Brachial Plexus Injury

What Is the Brachial Plexus?

The brachial plexus is a network of peripheral nerves that run from your spinal cord down to your hand. 

Your doctor will perform a thorough physical exam to assess your function and pain. They may also recommend one or more of the following tests.

Electromyography (EMG) and Nerve Conduction Studies
Neurologists use electrodes -- either surface electrodes placed on the skin or needle electrodes inserted into a muscle -- to stimulate nerves and record electrical activity in the muscle.

Imaging Scans
CT, MRI, X-ray and/or ultrasound scans can show the brachial plexus injury in detail, as well as surrounding bone or soft-tissue injuries and scar tissue.

Your doctors will consider many factors -- including your injury type, severity, symptoms, and time since the injury occurred -- to create a customized treatment plan to meet your needs. Less severe brachial plexus injuries can heal with conservative treatment. Others may need surgery.

Non-Surgical Treatments

• Physical therapy and occupational therapy: Research shows that people with brachial plexus injuries who start physical and occupational therapy early have better overall outcomes whether or not surgery is needed. Our highly specialized outpatient rehabilitation program helps you preserve function in your arm and hand and prevent complications like contractures (when tendons shorten from lack of use) and joint stiffness.
• Pain management: Medications, creams, and injections can reduce pain.  

Surgical Treatments
Depending on the type of injury, surgery to repair brachial plexus injuries is most effective when it occurs within six to 12 months of the initial injury. After surgery, physical and occupational therapy are vital to maximizing function and re-training the brain to use new nerve or muscle tissue. These are the main types of surgery that restore function:

• Muscle transfer: During this technique, also called free functioning muscle transfer, surgeons identify a working muscle in another area of your body and move it to the location in your arm that is not working to restore a specific function (for example, bending the elbow).
• Neurolysis: Surgeons loosen and remove scar tissue around the damaged nerve to restore function.
• Nerve graft: Surgeons remove a small section of a damaged nerve and replace it with a section of nerve harvested from another part of your body, usually the leg, or from a cadaver.
• Nerve transfer: Surgeons move a portion of a damaged nerve that is close to the weak or paralyzed muscle and connect it with a functioning nerve.

Dorsal Root Entry Zone (DREZ) Lesioning
DREZ lesioning is a surgical procedure that reduces pain in the shoulder, arm, and hand due to brachial plexus avulsions. The DREZ procedure was pioneered at Duke, and we are the only center in North Carolina, and one of the few in the U.S., offering this advanced treatment option. 

Expert Team Approach to Care
From diagnosis through surgery and beyond, every step of your care is managed by highly trained peripheral nerve experts who help you maximize your shoulder, arm, and hand function. Our occupational therapist is specifically board-certified in hand therapy, and our neurosurgeons and orthopaedic surgeons are fellowship-trained in peripheral nerve surgery. We also collaborate with plastic surgeons who specialize in reconstructive microsurgery and neurologists who are highly experienced in administering nerve conduction studies.

Brachial Plexus Thought Leaders and Researchers
Many of our providers participate in peripheral nerve organizations and attend national conferences to stay up to date on the latest advances in the field. We take part in clinical research to better understand brachial plexus injuries and find new and better ways to treat them.