Conditions: brachial plexus injury
What is the brachial plexus?
Right brachial plexus, from Gray’s Anatomy.
The brachial plexus is a network of nerves that originate in the spinal cord and traverse the low neck before passing under the collarbone (clavicle), through the arm pit (axilla) and then on to their final destinations on the chest, shoulder arm, forearm, and hand. These nerves provide for sensation as well as function of the target muscles. Anatomists divide portions of the interweaving nerve structure into roots, trunks, divisions, and cords.
Click to enlarge.
Why is the brachial plexus affected by surgery?
Surgical dissection near the brachial plexus is a risk for injury to it. Within the neck, removal of lymph nodes in the lower aspect of the neck is a risk as the boundary between lymph node bearing tissue and a portion of the brachial plexus is a paper thin layer of fascia. A tumor, whether benign or cancerous, also has the ability to expand around the roots, trunks, divisions, or cords of the brachial plexus, requiring additional dissection during an operation to remove it. Furthermore, some tumors, particularly cancerous ones, may invade into nerves, including the nerves of the brachial plexus.
What are the symptoms of brachial plexus neuropathy?
Depending on the specific nerve fibers and branches injured, sensation and movement of some part of the arm can occur with brachial plexus neuropathy (dysfunction).
HOw is brachial plexus neuropathy prevented?
Overall, most cases of brachial plexus neuropathy occur from motor vehicle accidents and childbirth, which will not be discussed here. From the perspective of tumor surgery in the neck (specifically removal of lymph nodes, thyroid, parathyroid, and a branchial cleft cyst), brachial plexus injury is quite uncommon, but may occur, especially if tumor factors such as tumor growth around or invasion into the plexus is present.
How much will brachial plexus neuropathy bother someone?
The extent of a brachial plexus injury may vary from minor to major, potentially affecting movement and sensation of the entire arm. Thus, the degree of burden of a brachial plexus injury depends entirely on the extent of lost function.
Does brachial plexus neuropathy improve over time?
Nerve repair after injury to the brachial plexus may occur to a greater or lesser extent. Restoration of nerve function depends on anatomic continuity of the nerves, meaning a cut nerve with two portions not in physical contact, will not recover. If a root, trunk, division, or cord is injured by a stretch or other insult not including transection, the nerve fibers have a chance of recovery, though recovery may be very slow, incomplete, and the regrown nerve fibers may reach the wrong target, causing imperfect muscle movement or sensations.