Brachial plexus is a bunch of nerves starting from different levels of the spinal cord and it provides function and sensation to the whole upper limb. Traumatic injury to brachial plexus mostly occurs in severe road traffic accidents (especially on a motorcycle), traction injury to baby arm during childbirth, sports injuries and falls from heights. There will be partial or complete paralysis of the upper limb , which could be temporary or permanent. Trauma to brachial plexus is often associated with clavicle fracture, other bone fracture of upper limb and artery or vein injuries.
Once the Emergency department ruled out other injuries or in OPD your doctor will take a complete history and examine you to see the pattern of injury. There are different patterns of injuries depending on damage. There can be isolated or combined paralysis of different areas of limb.
Your doctor might ask you to wait for a few weeks to see evidence of spontaneous recovery, if there is no or minimal recovery, your doctor will ask for some tests like nerve conduction study (NCS) or electromyography(EMG) or MRI .
As a general rule if the nerve is damaged during its course it can be repaired using small patches of healthy nerve from the patient ‘s leg and if the nerve is unplugged from the spinal cord there is no way to relog it. In that situation the doctor will ask you to transfer other available nerves nearby to achieve as much function as possible.
This surgery took from 4 to 10 hours to complete depending on severity of damage, your surgeon will open up the brachial plexus by a long incision on neck and chest. Sometimes there is a need of additional incision on back, Arm and forearms as well. After the surgery whole of your upper limb will be immobilized using splint or dressings, and you will be allowed to do physiotherapy after a few days to keep your joints in good shape.
It took around a year for recovery and there is a possibility of incomplete or no recovery from the surgery. In that case your surgeon can perform additional surgeries like transferring a healthy muscle from the leg to improve functionality.
FAQS
1. Is full recovery possible?
A limb which can do most of the daily life work is the ultimate goal, of course full recovery to before injury is highly unlikely.’
2. Do I need to undergo additional procedures after the main surgery?
Yes. Most complete brachial plexus injuries require additional procedures which your surgeon will plan and discuss with you.
3. It’s been 2 years since my brachial plexus injury, what should I do?
There are still options like tendon transfers , free functional muscle transfers, which can make your limb functional.
Written by : Dr. Obaidur Rahman
Copyrights: Pakistan association of Plastic Surgeons