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Treatments and drugs
By Mayo Clinic staff
Nerves that have only been stretched have a fair chance of recovering on their own. But the healing process sometimes forms scar tissue that must be removed surgically to improve the nerve's function. Surgical repair is often required for nerves that have significant surrounding scar tissue or that have been cut or torn.
Types of surgery
In many cases, surgeons can take less important nerves from other parts of your body to help restore your arm's function:
- Nerve graft. In this procedure, the damaged part of the brachial plexus is removed and replaced with sections of nerves cut from other parts of your body — rather like splicing a bit of new electrical wiring in between two sections of old electrical wiring.
- Nerve transfer. When the nerve root has been torn from the spinal cord, surgeons often take a less important nerve that's still attached to the spinal cord and hook it into the nerve that's no longer attached. In some cases, surgeons may perform this technique at a level close to the targeted muscle in an effort to speed up recovery rather than doing a repair (nerve graft) farther from the muscle. Nerve tissue grows slowly, about an inch a month, so it can take several years to fully recover after 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.
Partly because of the risk of muscle atrophy, surgery to repair brachial plexus nerves should ideally occur within three to six months after the injury. The success rate drops greatly if nerve surgery occurs more than a year after the injury. If your muscles deteriorate, your surgeon may remove a less important muscle or tendon from another part of your body and transfer it to your arm.
Pain control
Pain from the most severe types of brachial plexus injuries has been described as a crushing sensation or a constant burning. Drugs containing opiates, such as codeine, are typically used immediately after the injury. Antidepressant and anticonvulsant medications also can be helpful, and a procedure called transcutaneous electrical nerve stimulation (TENS) sometimes provides relief. TENS involves using electrodes attached to your skin to deliver electrical impulses to nearby nerve pathways to help control and relieve pain. In extreme cases, surgery may be necessary.
- Brachial plexus injury (Erb's palsy). American Society for Surgery of the Hand. http://www.assh.org/Content/NavigationMenu/PatientsPublic/HandConditions/BrachialPlexusInjury/Brachial_Plexus_Inj.htm. Accessed Oct. 24, 2008.
- Burners and stingers. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=226&topcategory=Shoulder. Accessed Oct. 24, 2008.
- NINDS brachial plexus information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/brachial_plexus/brachial_plexus.htm. Accessed Oct. 24, 2008.
- Erb's palsy (brachial plexus birth injury). American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=314&topcategory=Shoulder. Accessed Oct. 24, 2008.
- Shin AY, et al. Adult traumatic brachial plexus injuries. Journal of the American Academy of Orthopaedic Surgeons. 2005;13(6):382-396.
- Uehara DT et al. Injuries to the Shoulder Complex and Humerus. In: Tintinalli JE et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 6th ed. Chapel Hill, N.C.: The McGraw-Hill Companies; 2004. http://www.accessmedicine.com/content.aspx?aID=612543&searchStr=injury+of+brachial+plexus. Accessed Nov. 11, 2008.
- McMahon PJ et al. Sports Medicine: Shoulder Neurovascular Injury. In: Skinner HB. Current Diagnosis & Treatment in Orthopedics. 4th ed. Irvine, Calif.: The McGraw-Hill Companies; 2006. http://www.accessmedicine.com/content.aspx?aID=2319261&searchStr=injury+of+brachial+plexus. Accessed Nov. 11, 2008.
