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 doctor may recommend physical therapy to keep your joints and muscles working properly, maintain the range of motion, and prevent stiff joints.
The healing process sometimes forms scar tissue that must be removed surgically to improve the nerve's function. Surgical repair is often required for nerves that have significant surrounding scar tissue or that have been cut or torn.
Surgery to repair brachial plexus nerves should generally occur within three to six months after the injury. The chances of improved function after surgery drop if nerve surgery occurs more than six months after the injury, as the muscles may not recover their function.
Types of surgery
- Nerve graft. In this procedure, the damaged part of the brachial plexus is removed and replaced with sections of nerves cut from other parts of your body. This helps restore your arm's function.
Nerve transfer. When the nerve root has been torn from the spinal cord, surgeons often take a less important nerve that's still attached to the spinal cord and attach it to the nerve that's no longer attached to the spinal cord. Surgeons sometimes may transfer two nerves to attach to two different nerves.
In some cases, surgeons may perform this technique at a level close to the targeted muscle in an effort to speed up recovery rather than doing a repair (nerve graft) farther from the muscle.
Sometimes doctors may perform a combination of nerve graft and nerve transfer.
Nerve tissue grows slowly, about an inch a month, so it can take several years to fully recover after surgery. During the recovery period, you must keep your joints flexible with a program of exercises. Splints may be used to keep your hand from curling inward.
- Muscle transfer. Muscle transfer is a procedure in which your surgeon removes a less important muscle or tendon from another part of your body and transfers it to your arm. This may be necessary if your arm muscles deteriorate.
Pain from the most severe types of brachial plexus injuries has been described as a crushing sensation or a constant burning. Drugs such as codeine sulfate are generally used immediately after the injury. Antidepressant, anticonvulsant and muscle relaxant medications also can be helpful.
Pain control and a device called transcutaneous electrical nerve stimulation (TENS) sometimes provide relief. TENS involves using electrodes attached to your skin to deliver electrical impulses to nearby nerve pathways to help control and relieve pain. In extreme cases, surgery may be necessary.
May. 01, 2014
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- Yang LJ, et al. A systematic review of nerve transfer and nerve repair for the treatment of adult upper brachial plexus injury. Neurosurgery. 2012;71:417.
- Neuropathic pain. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/neurologic_disorders/pain/neuropathic_pain.html?qt=neuropathic%20pain&alt=sh. Accessed Oct. 3, 2013.
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