If you've recently been diagnosed with a brachial plexus injury you may be worried about what it is, it it's a serious problem, and what you can do to get rid of shoulder and arm pain and/or improve the strength in your arm.
In this post, you'll learn all about brachial plexus injuries so that can make the best decisions about your health.
What is the Brachial Plexus?
The brachial plexus is a bundle of nerves that come a from your lower neck and upper back (C5-T1 nerve roots)
These nerves have both sensory and motor functions.
Sensory - Incoming information from your arms such as the touch, temperature, vibration, and nociception (things that could potentially be damaging)
Outgoing - messages from your brain to your arm to tell your muscles to move your arms, wrist, and hand.
As you can see from the image above, the brachial plexus divides and merges several different times at different levels.
Depending on the location the nerves are classified by different names:
- Roots
- Trunks
- Divisions
- Cords
- Branches
The branches of the nerves then go down into your arm.
The branches of the brachial plexus include the following nerves:
- axillary - nerve to your shoulder
- musculocutaneous - nerve to your biceps
- median - nerve to the palm-side of your forearm and first 3 fingers
- radial - nerve to the top of your forearm and back of hand
- ulnar - nerve to your ring and little finger and the inside of the forearm
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What is a Brachial Plexus Injury?
A brachial plexus injury is a disruption of the communication between the spinal cord and the upper extremity.
What Causes A Brachial Plexus Injury?
A brachial plexus injury is most commonly caused from a shoulder dislocations or a compression or stretch of the brachial plexus.
How Serious Is A Brachial Plexus Injury?
Sometimes brachial plexus injuries are serious in nature and other times they aren't.
The severity depends based on the location of the injury and the extent of the injury. The degree of sensation loss and/or weakness can vary based on the injury.
Some people may have a temporary loss of feeling and strength while others will be unable to use or feel a portion of their arm forever.
The severity and the way the nerves are injured helps classify brachial plexus disorders.
There are five types of brachial plexus injuries:
- Stretch: a nerve may bet overstretched such as a "stinger" in a football player.
- Compression: a pinched nerve, for example in the neck or between the first rib and collar bone
- Rupture: A partial or complete tear of a nerve. Symptoms may or may not resolve completely.
- Neuroma: a swelling or scar around a nerve that may happen after a nerve injury.
- Avulsion: the nerve root is completely detached from the spinal cord due to a high-impact traumas motorcycle accident. May cause some permanent weakness or loss of feeling.
Brachial Plexus Injury Diagnosis
Most of the diagnosis of a brachial plexus injury can be done by a clinical examination.
By testing the strength, sensation, and reflexes in the arms, a skilled clinician should be able to distinguish between a neck, brachial plexus, and shoulder problem.
Diagnostic Tests
Imaging studies such as x-rays and MRIs usually aren't especially helpful in diagnosing a brachial plexus injury.
An x-ray can rule out a shoulder fracture and an MRI can show pinched nerves in the neck. However, most of the time a brachial plexus injury is more of a functional problem than an anatomical one.
Than means that an x-ray or MRI could come back normal, but there may still be a problem.
If you are looking into a diagnostic test for a brachial plexus injury, a nerve conduction velocity (NCV) and electromyography (EMG) study is the best options.
This type of study tests for nerve function and electrical activity of the nerves in the brachial plexus. It's a physiological (functional) test, not an anatomical (structural) test.
Symptoms Of Brachial Plexus Injury
The symptoms of a brachial plexus injury can vary significantly based on the location and severity of the injury.
Common symptoms of brachial plexus injury, include:
- Numbness or loss of sensation of the arm or hand
- Burning, stinging, or severe pain of the arm or hand
- Weakness or paralysis of the arm or hand
Brachial Plexus Injury vs. Pinched Nerve In Neck
A brachial plexus injury usually occurs at the level of shoulder or upper arm. At this point, the nerve has branched and merged with multiple nerve roots of the lower neck and upper torso.
In contrast, cervical radiculopathy is radiating pain, numbness, or tingling from a pinched nerve in your neck. At this point, the injury only affects 1 or 2 nerve roots.
Furthermore, a pinched nerve in the neck will present with specific muscular weaknesses, loss of sensation, and/or reflex changes whereas the effects of a brachial plexus injury are more widespread.
Treatment For Brachial Plexus Injury
There are several conservative treatments for brachial plexus injuries. These treatments include corticosteroid injection or creams, medications, and physical therapy.
Medications and corticosteroid injections or creams can help with the pain management and decrease pain during healing.
However, these types of treatment only mask the pain and don't address the root cause of the problem.
In contrast, a skilled physical therapist establishes a plan of care that specifically addresses the root cause of the problem.
This helps you fix the problem for the long-term so that you can get back to doing all of the things you need and want to do with your arm.
Brachial Plexus Injury Exercises
Exercises for brachial plexus injury depend on the underlying cause of the problem.
For example, a pinched or compressed nerve would be treated much different that an overstretched nerve.
In the case of a compressed nerve root in the neck, you want to stretch your neck to take the pressure off of the nerve root. Read our post about Pinched Nerves In Neck Exercises for more information on this type of problem.
Thoracic Outlet Syndrome Exercises
If the brachial plexus is being compressed between the first rib and the collar bone, this is referred to as thoracic outlet syndrome.
In this case, stretching the muscles attaching to the first rib while stabilizing the first rib with a towel is the best exercise for this type of brachial plexus problem. Learn how to do that exercise here.
The brachial plexus also runs under the pectoralis minor muscle in the chest, which is cut away in the thoracic outlet drawing above.
If the brachial plexus is being compressed by a stiff pectoralis minor, then stretching your chest muscles can help relieve this compression.
Additionally, regardless of the cause of your problem, sitting with good posture with your arms supported helps most types of neck and shoulder problems.
With any exercise, always listen to your body and stop if your symptoms are getting worse. Be particularly concerned if the numbness or weakness in your arms or hands is getting worse during or after a particular exercise.
When To Get Help For Brachial Plexus Injury
Mild injuries may cause symptoms that last for a few days to a couple of weeks. However, more serious injuries could result in permanent nerve damage.
Therefore, it's always important to seek professional professional help if you have a brachial plexus injury - or any type of nerve injury for that matter.
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