A brachial plexus injury (BPI) involves damage to the intricate network of nerves that originates in the spinal cord and extends through the neck into the arm. This nerve bundle, spanning the C5 to T1 vertebrae, controls all movement and sensation in the shoulder, arm, and hand. Because a BPI disrupts the communication pathway between the brain and the limb, it can result in significant weakness, numbness, or even paralysis. Due to the complex anatomy and varied severity of injuries—from mild stretching to complete nerve avulsions—effective treatment demands highly specialized, coordinated medical expertise focused on peripheral nerve injuries.
Initial Steps in Diagnosis
The diagnostic journey for a brachial plexus injury often begins in the emergency room or with a primary care physician, but specialized doctors quickly take over. A neurologist or a physiatrist, specializing in physical medicine and rehabilitation, is often the first specialist to conduct a detailed assessment. These physicians use electrodiagnostic tests to precisely locate and measure the extent of the nerve damage.
Electromyography (EMG) and Nerve Conduction Studies (NCS) are primary tools, measuring the electrical activity in the muscles and the speed of signal transmission along the nerves. These tests distinguish between a nerve that is merely stunned and one that is completely torn, directly informing the treatment plan. Imaging studies, including magnetic resonance imaging (MRI), are also performed to provide a detailed view of the soft tissues, nerves, and surrounding blood vessels.
In more severe cases, CT myelography may be necessary. This specialized test involves injecting a contrast dye into the spinal canal to visualize whether the nerve roots have been pulled completely away from the spinal cord, known as an avulsion injury. The data gathered from these diagnostic steps is used by the surgical team to determine if and where a nerve can be repaired.
Surgical Experts for Nerve Repair
When a brachial plexus injury requires surgical intervention, a highly specialized group of surgeons must be involved. The primary surgical experts are often plastic surgeons or neurosurgeons who have completed advanced fellowship training in peripheral nerve surgery. These surgeons possess the microsurgical skill necessary to handle delicate nerve tissue.
The goal of surgery is always to restore connection and reinnervate the paralyzed muscles before they permanently atrophy. For nerve tears where the gap is short, a surgeon may perform a nerve graft, bridging the gap using a section of an expendable sensory nerve harvested from another part of the body. For more challenging injuries, a nerve transfer may be performed, rerouting a less important functioning nerve to power a more functionally important muscle, such as those controlling elbow flexion.
Nerve transfers have shown favorable outcomes in restoring function in certain complete upper brachial plexus injuries. Orthopedic surgeons with specialized training in hand and upper extremity surgery are also part of the surgical team. They typically become involved later to perform tendon transfers, moving a working tendon to replace the function of a paralyzed muscle, especially if a significant amount of time has passed since the injury.
Rehabilitation and Functional Recovery Specialists
The immediate surgical repair is only the first step in a long-term recovery process, which is managed by dedicated rehabilitation specialists. Physiatrists, or doctors of physical medicine and rehabilitation, oversee the entire non-surgical treatment and recovery plan. They coordinate care, manage pain and spasticity, and prescribe the necessary therapy to maximize functional return and optimize the patient’s quality of life.
Physical therapists (PTs) and occupational therapists (OTs) are directly involved in the daily work of recovery and are essential for preventing joint stiffness and muscle contracture. Physical therapists focus on large-scale motor function, working to maintain range of motion and strengthen muscles as the nerves regenerate. Occupational therapists concentrate on restoring fine motor skills and the ability to perform daily living activities, such as dressing, bathing, and eating.
Pain management specialists, who may have a background in anesthesiology, are also important members of the team. Brachial plexus injuries can cause intense neuropathic pain, which is distinct from typical musculoskeletal pain. These specialists use various medications and interventions to address this chronic nerve pain, which can be debilitating and disruptive to the rehabilitation process.
Locating Comprehensive Treatment Centers
Because a brachial plexus injury requires such a specific and coordinated approach, the best care is typically found at specialized, multidisciplinary nerve centers. These centers are generally located within major academic medical institutions or large specialty hospitals. They provide a centralized location where all necessary specialists—surgeons, neurologists, physiatrists, and therapists—work together.
This collaborative team approach ensures that diagnosis and treatment plans are comprehensive and seamlessly integrated, which is vital for an injury that involves a complex timeline of nerve regeneration. Patients should prioritize centers that explicitly advertise a dedicated brachial plexus program with multiple specialists. Finding a facility with expertise in both delicate surgical repair and intensive, long-term rehabilitation is the most practical step toward achieving the best possible outcome.