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:
- X-ray. An X-ray of your shoulder and neck can tell your doctor if you have fractures or other associated injuries.
- 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 they 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 a powerful magnetic field 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.
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 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 your hand from curling inward.
Types of surgery
- 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 your 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 your body, typically the thigh, transfers it to your 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 doctor might suggest a surgical procedure to interrupt the pain signals coming from the damaged part of the spinal cord.
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.
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.