A team of Duke experts collaborates to care for adults with brachial plexus injuries -- damaged nerves in the shoulder, arm, and hand. We offer the full range of treatment options, from highly specialized physical and occupational therapy to the most advanced approaches in neurosurgery, plastic surgery, and orthopaedic surgery. We advocate for early assessment and treatment to help you avoid chronic pain and restore sensory and motor function.
The brachial plexus is a network of peripheral nerves that transmit signals among your brain, spinal cord, arm, and hand. Signals travel from the spinal cord to stimulate muscle movement, while signals travel from the arm to the spinal cord and brain to relay sensory information.
There are several types of brachial plexus injuries:
The most common cause of brachial plexus injuries is trauma from things like high-speed impacts, athletic injuries, knife and gunshot wounds, or vehicle accidents. Tumors, radiation, and surgery can also damage the brachial plexus.
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Your doctors will perform a thorough physical exam to assess your motor function, sensory deficits, and areas of pain. They may also recommend one or more of the following tests:
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.
CT, MRI, X-ray and/or ultrasound scans can show brachial plexus injuries and related problems 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 may heal with conservative treatment. More complex injuries that involved greater nerve damage may need surgery.
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 as well as maintaining good mental health, 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 and reduce pain:
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.
Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our orthopaedics, neurology, and neurosurgery programs are nationally ranked and are the highest-ranked programs in North Carolina, according to U.S. News & World Report for 2025–2026.
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, plastic surgeons, and orthopaedic surgeons are fellowship-trained in peripheral nerve surgery. We also collaborate with specialized neurologists, physiatrists, and pain psychologists who are highly experienced in diagnosing and treating these injuries and creating comprehensive care plans within our specially designed nerve health program.
Many of our providers participate in peripheral nerve organizations and attend national conferences to learn about the latest advances in the field and present research. Our researchers are always working to better understand brachial plexus injuries and find new and better ways to treat them.
