Brachial Plexus Injuries

Overview

The brachial plexus is a network of nerves that supplies nerve fibers to the chest, shoulder and arm. It branches out of the spinal cord within the neck through a person’s armpit. Usually, brachial plexus injuries are caused by trauma to the neck and shoulder. Injuries to this area typically come from motorcycle or car accidents, falls, lacerations or medical conditions.

Partial Injuries

Partial injuries usually occur in the upper part of the brachial plexus and cause paralysis in the shoulder and elbow.

When treating patients with these injuries, our surgeons use nerve transfers, a procedure where a less essential nerve or nerve section is "transferred," to restore function in a more crucial nerve. This innovative strategy restores useful function more quickly than grafting.

It is important for patients to see a physician soon after the accident or injury. Surgeons generally prefer to schedule operations within three to four months after the injury but can operate earlier in some circumstances.

Sometimes when patients present late and the window for nerve transfer has passed, tendon transfer or muscle transplants can be useful options to restore function.

Surgical Options for Complete Injuries

“Complete injury” to the brachial plexus usually means patients are not able to feel or move their arm.

With such injuries, it is important to determine how the nerves were damaged. If nerves are avulsed (pulled out of the spinal cord), the surgeon can operate relatively quickly after the injury instead of giving time for recovery as this type of nerve damage will not heal on its own.

If nerves are scarred or torn, grafts can be used.

Usually, though, a combination of nerve transfers and grafts are used in reconstructive surgery for complete brachial plexus injuries. We work with each patient to determine the best course of action for the individual’s injury or condition.

Patients can usually undergo surgery three to four months after the initial injury. Receiving physical therapy before and after surgery is a crucial part of the process. When nerves get transferred, it’s important to keep the joints where nerves will be transferred from strong and flexible before surgery. After the surgery, physical therapy will help the patient learn how to use their shoulder and arm again.

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The Mass General Paralysis Center is a multidisciplinary center featuring physicians and surgeons from a variety of service lines including Neurosurgery, Neurology, Imaging, Orthopaedics, Plastic Surgery and more. Our doctors work together to determine a treatment option that can address each patient’s unique situation. The Paralysis Center opened in 2018 and is led by Justin Brown, MD.