Brachial plexus surgery is a surgery performed to treat brachial plexus injuries.
The brachial plexus is a network of nerves that originates at the spinal cord near the neck and passes down your upper arm from under your collar bone. It consists of 5 nerve roots:
These nerves join to form the upper, middle and lower trunks of the brachial plexus, which split into nerves that supply your upper limbs, controlling your shoulder, elbow, wrist and hand. An injury to any part of these nerves can stop signals to and from the brain and may partially or completely paralyze your arms. Brachial plexus injuries can occur in both infants during child birth and adults due trauma to the brachial plexus.
The types of brachial plexus injury may include:
Your doctor will first take your medical history, conduct a clinical examination and wherever necessary, order tests to complete the diagnosis of brachial plexus injury.
Imaging tests such as magnetic resonance imaging (MRI) and computerized tomography (CT), using a contrast dye, may be ordered to visualise the nerve damage.
Your doctor may ask for
Minor injuries of the brachial plexus such as neurapraxia may recover on their own without any therapy, but surgery is necessary for treatment of nerve rupture or nerve avulsion.
Your doctor may recommend surgery after 3 months in case of partial paralysis or anytime within 2 months in case of complete paralysis. Delaying the surgery beyond a specified time may increase the risk of muscle atrophy, thus diminishing the chances of recovery.
Several surgical options are available depending on the patient’s condition. The type of brachial plexus surgery will differ for infants and adults. Some of the common techniques followed include:
As with any surgery, there are risks involved. Associated risks of nerve reconstruction surgery may include:
After the surgery you will have to wear a sling for the first few weeks to protect your arm and aid in wound healing. Your doctor may prescribe medications to relieve pain. Physical therapy involving range of motion exercises for the elbow, shoulder and hand may be advised a few weeks later. You also may be instructed to perform strengthening exercises after your arm movements are regained.
Various factors that influence recovery after brachial plexus surgery are:
In case of infants, mild injury to the brachial plexus may resolve within 3 to 6 months, whereas severe injuries may require treatment for over a year and regular follow-ups.
In case of adults, it may take more than a year to achieve complete improvement after surgery. Younger patients recover faster, whereas recovery is slower (and usually incomplete) in patients over 45 to 50 years of age.
The prognosis of brachial plexus surgery in infants is best when treatment is started within 4 weeks of birth. Infants with stretch or neuropraxia injuries and upper brachial plexus injuries generally have a good prognosis.
Adults with injury to the C5 and/or C6 nerves generally experience near complete recovery.
Patients with complete paralysis and injury to the C5, C6 and C7 nerves may experience difficulty in achieving complete recovery to the original extent.
Patients with complete paralysis (C5,6,7,8 and T1) usually cannot expect complete recovery.
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