Brachial plexus injury refers to any damage to the bundle of connected nerves in the neck region of your spinal cord which send branches down into your shoulders, arms, and hands. This group of nerves is called the brachial plexus.
Brachial plexus injuries vary in severity. Mild brachial plexus injuries may heal without treatment. Proper diagnosis is essential for deciding which patients have the potential for spontaneous recovery. If it is apparent that the severity and type of injury precludes the potential for spontaneous recovery (e.g., avulsion), early surgery is indicated. Otherwise surgery is typically delayed for 3 -4 months to allow for spontaneous recovery.
Nerve injury surgery to repair damaged nerves is complex, requiring a specialized experienced surgeon.
Surgical intervention serves two functions:
- Confirmation of diagnosis
- Repair of injury
Several factors determine the type of intervention performed including:
- preoperative diagnosis
- interval between injury and surgery
- intraoperative diagnosis
Procedures to restore function include neurolysis, neurotization, tendon transfers, and free muscle transfers.
After surgery: recovering from a brachial plexus injury
Recovery of function after a brachial plexus injury is a lengthy process. Nerves grow at about one inch per month, so it may take several months before the first signs of recovery are apparent.
Recovery progresses from the muscles of the shoulder, to those of the arm, and finally the hand. Physical therapy is essential to strengthen recovering muscles and maintain flexibility of joints.
Pain from surgery is usually minimal and can be managed by pain medications.
In brachial plexus injuries associated with avulsion of nerve roots from the spinal cord, patients may develop severe debilitating pain. Additional interventions, including the DREZ procedure, may be indicated.
The determination of extent of recovery is usually not made until enough time has passed for complete reinnervation (for the nerves to grow back) and strengthening (about one and a half to two years). Recovery may continue to occur for up to four years. If there is incomplete recovery, patients should be evaluated for the further interventions. These may include muscle or tendon transfers or releases to optimize movement of the limb.