From my experience it is not often that true brachial plexus injuries are seen in the work place, but when they do occur, treatment can be delayed or aggravated due to misdiagnosis and missed symptoms. The brachial plexus is a network of nerves originating from the spinal cord and branch into the shoulder and upper limbs. Brachial Plexus Neuropathy (BPN) or Brachial Plexus Injury (BPI) is a condition that occurs when the brachial plexus nerves are damaged or injured causing symptoms into the shoulder, arm, and hand. These symptoms can include: pain, muscle weakness, loss of sensation which can include numbness, tingling, and/or burning. In severe cases there can be complete loss of sensation or even paralysis. Inability to lift the wrist can be an indication of BPN.
These injuries are usually caused by trauma (blunt trauma, stab, gunshot wound, or high-speed vehicular accidents) and inflammatory processes or compression of the nerve. The type of injury will determine the outlook for recovery. Types of injuries include:
- Avulsion – the nerve has been pulled out from the spinal cord with no chance of recovery.
- Rupture – the nerve has been stretched and partially torn but not at the spinal cord.
- Neurapraxia – the nerve has been gently stretched or compressed with good prognosis for rapid recovery.
- Axonotmesis – the axons have been severed and has a moderate prognosis.
- Neurotmesis – the entire nerve has been divided and has poor prognosis.
- Neuroma – this refers to a type of tumor that grows from a tangle of divided axons (nerve endings), which fail to regenerate. The prognosis will depend on the percentage of axons do regenerate.
Diagnosis of injury can include history of injury, EMG/NCS, and MRI/CT scan. A physical exam can include findings of diminished reflexes, muscle atrophy, inability to flex hand, and difficulty in arm/hand movement. Depending on the type and severity of the injury, some injuries recover on their own while others may require therapy for muscle strengthening and increasing range of motion. Medications for pain can be prescribed, as well as medication for nerve pain such as Lyrica or Neurontin. Other injuries may require surgical intervention for nerve decompression. An EMG can be repeated to track rate of recovery of the nerve and to help in providing prognosis. In some cases, there is spontaneous recovery. A correct diagnosis will assist in directing proper treatment that will lead to recovery of a brachial plexus injury.
References
John Hopkins Medicine Dr. Allan Belzberg
Healthline Brachial Plexus Neuropathy
John Hopkins Medicine Dr. Allan Belzberg
Healthline Brachial Plexus Neuropathy