From the Guidelines
Brachial plexus injuries typically cause symptoms related to nerve damage in the shoulder, arm, and hand, including pain, weakness, numbness, and paresthesia, and treatment depends on the severity of the injury, with prompt medical attention crucial for improving outcomes 1. The symptoms of brachial plexus injuries can vary depending on the location and severity of the injury.
- Upper plexus injuries (Erb's palsy) affect the shoulder and elbow, causing the arm to hang limply with the forearm rotated inward.
- Lower plexus injuries (Klumpke's palsy) primarily affect the hand and wrist, causing a claw-like appearance of the hand.
- Complete plexus injuries result in a flail arm with no function. Associated symptoms may include Horner's syndrome (drooping eyelid, constricted pupil, and reduced sweating on the affected side) in severe cases. Treatment may include physical therapy, pain management with medications like gabapentin (300-1200 mg three times daily) or pregabalin (75-300 mg twice daily) for neuropathic pain, and possibly surgical intervention for severe cases, with the best results typically seen when treatment begins within 3-6 months of injury 2. The diagnosis of brachial plexus injuries can be confirmed by electrodiagnostic studies and imaging tests such as MRI, which can help determine the extent of the injury and guide treatment decisions 3. In cases of traumatic brachial plexopathy, imaging tests such as MRI can help identify the location and severity of the injury, and can also detect associated complications such as pseudomeningocele, spinal cord edema or hemorrhage, and nerve root avulsion 4. Overall, prompt medical attention and early intervention are crucial for improving outcomes in patients with brachial plexus injuries, and treatment should be tailored to the individual patient's needs and the severity of the injury 5.
From the Research
Brachial Plexus Injury Symptoms
The symptoms of brachial plexus injury can be complex and multifaceted, affecting various aspects of a patient's life. Some common symptoms include:
- Sensorimotor dysfunction, which can affect movement and touch 6
- Sensation abnormalities, including pain, allodynia, and insomnia 7
- Functional impairment, which can impact daily activities and quality of life 8, 9
- Psychosocial aspects, such as depression, anxiety, and financial well-being 9
Diagnosis and Treatment
Diagnosing brachial plexus injury typically involves a detailed history, comprehensive physical examination, and critical review of imaging and electrodiagnostic studies 9. Treatment options may include:
- Surgical reconstruction, such as neurolysis, nerve grafting, and nerve transfers 9
- Oral gabapentin for managing neuropathic pain 7
- Multidisciplinary team approach, including peripheral nerve surgeons, neurology, hand therapy, physical therapy, pain management, social work, and mental health 9
- Elective amputation and prosthetic rehabilitation in severe cases 10
Management and Outcomes
Effective management of brachial plexus injury requires a holistic approach, addressing all aspects of the patient's care simultaneously 10. Outcomes can be improved with: