Dr. Leena Jain, a leading Plastic Surgeon in Mumbai, treats brachial plexus injuries. She is an expert microsurgeon with considerable experience in hand reconstruction. In this blog, she has her insight on treating brachial plexus injuries.
The brachial plexus is a network of nerves that transmits sensory and movement signals to the hands and arms for the upper spinal cord located in the neck. Injury to the neck and/or shoulder region can affect the brachial plexus network, and the patient complains of numbness, weakness, pain, and even paralysis in these regions.
Depending upon the extent of injury, some brachial plexus injuries are self-healing, and the patient can recover to near normal or normal functioning. On the other hand, severe and extensive brachial plexus injuries are best resolved with surgeries. The outcomes of brachial plexus surgery are mobilizing the patient, restoring sensation, and relieving the pain.
Dr. Leena Jain, a famous hand surgeon in Mumbai, states that diagnosing the brachial plexus injury is very important. Patients with the following conditions required brachial plexus surgery to recover well -
- Neck and shoulder trauma injuries resulting in torn or severely stretched nerves or severed nerves in the brachial plexus
- Nerve damage during the surgery or trauma leading to loss of function in the arm accompanied and debilitating and continuous pain
- Neuromas formed on account of scarred nerves
- Nerve tumors of the brachial plexus i.e., neurofibromas, schwannomas, and so on.
The plastic surgeon will conduct an in-depth investigation to know which nerves are injured, the extent of damage, and the location. Then, a multidisciplinary team comprising of neurologists, plastic surgeons, neurosurgeons will ensure that a thorough repair surgery is performed for best outcomes.
The medical examination involves
- An in-depth history of health condition
- The occurrence of the injury
- Symptoms and their impact on normal activities and quality of life
- Physical examination to study the pain, sensation, and motor function on comparing the affected and the unaffected side.
- Imaging studies – MRI and Ultrasound to view the injury, its location and extent
- EMG for nerve function and decision which nerves can be chosen for repair
Planning and scheduling brachial plexus surgery
Immediate scheduling of brachial plexus surgery is advisable if the patient is injured due to a knife or any other penetrating object.
Scheduling the brachial plexus surgery later is advised if the injury is due to crushing or stretching. The patient’s recovery from the injury is observed for weeks or months as self-healing of brachial nerves is possible.
EMG tests and physical therapy are advised at regular intervals to determine the state of recovery. Brachial plexus surgery is advised to restore sensation and movement in case of poor recovery. This surgery is advised three to six months after the injury for best results.
Delaying the surgery for more than two years is not recommended as the affected muscles in this region shrink permanently, and this condition is referred to as atrophy, and they are resolved through muscle or tendon transfers.
Various surgeries to treat brachial plexus condition
The focus of the brachial plexus surgery is to relieve the patient from pain and establish the motor function of the hand, arm, and shoulder along with restoring sensation.
The plastic surgeon will take an overview of the extent of nerve injury, location and type, and an overview of the existing health condition of the patient. Also, the impact of injury affecting the quality and work of life is also considered.
Nerves used in these procedures are,
- The medial pectoral nerve in the front of the shoulder
- The intercostal nerve under the ribs
- The musculocutaneous nerve in the arm
- Other nerves in the forearm and hand
Procedures your surgeon might recommend are:
Brachial Plexus Nerve Repair
The surgeon performs the Brachial Plexus Nerve Repair surgery to repair the cut or torn nerve. The procedure involves sewing the ends together and reconnecting them. This surgery is done using small, specialized instruments and a microscope.
Brachial Plexus Decompression and Neurolysis
Decompression surgery is performed to treat a compressed nerve and release the pressure. This surgery also addresses the loss of function and associated symptoms. The surgery also known as neurolysis removes the adhesions or scar tissues in and around the injured nerve.
Nerve Grafting Surgery
This surgery is performed to remove an injured or severely scarred nerve. The injured nerve cannot carry signals from the brain to the hand and arm; hence, the patient is in a paralytic condition.
The plastic surgeon removes the damaged brain and replaces it with a nerve graft of an expendable sensory nerve. The graft could be taken from the sural nerve in the leg. This procedure creates a bridge that becomes a passage for nerve regeneration as the nerve graft replaces the damaged nerve.
Nerve Transfer Surgery
The aim of the nerve transfer surgery is to lay the framework for new nerve growth while developing a pathway for signals. In this surgery, the nearby functioning nerve performs an unimportant function.
This surgery proves to be the best option to restore movement and sensation to the skin and muscles. The timing is the key feature of a nerve transfer surgery, as restoring nerve supply is essential before the onset of irreversible atrophy.
Also, the location of the injury and the type of injured nerve determines the feasibility of nerve transfer surgery.
Tendon Transfer Surgery
In certain conditions especially if a considerable time has passed after the injury, tendon transfer is the most reliable option for restoring movement after a brachial plexus injury.
This option is given serious thought when nerve transfers and nerve grafting are not possible. There is no time constraint for performing tendon transfer surgeries.
The tendon transfer surgery is performed on a paralyzed tendon and an expendable and functioning tendon is attached. The functioning tendon will act upon the paralyzed tendon and attempt to restore movement in the upper extremity.
Functional Muscle Transplant
A functional muscle transplant is ideal if a considerable time has passed after the occurrence of brachial plexus injury. Also, it is impossible to perform nerve repair, grafting, and transfer in that condition. Mostly, a nonessential muscle is transplanted to the impaired muscle in the upper extremity.
The surgeon uses a microscope, tiny blood vessels are connected to the transplanted muscle to restore the blood flow. Similarly, a nearby nerve is connected to provide motor functionality to the transplanted muscle.
So, it is feasible to perform functional muscle transfer and tendon transfer surgeries after the brachial plexus injury, and there is no such time factor involved.
One of the best Microsurgeon and Hand surgeons in Mumbai, Dr Leena Jain advocates for the early resolution of brachial nerve injuries.
She emphasizes that timely treatment of these injuries through surgery is the best way to relieve pain and discomfort and get back to a routine lifestyle.