Treating Brachial Plexus Injuries
Brachial plexus injuries (BPI) can occur due to any number of physical traumas, such as falls or vehicle accidents. When BPIs occur, they result in loss of sensory and physical function in parts of the arm or throughout the entire arm, depending on the specific point of nerve injury. There are various strategies used to help reverse some or all of these lost functions.
Watch And Wait
In many cases, BPI is not serious and the problem will resolve over time. Minor BPIs may be caused by falls or high-impact sports. A combination of rest and physical therapy may help the person regain their previous function, since nerves have regenerative properties. Unfortunately, some BPIs are severe, such as when the nerves have been pulled off the spinal cord. In this case, repairing the damage may not be an option. In this extreme case, permanent paralysis and loss of sensory function in the affected arm is usually the end result and is unlikely to improve with time.
Nerve Grafts
Some damage is limited to sensory problems, such a numbness or tingling in the arm. This may be caused by small injury to the nerve that can be repaired. If a nerve within the brachial plexus is compressed or severed, it may be repaired with a nerve graft when there are healthy ends on either side of the damage. In this procedure, a nerve from another part of the body that is considered unnecessary is used as the donor nerve.
Although the area of the body where the nerve is harvested will experience numbness or other sensory deficits, it is not vital to daily functioning and will improve over time. Once the nerve is harvested from the donor area, it is surgically grafted onto a compressed nerve area or sutured between the two healthy ends of the nerve. As the graft heals, the graft will allow nerve conduction to continue along the damaged nerve with the hopes of regaining some or all sensory function.
Nerve Transfer And Transplant
If there is a larger area of damage to a nerve or there are no healthy nerve ends to connect, a graft may not be sufficient to repair the damage, or the surgeon may need a longer piece of nerve for the repair. Similar to a nerve graft, a nerve transfer entails finding a donor region where the nerve is not vital to functioning. A transfer is used to replace all nerve function and is typically used when nerves in the brachial plexus have been completely severed, but the nerve root remains intact at the spine. When a nerve transfer is successful, it can help with both sensory and motor function.
In rare cases, a large segment of nerve may be transplanted from a deceased donor. A transplant may be done if adequate amounts of nerve tissue cannot be harvested for transfer from the patient. Due to the complexities associated with transplants, mainly the indefinite use of anti-rejection medications, it is typically avoided.
Muscle Transfer
Muscle transfers are used to help restore lost muscle function in the arm, and the procedure may be done even when a BPI occur several years ago. A muscle is harvested from the donor site, which is typically the inner thigh, and it is harvested along with its blood and nerve supply. The muscle is attached beginning with the blood supply, and then the nerves are attached. The first hurdle in muscle transfer is ensuring the blood supply is successful. Although surgeons can determine if the muscle initially has adequate blood supply before closing, it may take several days to be certain the blood supply remains intact and has not clotted off.
BPIs can range from mild, reversible problems to permanent loss of arm function. Procedures to replace lost nerve and muscle function combined with physical therapy can give people with BPIs the best chance regaining normal (or near normal) limb function. To contact an orthopedist for more information on treatment options for BPI, visit a site like http://www.jpspottdo.com.
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