Brachial Plexus Injury

Brachial Plexus Injury

A brachial plexus injury (BPI) occurs when the network of nerves intertwining from the spinal cord to the shoulder and hand (the brachial plexus) gets stretched, compressed or torn from the spinal cord.  The brachial plexus controls the motion of your wrists, hands and arms and enables simple motor functions like lifting of arms, typing on your Keyboard, throwing a ball, etc.

Minor injuries could occur while playing contact games, as a result of inflammatory conditions or during childbirth. Correct diagnosis and early treatment procedures should be followed. About 70% of the injuries are because of road traffic accidents

Types of BPI

There are various ways of segmenting the injury types.

Minor Injuries

Stingers or burners as they are called, minor brachial plexus injuries are usually caused due to contact sports like football, rugby, wrestling, etc.

Symptoms 

  • Burning sensation /shock sensation in the arm
  • Weakness of the arm
  • Discomfort around the shoulder region

Usually lasts for a few seconds or minutes, in rare cases could wane to a month.

Major Injuries

More severe brachial plexus injuries or avulsions are caused when the nerves are ripped away from the spinal cord. 

Symptoms 

  • Inability to move the arm
  • Severe pain
  • Complete loss of sensation in the shoulder, arm and/or the entire extremity

Site of Injury

Upper Plexus Injury:
  • Caused due to an increase in angle between the neck and shoulder.
  • Traction of upper nerve roots
  • Classically called Erb’s Palsy
Lower Plexus Injury:
  • Caused due to upward pull in hands
  • Traction of lower nerve roots
  • Classically called Klumpke’s Paralysis
Leffert’s Classification (Based on the mechanism & level of injury)
  • Open : Usually due to stabbing
  • Closed: usually due to road traffic accidents
  • Supraclavicular
  • Infraclavicular
  • Combined
  • Radiation induced
  • Obstetric
  • Erb’s Palsy
  • Klumpke Palsy
  • Mixed

Causes

The main causes of the BPI are:

  • Contact sports: In football, rugby etc collision between players can lead to fracture of the clavicle and so brachial plexus avulsion can occur.
  • Birth Injury: Also called Erb’spalsy wherein during childbirth, if the weight of the infant is high or the labour is prolonged, it is possible that the child’s shoulder gets wedged in the birth canal causing injury
  • Lugging heavy objects: Children or adults carrying heavy bags or rucksacks on the shoulders for extended time period could cause injury to the brachial plexus
  • Accidents: Road traffic accidents, falls or sometime bullet wounds could result in brachial plexus injuries
  • Industrial trauma: Weight falling on the back, or being pulled into a machine
  • Tumors and cancer treatments: Tumors could grow in the brachial plexus area which would lead to nerve damage. Radiation used as treatment for the cancer, targeted to the brachial plexus could also cause injury.

Treatment of Brachial Plexus Injury

At Plexus, Regenerative Rehabilitation has helped in attaining positive results in Brachial Plexus Injury. The treatment  program comprises of stem cell therapy which comprises of the extraction and administration of the patient’s own stem cells taken from the bone marrow. The regenerative properties of the stem cells help in repairing the damage caused due to traction or tear. The rehabilitation program comprises of a number of therapies and treatment approaches that aim at restoring the lost function.

Regenerative medicine/ Stem cell therapy 

Autologous stem cells are extracted from the patient’s bone marrow and injected back . Know more about stem cells and the procedure here – http://www.plexusnc.com/stem-cell-therapy/

Rehabilitative services 

When patients experience traumatic injury to the nerves in the brachial plexus or other peripheral nerves that serve the hand, arm or shoulder, they often lose function and sensation in some or all of the affected limb. Physiotherapy and Occupational Therapy are the key therapeutic services that aim to restore function in the severed limb.

Specialised Physiotherapy services are provided that focus on improving the strength of the affected muscles, relieve pain, improve tone and sensory awareness of the extremity.

Direct current stimulation, bracing, therapeutic exercise, and biofeedback are used to maximise the use of  upper extremity.

Occupational therapy services comprise of a number of treatment approaches that help to improve functioning of the entire limb. These include Muscle re-education and retraining Therapy, Sensory Re-education Therapy, Mirror Therapy, Hand Function Training, ADL training using Task Oriented approach, Hand Splinting and functional retraining.

Rehabilitation While Monitoring an Injury

For some patients, those with neurapraxia (a nerve that has been stretched, but not disrupted or severed) , the course of treatment involves several months of monitoring and providing rehabilitation services to the patient to maintain the injured limb’s range of motion, prevent unaffected muscles from atrophying and preventing the development of soft tissue contractures.. Movement is also important to help treat edema or swelling in the area, which can contribute to stiffness.

Sometimes the  patient is provided with a custom made orthoses/splint as part of his or her post-injury recovery. For example, if the patient is unable to use the muscles that control the wrist, the joint flexes forward in an abnormal position.  Splinting helps hold the wrist in a neutral position during recovery—thereby protecting it and preventing possible contractures from developing that can  limit movement and restrict functioning.. It is important that the splint is customised according to the patient’s sensory assessment since areas with sensory loss require special care and attention of the treating therapist.

Rehabilitation Following Surgery

Those who undergo a surgical procedure, such as a nerve graft or a nerve transfer to repair their injury, also benefit from our rehabilitation services. Customised therapy programs help to reduce pain, improve functioning and minimise complications arising as a result of prolonged immobilisation and disuse.

Retraining the Brain and Restoring Nerve Connections to the Limb

Retraining the brain to send information along the new nerve pathway is the long-term and ultimate goal for our patients. Due to persistent non use of the extremity and loss of neuronal connections,  the sensory and motor parts of the brain which carry representation of the involved  extremity get affected.

Mirror Therapy

Another treatment technique that helps to establish a connection between the brain and the regenerated nerve fibres is mirror therapy. At Plexus this form of therapy is carried out by knowledgeable and experienced professionals who are experts in the field.

Biofeedback 

Biofeedback is sometimes used to help patients stay motivated and assess their progress. To use the mechanism, an electrode is attached to the skin over the affected muscle. As the muscle contracts, the electrode transmits information to the machine that registers the strength of the contraction. This information is then communicated back to the patient through lights on a bar and with a sound emitted by the machine. As the muscle contractions grow stronger, the lighted bar becomes longer and the beeping sound becomes louder.

Helping Recovering Patients Perform Day-to-Day Activities 

Difficulty in performing daily activities is one of the most challenging aspect of any injury. In brachial plexus Injury, since the arm and the hand functions are impaired or lost, daily life becomes extremely challenging. Our Occupational Therapists who specialise in the field of Hand Rehabilitation help these patients in performing these impossible tasks with greater ease. The patient’s daily life functions are assessed on a scale and patient specific splints and adapted aids are customised to improve engagement of the affected extremity in daily activities. As the patient recovers, slowly he or she is weaned off these aids.

Sensory re-education

As a manifestation of the injury, diminished sensation or complete loss of sensation is  common. Sensory re-education therapy is a therapeutic program using sensory stimulation to help sensory-impaired patients recover functional sensibility in the damaged area and learn adaptive functioning.Sensory  reeducation helps patients with various forms of sensory loss and impairment retrain their sensory pathways, adapt to changed abilities, and regain function.

Hand Splinting

Hand Splinting

Plexus has an in house splinting facility which is one of its kind. Patients with brachial plexus injury are at a high risk of developing contractures which turn into fixed deformities with time. Splints help in preventing and correcting these contractures and also help in improving the functioning of the weak muscles. 

Hand Splinting: Custom made wrist orthosis

Helping Patients Establish Goals

We spend a lot of time with patients helping them establish realistic goals and expectations and encouraging them to remain motivated. Because we have regular follow ups,, we have the opportunity to keep discussing their progress. In the beginning these injuries can be so overwhelming; it can be hard to absorb all the information about recovery at once.

A Long-term Recovery Process

Because nerve regenerates very slowly, patients may not see results for six months or so. Progress continues several months following the procedure. Ongoing progressive rehabilitation aids in enhancing the speed of recovery.

Patients’ Frequently Asked Questions (FAQs)

  • Will my arm start functioning again?
    Yes, recent advances in stem cell therapy can help you restore sensation and motor function in the least possible time.
  • To what extent will I improve following treatment at Plexus?
    The percentage of improvement depends on the extent of initial damage, the period of immobilisation, the post surgical status of the extremity and the presence of any secondary complications. Even though the improvement depends on a number of factors, we have seen great results withRegenerative Rehabilitation.
  • Will my sensation improve?
    Yes, definitely. Normalisation of sensation is attained before motor development takes place in most of our cases with brachial plexus injury. The extremity becomes more tolerant to touch sensation if hypersensitivity persists and areas withdiminished sensation improve in their sensory awareness.
  • Will the stem cell therapy be painful?
    Stem cell therapy is not at all a painful procedure.
  • What is the success rate of this treatment?
    100%. This means that all patients who undergo this treatment improve and the extent of improvement varies from one person to another.
  • What kind of rehabilitation is required? Can I take physiotherapy elsewhere?
    The extent of injury varies from one patient to another and no two patients are alike. So is the treatment program at Plexus. We offer a complete rehabilitation program which is customised according to the patient’s deficits. Our rehabilitation approach varies from one patient to the other and our treatment program is progressive in nature. It is recommended to undergo a systematic form of holistic rehabilitation to get desired results and not physiotherapy alone.
For enquiries related to treatment of Brachial Plexus Injury, send a message to www.plexusnc.com

Glimpses of Brachial Plexus Injury Treatment Program at Plexus