Brachial Plexus Injury – Diagnosis and Treatment

Diagnosis

Doctors start the process by asking about symptoms and checking the affected areas, such as the neck, shoulder, arm, and hand.

A physical examination helps determine changes in movement, sensation, and strength. The exam often includes simple tests to see if there is numbness or weakness.

When doctors suspect a brachial plexus injury, they often use several tests to learn more about the problem:

Test Name	What It Does
X-ray	Shows broken bones or damage near the shoulder and neck.
Magnetic Resonance Imaging (MRI)	Gives detailed images of the nerves and tissues. It shows how much the nerves and nearby structures are hurt.
CT Myelography	Uses dye and X-rays to spot injuries to nerve roots and the spinal cord.
Electromyogram (EMG)	Measures the electrical activity in muscles at rest and during movement.
Nerve Conduction Study	Checks how fast and well the nerves send signals.

Doctors usually order an X-ray first to check for fractures or bone injuries that might have happened with the nerve damage.

MRI scans give detailed images of the brachial plexus nerves. They can spot swelling, tearing, or other damage. High-resolution MRI types, such as diffusion tensor imaging, provide even better pictures to help doctors plan treatment.

Doctors may recommend a CT myelogram if the MRI does not give clear answers. This test uses contrast dye and special X-ray images to show the nerve roots and spinal cord.

An EMG uses tiny needles to check how muscles react and whether they are getting the right signals from the nerves. Doctors often perform a nerve conduction study at the same time to show how quickly electrical signals move through the nerves.

These tests together help doctors build a clearer picture of the injury and decide on the next steps for care.

Treatment

Doctors create a personalized treatment plan based on the seriousness of the injury, where it happened, and how long it has been since the damage occurred.

The main goals are to restore as much movement and feeling as possible, reduce pain, and help with daily activities. Physical therapy often starts early to keep joints and muscles working and prevent stiffness.

Some nerve injuries—especially if the nerves are just stretched—can get better without surgery. In these cases, doctors might recommend exercises, splints, and close monitoring of nerve function during recovery.

More severe injuries, like nerves that are torn or cut, usually require surgical repair to restore function.

Types of Surgical Procedures

Doctors use several types of operations for brachial plexus repair:

Procedure	Description
Neurolysis	Removes scar tissue from around the nerves to let them move and heal more easily.
Direct Nerve Repair	Connects cut nerves end-to-end. Used if the nerve injury is clean and not too long ago.
Nerve Graft	Nerves from other areas are used as a bridge to replace the damaged section of the plexus.
Nerve Transfer	Healthy nerves that are less critical are rerouted to take over the function of damaged nerves.
Muscle or Tendon Transfer	Moves a muscle or tendon from another part of the body, like the thigh, into the arm, reconnecting blood vessels and nerves.

If surgery is needed, doctors usually operate within a few months after the injury. Newer imaging tools help the surgical team decide exactly when to operate.

Nerve healing takes months or even years before the final outcome is clear. Follow-up physical therapy protects joint movement and supports muscle recovery during this time.

Managing Pain

Many people with major brachial plexus injuries suffer from severe pain, which may feel crushing or burning and can persist for years. Most people notice the pain decreases over time, often within three years.

Doctors start pain management with medication. If pain continues, doctors may suggest surgery to block the pain signals from reaching the brain. This approach can help those who do not respond to standard treatments.

Pain specialists and the rehabilitation team work together to find the safest and most effective plan to help patients stay active with physical therapy and daily life.

Getting Ready for Your Visit

Being prepared can help make the appointment go smoothly. Before the visit, write down any symptoms such as weakness, numbness, paralysis, or loss of sensation. Note how the symptoms started, when they began, and if they have changed over time.

Make a complete list of all medications, including vitamins and supplements. Some tests may require you to stop certain medicines or avoid using lotions on the day of testing.

Check with the clinic about any special steps you need to take before arriving.

Bring a friend or family member to help remember information and details discussed during the appointment.

To stay organized and make sure all your concerns are addressed:

• List your symptoms and questions ahead of time.
• Ask about all possible treatment options for weakness, loss of feeling, or movement problems.
• If something is unclear or if there is not enough time for all your questions, request to follow up with a nurse or healthcare provider later.

What to Bring	Why It Matters
List of symptoms	Ensures nothing is forgotten.
Medications and supplements	Some may affect your tests.
Friend or family member	Provides support and backup.