Brachial Plexus Injuries

The brachial plexus is a complex of nerves that are formed as the spinal nerves exit the spinal cord at the neck. All the nerves that supply the arm originate from the brachial plexus. Some of the main branches of the brachial plexus are the suprascapular nerve, musculocutaneous nerve, axillary nerve, median nerve, radial nerve and the ulnar nerve. These nerves have sensory and motor functions, are responsible for the movement of the arms and supply sensation to the skin.

Brachial plexus injuries may cause symptoms such as numbness or loss of feeling in the hand or arm, an arm which may hang limply, and a burning, stinging or severe pain in the shoulder or arm. The condition may also result in the inability to control or move the shoulder, arm, wrist or hand.

Injuries to the brachial plexus are devastating and can result in completely paralysed arms. Brachial plexus injuries are either due to a sharp mechanism (stab) or a blunt mechanism (e.g., motorbike accident).

Sharp injuries require urgent surgery to repair the cut nerves. This involves Prof McGuire performing microsurgery, which may be done with magnification, special instruments and very small stitches. Recovery takes very long and is virtually never complete. Depending on the extent of the initial injury, there will likely be persistent weakness and loss of function.

Blunt injuries have a wide spectrum of injury. Sometimes the brachial plexus nerves are just bruised and can recover spontaneously over weeks or months. This is called a neuropraxia. With a more severe injury, the brachial plexus nerves can rupture or pull out of the spinal cord. Unlike a sharp injury, the nerves cannot be repaired in this situation because there is either a gap when they rupture, or there is nothing to repair them to if they pull out of the spinal cord. Various specialist techniques are required here to reconstruct the injury, including nerve transfers and nerve grafting. Again, full recovery is not likely.