Brachial Plexus Injury
Description
Brachial Plexus Injuries have a large impact on function, and can lead to significant psychological and physical disabilities. They can occur from motor vehicle accidents, neoplasms, or birth-related injuries that are stretch or compressive in nature. Most injuries occur through traction forces when the head and neck move away from the ipsilateral shoulder, resulting in partial nerve lesions, ruptures or avulsions. Many of the injuries occur in C5 or C6 spinal nerves or upper trunk. The diagnosis and functional limitations are difficult to differentiate because neuronal regeneration occurs according to the amount of injury. If extensive, patient may require surgery.
Signs & Symptoms
- Limited PROM & AROM of upper extremity
- Decreased strength
- Loss of function
- Numbness/tingling in nerve distribution
Diagnostic Tests
- Need complete description of injury for type and severity of forces
- Complete Neurological Exam- motor and sensory
- Bernard-Horner sign for C8-T1 avulsion (not present until 48 hours after injury)
- Tinel’s sign- start distal and move proximal looking for tingling/numbness
PT Implications
- If nerve rupture or avulsion, refer to physician for possible surgery
- Maintain ROM (especially elbow flexion) with aggressive stretching, splints, positional education
- Maintain shoulder stability with active abduction
- Target wrist and hand function