Brachial Plexus Disorders
Shoulder pain originating with nerve entrapments
Understanding Brachial Plexus Injuries
The nerves that supply the skin and muscles of the shoulder, arm, and hand emerge from the spine and form the brachial plexus. This complex collection of nerves is arrayed between the spine and the shoulder joint. Along the way, it is subject to various types of injuries and entrapments.
Among the milder injuries causing pain and weakness is a group of conditions collectively called Thoracic Outlet Syndrome (TOS) — these involve entrapment or irritation of the nerves. More severe trauma can injure the nerves, stretch them severely, or even break or tear them. The most common causes of severe injuries to the brachial plexus are motor vehicle injuries – particularly motorcycle injuries – and severe blows to the shoulder.
When the brachial plexus is injured so severely as to cause a paralysis of the arm, it is important for the physician to try to determine whether the problem will resolve on its own or whether it will require surgery to repair or reconstruct the nerves. Often, MR Neurography can provide definitive information about the precise location and severity of the injury.
In general, in the case of complete paralysis requiring surgical nerve repair, the surgery should be undertaken within six months of the date of the injury.
Types of Brachial Plexus Injuries
Brachial plexus injuries can range from mild stretching to complete nerve tears. Birth injuries can occur when an infant's shoulder becomes caught in the birth canal during a difficult delivery. Adult injuries commonly result from motorcycle accidents, severe falls, or direct trauma to the shoulder region.
Symptoms may include weakness or paralysis of the arm, loss of sensation, and severe pain radiating from the shoulder down the arm. The specific symptoms depend on which nerves in the plexus are affected and the severity of the injury.
Diagnosis and Evaluation
Accurate diagnosis of brachial plexus injuries requires a thorough neurological examination combined with advanced imaging. MR Neurography provides detailed visualization of the nerve structures, allowing physicians to determine the exact location and extent of the injury.
This information is critical for determining whether the injury will heal on its own or requires surgical intervention. Early and accurate diagnosis significantly improves treatment outcomes and helps prevent permanent disability.
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