Shoulder Injuries from Car Accidents
The human body is very intricate. The body is a symphony of signals and communication between these distinct sections, with hundreds of muscles, thousands of tendons, and billions of neurons. Each component of the body must operate perfectly for the body to function effectively. This implies that even the tiniest disturbance in communication between these components might cause the body to malfunction.
This is exhibited when the body is exposed to a stressful incident that disrupts the connection between our bodily components. During a vehicle collision or a fall, the force imparted to the human body is sure to harm at least one of the billions of body components. Damage to the brachial plexus is one of the most prevalent but underdiagnosed injuries that arise from a traumatic incident. These injuries to the neck and shoulders may be fairly severe.
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What is the brachial plexus, and what does it do?
The brachial plexus is a network of nerves that links the nerves in the arm and arises from nerve roots in the cervical (neck) and upper trunk (torso) regions of the spinal cord (C5-T1). The actions of your wrists, hands, and arms are controlled by these nerves, enabling you to lift your arm, write on a computer, or throw a baseball.
The brachial plexus nerves are sensory and extend to the skin. For example, they may inform you that the pan you just took is too hot to handle.
Anatomy of the Brachial Plexus
The brachial plexus nerves branch and merge via the shoulder and down the arm from the roots and are divided into many sections: Trunks, divisions, cables, and branches are all examples of tree parts. These portions are not functionally distinct. However, they do assist in explaining the brachial plexus’ complicated structure.
Five primary nerve branches go down the arm from the brachial plexus:
Musculocutaneous nerve: This nerve originates from the C5-C7 nerve roots and flexes muscles in the upper arm at the shoulder and elbow.
Axillary nerve: Derived from C5 and C6 nerve roots, it aids shoulder rotation and allows the arm to raise away from the body.
Median nerve: This nerve originates in the C6-T1 nerve roots and allows mobility in the forearm and portions of the hand.
Radial nerve: This nerve originates in the C5-T1 nerve roots and regulates muscles in the upper arm, elbow, forearm, and hand.
Ulnar nerve: The ulnar nerve, rooted in C8-T1, is responsible for fine motor control of the fingers.
What is a brachial plexus injury, and how does it happen?
The brachial plexus may be harmed in various ways, including pressure, tension, and overstretching. Cancer or radiation therapy may potentially cause the nerves to be severed or damaged. Brachial plexus injuries may occur in newborns during delivery.
Brachial plexus injuries disrupt the connection between the spinal cord and the arm, wrist, and hand completely or partially. Brachial plexus injuries often result in a complete loss of feeling in the affected region. This might prevent you from using your arm or hand.
The severity of a brachial plexus injury depends on which section of the nerve is affected and how severe the injury is. Some people’s function and sensation recover to normal, while others may have lifetime problems due to their inability to use or feel a portion of their arm.
Injuries to the Brachial Plexus
The degree of the injury and how the nerves are affected are used to classify brachial plexus injuries.
Plexus Brachii Neuropraxia (Stretch) is a condition in which the nerves are stretched to the point of damage. Compression and traction are the two major causes of this damage. The brachial plexus nerve root is squeezed in a compression injury, commonly caused by head rotation. The most prevalent kind is compression neuropraxia, which affects mostly elderly adults.
Traction neuropraxia is a condition in which the nerve is dragged downward. This damage is less prevalent than compression neuropraxia, although it affects teenagers and young adults more often.
Depending on whether the major symptom is a burning or stinging sensation, these injuries are referred to as brachial plexus “burners” or “stingers.” They may also make you feel like you’re getting an electric shock.
Rupture of the Brachial Plexus
In a brachial plexus rupture, a severe strain causes the nerve to rip, either partly or fully. Unlike neuropraxia, this is more devastating damage. Ruptures may cause weakness in the shoulder,
arm, or hand, as well as the inability to utilize particular muscles. These injuries may also cause excruciating agony.
These injuries may typically be healed with surgery, depending on the degree and location of the rupture.
Neuroma of the Brachial Plexus
Scar tissue may occur when nerve tissue is harmed, such as a cut during surgery, as the nerve tries to heal itself. A neuroma is a kind of scar tissue that may cause a painful knot on a brachial plexus nerves.
Surgical excision of the damaged nerve tissue is used to treat brachial plexus neuromas. The surgeon either plugs the nerve or connects it to another nerve to prevent another neuroma from growing.
Neuritis of the Brachial Nerve
Brachial neuritis, often known as Parsonage-Turner syndrome, is a rare, degenerative illness affecting the brachial plexus nerves. This condition begins with significant shoulder and upper arm discomfort and develops to weakening, muscle atrophy, and even sensory loss. The shoulder and arm are the most often affected areas. However, the legs and diaphragm may also be affected. Brachial neuritis has no established etiology. However, it might be linked to an immunological reaction produced by infections, injury, childbirth, or other events.
Avulsion of the Brachial Plexus
When the nerve’s root is entirely removed from the spinal cord, it is called a brachial plexus avulsion. Trauma, such as a car or motorbike collision, is the most common cause of this injury. Avulsions, which are more severe than ruptures, can produce excruciating agony. Avulsions may cause lifelong weakness, paralysis, and loss of sensation since reattaching the root to the spinal cord is difficult, if not impossible.
Brachial Plexus Injuries: What Causes Them?
Birth Injury to the Brachial Plexus (Obstetric Brachial Plexus Injury)
During birth, the brachial plexus nerves in the shoulder of newborns are susceptible. Brachial plexus injury is quite frequent during childbirth, occurring in one to two out of every 1,000 deliveries. Larger newborns, as well as babies born to moms with diabetes, are more vulnerable to this damage after difficult vaginal births.
Large newborns are more likely to have brachial plexus injuries after labor. The underlying brachial plexus nerves might be harmed when the baby’s head is extended away from the shoulder. Brachial plexus injuries may also occur in babies born in the breech position (the bottom end comes out first) or in those whose labor lasts an abnormally long duration. Shoulder dystocia occurs when the shoulder becomes trapped beneath the pubis during birth, causing damage to the brachial plexus.
The damage to the brachial plexus at birth usually takes one of two forms:
Erb’s palsy: an upper brachial plexus nerve lesion that causes numbness and loss of mobility around the shoulder, as well as the inability to bend the elbow, elevate an arm, or bring things to the mouth.
Klumpke’s palsy: less common damage to the lower brachial plexus that results in loss of mobility and/or feeling in the wrist and hand, including the inability to move fingers.
These injuries might be of varying degrees of severity. Some infants with brachial plexus birth injuries heal independently, but most children will need physical and occupational therapy to restore all or most of their full function. To attain excellent function, a smaller group will need surgical intervention. Early detection and treatment may help to enhance long-term outcomes.
Adult Brachial Plexus Injuries and Their Causes
Brachial plexus injuries may occur in adults for a variety of reasons, including:
Violent trauma, such as falls or car accidents.
Athletic injuries, particularly in contact sports such as football.
Gunshot wounds: a bullet pierces or comes near to piercing the nerves.
Medical trauma: a nerve is severed during surgery or is injured by injection or the body’s placement during operation.
Cancer: the brachial plexus is invaded by a tumor.
Radiation therapy: The nerves in the region are damaged by radiation therapy. Symptoms of a Brachial Plexus Injury
The severity of the injuries and where they occur along the length of the brachial plexus determine the symptoms—nerve injuries in the neck, which originate higher up on the spinal cord, damage the shoulder. The arm, wrist, and hand are impacted if nerves that originate lower in the brachial plexus are damaged.
Numbness or lack of sensation in the hand or arm are common signs of brachial plexus injuries.
Loss of control or movement of the shoulder, arm, wrist, or hand.
A languidly dangling arm.
Pain in the shoulder or arm that is burning, stinging, or acute and abrupt.
Depending on the kind and amount of the damage, brachial plexus injury pain may range from moderate to severe and from transient to chronic. A simple stretched nerve, for example, may ache for a week or two, but a burst nerve may cause significant, long-term pain that may need physical therapy and even surgery.
What are the signs and symptoms of a brachial plexus injury?
To diagnose a brachial plexus injury, a health care professional will examine the hand and arm and test for sensation and function.
These are some of the most common diagnostic tests.
An X-ray of the neck and shoulder to look for fractures or other injuries in the bone and thick tissues around the brachial plexus nerves.
Imaging studies, such as an MRI or a CT scan, give a contrast dye to demonstrate the damage to the brachial plexus nerves.
Nerve conduction studies and electromyograms, which employ needle electrodes to measure nerve function and electrical activity.
Your doctor may repeat these tests every few weeks or months to keep track of your improvement.
Treatment for Brachial Plexus Injuries
Is it possible for a brachial plexus injury to heal on its own?
Brachial plexus injuries may not usually need medical attention. Some individuals, especially newborns born with brachial plexus birth damage or adults with neuropraxia, recover without therapy. However, the injury might take weeks or months to heal.
While some activities might aid in healing and function, more serious injuries may need surgery. Any suspected brachial plexus injury should be examined by a health care practitioner as soon as possible.
Brachial Plexus Injuries: Nonsurgical Treatment
A mix of nonsurgical treatment approaches works effectively for mild brachial plexus injuries. One or more of the following treatments may be suggested by your doctor:
Physical therapy to learn exercises that may aid in the restoration of function in the arms and hands, as well as improve range of motion and flexibility in tight muscles and joints.
Pain management using corticosteroid creams or injections; assistive equipment such as braces, splints, and compression sleeves.
Occupational therapy in situations with significant muscular weakness, numbness, or discomfort to focus on practical activities like dressing and cooking.
Brachial Plexus Injuries and Surgical Treatment
If a brachial plexus injury does not heal on its own, surgery may be required to correct the damage. Because nerve tissue develops and repairs slowly, the consequences of brachial plexus surgery might take months to years to show.
For the greatest chance of healing, brachial plexus surgery should be performed within six months following the injury. The following procedures may be suggested by your surgeon:
Nerve repair entails reattaching a torn nerve.
Neurolysis is the process of eliminating scar tissue from a damaged nerve to enhance function.
Nerve graft: connecting two ends of a split nerve with a healthy nerve from another body region to guide the healing process.
Nerve transfer: joining a less significant but still functioning nerve to a damaged nerve provides a foundation for future development.
Tendon and muscle transfers: restoring function by shifting a less significant tendon or muscle from one body region to the arm.
Your doctor can advise you on whether or not you are a suitable candidate for surgery. What Causes a Brachial Plexus Injury?
A brachial plexus injury occurs when these nerves are stretched, squeezed, pulled apart, or torn away from the spinal cord in the most severe instances. Falls, motor vehicle accidents, and, most often, motorbike accidents may result in a brachial plexus injury. Brachial plexus injuries are common during childbirth as well.
The way the arm and neck are impacted during the traumatic event frequently determines how damaged the brachial plexus. The injury is frequently caused by one of two things: (1) a forced widening of the angle between the shoulder and the neck, or (2) a forced widening of the angle between the arm and the chest wall.
When a fall causes the shoulder to drop as the head is pulled in the opposite direction, the angle between the shoulder and the neck is forcefully expanded. This is typical in vehicle accidents when the force of the crash pushes the head to one side, and the shoulder is pulled in the other way by the seatbelt. If the infant’s head and neck are dragged to the side at the same time the shoulders pass through the birth canal, exerting pressure on the shoulders in the opposite direction, a brachial plexus injury may develop.
There are a variety of conditions in which the angle between the arm and the chest wall is forced to broaden. This happens most often when someone falls on their side with their arm stretched over their head. The force of the hit effectively tears the nerves, causing significant brachial plexus injury. The infant’s arm may be stretched over their head, or their shoulder may be stuck under the pelvis during delivery; this tugging on the arm, along with pressure on the chest wall, is enough to stretch these nerves and cause lifelong injury.
Brachial Plexus Injury Symptoms
Depending on the nature and location of the damage, the symptoms of a brachial plexus injury vary. The following are the most typical symptoms: • weakness or numbness • loss of feeling
loss of mobility • discomfort in the affected region.
Furthermore, pain from a brachial plexus injury is often characterized as a burning feeling or if pins and needles are being pressed on the skin.
Brachial Plexus Injury Diagnosis
Because of the wide range of brachial plexus injuries, appropriate care requires a thorough and complete knowledge of the nature of each patient’s damage.
A brachial plexus injury is diagnosed using various methods, including clinical examination, electrodiagnostic investigations, and imaging techniques such as CT or MRI. Because of the brachial plexus’s intricacy and the many sections of the body it impacts, injuries are often misdiagnosed. It is typical for injuries to be ascribed to a specific muscle or tendon controlled by the brachial plexus rather than the base of the issue, which is the brachial plexus.