Is Brachial Plexus Injury (BPI) the same as Brachial Plexopathy?

Brachial Plexus Injury (BPI) and Brachial Plexopathy

Yes, brachial plexus injury (BPI) and brachial plexopathy are essentially the same condition, referring to damage or dysfunction of the brachial plexus nerve network. 1

Definition and Terminology

• Brachial plexopathy is the medical term that describes any pathological condition affecting the brachial plexus, while brachial plexus injury specifically refers to traumatic damage to this nerve network 1, 2
• Both terms are used interchangeably in clinical practice and medical literature, particularly when discussing traumatic etiologies 1, 3
• The term "plexopathy" is the broader medical terminology that encompasses all disorders affecting a nerve plexus, whether traumatic or non-traumatic in origin 1

Anatomical Considerations

• The brachial plexus is a complex network of nerves originating from spinal nerve roots C5-T1 that provides motor and sensory innervation to the upper limb 3
• It consists of five anatomical sections: roots, trunks, divisions, cords, and terminal branches 3
• Terminal branches include the musculocutaneous, median, axillary, radial, and ulnar nerves 3

Etiologies

Brachial plexopathy/BPI can be classified based on etiology:

1. Traumatic causes:

   • Blunt force injuries (falls, sports injuries, motor vehicle accidents) 1, 4
   • Penetrating injuries (gunshot wounds) 1
   • Compression injuries (hematomas) 4
   • Traction or stretch injuries 4, 5

2. Non-traumatic causes:

   • Inflammatory conditions (Parsonage-Turner syndrome/brachial neuritis) 1, 2
   • Neoplastic involvement (direct invasion, metastases) 1
   • Radiation-induced plexopathy 1
   • Hereditary neuralgic amyotrophy 2
   • Thoracic outlet syndrome 1, 2

Classification of Traumatic Brachial Plexopathy

• Preganglionic injuries: Involve intraspinal nerve roots 1
• Postganglionic injuries: Involve plexus lateral to the dorsal root ganglion 1
• Location-based: Upper trunk, extended upper trunk, lower trunk, or complete (swinging hand) 3

Clinical Presentation

• Pain in shoulder and arm with neuropathic character 1
• Weakness, sensory loss, and flaccid loss of tendon reflexes in regions innervated by C5-T1 1
• Paralysis of shoulder, arm, and/or hand with paresthesias 4
• Altered temperature and color of the limb due to autonomic nervous system involvement 4

Diagnostic Approach

• Imaging: MRI of the brachial plexus is the gold standard for evaluation due to superior soft-tissue contrast and spatial resolution 1
• Timing: Imaging for traumatic cases should be delayed until approximately 1 month after injury to allow for resolution of hemorrhage and edema 1
• Electrodiagnostic studies: Help confirm the diagnosis and determine the extent of nerve damage 4, 2

Treatment Options

• Conservative management: Physical therapy including range of motion exercises, muscle stretching, strengthening, electrothermal therapy, and sensory re-education 6
• Surgical interventions: Neurolysis, nerve grafting, neurotization, arthrodesis, tendon transfers, free muscle transfers, or bionic reconstruction depending on injury type 3
• Timing: Penetrating and open injuries often require early surgical exploration, while blunt and closed injuries may be managed operatively or non-operatively based on severity 1

Prognosis

• Depends on the extent and site of injury, as well as surgical expertise 2
• Complete nerve ruptures generally have worse outcomes and often require early operative management 1
• Bilateral brachial plexus injuries are associated with particularly poor functional outcomes 5

Common Pitfalls in Diagnosis

• Clinical diagnosis can be challenging as symptoms may overlap with radiculopathy (single nerve root involvement) 1
• Delayed onset of symptoms may occur in compression injuries, with paralysis not evident until 48 hours after the initial trauma 4
• Post-traumatic imaging performed too early may miss important findings due to obscuration by hemorrhage and edema 1