severity of the injury. Even with surgery, some people experience permanent disability, ranging from weakness in the hand, shoulder or arm to paralysis.

Although damage to your brachial plexus often can't be prevented, you can take steps to reduce the risk of complications once an injury has occurred:

  • For yourself. If you temporarily lose the use of your hand or arm, daily range of motion exercises and physical therapy can help prevent joint stiffness.

    Avoid burns or cuts, as you may not feel it if you're experiencing numbness.

    If you're an athlete who has experienced several injuries to the brachial plexus area, your doctor may suggest you wear specific padding to protect the area during sports.

  • For your child. If you're the parent of a child with Erb's palsy, it's important that you exercise your child's joints and functioning muscles every day, beginning when your baby is about 3 weeks old. This helps prevent the joints from becoming permanently stiff and keeps your child's working muscles strong and healthy.
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