Nerves that have only been stretched have a fair chance of recovering on their own. But 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.
Types of surgery
In many cases, surgeons can take less important nerves from other parts of your body to help restore your arm's function:
- 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 — rather like splicing a bit of new electrical wiring between two sections of old electrical wiring.
- 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 hook it into the nerve that's no longer attached. 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. 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.
Partly because of the risk of muscle atrophy, surgery to repair brachial plexus nerves should ideally occur within three to six months after the injury. The success rate drops greatly if nerve surgery occurs more than a year after the injury.
Muscle transfer — 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 — 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 containing opiates, such as codeine, are typically used immediately after the injury. Antidepressant and anticonvulsant 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.
Feb. 24, 2011
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