About brachial plexus palsy
What is brachial plexus palsy?
Brachial plexus palsy, also known as Erb's palsy, is a paralysis or weakness of the arm caused by an injury to one or more nerves that control and supply the muscles of the shoulder and upper extremities (upper brachial plexus). It is more commonly seen in newborns (neonates) and is often the result of a difficult delivery. When it occurs in adults, the cause typically is an injury that has caused stretching, tearing or other trauma to the brachial plexus network. The brachial plexus is the network of nerves that conducts signals from the spine to the shoulder, arm, and hand.
There are four types of brachial plexus injury, avulsion, the most severe type, in which the nerve is ripped from the spine, rupture, in which the nerve is torn but not at the point at which it is attached to the spine; neuroma, in which the nerve is torn and has tried to heal but scar tissue has grown around the site; and neuropraxia (stretch), the most common form of injury, in which the nerve has been damaged but not torn.
What are the symptoms for brachial plexus palsy?
A cross section of spine (on left) shows how nerve roots are connected to the spinal cord. The most severe type of nerve injury is an avulsion (A), where the nerve roots are torn away from the spinal cord. Less severe injuries involve a stretching (B) of the nerve fibers or a rupture (C), where the nerve is torn into two pieces.
Signs and symptoms of a brachial plexus injury can vary greatly, depending on the severity and location of the injury. Usually only one arm is affected.
Minor damage often occurs during contact sports, such as football or wrestling, when the brachial plexus nerves get stretched or compressed. These are called stingers or burners, and can produce the following symptoms:
- A feeling like an electric shock or a Burning sensation shooting down the arm
- Numbness and Weakness in the arm
These symptoms usually last only a few seconds or minutes, but in some people the symptoms may linger for days or longer.
More-severe symptoms result from injuries that seriously hurt or even tear or rupture the nerves. The most serious brachial plexus injury occurs when the nerve root is torn from the spinal cord.
Signs and symptoms of more-severe injuries can include:
- Weakness or inability to use certain muscles in the hand, arm or shoulder
- Complete lack of movement and feeling in the arm, including the shoulder and hand
- Severe pain
What are the causes for brachial plexus palsy?
Damage to the upper nerves that make up the brachial plexus tends to occur when the shoulder is forced down while the neck stretches up and away from the injured shoulder. The lower nerves are more likely to be injured when the arm is forced above the head.
These injuries can occur in several ways, including:
- Contact sports. Many football players experience burners or stingers, which can occur when the nerves in the brachial plexus get stretched beyond their limit during collisions with other players.
- Difficult births. Newborns can sustain brachial plexus injuries. These may be associated with high birth weight, breech presentation or prolonged labor. If an infant's shoulders get wedged within the birth canal, there is an increased risk of a brachial plexus palsy. Most often, the upper nerves are injured, a condition called Erb's palsy.
- Trauma. Several types of trauma — including motor vehicle accidents, motorcycle accidents, falls or bullet wounds — can result in brachial plexus injuries.
- Tumors and cancer treatments. Radiation treatment to the chest or neck may cause tumors to grow in or along the brachial plexus, or put pressure on the brachial plexus or spread to the nerves. Radiation treatment to the chest may cause damage to the brachial plexus.
What are the treatments for brachial plexus palsy?
Treatment depends on several factors, including the severity of the injury, the type of injury, the length of time since the injury and other existing conditions.
Nerves that have only been stretched may recover without further treatment.
Your provider may recommend physical therapy to keep the joints and muscles working properly, maintain range of motion, and prevent stiff joints.
Surgery to repair brachial plexus nerves should generally occur within six months after the injury. Surgeries that occur later than that have lower success rates.
Nerve tissue grows slowly, so it can take several years to know the full benefit of surgery. During the recovery period, you must keep your joints flexible with a program of exercises. Splints may be used to keep the hand from curling inward.
Types of surgery Nerve graft Open pop-up dialog box Close Nerve graft Nerve graft
Nerve tissue can be removed from other parts of the body to replace the damaged portions of the brachial plexus nerves.
Nerve transfer Open pop-up dialog box Close Nerve transfer Nerve transfer
Nerve transfers are particularly helpful in the most serious types of brachial plexus injuries, called avulsions, when the nerve root has been torn out of the spinal cord. They may also be used when surgeons are trying to speed up muscle recovery. Because the nerve reconstruction is often close to the muscle, nerve recovery may be faster and perhaps better than other techniques.
Muscle transfer Open pop-up dialog box Close Muscle transfer Muscle transfer
If the arm muscles have atrophied from lack of use, a muscle transfer may be needed. The most commonly used donor muscle is in the inner thigh. A section of skin and tissue attached to the donor muscle may also be removed. This skin flap can help the surgeons monitor whether the muscle is getting enough blood after it has been transferred to its new location.
- Neurolysis. This procedure consists of freeing up the nerve from scar tissue.
- Nerve graft. In this procedure, the damaged part of the brachial plexus is removed and replaced with sections of nerves taken from other parts of the body. This provides a bridge for new nerve growth over time.
- Nerve transfer. When the nerve root has been torn from the spinal cord, surgeons often take a less important nerve that's still working and connect it to a nerve that's more important but not working. This provides a bypass for new nerve growth.
- Muscle transfer. Muscle transfer is a procedure in which your surgeon removes a less important muscle or tendon from another part of the body, typically the thigh, transfers it to the arm, and reconnects the nerves and blood vessels supplying the muscle.
Pain from the most severe types of brachial plexus injuries has been described as a debilitating, severe crushing sensation or a constant burning. This pain resolves for most people within three years. If medications can't control the pain, your provider might suggest a surgical procedure to interrupt the pain signals coming from the damaged part of the spinal cord.
What are the risk factors for brachial plexus palsy?
Participating in contact sports, particularly football and wrestling, or being involved in high-speed motor-vehicle accidents increases the risk of brachial plexus injury.
Is there a cure/medications for brachial plexus palsy?
In most cases, you can expect the pain of brachial neuritis to lessen after several days or weeks. The muscle weakness should resolve within a few months. As a general rule, the longer the painful period lasts, the longer your overall recovery will take. Some people find that their muscle weakness lasts for a number of years, and a few are left with a permanent, although slight, loss of strength.