From the Guidelines
Treatment for a suspected brachial plexus injury or strain initially involves rest, ice, compression, and elevation (RICE protocol) for the first 24-48 hours to reduce inflammation and pain. Over-the-counter pain medications such as ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) can help manage pain and reduce inflammation 1, 2. For more severe pain, a physician may prescribe stronger analgesics or muscle relaxants like cyclobenzaprine (5-10mg three times daily) for short-term use. Physical therapy is crucial for recovery and typically begins after the acute phase, focusing on gentle range of motion exercises, followed by strengthening and stretching of the affected muscles. Nerve gliding exercises may also be recommended to improve nerve mobility. For severe injuries with significant nerve damage, surgical intervention might be necessary, as seen in cases of traumatic brachial plexopathy where imaging can help determine the extent of plexus injury and guide treatment planning 3, 4. It's essential to seek medical evaluation promptly as brachial plexus injuries can range from mild strains to complete nerve avulsions, and proper diagnosis through physical examination, electromyography (EMG), or MRI will guide appropriate treatment 5, 6. Recovery time varies based on injury severity, from weeks for mild strains to months or years for more serious injuries. In cases of suspected thoracic outlet syndrome, which can cause brachial plexus compression, imaging studies such as MRI can help diagnose and plan for intervention 7. Given the complexity and variability of brachial plexus injuries, a comprehensive approach considering the latest evidence and individual patient needs is crucial for optimal outcomes.
From the Research
Treatment Options for Suspected Brachial Plexus Injury or Strain
- The treatment for a suspected brachial plexus injury or strain depends on the severity and type of injury, with options ranging from conservative management to surgical intervention 8, 9, 10.
- Conservative treatment may include physical therapy modalities such as kinesiotherapy, electrothermal and phototherapy, manual therapy, and sensory re-education strategies 9.
- Surgical exploration and nerve repair may be necessary in cases of severe injury, such as root avulsion or rupture, and should be performed as early as possible to achieve good results 8, 10.
- Intercostal nerve transfer is a recommended treatment for restoring elbow flexion in root avulsion type of injury, with best results achieved in patients younger than 30 years who receive the operation within 6 months after injury 8.
Timing and Approach to Treatment
- Early intervention with rehabilitation is necessary to ensure recovery of limb function and prevent complications such as muscle atrophy and joint contracture 11.
- Surgery should be performed within 3-6 months from the injury when no signs of recovery are present, and patients with suspected neurological complications require systematic control 10.
- Comprehensive knowledge of anatomy and adept skills are crucial to avoid nerve injuries during procedures such as brachial plexus block or vessel puncture, and patients should be encouraged to immediately inform the doctor of any experience of numbness/paresthesia during the procedure 12.
Specific Treatment Approaches
- Nerve grafting is indicated for a rupture in the root demonstrating a positive spinal cord evoked potential (ESCP) or somatosensory evoked potential (SEP) potential, in the trunk or in the cord 8.
- Exploration of the brachial plexus should be extended distally as far as possible to achieve good results after nerve grafting 8.
- Medical treatment and rehabilitation can lead to nearly complete recovery of limb function in cases of brachial plexus injury or strain, as seen in a reported case of a 36-year-old woman who developed right upper and lower limb paralysis after sedative drug overdose with prolonged immobilization 11.