After referral to our unit you will be assessed by medical staff either as an inpatient on the ward or in one of our outpatient clinics.
Assessment will involve us firstly asking you how your injury occurred, initial treatment, your symptoms (including pain, sensation and movement) and any recovery you have had. We will examine your injury assessing your movement, power and sensation. We may also send you for tests which may include nerve conduction studies, MRI or CT scans.
What treatment will I receive after the assessment?
A member of the team will discuss the results of all of the investigations with you and whether an operation is necessary. If the injury to the brachial plexus is mild and recovery is expected without surgery, then you will be seen in an outpatient clinic to help you with any problems that you may encounter with your arm and to review your progress.
If it is clear that rupture or avulsion of the brachial plexus has occurred then surgical exploration and repair of these nerves may be offered. If you have other more serious injuries then the brachial plexus surgery may have to be delayed until these injuries are stabilised.
How are nerves repaired?
In clean cut injuries of nerves, each raw end of the nerve may be repaired (with the aid of an operating microscope) to the other cut surface of the nerve. This end-to-end repair is usually not possible in the case of brachial plexus injuries, partly because the injury produces weakness at the shoulder muscles, which in turn allows the shoulder to droop consequently pulling the nerve ends apart. However, in the commonest injuries, the nerves are torn or stretched and the damaged segment of nerve either side of the rupture must be removed and repaired using grafts of nerves from the legs. When nerves have been repaired, the nerve fibres then have to grow through the repair and out into the arm to the muscle or area of skin that they supply. These nerves grow very slowly and maximum recovery after nerve repair is lengthy. Furthermore, no nerve repair achieves complete recovery because of the impossibility of each individual microscopic nerve fibre reaching precisely and accurately the area it is best suited to supply.
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