Brachial plexus is a network of nerves in the shoulder that carries movements and sensory signals from the spinal cord to the arms and hands. Injuries occur following trauma to the neck. They can cause pain, weakness and numbness in the arm and hand. Most people with minor brachial plexus injuries recover 90-100%of the normal function of their arms. Surgery is often required in severe brachial plexus injuries.

Brachial plexus can be injured in many different ways, from pressure or being stretched too far. The nerves can be cut or damaged by cancer or radiation. Sometimes brachial plexus injuries happen to babies during birth. These injuries cut off all or parts of communication between the spinal cord and the arm, wrist and hand. The severity of the injury varies depending on the extent of the injury. In some people, function and feeling returns to normal, while others may have life long disabilities.

SYMPTOMS

1. Numbness in hand or arm
2. Inability to move the shoulder, arm, wrist or hand
3. An arm that hangs limp
4. Burning, stinging or severe sudden pain in the shoulder or arm.

HOW ARE THEY DIAGNOSED

1. Imaging modalities like CT scan or MRI scan may    show the injury to brachial plexus.
2. Tests that use needle electrodes to determine nerve function and electrical activity are a must.

These tests may have to be repeated to monitor the progress of the disease.

TREATMENT

1. Some minor forms of brachial plexus injuries don’t need any treatment.
2. Non surgical treatment
   1. Physical therapy with exercises may help restore function and improve range of motion
   2. Assist devises like braces and splints
   3. Medication to relieve pain Occupational therapy to improve practical skills

3. Surgical treatment

Injuries that fail to recover on their own need surgery.

1. Nerve repair: reconnecting a torn nerve
2. Neurolysis: removing scar tissue form the injured nerve 
3. Nerve graft: using a healthy nerve to connect two ends of a separated nerve
4. Nerve transfer: attaching a functional nerve to a damaged nerve
5. Tendon and muscle transfer: moving a tendon from one part to arm to restore function

FOLLOW UP CARE

Recovery can take several weeks to months and one has to do regular physiotherapy.

LONG TERM EFFECTS:

1. Without prompt treatment there may be permanent disability
2. Chronic pain may result without prompt treatment