Overview, Gross Anatomy, Blood Supply of the Brachial Plexus

What is the brachial plexus?

The brachial plexus is a set of nerves that send signals or messages from the spinal cord to other parts of the body like shoulders, arms and hands. Brachial nerves are a set of somatic nerves that are formed by combining ventral rami (roots) and the thoracic nerves.

The plexus is responsible for both motor and sensory innervations of the muscles of the upper extremity, which includes the scapular region.

The brachial plexus controls the movement of your wrists, arms and hands. They also make your movement easy. For example, raising your arm, typing on a keyboard and playing a sport like a baseball.

The brachial nerves branch and fuse and then run through the shoulder and arm. The brachial nerves end into five major branches and extend down the arm. These nerves are listed below.

Musculocutaneous nerve

The musculocutaneous nerves originate from the roots of C5-C7 and flex the muscles in the upper arm, elbow and both shoulders.

Median nerve

The median nerves start in the nerve roots of C6-T1 and aid the movement of the forearm and other parts of the hands.

Axillary nerve

The axillary nerves stem from the nerve roots of C5 and C6. The axillary nerves help the free movement of shoulders and lift the arms away from the body.

Radial nerve

The radial nerves start in the nerve roots of C5-T1. Additionally, it controls the movement of muscles in the elbow, upper arm, hand and forearm.

Ulnar nerve

The nerves roots from C8-T1 and controls the movement of fingers.

Symptoms of brachial plexus injury

The symptoms of brachial plexus injury may vary from one person to another, depending on the site of injury. In most cases, one arm is affected.

Some of the common symptoms of brachial plexus injury are listed below.

• A sharp burning pain that runs down the arm, which starts from the shoulders. Numbness and weakness in the injured arm.
• Inability to move the hand or certain muscles in the hand, arm and shoulders.
• Severe pain.
• Complete cessation of movement.

In severe cases, brachial plexus injury can lead to permanent disability and weakness. The other symptoms include

• Weakness in the arm,
• Neck pain and
• Recurrent stings and burns.

Causes of brachial plexus injury

The brachial plexus injury can occur when the shoulder is forced down while the neck is being stretched. Some of the common brachial plexus injuries are listed below.

Contact sports

People who play sports are more prone to this type of injury. When people play games like football, there are possibilities for collision with other players.

This can stretch the brachial nerves beyond the limit and lead to injury. This type of contact sports injury is common.

Difficult births

When there is a certain difficulty in labour, it can lead to brachial plexus injury. For example, when a baby is associated with prolonged labour, overweight or breech presentation, it can lead to such type of injury.

Breeched presentation is the birth position of the baby when the baby’s feet come out first. This can cause the shoulders to become wedged and can injure the brachial plexus nerve. In most cases, the upper nerves are injured.

Trauma

Trauma incidents like car accidents and major falls can result in brachial plexus injury. Motorcycle injury and bullet wounds can also lead to brachial plexus injury.

Tumours and cancers

According to NCBI, breast and lung cancer are the common causes of the brachial plexus. Lymphomas, squamous cell carcinomas and melanomas are some of the tumours that metastasise the axillary nodes and cause brachial plexus injury.

Treatment

Treatment for brachial plexus depends on the person. In most cases, the brachial plexus will not require any specific treatment and will heal on its own. However, it will take several weeks and months for the injury to heal.

Babies that are born with brachial plexus injury will recover on their own without any specific treatments. There are certain exercises to help with the healing and to improve the functions of the arm.

Some of the non-surgical treatments for the brachial plexus are discussed below.

Physical therapy

Physical therapy will help to restore the movement of arms. It also helps with the motion and flexibility of stiff muscles and joints.

Corticosteroid

Corticosteroid creams or injections will help with the healing and reduces pain.

Occupational therapy

Occupational therapy will help restore daily motion and reduces numbness and muscle weakness.

The brachial plexus injury that does not recover on its own will require surgery. The surgical procedures will be recommended by the doctor.

A Nerve repair will help reconnect the damaged nerves.

Neurolysis will help remove the scarred tissues in the injured nerve. This treatment will help improve the functions of the arm.

A Nerve graft will help to fasten the healing process. With the help of a healthy nerve from the other part of the body, the injured nerves will be connected, and new functional nerves will be formed.

There is post-surgery care requirement for the brachial plexus. The healing will also depend on the severity of the injury. Post-surgery regular physical exercise will be required to prevent muscle atrophy.

Regular checkups with the neurologist will also be required to monitor the progress and the healing process.

Risk factors

The risk factor of brachial plexus injury is for people who are involved in sports like football and wrestling and who drive high-speed motor vehicles. Sudden trauma can also increase the risk of brachial plexus injury.

Complications

Brachial plexus injury that occurs in adults and children will heal over time. However, there can be certain complications that have a permanent or temporary effect.

Stiff joints

Pain

For some people, the brachial plexus nerve can lead to paralysis or stiff joints. Stiff joints can make movement difficult and affects the quality of life.

Pain can be caused due to nerve damage. It can also indicate the start of the healing phase.

Numbness

Numbness is one of the major complications of brachial plexus injury. When your joints become numb, you can hurt yourself, and you will not know you’re hurt.

Muscle atrophy

Muscle atrophy can be caused when new nerves grow. During this phase, when there is a lack of movement, it can lead to muscle atrophy.

Prevention

Some injuries are inevitable. However, if you are watchful, these can be avoided. People who are athletes are prone to such types of injuries. When you play sports, you have to be watchful. Collision with other players can be avoided to prevent such injuries.

If the injury has occurred with proper exercise, the healing will be hastened. If children have brachial plexus injury, parents should make sure that the child practices certain exercises to prevent stiffness.

When to see a doctor?

In most cases, the brachial plexus will heal on itself. Consult your doctor if you have the following symptoms.

• Pain
• Stiffness
• Lack of movement and
• Any other discomfort.

Conclusion

Brachial plexus injury can heal on its own. But if the injury is severe, it will require surgery to regain the functions of the arm.

Post-surgery care will also be required. The arm can become stiff if there is a lack of movement. So, physical activity and exercise will be required to have prompt actions.

In rare cases, brachial plexus injury can result in Horner’s syndrome, in which certain sympathetic nerves will be damaged.

Chronic pain can also indicate that a person is affected by brachial plexus injury. So proper care will be required to heal from the injury.

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