Britta Ferrier & Kaylee Kennedy

BRACHIAL
I I 111 PLEXUS
I INJURY
331313
Diagnosis Etiology Age of onset
The brachial plexus is a complex Brachial plexus injuries can be a result There is a significant
network of nerves near the neck of trauma, tumors, or inflammation. inclination toward males
that sends signals from your Causes include: injuries from sports between the ages of 15 & 25
spinal cord to your shoulder, arm, (Burner syndrome), falls, auto years old (sports injuries)
and hand to provide sensory and accidents (most commonly
motor innervation. Brachial motorcycle), difficult birth delivery Risk factors
plexus injuries are caused by (obstetric brachial plexus injury/Erb’s • Dislocation of
damage to those nerves. palsy), or tumor and cancer glenohumeral joint
treatments, • Spinal cord injury
• Direct pulling injury
• Contact sports
Types of injuries
Neurapraxia:
• High speed auto accidents
• Stretch injury outside of the spinal cord that irritates the nerve, but does not tear
Incidence/prevalence
• Most common & least severe
• Can heal on its own, usually within 3 months • 70% of traumatic BPIs are
• Can happen in adults & children due to auto accidents (70%
Neuroma motorcycle)
• Stretch injury that damages some of the nerve fibers • Obstetric BPI: 0.5%-4% per
• May result in scar tissue that compresses the remaining healthy nerve 1000 live births
• Some, but not total, recovery usually occurs
Rupture
• Stretch injury outside of the spinal cord that causes part of the nerve to be torn Symptoms
• Will not heal on its own • Limp, or paralyzed arm
• Happens when the nerve itself it torn • Temporary numbness & tingling
Avulsion • Lack of muscle control in the arm,
• Most severe type of injury hand, or wrist
• Occurs when the root of the nerve is torn directly from the spinal cord • Lack of sensation in arm or hand
• Possible to repair a rupture by “splicing” a donor nerve graft from another nerve • Horner’s syndrome (droopy eyelid,
• Cannot be surgically repaired, but possible to surgically replace damaged nerve via smaller pupil size)
nerve transfer

Functional Performance Deficits

Diagnosis & Assessment • BPIs generally have detrimental
• BPIs vary greatly in severity, depending upon the type of
consequences for the function of the upper
injury and the amount of force placed on the brachial plexus
• Diagnosis is based on clinical presentation, patient history,
limb and quality of life
and results of imaging and nerve conduction studies, which • Severe cases can impact participation in
assess the latency of the muscle contraction when the nerve is ADLs, leisure activities, and employment
artificially stimulated • Patients may also experience profound
• Imagery used to diagnose BPI includes: electromyography emotional and financial hardship related to
(EMG), MRI, CT body image and lifestyle changes

Comorbidities & Complications

• Stiff joints

• Pain(may become chronic)

• Numbness (risk of burning or injuring self without knowing)

• Muscle atrophy ( slow regrowth of nerves + disuse cause muscles to break down)

• Permanent muscle weakness or paralysis (influential factors: age, type, location, severity)

• Surgical treatment may not fully restore function

• Wound from surgery may become infected

Medical Intervention & Treatments

Surgical interventions *may improve overall outcome, but generally
functionality is still significantly decreased
• Neurolysis: removal of fibrous scar tissue surrounding damaged
nerve; nerve function tested before & after using direct nerve
stimulation to determine improvement in nerve conductivity
• Nerve graft: for clear margin injuries with a healthy stump and no
axial damage; outcomes of procedure are influenced by length of
nerve, presence of available healthy donor nerves, & gap needing to be
covered
• Arthodesis: generally a secondary option after first treatment is not
effective or the patient does not have spontaneous recovery; involves
fusing the shoulder with only 20 degrees of abduction, 30 degrees of
both flexion and internal rotation
• Tendon transfer: useful to restore UE function in injuries with only
parietal paralysis due to injury; different muscles can donate
tendons for different functions (I.e. trapezius tendon to deltoid
muscle to restore UE function in injuries with only partial paralysis
Non-surgical Treatments
• Several months of physical therapy & occupational therapy
• Mild cases may have spontaneous recovery
• Many children injured during birth improve or recover by 3 to 4
months of age

OT INTERVENTION
GOAL: minimize negative consequences of injury, maximize functional use of the affected limb through a range of
person-centered interventions, & provide emotional/psychological support & education
Minimize negative consequences of Maximize functional use of affected Provide emotional support & education:
injury: limb: • Assess anxiety level
• Maintain tissue length • Sensorimotor & functional • If needed, request referral to mental health
• Maximize ROM retraining clinician for supportive counseling in
• Pain management • Strengthening innervated & weak coping with a major injury
• Educate & encourage patient & family
• Sensory disturbances muscle groups
discussion of treatment risks and
• Edema • Compensatory strategies &
benefits & prognosis
• Stiffness adaptive equipment

Media/Visuals:

BPI stretches & exercises: https://www.youtube.com/watch?v=oVWfYUk4vOA