History and exam
Key diagnostic factors
common
presence of risk factors
Brachial plexus injuries are quite rare and can result from a variety of causes. This makes the establishment of a risk factor panel difficult, and there is no strong epidemiological literature on the subject.[26][27] However, motor vehicle accidents are probably the most common, and Parsonage-Turner syndrome, neurofibromatosis, and poor surgical positioning are less frequent risk factors.
presence of polytrauma/multiple injury
The brachial plexus is vulnerable to injury due to its relatively superficial and exposed position in the lateral neck.
paralysis of shoulder
Occurs with upper trunk injury, which is the most common presentation.
paralysis of bicep
Occurs with upper trunk injury, which is the most common presentation.
numbness of radial digits of hand and shoulder
Occurs with upper trunk injury, which is the most common presentation.
uncommon
paralysis of triceps
If additional involvement of the C7 root.
paralysis of wrist/finger extensors
If additional involvement of the C7 root.
flail/insensate extremity
If complete injury to all 5 nerve roots.
absent tendon reflexes
If complete injury to all 5 nerve roots.
Risk factors
strong
motor vehicle accident
Traumatic injury to the neck area can result from a motor vehicle accident and is especially common in motorcycle and all-terrain vehicle (ATV) accidents.
age <50 years
Common in younger age group, usually younger than 50 years, due to higher incidence of high-speed activities (motorcycle accidents, athletic trauma).
male sex
More common in men. The majority of traumatic brachial plexus injuries are related to motor vehicle accidents, gunshot or stab wounds, contact sport accidents, or workplace accidents during heavy physical labour.
Parsonage-Turner syndrome
Parsonage-Turner syndrome affects the brachial plexus, leading to shoulder pain and upper extremity muscle weakness. Although the exact cause is poorly understood, it has been linked to viral infections and other causes. It usually abates on its own.
weak
neurofibromatosis
Although neurofibromas are common in the general population, they rarely cause motor symptoms due to brachial plexus compression. However, they are prevalent enough that magnetic resonance imaging is essential to rule out tumours of the brachial plexus when weakness is present without a history of initiating trauma.
improper positioning during surgery
Brachial plexus injury through stretch and compression can occur with supine or prone positioning when the arms are abducted from the side. Placement of the arms at the side wherever possible is important in prevention of brachial plexus stretch and compression injuries during surgical procedures.
tumours (primary and metastatic tumours)
Tumours on the brachial plexus nerves can cause paralysis distal to the tumour site. The Pancoast tumour of the lung apex results in typical lower root symptoms, such as pain and paralysis of the hand, and is common enough that it should be considered in any case of significant hand pain without another obvious cause.
rib abnormalities
Compression of the brachial plexus nerves as they pass from the neck into the axilla can cause paralysis.
metabolic disorders
Some metabolic disorders including diabetes mellitus, liver diseases, and renal disease may result in nerve injury.[14]
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