Inside the shoulder is your brachial plexus—a network of nerves that carry messages from your brain to the muscles of your shoulder, arm, wrist, and hand. These nerves let you feel sensations and make movements, from shrugging to bending your elbow and snapping your fingers.
A brachial plexus injury jumbles or blocks nerve communication, causing disruptive symptoms such as:
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Burning, stinging, or shooting pain
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Inability to move muscles or joints
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Numbness or weakness, which is also called neuropathy or plexopathy
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Permanent loss of movement or sensation
Swift care from a brachial plexus specialist can preserve or recover nerve sensation and function. We are one of few health centers in the Mid-Atlantic to offer. And we make it easy for you to visit us at locations from Baltimore to D.C.
Causes of brachial plexus injuries
Sudden physical trauma such as a shoulder dislocation, laceration, or broken bone is the most common cause of brachial plexus injuries, which can affect one or both sides of the body. Most happen due to accidents such as sports injuries, vehicle wrecks, or falls.
When the shoulder is involved, the direction of the injury impacts where the brachial plexus damage occurs:
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Injuries above the collarbone happen when the shoulder is pushed down but the neck is stretched away from the shoulder.
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Lower injuries occur when the arm is forced upward above the shoulder.
Nerve damage can also occur if a tumor compresses (squashes) a nerve or as a side effect from radiation therapy to the chest. While some nerve injuries heal on their own, many patients need treatment to restore lost sensation or movement.
Brachial plexus diagnosis
Once your initial injury is stabilized, we use advanced imaging to assess nerve damage:
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X-rays to see where fractures or bone injuries may be damaging the nerves.
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Electromyography (EMG) to look at the electrical activity of the muscles.
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Magnetic resonance neurography (MRN), a type of MRI designed to examine the nerves.
If the nerves are stretched, strained, or partially torn, we watch over a couple of weeks for signs that the nerves are healing. If the nerve still has roots intact, it could heal on its own or with treatment. But if the nerves are completely severed, we know the condition will not improve and we will need to create a personalized treatment plan right away.
MedStar Health unites a team of internationally recognized experts to stabilize your initial injury, pinpoint the damaged nerves, and help you get back to a more active and pain-free life.
Advanced treatment options
Most patients will not need surgery and can heal with nonsurgical care such as:
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Bracing or splinting to keep the shoulder or arm still while the nerves heal.
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Occupational therapy (OT) or physical therapy (PT) to restore strength, function, and range of motion.
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Steroid injections to reduce inflammation and manage pain.
Surgery is only recommended if it might relieve symptoms or restore function. Our fellowship-trained nerve surgeons are world-renowned leaders in the latest procedures, including:
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Grafting: We place an expendable nerve from elsewhere in the body at the injury site to become a “bridge” for messages from the brain to the muscle.
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Transfer: An expendable nerve is placed near (not at) the injury site, “rewiring” it to do the job of the damaged nerve.
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Disconnection or removal: If the nerve causing symptoms doesn’t have a vital job, we can remove, disconnect, or desensitize it without reducing function.
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Repair or reconstruction: This may involve reconnecting the ends of a torn nerve or rebuilding its framework, much like fixing the plastic covering on a wire.
Nerve fibers regenerate at about a millimeter a day—it can take several weeks or months for nerves to heal. Going to PT and OT will help you remaster movement, and your care team will see you regularly to celebrate your progress and adjust your treatment plan, if needed.
Choosing MedStar Health
Brachial plexus injuries are complex, and we take a team approach to diagnosis and treatment. From stabilizing the initial injury through nerve treatment and recovery, our team is internationally recognized for brachial plexus injury management.
MedStar Health is home to the Curtis National Hand Center, the only Level 1 Hand and Upper Extremity Trauma Center in Maryland designated by the Maryland Institute for Emergency Medical Services.
We bring together orthopedic experts, plastic surgeons, fellowship-trained hand surgeons, oncologists, and physical and occupational therapists to assess your nerve injury and design a personalized treatment plan.
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