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Brachial Plexus Injuries

Brachial Plexus and Peripheral Nerve Clinic

What is a brachial plexus injury?

The brachial plexus is a network of nerves that come from the spinal cord in the neck. These nerves provide signals from the brain and spinal cord to provide movement to the shoulders, arms and hands. An injury to the brachial plexus can impact the sensation, movement and strength of you or your child’s arm.

Injury to the brachial plexus is can be caused by force on the nerves either during the birthing process or through a traumatic event. This type of peripheral nerve injury is the most frequently encountered by a pediatric neurosurgeon. Birth or obstetrical brachial plexus injuries are found in early childhood are more likely to occur during a difficult delivery. Later in life, brachial plexus injuries occur most often due to an intense trauma such as a fall, motorcycle, ATV, motorbike or car accident.

The injury occurs when the nerve fibers of the brachial plexus are either stretched or torn and happens when a child’s shoulder has been pressed down forcefully while the head is pushed up and away from that shoulder.

What types of palsies can result from these injuries?

  • Upper Trunk Injury (also known as Erb’s Palsy) is the most common type of brachial plexus injury. This injury occurs to the upper set of nerves of the brachial plexus, usually effecting the movement and strength of the shoulder and upper arm.
  • Lower Trunk Injury (also known as Klumpe’s Palsy) is an injury that is very not common but can be seen with trauma injuries involving the lower set of nerves of the brachial plexus. These type of injuries usually effect the movement and strength of the lower arm and hand.
  • Total or complete palsy occurs when both upper and lower sets of nerves of the brachial plexus are injured. This injury may largely effect movement and strength of the child’s entire upper extremity including the shoulder, arm and hand.

What types of injuries can occur to the nerve?

Some of the words you may hear during your visit:

  • A “neuropraxia” is a stretch to a nerve, like a concussion to the nerve, it usually resolves on its own with time.
  • A “neuroma” results from a stretch nerve injury that has tried to heal itself resulting in a large amount of nerve scar tissue building up and does not allow for complete return of function. This type of injury may require surgery to improve long term outcomes.
  • When the nerve is stretched beyond tolerance, a “rupture” or a tear may occur along the nerve itself.  It may have some fibers remaining connected but this type of injury usually requires early surgery to try to recover function.
  • An “avulsion” of nerve is when the nerves are pulled from the spinal cord and unlikely to recover function. Early surgery is recommended in these cases but often require alternative types of surgeries to gain function.
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