Brachial Plexus: Treatment, Procedure, Cost and Side Effects

The brachial plexus is a network of intertwined nerves that begin from the spinal cord in the neck and travel down the arm. These nerves are responsible to control the muscles of the shoulder, elbow, wrist and hand, as well as provide feeling in the arm. Most traumatic brachial plexus injuries occur when the arm is forcefully pulled or stretched. Some brachial plexus injuries are minor and are known as stingers or burners. These injuries completely recover in several weeks. Other injuries are severe enough. These are caused as a result from auto or motorcycle accidents and could cause some permanent disability in the arm. People also become paralyzed, with a loss of function and sensation in the arms.

Symptoms of brachial plexus injury vary from person to person depending upon the type and location of the injury as well as whether the patient sustained other injuries. The most common symptoms of brachial plexus injury include weakness or numbness in the arms and adjoining, loss of sensation, loss of movement (paralysis), pain. This pain is neuropathic in nature and can last for a very long time.

Treatment of brachial plexus injury depends on several factors. These factors include the severity of the injury, the type of injury, the length of time since the injury and other existing conditions. Nerves which have been stretched minutely and can heal with rest do not need any further medical assistance. Ample rest and proper care will heal the nerve. Physical therapies may be recommended to keep the joints and muscles working properly, maintain the range of motion, and prevent stiff joints. For severe injuries, surgeries like nerve graft, nerve transfer and muscle transfer are done within six to seven months after the injury. Narcotic medications are prescribed to heal and provide relief from the pain.

Patients with brachial plexus injuries must be evaluated and treated within an appropriate time to avoid and prevent complications. It is best treated within 6 to 7 months after injury. The treatment depends on the type, severity and duration of the injury and its location.

The doctor will first diagnose the symptoms and conduct physical examinations to detect the location and severity of the injury. Electromyography (EMG), Magnetic resonance imaging (MRI) ,Computerized tomography (CT) myelography, Angiogram and Nerve conduction studies are performed to detect the injuries of brachial plexus. After this, the treatment begins. Treatment can be categorised under two categories- non surgical treatment and surgical treatment.

Nerves that have only been stretched may recover without further treatment. Minor injuries, like stingers or burners can be treated by non surgical methods. Non surgical treatments take around weeks to months to heal naturally and provide better functional outcomes. Surgical treatments are undertaken when the nerves fail to recover on their own or when the cases are severe. Surgical operations include nerve graft, nerve transfer, muscle transfer etc. In nerve graft procedure, the damaged part of the brachial plexus is removed and replaced with nerves from other parts of the body. Also, muscles and tendons from the thighs are transferred to the arms. Narcotic medications are often used to pacify the pain due to brachial plexus injury and post surgical pains.

Any person with brachial plexus injuries must consult a doctor and evaluate the issues without delay. Delay in treatment and negligence can cause permanent weakness or disability in the patient. Even if the pain seems to be a minor one, one may need medical care and assistance. Symptoms like recurrent burners and stingers, weakness in the hand or arm, weakness in any part of the arm following trauma, complete paralysis of the upper extremity following trauma, neck pain, pain and uneasiness in both arms and in upper and lower limbs must be consulted with a doctor without further delay.

People with temporary arm pain that disappears within one or two days do not need to consult a doctor. When the arms are provided ample rest and they function properly without any numbness and uneasiness, are relatively risk free.

Although side effects associated with the brachial plexus treatment are rare, risks associated with surgery to repair a brachial plexus injury may include failure to improve, tingling or diminished strength in areas of the hand or forearm, and post-surgical stiffness. These side effects are mostly and in general, temporary. The surgery can last for long durations, and the resulting pressure to certain areas of the body can cause temporary pain in the patients. A huge effort is made to pad these areas with special gel pads during surgery in order to minimise the pain.

Physical therapy and bracing are often used after treatment. Recovery from brachial plexus is a time taking process. During recovery, patients are taught to use the other unaffected arm effectively to perform daily activities. Physiotherapist advices specific exercises to prevent stiffness, contractures, or muscle atrophy in the patients. Pain may be managed with medications, therapy, and assistive devices.

Surgical operations for a brachial plexus injury can range from 3 to 12 hours. After that, it takes weeks or months to recover and function properly. Neural recovery time is lengthy, with the nerves growing at a rate of 1 mm per day (1 in. per month). Also, non surgical treatments take weeks or months, approximately six to eight months to work properly.

Non surgical treatments of brachial plexus injury are not expensive. Minor injuries heal with ample rest and medicines. Surgical treatment of brachial plexus is expensive and incurs a cost of around Rs. 25,000- Rs 50,0000.

The treatment when done within six to eight months of injury can recover the nerves and bring back normalcy of the arms and its functioning. This treatment, whether surgical or non surgical is permanent. But, when the injuries are severe and when the treatment is delayed for more than six months, then the situation worsens and causes permanent disability in the patients.

Apart from the surgical and non surgical treatment of brachial plexus injury, homeopathic treatment can also be used to cure brachial plexus injury. Homeopathic medicines like Causticum, Plumbum and Hypericum can be used to treat the pain and reduce the swell. Arnica can also be used to lessen the pain and provide relief. Also, measures may be taken at home to heal faster. Exercising regularly will help to bring the nerves back to senses and keep the muscles and joints elastic. Physiotherapy and daily exercises and arm movement will greatly help keep the muscles and joints moving normally.