Diagnosis

To diagnose your condition, your doctor 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:

  • Electromyography (EMG). During an EMG, your doctor inserts a needle electrode through your skin into various muscles. The test evaluates the electrical activity of your 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 measure the speed of conduction in your 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 powerful magnets and radio waves to produce detailed views of your 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 reconstruction of it. 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 your body. CT myelography adds a contrast material, injected during a spinal tap, to produce a detailed picture of your spinal cord and nerve roots during a CT scan. This test is sometimes performed when MRIs don't provide adequate information.
  • Angiogram. If your doctor suspects that the blood vessels feeding your arm might be injured, he or she might suggest an angiogram — an imaging test where contrast material is injected into an artery or vein to check the condition of your blood vessels. This information is important in planning your surgical procedure.

Treatment

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 six to seven months after the injury. If nerve surgery occurs more than six to seven months after the injury, 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 harvested 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 connect it to the nerve that's no longer attached to the spinal cord.

    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 (2.5 centimeters) a month, 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 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, typically the thigh, transfers it to your arm, and reconnects the nerves and blood vessels supplying the muscle.

Pain control

Pain from the most severe types of brachial plexus injuries has been described as a debilitating, severe crushing sensation or a constant burning. Narcotic medications are often used initially, but may be changed as your recovery progresses to optimize pain relief.

Preparing for your appointment

A number of 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.

This is especially important if your child has a brachial plexus injury. For most babies, the injury heals on its own to the point that surgery is unnecessary, but children who don't show improvement in the first three to six months of life may require surgery. This means parents face some difficult decisions, and it's often helpful to have a friend or family member who can offer advice and support.

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 doctor 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 doctor call you later.