Definition Brachial plexopathy refers to injury of the network of nerves going to the arm from the base of the neck, known as the brachial plexus.
What are the signs and symptoms of the injury? Symptoms of this disorder include weakness or paralysis of the shoulder and/or upper arm. Numbness usually accompanies the weakness. Usually, there is some difficulty lifting the arm forward and rotating it outward. Partial dislocation as a result of muscle weakness may occur, causing shoulder discomfort. The muscles may become noticeably smaller, depending on the location of the nerve injury.
What are the causes and risks of the injury? Adult brachial plexopathy is most often caused by downward pressure on the shoulder, which stretches the nerves. This usually occurs while the neck is tilted away from that shoulder. A fracture of the collarbone may also lead to nerve injury. Other causes include infiltration by malignant cells, or radiation therapy.
What can be done to prevent the injury? The best prevention is to be cautious and avoid injury. Sports safety guidelines should be followed for adults, adolescents and children. Athletes who have suffered previous injuries may benefit from wearing special neck collars.
How is the injury recognised? Diagnosis is suspected based on how the injury occurred and what the signs and symptoms are. Neurological examinations, such as CT scans of the neck, confirm the diagnosis and assess nerve damage.
What are the treatments for the injury? Treatment depends on the type and severity of the injury. It varies from observation to nerve repair to grafting. Regardless of severity, physiotherapy is important. Exercising can help maintain range of motion of the joints, stretch shortened muscles, and strengthen the healthy muscles. If nerve roots have been torn, a nerve grafting operation can be performed. However, if a nerve root is separated from the spinal cord, nerve repair will not restore function. A muscle or tendon transfer operation can provide an alternative structure to perform a specific movement in the case of paralysis.
What are the side effects of the treatments? As with any operation, surgery can lead to complications such as infection or failure to improve function.
What happens after treatment for the injury? Nerve grafting generally has good results as long as a nerve root was not separated from the spinal cord. With repair of the nerves of the upper body, 75% of persons will regain bending of the elbow. If a partial injury has not shown signs of improvement within 9 months of injury, the chance of a good recovery is poor.
Author: Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 21/10/2004 Contributors Potential conflict of interest information for reviewers available on request
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