Q: Can you please explain a brachial plexus injury to me? My brother is a garbage man. His arm got caught in the automatic trash compactor. They say he has this type of nerve injury and may never recover fully.

A: Brachial plexus injuries refer to stretching, avulsion, or rupture of a group of nerves that come from the spinal cord in the neck. Avulsion tells us the nerve root is torn from the spinal cord where it attaches. Rupture refers to a complete tear across the nerve dividing it into two or more parts. Plexus refers to the entire group of nerves as they first start out with several main branches that divide to form a much larger number of nerve groups.

These nerves provide both sensation (pain, temperature, touch, vibration) and motor function (muscle contraction) for the entire upper extremity including the shoulder, arm, wrist, and hand. Brachial plexus injuries are usually caused by some type of trauma such as a car accident, fall onto an outstretched arm (especially if the head and face are turned away from that side), and stretching or pulling on the hand, wrist, or forearm. Gunshot wounds, knife lacerations, and other blunt open injuries are also likely causes of nerve avulsion or rupture.

No two brachial plexus injuries are alike. These can be very complex and difficult injuries to treat and reach recovery. It will help both you and your brother to find out where in the plexus the injury has occurred and how severely the nerve is damaged. This will give you some idea of what to expect, what kind of treatment is recommended, how long recovery will take, and the best way to offer him support during the treatment.

Reference: Jennifer L. Giuffre, MD, et al. Current Concepts of the Treatment of Adult Brachial Plexus Injuries. In Journal of Hand Surgery. April 2010. Vol. 35A. No. 4. Pp. 678-688.