Brachial plexus injury

Last reviewed: 6 Jun 2022
Last updated: 28 Jan 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of polytrauma/multiple injury
  • paralysis of shoulder
  • paralysis of bicep
  • numbness of radial digits of hand and shoulder
  • paralysis of triceps
  • paralysis of wrist/finger extensors
  • flail/insensate extremity
  • absent tendon reflexes
More key diagnostic factors

Risk factors

  • motor vehicle accident
  • neurofibromatosis
  • improper positioning during surgery
  • age <50 years
  • male sex
  • Parsonage-Turner syndrome
  • tumors (primary and metastatic tumors)
  • rib abnormalities
  • metabolic disorders
More risk factors

Diagnostic investigations

1st investigations to order

  • Electromyography
More 1st investigations to order

Investigations to consider

  • MRI
  • CT/myelography
More investigations to consider

Emerging tests

  • Ultrasound

Treatment algorithm

ACUTE

upper (C5-6) with or without middle (C7) root injury

isolated lower root (C8-T1) injury

total root avulsion (C5-T1) injury

Contributors

Authors

Rahul K. Nath, MD
Rahul K. Nath

Director

Texas Nerve and Paralysis Institute

Houston

TX

Disclosures

RKN is an author of a number of references cited in this topic.

Peer reviewers

Abdelouahed Amrani, MD

Professor

Children's Hospital

Rabat

Morocco

Disclosures

AA declares that he has no competing interests.

S. Raja Sabapathy, MS, MCh, DNB, FRCS, MAMS

Director and Head

Department of Plastic, Hand and Reconstructive Microsurgery and Burns

Ganga Hospital

Coimbatore

India

Disclosures

SRS declares that he has no competing interests.

  • Brachial plexus injury images
  • Differentials

    • Functional or psychogenic weakness (e.g., unilateral loss of motor function or psychogenic parkinsonism)
    • Amyotrophic lateral sclerosis (ALS)
    • Brain or spinal cord injury
    More Differentials
  • Guidelines

    • ACR appropriateness criteria: plexopathy
    More Guidelines
  • Patient leaflets

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    Whiplash

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