Brachial Plexus Surgery
1) Brachial Plexus Injury
The brachial plexus is the network of nerves that sends signals from your spinal cord to your shoulder, arm and hand. A brachial plexus injury occurs when these nerves are stretched, compressed, or in the most serious cases, ripped apart or torn away from the spinal cord.
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.
- 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 the symptoms may linger for days or longer.
- 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
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
- Neck pain
- Symptoms in both arms
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.
Tumors and cancer treatments
Radiation treatments to the chest may cause damage to the brachial plexus.
Participating in contact sports, particularly football and wrestling, or being involved in high-speed motor-vehicle accidents increases your risk of brachial plexus injury.
Given enough time, many brachial plexus injuries in both children and adults heal with little if any lasting damage. But some injuries can cause temporary or permanent problems, such as:
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 them if you’re experiencing numbness. If you’re an athlete who has experienced 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 a brachial plexus palsy, it’s important that you exercise your child’s joints and functioning muscles every day, beginning when your baby is just a few weeks old. This helps prevent the joints from becoming permanently stiff and keeps your child’s working muscles strong and healthy.
2) Brachial Plexus Surgeries
The brachial plexus is a network of nerves that conveys movement and sensory signals from the upper spinal cord in the neck down into the arms and hands. Trauma to the neck or shoulder can injure the brachial plexus, causing pain, numbness, weakness or paralysis in the arms or hands.
Before recommending surgery, the surgeon needs to understand which nerves are affected and the injury’s location and severity. If you need brachial plexus surgery, a multidisciplinary team of neurosurgeons, plastic surgeons and neurologists will work with you to determine the best treatment approach based on the injury and your treatment goals.
Details about weakness or paralysis, loss of sensation, and the quality of pain (dull, stabbing, burning, stinging, etc.) can provide important diagnostic clues on the location and severity of injury to the brachial plexus nerves.
The surgeon works with you to focus on the most distressing or debilitating symptoms or issues caused by the injury. In planning your surgery, these considerations help customize the approach and address your specific needs.
The goal of brachial plexus surgery is to relieve your pain and restore sensation and motor function to your shoulder, arm and hand.
Procedures your surgeon might recommend include:
- When a nerve has been cut or torn, the surgeon may be able to re-connect it by sewing the ends back together. This is performed with the help of a microscope and small, specialized instruments.
When a nerve is compressed but otherwise intact, a decompression surgery can help relieve the pressure on the nerve and address related symptoms and loss of function. This can be done by removing scar tissue or adhesions (a procedure called neurolysis) from around the injured nerve.
When a nerve has been injured or scarred severely, it may no longer be able to carry signals from the brain to the arm and hand, leading to paralysis.
During a nerve transfer, a nearby functioning nerve that is performing a noncritical function is connected to the injured nerve. This creates a framework for new growth and a pathway for signals.
During a tendon transfer, a functioning and expendable tendon is attached to a tendon that is paralyzed as a result of brachial plexus injury.
In some cases, a tendon transfer offers the best option for restoring movement after a brachial plexus injury. The most common reason for the procedure is that too much time has passed after the injury and nerve grafting or transfers are no longer options.
Functional muscle transplant is another option to restore movement when too much time has passed after the brachial plexus injury and when nerve repair, grafting or transfer is no longer possible.