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Brachial plexus is a network of nerves that conducts signals or movement from the spinal cord to the arm and hand. A Brachial plexus injury is a nerve injury – an avulsion, rupture, neuroma or praxis to these nerves. Acute brachial plexus neuritis is an uncommon disorder of unknown etiology that is easily confused with other neck and upper extremity abnormalities, such as cervical spondylosis and cervical radiculopathy.1-3 Patients with acute brachial plexus neuritis present with a characteristic pattern of acute or subacute onset of pain followed by profound weakness of the upper arm and amyotrophic changes affecting the shoulder girdle and upper extremity.

The prognosis for a brachial plexus injury is dependent on the severity of the injury. Patients with stretch injuries have the best potential for recovery of normal arm and hand function. When the nerve is cut or severely torn, recovery is poor, although surgery may improve the outcome. Recovery in Parsonage-Turner syndrome depends on how severely inflammation has damaged the nerve.

Physical or occupational therapy exercises. Surgery plus therapy exercises. Most children will regain full use of their motor function through therapy alone. For those children who do not regain their motor function by 3-6 months of age, nerve surgery can be an effective treatment to improve arm function following a brachial plexus injury.

The goal of treatment is to enable the patient to return to sport or activity as soon as possible while not worsening the injury, which could lead to permanent damage. Return to activity will be determined by how quickly the nerves recover. A patient should be able to have full range of motion in the neck, including being able to turn the head fully to look over both shoulders, and extend the head backward, forward and side to side as far as possible. If any of these actions causes burning in the neck or shoulder, the patient should not return to contact sports. In general, the longer the patient has symptoms before treatment is started, the longer it will take to make a full recovery.

An elbow conformer splint can also be used for a soft tissue contracture caused by the elbow flexors overpowering extensors. It is also beneficial to maintains the arm in extension for active reaching to strengthen deltoid or in weight bearing activities when the triceps are weak.

Infants with mild injuries who do not heal by 3 to 4 months of age, or those with more severe injuries (such as avulsions or ruptures), need surgery to improve or correct nerve function. This surgery is best performed by a highly skilled, experienced team and ideally should occur within three to six months after birth. After children turn 1 year old, nerve surgery may not be as successful.

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Surgery may be indicated if the patient doesn’t recover adequate function within several months. Surgery on the nerves, if required, should ideally occur within three to six months and not later than one year after the injury. When evaluation is delayed beyond six to nine months, treatment options are fewer and more limited, although evaluation and treatment will likely still be of value.



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