Brachial Plexus Injuries in Adults

About Brachial Plexus Injuries in Adults at Kayakriti

The brachial plexus is a network of nerves that arises from the cervical spine and travels through the neck and armpit to control movement and sensation in the shoulder, arm and hand. Brachial plexus surgery becomes relevant when these nerves are stretched, compressed, torn or avulsed during high-energy trauma, most often road traffic accidents involving young men aged fifteen to twenty-five years.

Patients usually present with sudden weakness or loss of movement in the shoulder, elbow or hand after an accident. Common findings include inability to lift the arm, weak elbow flexion, poor grip or numbness across the limb. Recognising these signs early is essential because nerve injury treatment arm outcomes depend heavily on timely referral to a plastic surgeon experienced in nerve work.

We classify injuries into partial and complete patterns. Upper-type injuries affect C5-C6 with or without C7 and weaken shoulder abduction and elbow flexion. Lower-type injuries involve C8-T1 and impair finger and hand function. Complete (total arm) injuries affect all five roots and produce a flail limb. Knowing the pattern guides arm nerve damage treatment, including the choice of nerve transfer or graft.

If recovery does not begin within three weeks, we recommend specific investigations. Nerve conduction studies and electromyography assess nerve and muscle function. MRI of the cervical spine and brachial plexus identifies root avulsions and pseudomeningoceles. Plain radiographs and CT imaging may be added when associated fractures or vascular injury are suspected, helping us plan nerve repair surgery accurately.

Treatment is staged by time since injury. Within the first year, options include direct nerve repair, nerve grafting or distal nerve transfers that reanimate key muscles. Beyond a year, regenerated nerves often cannot reach distant muscles, so muscle and tendon transfers, free functioning muscle transfer and selective joint procedures become the main tools to restore shoulder, elbow and hand function.

Recovery after brachial plexus surgery is gradual. Patients follow a structured rehabilitation programme with physiotherapy, splinting and electrical stimulation, with reviews every few weeks. Improvement continues over twelve to twenty-four months as nerves regenerate. Our team supports patients throughout this journey with realistic goal-setting, regular progress assessments and timely additional procedures where required.

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