What happens in a brachial plexus injury?

A brachial plexus injury (BPI) occurs when the network of nerves intertwining from the spinal cord to the shoulder and hand (the brachial plexus) gets stretched, compressed or torn from the spinal cord.  The brachial plexus controls the motion of your wrists, hands and arms and enables simple motor functions like lifting of arms, typing on your Keyboard, throwing a ball, etc.

Minor injuries could occur while playing contact games, as a result of inflammatory conditions or during childbirth. Correct diagnosis and early treatment procedures should be followed. About 70% of the injuries are because of road traffic accidents.

What are the types of BPI?

Minor Injuries

Stingers or burners as they are called, minor brachial plexus injuries are usually caused due to contact sports like football, rugby, wrestling, etc.

Symptoms 

• Burning sensation /shock sensation in the arm
• Weakness of the arm
• Discomfort around the shoulder region

Usually lasts for a few seconds or minutes, in rare cases could wane to a month.

Major Injuries

More severe brachial plexus injuries or avulsions are caused when the nerves are ripped away from the spinal cord. 

Symptoms 

• Inability to move the arm
• Severe pain
• Complete loss of sensation in the shoulder, arm and/or the entire extremity

According to the Site of Injury

Upper Plexus Injury:

• Caused due to an increase in angle between the neck and shoulder.
• Traction of upper nerve roots
• Classically called Erb’s Palsy

Lower Plexus Injury:

• Caused due to upward pull in hands
• Traction of lower nerve roots
• Classically called Klumpke’s Paralysis

What are the major causes of BPI?

• Contact sports: In football, rugby etc collision between players can lead to fracture of the clavicle and so brachial plexus avulsion can occur.
• Birth Injury: Also called Erb’spalsy wherein during childbirth, if the weight of the infant is high or the labour is prolonged, it is possible that the child’s shoulder gets wedged in the birth canal causing injury
• Lugging heavy objects: Children or adults carrying heavy bags or rucksacks on the shoulders for extended time period could cause injury to the brachial plexus
• Accidents: Road traffic accidents, falls or sometime bullet wounds could result in brachial plexus injuries
• Industrial trauma: Weight falling on the back, or being pulled into a machine
• Tumors and cancer treatments: Tumors could grow in the brachial plexus area which would lead to nerve damage. Radiation used as treatment for the cancer, targeted to the brachial plexus could also cause injury.

What does the Plexus program offer?

Intensive Rehabilitative services along with a unique combination of medications and/or nutritive therapies.

Physiotherapy and Occupational Therapy are the key therapeutic services that aim to restore function in the severed limb.

Specialised Physiotherapy services are provided that focus on improving the strength of the affected muscles, relieve pain, improve tone and sensory awareness of the extremity.

Direct current stimulation, bracing, therapeutic exercise, and biofeedback are used to maximise the use of  upper extremity.

Occupational therapy services comprise of a number of treatment approaches that help to improve functioning of the entire limb. These include Muscle re-education and retraining Therapy, Sensory Re-education Therapy, Mirror Therapy, Hand Function Training, ADL training using Task Oriented approach, Hand Splinting and functional retraining.

Mirror Therapy

Another treatment technique that helps to establish a connection between the brain and the regenerated nerve fibres is mirror therapy. At Plexus this form of therapy is carried out by knowledgeable and experienced professionals who are experts in the field.

Biofeedback 

Biofeedback is sometimes used to help patients stay motivated and assess their progress. To use the mechanism, an electrode is attached to the skin over the affected muscle. As the muscle contracts, the electrode transmits information to the machine that registers the strength of the contraction. This information is then communicated back to the patient through lights on a bar and with a sound emitted by the machine. As the muscle contractions grow stronger, the lighted bar becomes longer and the beeping sound becomes louder.

Helping Recovering Patients Perform Day-to-Day Activities 

Difficulty in performing daily activities is one of the most challenging aspect of any injury. In brachial plexus Injury, since the arm and the hand functions are impaired or lost, daily life becomes extremely challenging. Our Occupational Therapists who specialise in the field of Hand Rehabilitation help these patients in performing these impossible tasks with greater ease. The patient’s daily life functions are assessed on a scale and patient specific splints and adapted aids are customised to improve engagement of the affected extremity in daily activities. As the patient recovers, slowly he or she is weaned off these aids.

Sensory re-education

As a manifestation of the injury, diminished sensation or complete loss of sensation is common. Sensory re-education therapy is a therapeutic program using sensory stimulation to help sensory-impaired patients recover functional sensibility in the damaged area and learn adaptive functioning. Sensory reeducation helps patients with various forms of sensory loss and impairment retrain their sensory pathways, adapt to changed abilities, and regain function.

Hand Splinting

Plexus has an in house splinting facility which is one of its kind. Patients with brachial plexus injury are at a high risk of developing contractures which turn into fixed deformities with time. Splints help in preventing and correcting these contractures and also help in improving the functioning of the weak muscles. 

What about the sensation? Will it improve?

Yes, definitely. Normalization of sensation is attained before motor development takes place in most of our cases with brachial plexus injury. The extremity becomes more tolerant to touch sensation if hypersensitivity persists and areas with diminished sensation improve in their sensory awareness.

To what extent will improvement be noticed following treatment at Plexus?

The percentage of improvement depends on the extent of initial damage, the period of immobilization, the post-surgical status of the extremity and the presence of any secondary complications. Following treatment at Plexus, there is a definite improvement in the patients strength and sensory functions though the percentage varies from one person to another.

What kind of rehabilitation is required? Can I take physiotherapy elsewhere?

The extent of injury varies from one patient to another and no two patients are alike. So is the treatment program at Plexus. We offer a complete rehabilitation program which is customised according to the patient’s deficits. Our rehabilitation approach varies from one patient to the other and our treatment program is progressive in nature. It is recommended to undergo a systematic form of holistic rehabilitation to get desired results and not physiotherapy alone.