Frequently Asked Questions About Brachial Plexus Injury

Surgical treatment comes to the agenda in injuries caused by piercing-cutting tools (glass, knife cuts, etc.), in open clavicle fractures if there is weakness in the hand and arm muscles on the affected side, in nerve injuries accompanied by vascular injuries, and in cases where no signs of nerve recovery are detected by clinical examination or EMG 3-6 months after the injury. In these patients, spontaneous healing of the nerve tissue is expected; however, if there is no sign of recovery, surgical methods such as nerve repair, nerve graft, or nerve transfer are used so that the loss of function does not become permanent. The timing of surgery is planned according to the type of injury, the patient's age, muscle strength, and the level of nerve damage. Correct surgical interventions performed in the early period play an important role in regaining arm and hand functions.

This injury, which usually occurs during normal vaginal delivery, is seen more frequently in difficult and prolonged deliveries, breech presentations, and cases where the baby is large. During delivery, the baby's shoulders may become stuck in the pelvis. When one side of the baby's neck is excessively stretched, the nerve bundle forming the brachial plexus may be damaged to varying degrees.

The findings may vary according to the degree of nerve damage. Inability to make a fist with the affected hand, color difference between the arms, one arm being softer than the other, larger babies always grasping objects with the same hand, and inability to bring the hand to the mouth are findings indicating brachial plexus damage.

The nerve bundles forming the brachial plexus are reached through incisions to be made from the neck and/or armpit. Torn nerves are repaired with microsurgical methods. Diseased nerve tissues in which scar tissue has formed are removed and nerve repair is performed. For the repair of nerves injured beyond repair, a neighboring nerve from the nerve bundle forming the brachial plexus or another less-used nerve from another part of the body may be brought to the damaged area. Sometimes, despite the nerve surgery performed, weakness may continue in the patient's shoulder, arm, and hand. The patient may have difficulty bringing the hand above the head, bending the elbow and wrist, and moving the fingers. In such cases, a surgical procedure called tendon transfer may be required. Tendons are structures that connect muscles to bones and move our joints. In a patient with brachial plexus injury, a tendon is detached from where it is attached and connected to another place, and thus the joints that cannot be moved are enabled to move. This surgical method especially enables the recovery of shoulder, elbow, and wrist movements. Since special training is required after tendon transfer, the patient must reach an age where they can cooperate with their doctor.