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.
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.
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.
The best prevention is to take due precautions to 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.
Diagnosis is suspected based on how the injury occurred and what the signs and symptoms are. A careful neurological examination and a CT scan of the neck can confirm the diagnosis and assess nerve damage.
Treatment depends on the type and severity of the injury. It varies from observation to nerve repair to grafting. Regardless of severity, physical therapy 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 the person an alternative means of performing a specific movement in the case of paralysis.
As with any operation, surgery can be complicated by infection, bleeding, or reactions to anesthesia, or may failure to improve function.
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.
