Brachial Plexus Injury

Aka: Brachial Plexus Injury, Brachial Plexus Neuropathy, Brachial Neuralgia

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II. Epidemiology

  1. Uncommon injury
  2. Often requires significant Trauma
    1. Motorcycle accidents
    2. Brachial Plexus Burner
    3. Brachial Plexus Injury from Birth Trauma

III. Signs

  1. Involved region depends on degree of brachial plaxus involvement
  2. In severe cases, arm may be completely paralyzed and Anesthetic
  3. Horner's Syndrome implies poor prognosis

IV. Differential Diagnosis

  1. Brachial Plexus Burner or Stinger
  2. Brachial Neuritis
  3. Cervical Spine Injury
  4. Peripheral Neuropathy
  5. Cervical Cord Neuropraxia
  6. Spinal Cord Syndrome
  7. Thoracic Outlet Syndrome

V. Management

  1. See Brachial Plexus Burner
  2. See Brachial Plexus Injury from Birth Trauma
  3. Conservative Management for 3 weeks
    1. Maintain Shoulder and arm range of motion
  4. Myelography and Electromyography evaluation
    1. Normal Electromyogram (EMG)
      1. Consider early surgery
      2. Microscopic neurolysis and nerve repair
    2. Traction Meningoceles or dye pockets
      1. Indicates nerve roots avulsed from cord
      2. Suggests complete, non-reparable and poor prognosis
      3. Consider amputation above elbow 1 year after injury

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