In brachial plexus injuries, the term avulsion is used to describe a condition where the roots of the nerves are torn away from the spinal cord. Multiple root avulsion is the most common diagnosis in high-energy, traumatic brachial plexus injuries, such as occur in a motorcycle or off-road vehicle accident.
Injury to the axillary nerve—and resulting paralysis of the deltoid muscle—usually results from shoulder trauma such as dislocation and/or fracture. Motor vehicle accidents, a fall from a height, or a sports injury from skiing, snowboarding, football or rugby are among the common causes. However, axillary nerve palsy may also result from conditions including brachial neuritis and quadrilateral space syndrome.
The term birth palsy (or paralysis) refers to injuries to the brachial plexus incurred as the baby emerges from the birth canal. In such instances, the baby’s shoulder is stuck against the mother’s pubic bone during delivery (a condition also referred to as shoulder dystocia), as the head emerges in the other direction, resulting in a traction injury. Infants may have either partial birth palsy, in which only the upper or the lower roots are damaged, or complete birth palsy or avulsion of all the nerve roots. Erb’s palsy is the diagnosis given when the upper roots, usually C5-C6, are affected; Klumpke’s palsy, describes the condition in which the lower roots—C8, T1—are affected. Erb’s palsy is the more commonly seen injury. The inability of the infant to bend his or her elbow is a hallmark of a birth palsy. Nonsurgical treatment may be sufficient if the injury involves a stretched but not disrupted nerve, usually referred to as a neurapraxia. When surgical intervention is necessary, good outcomes can be achieved in appropriately screened patients.
Note: Both Erb’s palsy and Klumpke’s palsy may occur in adults. Erb’s palsy is more likely to result from a motor vehicle injury, such as a motorcycle accident, and Klumpke’s palsy from an injury incurred while hanging on to an object with the body weight suspended from the limb.
The brachial plexus refers to a complex web of large nerves that exit from the spinal cord in the neck and direct the movement and sensation of the entire upper limb. Traumatic brachial plexus injuries, which are most commonly sustained in high-speed motor vehicle accidents or while engaged in sporting events, affect the sensibility and muscle power in part of or the entire limb. Approximately 15% of brachial plexus injuries have an injury to the blood supply of the arm as well, and emergency surgery may be indicated.
Patients with injuries to the brachial plexus or other major nerve injuries near the neck or shoulder may have complete or partial loss of function in the arm, with or without sensation. Complete loss of function may also be called flail arm, arm palsy or arm paralysis. Neuropathic or nerve pain is also a sign of serious injury, as is muscle weakness, which is the result of an interruption of electrical signals from nerve to muscle. Treatment of these injuries by many different specialists addresses both the underlying condition and associated pain.
This form of brachial plexus injury involves disruption of nerves at the C8 and T1 levels. It is characterized by a drooping eyelid (ptosis), decreased pupil size (myosis), and dryness of the eye (anhidrosis). A drooping eye is often a sign of an avulsion, a complete tear of the nerve from its attachment at the spinal cord.
Patients with double crush syndrome have injuries or compression in two separate areas. The most common area is a pinched nerve in the cervical spine as a result of arthritis and disc disease. The other area involves carpal tunnel syndrome, increased pressure on the median nerve of the wrist, or cubital tunnel syndrome, pressure on the ulnar nerve at the elbow. Treatment may be administered in stages, addressing the more significant compression first.
A common neck injury in football involves compression or stretching of a nerve root. Referred to as “burners” or “stingers,” they make up approximately 10 percent of all cervical spine neurologic injuries, and two-thirds of all college football players experience at least one of these injuries. These injuries occur from either a pinching (compression) of the nerve on the same side where the neck is flexed/extended or a stretching of the nerve on the opposite side where the neck is flexed/extended.
Those affected may experience sharp, burning pain that may radiate into the shoulder and down the arm to the hand. The symptoms only occur on one side and may include weakness and paresthesia (numbness or tingling) in the involved extremity for several seconds to several minutes. Raising the arm (deltoid), flexing the elbow (bicep), and rotating the arm outwards (using the external rotator muscles of the rotator cuff) may be restricted as a result of motor weakness.
Neck injuries are a particular concern in contact sports such as football, and they require special attention because of the devastating consequences if such injuries are severe. Cervical nerve root and spinal cord injuries are among the most common cervical spine neurologic (nerve) injuries.
Nerve lacerations—cuts or wounds caused by any sharp material, such as glass or metal—accompanied by any difficulty in movement or in sensation, are serious injuries and should be treated immediately. Treatment options vary, depending upon the severity and degree of laceration (partial or complete).
Compression or stretching of a nerve root or the brachial plexus can cause a sharp, burning pain that may radiate into the shoulder and down the arm to the hand. The symptoms only occur on one side and may include weakness and paresthesia (numbness or tingling) in the involved extremity for several seconds to several minutes. Raising the arm (deltoid), flexing the elbow (bicep), and rotating the arm outwards (using the external rotator muscles of the rotator cuff) may be restricted as a result of motor weakness.
Nerves are composed of three layers of protective covering and the nerve fibers or axons inside the nerve that deliver sensory and motor messages between the brain and muscle. Tumors may develop in any portion of the nerve. Removal of a tumor that involves the axons may disrupt nerve function and result in the need for a treatment such as nerve transfer or nerve graft. However, removal of benign nerve tumors of the sheath, such as Schwannomas, will not affect nerve function. Malignant nerve tumors rarely occur.
A condition in which scar tissue has grown around a disrupted nerve.
A stretched nerve.
Parsonage-Turner Syndrome (PTS), also referred to as idiopathic brachial plexopathy or neuralgic amyotrophy, is a rare disorder consisting of a complex constellation of symptoms with abrupt onset of pain in the shoulder, which is followed by progressive neurologic increasing of motor weakness, a reduced sense of touch, and numbness. Although the cause of the condition is unclear, it has been reported in various clinical situations, including following surgery, following treatment for infections, after an accident or trauma, or after receiving a vaccination. The identification of the syndrome in the postoperative patient remains a challenge as symptoms may easily be attributed to secondary consequence of surgery, recovery, or the anesthetic used for the surgery to block pain. Early recognition and treatment can have improved outcomes for patients.
Thoracic outlet syndrome (TOS) is a syndrome that can cause any combination of pain, weakness, numbness, tingling, a cold sensation or, sometimes, a more general type of discomfort in one or both upper limbs. This can be the result of compression of the vascular structures (arteries and/or veins), neurological structures (nerves between the shoulder and neck, known as the brachial plexus), or involvement of both the vascular and neurological structures. Learn more about TOS.
As the name suggests, winged scapula is a rare condition in which the shoulder blade juts out in a “wing-like” way from the back causing upper extremity limitations in lifting, pulling, and pushing. The condition results from an injury to the long thoracic nerve, which innervates (supplies nerves stimulus to) the serratus anterior muscle. Once this connection is disrupted, the joint becomes unstable and the scapula “pops” out of place. While usually caused by trauma, including brachial plexus injury, winged scapula may occur as the result of an isolated sports injury or a lymph node biopsy. Some patients with winged scapula are still able to use the arm on the affected side, but prompt treatment is recommended, even in instances when the condition is not caused by traumatic injury. An unstable shoulder may result in other conditions such as bursitis and chronic pain, and difficulty raising the shoulder.