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Brachial plexus injury is caused by extreme traction exerted on the upper limb causing avulsion of the brachial plexus roots between C5 to T1 either completely or partially in the side of the injury. After injury the affected limb will loose muscle function either completely or partially depending on the severity of the injury. Brachial plexus injury can be classified into three categories: preganglionic lesions, postganglionic lesions, and a combination of the two. A preganglionic lesion involves avulsion of nerve roots from the spinal cord, whereas a postganglionic lesion involves disruption or damage distal to the sensory ganglion. Posts ganglionic injuries are amenable to repair for motor function and pre ganglionic lesions are not amenable to repair hence the functions of some denervated muscles are restored with nerve transfers procedures.

What surgery is available for brachial plexus injuries to improve function?

Surgery may be possible to repair damaged nerves. In order to have a chance of success this surgery must be performed within a few months of the injury.

Nerve Graft
Usually when the nerves are torn, the damaged segment of nerve, either side of the injury, must be removed and repaired using grafts from somewhere else (like the forearm or the lower leg area). The nerve graft acts as a guide through which new nerve fibers can grow and cross the gap caused by the injury. These nerves grow very slowly, recovery time is lengthy and complete recovery may be impossible due to the way that each individual microscopic nerve fibre grows in position. 

Nerve Transfer
Undamaged nerves in the area that are doing less valuable jobs can be transferred to other parts of the brachial plexus to try and regain some function within the limb. As the nerves used in this transfer start to recover you will need to work very hard at retraining these nerves to move your arm and initially you may have to do different movements to make your arm work.

Tendon transfers
Each muscle has a starting point (origin) and tapers into a tendon that attaches onto bone (insertion). During surgery the origin is left in place and the tendon attachment/insertion is detached and reattached into a different place.  

What other treatment may I have?

You can start exercises aimed at preventing joint stiffness. These exercises do not make the nerves heal any faster but keep joints supple and help you look after the arm. You may also get some help and advice with pain management.

You will be given a ‘sling’ to help support your arm and you will be advised on how and when to wear this. The length of time that your arm needs to be immobilized will depend on the severity of your injury and the healing of any other associated injuries e.g. dislocated shoulder or fractures of the arm.

Alternative treatments:
Treatments are aimed at improving the muscle mass and release spasm and stiffness. This can be achieved by medication, TENS machine, nerve stimulations and other alternative treatments like ayurvedic massages etc. These however do not improve function but help nerve recovery and prevent muscle wasting. In most cases time needs to be given to allow natural nerve repair.   

Do I need counseling?

Many people are put off counseling because they feel it’s a sign of weakness or that they’ve failed to cope with things on their own. This is far from the truth, as admitting to yourself that you need help is a strength, not a weakness. Your own feelings are what matter right now. You recognize that at this point in your life, you need someone to talk to, to help sort out your thoughts and feelings.

Counseling may help you get back on track if you are experiencing any of these issues:
• Feel very anxious, depressed, sad, tired or angry
• Find it difficult to cope with everyday issues such as work or socializing
• Have problems with sleeping and concentrating
• Have financial, sexual or relationship problems 

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