Where is brachial plexus

Sometimes when nerve tissue is injured, such as from a cut during surgery, scar tissue can form as the nerve attempts to repair itself. This scar tissue is called a neuroma, and it may result in a painful knot on one of the brachial plexus nerves. Treatment for brachial plexus neuromas includes surgical removal of the scarred nerve tissue.

The surgeon then either caps the nerve or attaches it to another nerve to prevent another neuroma from forming. Also called Parsonage Turner syndrome, brachial neuritis is a rare, progressive disorder of the nerves of the brachial plexus. This syndrome causes sudden, severe shoulder and upper arm pain and progresses from pain to weakness, muscle loss and even loss of sensation.

This syndrome usually affects the shoulder and arm, but it can also affect the legs and diaphragm. The cause of brachial neuritis is unknown, but could be related to an autoimmune response triggered by infections, injury, childbirth or other factors. A brachial plexus avulsion occurs when the root of the nerve is completely separated from the spinal cord. This injury is usually caused by trauma, such as a car or motorcycle accident.

More severe than ruptures, avulsions often cause severe pain. Because it is difficult and usually impossible to reattach the root to the spinal cord, avulsions can lead to permanent weakness, paralysis and loss of feeling. In babies, the brachial plexus nerves in the shoulder are vulnerable during birth. Injury to the brachial plexus is fairly common during birth, occurring in one to two births per 1, Larger babies in difficult vaginal deliveries are particularly prone to this injury, as are babies of mothers who have diabetes.

During childbirth, large babies may be at an increased risk for brachial plexus injuries. Babies in breech position bottom end comes out first and those whose labor lasts an unusually long time may also suffer brachial plexus injuries.

Shoulder dystocia occurs when the shoulder is temporarily stuck under the pubis during delivery, and can result in brachial plexus injury. The severity of these injuries can vary widely. Some children with brachial plexus birth injuries recover spontaneously, and most children will regain all or most of their normal function through physical and occupational therapy.

A smaller group will require surgical intervention to achieve good function. Early diagnosis and treatment can improve long-term results. Symptoms depend on where along the length of the brachial plexus the injuries occur and how severe they are.

Injuries to nerves that root higher up on the spinal cord, in the neck, affect the shoulder. If nerves that originate lower in the brachial plexus are injured, the arm, wrist and hand are affected. Brachial plexus injury pain can be mild to severe, and temporary to chronic, depending on the type and extent of the injury. For instance, a simple stretched nerve may hurt for a week or so, but a ruptured nerve can cause serious, long-term pain that might require physical therapy and potentially surgery.

A health care provider will examine the hand and arm and test for sensation and function to help diagnose a brachial plexus injury. These tests may be repeated every few weeks or months to allow your doctor to monitor your progress. Some people, particularly babies with a brachial plexus birth injury or adults with neuropraxia, recover without any treatment, though it can take as long as several weeks or months for the injury to heal. Certain exercises can help with healing and function, but more severe injuries may require surgery.

Prompt examination by a health care provider is essential after any suspected brachial plexus injury. Mild brachial plexus injuries respond well to a combination of nonsurgical treatment options. Your doctor may recommend one or all of the following:. Brachial plexus injuries that fail to heal on their own may require surgery to repair the damage.

Nerve tissue grows and heals slowly, so it can take months to years to see the results of brachial plexus surgery. Brachial plexus surgeries should take place within six months of injury for the best chance at recovery. Procedures your surgeon might recommend include:. Our experts at the Johns Hopkins Peripheral Nerve Surgery Center are well-versed in all types of brachial plexus injuries, from birth injuries to radiation treatment complications.

We use a holistic approach, creating an individualized treatment plan for each patient. In infants, if no improvement is seen after three months of occupational therapy, consulting a pediatric neurologist and pediatric neurosurgeon can help determine if your child can benefit from other interventions or surgery. Up to 1 in 10 babies with brachial plexus injury will require some level of surgery.

Prompt intervention is important. If the injury occurred during birth, the best time for surgery is when your child is between 4 and 9 months, as waiting longer than a year can limit the level of function a surgery might restore. Because nerves heal slowly, brachial plexus injury recovery can take several weeks to months, depending on the severity.

For avulsion and rupture injuries, there is no potential for full recovery unless surgical repair is done in a timely manner. For neuroma and neurapraxia injuries, the potential for improvement varies. Most patients with neurapraxia injuries have a fair prognosis of recovering spontaneously with a percent return of function.

If surgery is needed, microsurgical nerve repair may be undertaken as early as three months post injury. Primary nerve repair is typically completed by approximately six months of age following the injury. When the neuroma is large it must be removed and the nerve is then reattached either with end-to-end techniques or with nerve grafts. When the gap between the nerve ends is so large that it is not possible to have a tension-free repair using the end-to-end technique, nerve grafting is used.

This is used generally in those cases where there is an avulsion. Donor nerves are used for the repair. The parts of the roots still attached to the spinal cord can be used as donors for avulsed nerves. Because your child may not be able to move the affected arm alone, it is important for you to take an active part in keeping the joints limber.

A brachial plexus injury is a life-long condition. Management often focuses on preventing or minimizing deficits and maximizing the child's capabilities at home and in the community.

It is important to remember that your child is very adaptable. Be supportive and encouraging; focus on what your child can do. Positive reinforcement will help your child to develop a healthy sense of self-esteem and promote independence.

Look up additional information in the brachial plexus glossary. All rights reserved. Health Library. Causes of Brachial Plexus Injury A brachial plexus birth injury is thought to be caused by an injury involving the child's brachial plexus during the delivery process. Symptoms of Brachial Plexus Injury Patterns of muscle weakness or paralysis of the involved upper extremity depending on which nerves of the brachial plexus are involved Decreased sensation feeling in the involved upper extremity Pain Types of Brachial Plexus Injuries Avulsion The nerve is torn away from its attachment at the spinal cord; the most severe type.

Signs and symptoms of a brachial plexus injury can vary greatly, depending on the severity and location of your injury. Usually only one arm is affected. Minor damage often occurs during contact sports, such as football or wrestling, when the brachial plexus nerves get stretched or compressed.

These are called stingers or burners, and can produce the following symptoms:. These symptoms usually last only a few seconds or minutes, but in some people the symptoms may linger for days or longer. More-severe symptoms result from injuries that seriously injure or even tear or rupture the nerves.

The most serious brachial plexus injury occurs when the nerve root is torn from the spinal cord. Brachial plexus injuries can cause permanent weakness or disability. Even if yours seems minor, you may need medical care. See your doctor if you have:. Damage to the upper nerves that make up the brachial plexus tends to occur when your shoulder is forced down while your neck stretches up and away from the injured shoulder.

The lower nerves are more likely to be injured when your arm is forced above your head. Participating in contact sports, particularly football and wrestling, or being involved in high-speed motor-vehicle accidents increases your risk of brachial plexus injury.

Given enough time, many brachial plexus injuries in both children and adults heal with little if any lasting damage. But some injuries can cause temporary or permanent problems, such as:. Although damage to your brachial plexus often can't be prevented, you can take steps to reduce the risk of complications once an injury has occurred:. For yourself. If you temporarily lose the use of your hand or arm, daily range-of-motion exercises and physical therapy can help prevent joint stiffness.

Avoid burns or cuts, as you may not feel them if you're experiencing numbness. If you're an athlete who has experienced injuries to the brachial plexus area, your doctor may suggest you wear specific padding to protect the area during sports.

Brachial plexus injury care at Mayo Clinic.