Brachial Plexus Treatment Options

An important network of nerves, the brachial plexus is responsible for sending signals from the spine to the arm and hand. These nerves can be injured through excessive stretching, tearing, or compression. In rare cases, the nerves may be completely torn from the spinal cord.

Often associated with sports injuries and car accidents, the brachial plexus is particularly vulnerable during childbirth, when it may be harmed if the infant’s head pulls to the side while the shoulders pass through the birth canal, or if there is excessive pressure on the baby’s arms during a knees-first (breech) delivery.

Whether they occur in childbirth or through other circumstances, brachial plexus injuries are often addressed via surgery, which can restore some or all function to the impacted areas. Occasionally, injuries heal on their own, or with minimal physical therapy. Detailed below are the most effective treatments for brachial plexus injuries:

Physical Therapy

Mild brachial plexus injuries can sometimes be addressed without surgery, but physical therapy is recommended for nearly all patients. Physical therapists prescribe a range of exercises to be conducted regularly at home; these may include shoulder shrugs, neck stretches, and isometric exercises designed to build neck strength. Therapeutic taping may be used to correct arm positioning or splints for positioning of the wrist and hand.

Botox

Botulinum toxin (Botox) is a surprisingly effective treatment for brachial plexus injuries, particularly in treating muscle imbalances at the elbow or shoulder. By weakening overly strong muscles, Botox makes it easier for patients to build up weaker muscles through therapy.

Surgical Treatments

A variety of surgical options may be pursued to provide pain relief or restore function, including the following:

• Muscle transfer — In muscle transfer surgeries, a less important muscle (often from the thigh) is removed and transferred to the arm. The surgeon then reconnects blood vessels and nerves.
• Nerve transfer — If the nerve root tears away from the spinal cord, surgeons replace it with a less important nerve. Because nerve tissue grows slowly, it may take patients months, even years to notice the benefits of surgery.
• Nerve graft — Sometimes performed in conjunction with nerve transfers, nerve grafts involve replacing the damaged portion of the brachial plexus with nerves harvested from other regions of the body.

Drug Therapy For Pain Relief

Whether treated through surgery or allowed to heal on their own, brachial plexus injuries can cause intense pain, sometimes described as burning or crushing. This pain is typically eased via neuropathic pain medications, nonsteroidal anti-inflammatory drugs, or narcotic medications. Some patients may have to try multiple types of drug therapy before they find a solution that effectively reduces their pain.