To diagnose your condition, your provider will review your symptoms and conduct a physical examination. To help diagnose the extent and severity of a brachial plexus injury, you may have one or more of the following tests:
- X-ray. An X-ray of the shoulder and neck can tell the provider if you have fractures or other associated injuries.
- Electromyography (EMG). During an EMG, your provider inserts a needle electrode through the skin into various muscles. The test evaluates the electrical activity of the muscles when they contract and when they're at rest. You may feel a little pain when the electrodes are inserted, but most people can complete the test without much discomfort.
- Nerve conduction studies. These tests are usually performed as part of the EMG, and they measure the speed of conduction in the nerve when a small current passes through the nerve. This provides information about how well the nerve is functioning.
- Magnetic resonance imaging (MRI). This test uses a powerful magnetic field and radio waves to produce detailed views of the body in multiple planes. It often can show the extent of the damage caused by a brachial plexus injury and can help assess the status of arteries that are important for the limb or for its reconstruction. New methods of high-resolution MRI, known as magnetic resonance neurography, may be used.
- Computerized tomography (CT) myelography. Computerized tomography uses a series of X-rays to obtain cross-sectional images of the body. CT myelography adds a contrast material, injected during a spinal tap, to produce a detailed picture of the spinal cord and nerve roots during a CT scan. This test is sometimes performed when MRIs don't provide adequate information.
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 tissue can be removed from other parts of the body to replace the damaged portions of the brachial plexus nerves.
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.
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.
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.
Preparing for your appointment
Several tests may be used to help diagnose the type and severity of brachial plexus injuries. When you make your appointment, be sure to ask whether you need to prepare for these tests. For instance, you may need to stop taking certain medications for a few days or avoid using lotions the day of the test.
If possible, take along a family member or friend. Sometimes it can be difficult to absorb all the information you're given during an appointment. Someone who accompanies you may remember something that you forgot or missed.
Other suggestions for getting the most from your appointment include:
- Write down all your symptoms, including how you were injured, how long you've had your symptoms and whether they've gotten worse over time.
- Make a list of all medications, vitamins and supplements that you're taking.
- Don't hesitate to ask questions. Children and adults with brachial plexus injuries have several options for restoring lost function. Be sure to ask your provider about all the possibilities available to you or your child. If you run out of time, ask to speak with a nurse or have your provider call you later.