What is the brachial plexus?

The brachial plexus is a bundle of five intersecting nerves. You have two brachial plexuses, one on each side of your body. Each of the five nerves connects to the spinal cord at the neck or upper back. They intersect near the collarbone, then branch down through each shoulder, arm and hand. These nerves activate the muscles and provide feeling from your shoulders to your fingertips.

Medical Illustration Copyright © 2020 Nucleus Medical Media. All rights reserved.

What are brachial plexus injuries?

Brachial plexus injuries occur when this nerve bundle is damaged. Most brachial plexus injuries in adults come from traffic accidents or another high-impact trauma, such as a snowboarding accident. Most often, they happen when the arm is pulled down and the head is pushed in the opposite direction.

Less commonly, a tumor or inflammation can injure these nerves. Sometimes an infant’s brachial plexus is stretched and damaged during childbirth.

Types of brachial plexus injuries

Brachial plexus injuries range from mild to severe, depending on:

• How severely nerves are damaged
• Which and how many nerves are damaged
• Which parts of the nerves are damaged

In mild cases, stretched nerves may be able to repair themselves. In a severe injury, an entire arm may be left without movement or sensation.

One way brachial plexus injuries are described is by the severity of nerve damage:

• Neuropraxia: In the least severe type, the nerves are stretched.
• Rupture: In this type, nerves are partly or completely torn. 
• Avulsion: In the most severe type, a nerve is torn away from the spinal cord at the root.

Other types include:

• Neuroma: Scar tissue forms on a stretched nerve as it begins to heal.
• Brachial plexitis: This rare condition, also called Parsonage-Turner syndrome, has no known cause.
• Erb’s palsy: This is when a baby’s brachial plexus is stretched and injured during childbirth.
• Penetrating injuries: Gunshots, stab wounds and other invasive injuries can damage the brachial plexus.

Symptoms of a brachial plexus injury

Symptoms vary widely based on the injury’s severity, but they include:

• Weakness or numbness
• Loss of sensation the shoulder, arm and/or hand
• Paralysis in the shoulder, arm and/or hand
• Pain

Why timely treatment is vital

If you need brachial plexus surgery, it may be effective only if it’s done within three to six months after your injury. The chances of success decline after that, and they may vanish altogether after about a year.

Muscles are also more likely to regain function when nerve signals are restored within several months. After that, the muscle’s fibers may no longer be able to communicate with nerves, even if nerve signals are restored.

At the OHSU Nerve Center, you can expect a precise diagnosis so we can plan the most effective treatment. This gives you the best chance of recovering function and quality of life.

Why specialty care is important

Accurate diagnosis: Getting an accurate and timely diagnosis helps your care team plan effective treatment. It’s not uncommon for us to see patients with a brachial plexus injury that was missed or misdiagnosed elsewhere, delaying treatment and lowering chances of a successful outcome. Our team includes experts in neurology, neurosurgery, orthopaedics, reconstructive surgery and other areas, giving us a detailed understanding of these complicated injuries.

Other injuries: When someone has a brachial plexus injury from an accident, they often have other injuries, too. At OHSU, your care team can include any specialist you need. Your providers will work together to coordinate your care.

Timing: If you might need surgery, timing is crucial for a successful outcome. But the timing can vary from immediate to waiting a few months to see how much nerves heal on their own. Only a team with extensive knowledge of these injuries can pinpoint your needs and make the best recommendation.

Diagnosing brachial plexus injuries

Your doctor will start with an exam to check your function and symptoms. The doctor will also check for signs that indicate the location of the injury. Other tests might include:

• Imaging: You will have an X-ray, MRI or CT scan to give your doctor a clear view of the nerves and surrounding structures.
• Electromyography: This test measures whether or how well a muscle is responding to nerve signals.
• Nerve conduction study: This test gauges whether and how well nerves are sending and receiving signals.

Learn more about our diagnostic tests.

Treating brachial plexus injuries

Treatment varies based on the severity of the injury.

Monitoring and physical therapy

If your doctor thinks the nerves have been mildly stretched and can heal on their own, the doctor may recommend repeating tests in a few months to confirm that function is improving. Babies with brachial plexus injuries from childbirth, for example, usually heal on their own.

Your team may recommend bracing and physical therapy with one of our rehabilitation specialists during this time.

Medication

Your care team can recommend medication for the pain that often comes with brachial plexus injuries.

Surgery

We offer the most advanced options for repairing brachial plexus injuries. It’s important to understand that you may not regain all the function you had before the injury, though. Your team will go over options and expectations for your unique situation.

Nerve repair: A neurosurgeon reattaches two ends of a nerve that has torn apart.

Nerve graft: A neurosurgeon takes a nerve from elsewhere in the body where you don’t need it as much, and sews it between two damaged sections of nerve. The graft acts as a bridge as the nerve ends regenerate and reconnect.

Nerve transfer: Our team is the only one in Oregon to do this complex surgery. A neurosurgeon replaces a damaged nerve or nerves with a new nerve or nerves from elsewhere in the body where they’re not needed as much. Some upper torso injuries may require as many as four nerve transfers.

Learn more about treatment options.

Rehabilitation

OHSU rehabilitation specialists offer expertise in nerves and the complex structures of the hand and arm. They can help you recover from a brachial plexus injury and/or surgery.

Learn more

• Brachial Plexus Injuries, OrthoInfo, American Academy of Orthopaedic Surgeons
• Brachial Plexus Injuries Information Page, National Institute of Neurological Disorders and Stroke
• Brachial Plexus Injury, Physiopedia