Arm plexus paresis is neurological damage to the nerves in the shoulder and arm area, usually caused by trauma. Healing is a lengthy process, which often does not result in complete recovery of function.
What is brachial plexus palsy?
Arm plexus paresis refers to paralysis in the arm and/or shoulder girdle area. It is not a muscular deficit but a neurologic deficit, the cause of which is damage to the brachial plexus. As part of the peripheral nervous system, this provides motor supply to chest and shoulder muscles and motor and sensory supply to the arm and hand. The brachial plexus is formed by the anterior branches of the C5-C8 and Th1 spinal nerves. Arm plexus palsy is divided into complete and incomplete paralysis depending on the extent of damage. All muscle groups in the shoulder, upper arm, forearm, and hand may be partially or completely affected by the loss of function.
Causes
Damage to the brachial plexus can be due to a variety of causes. In most cases, it is traumatic and is caused by strong traction or pressure on the plexus. Traumatic plexus palsy can also occur during childbirth when obstetricians or forceps blades apply too firm pressure to the infant’s shoulder area. A mismatch between the child’s shoulder and the mother’s pelvis during a spontaneous delivery is also a risk factor. In addition to traumatic causes, arm plexus palsy can also be caused by space-occupying tumors. As they grow, these press on the surrounding tissue and the nerve fibers running through it. Plexus neuritis is an inflammatory reaction of the peripheral nervous system that occurs after infections or vaccinations. It is most commonly seen in the shoulder girdle, where the inflammation can cause neurological deficits. In some cases, brachial plexus palsy occurs as a late consequence of radiation therapy, because ionizing radiation can cause damage to the nervous system, as it does to other tissues of the human body.
Symptoms, complaints, and signs
Symptoms of brachial plexus palsy vary depending on the location and extent of the damage. A distinction is made between upper and lower paresis. Upper plexus palsy, or Erb’s palsy, is characterized by an internally rotated position of the arm with flaccid muscle tone. The affected vertebral segments are C5 and C6, whose exiting nerves supply the muscles in the shoulder and upper arm. The elbow extensors remain intact in Erb’s palsy. Inferior plexus palsy, or Klumpke’s palsy, affects segments C7 through Th1 and causes muscular deficits of the forearm and hand involving the elbow extensors. Sensory disturbances usually occur in the outer upper and lower arm, but are not reported by all affected individuals. Another symptom is burning pain that radiates down the injured arm into the hand and fingers. Pain occurs primarily when the nerves in the area of the spinal cord become dislocated. Untreated paresis leads to long-term muscle atrophy in the area supplied by the affected nerves. The body breaks down the inactive muscles over time, causing the damaged arm to become thinner than the other. In newborns, brachial plexus palsy often resolves on its own; however, the affected arm may later develop a growth disorder.
Diagnosis and course
The first step in diagnosis is a detailed discussion with the attending physician, as conclusions can be drawn from the medical history, especially in the case of traumatic paresis. Imaging techniques such as computed tomography or magnetic resonance imaging can detect injuries to bones or soft tissues. If CT and MRI are not sufficient to make a diagnosis, myelography provides an exact image of the spinal cord. Individual nerves as well as their injuries can thus be detected. The prognosis of arm plexus paresis varies depending on the extent. Because healing of the nerves is a lengthy process, neurological deficits cannot be ruled out even after a long period of time.
When should you see a doctor?
As a rule, the affected person should contact a doctor if there is severe pain or restricted movement in the respective body region. The restrictions themselves may also be associated with sensory disturbances or with paralysis. If these complaints occur, a doctor must be consulted in any case.A visit to the doctor is particularly necessary in the case of stabbing or burning pain. In most cases, the patient also suffers from reduced resilience and further also from severe muscle atrophy. Especially after an accident or after a serious injury, the affected area must be examined by a doctor in order to avoid consequential damage. This is especially true for children, as they continue to grow. This can prevent consequential damage and further restrictions in adulthood. Medical treatment is also necessary in the case of a visible growth disorder. To avoid further irritation of the affected region, the patient should avoid unnecessary stress or work. As a rule, arm plexus paresis can be treated relatively well with the help of therapies. In some cases, however, the symptoms cannot be completely limited. However, the patient’s life expectancy is not reduced by this disease.
Complications
Arm plexus palsy is a neurological nerve damage of the shoulder and arm area. If the fine plexus of the peripheral nervous system in the chest and shoulder muscles is damaged or acutely inflamed, motor disturbances of the arms and hands occur as a result. If the symptoms are not treated in time, the healing process is extremely difficult. In some cases, a functional disorder remains as a complication. The pathogenesis of the symptom has various causes. In most cases, arm plexus paresis is traumatic and may be due to a birth defect or accident. Sometimes the symptom can be a late consequence of bed confinement or chemotherapy, but it can also result from the growth of a tumor that severely presses the surrounding tissue and nerve fibers. Arm plexus paresis occurs equally in men and women of all ages. Most often, those affected have problems in the shoulder girdle. If the symptom remains untreated, serious complications result. The arm’s internal rotation position shifts, and signs of paralysis and loss of sensation make it difficult to cope with everyday life. Severe, burning pain may radiate from the spinal cord to the fingers. Muscle atrophy develops and the musculoskeletal system may become visibly deformed. In newborns with birth-related arm plexus palsy, the treatment plan should take effect early, otherwise the affected arm is at risk of growth disturbance. Physiotherapy and anti-inflammatory pain medication keep the symptom under control as far as possible. If arm plexus paresis is severely advanced, surgery is performed.
Treatment and therapy
Regeneration of arm plexus paresis begins with complete relief of the affected arm to avoid pressure or traction on the damaged nerve fibers. If this is not sufficient, surgical intervention is indicated. A nerve suture is used to reconnect the torn nerve endings, and in some cases a graft is required. This procedure is very complex and should therefore only be performed by experienced surgeons. If an open injury is present, the care of the plexus is in principle secondary to wound and vascular care. Physiotherapeutic exercises prevent muscle breakdown and keep the joints mobile. A regular exercise program alleviates poor posture and maintains symmetry of the body. An abduction splint is used in conservative therapy to facilitate nerve regeneration through optimal positioning. If pain is present, additional medication to relieve pain is indicated. Plexus paresis of a newborn requires an intensive therapy procedure so that the child can fully develop the function of the affected arm. Parents are intensively involved in the therapy and are encouraged to perform the exercises regularly with the child.
Outlook and prognosis
The prognosis for arm plexus paresis is unfavorable. Complete cure and freedom from symptoms are not possible with current medical options. The damage to the nerve plexus is irreversible and cannot be completely corrected despite state-of-the-art technology. With optimal care of the arm and shoulder, the complaints are alleviated to a significant extent. In addition, the patient is encouraged to actively participate in improving his or her well-being. This includes, in particular, relieving the shoulder and arm. Possible incorrect postures must be corrected, and targeted training can be used to optimize movement sequences.These exercise sessions are to be carried out on the patient’s own responsibility at regular intervals, even after treatment has been completed. In addition, the patient must learn not to overuse other areas of the body. Despite all efforts, the arm plexus paresis will not completely regress. Impairments will be present for life and these will affect the patient’s daily life. Certain physical stresses are no longer possible, so occupational changes may occur. The health interferences may furthermore increase in intensity. If further damage to the nerve plexus occurs or the patient behaves in a counterproductive manner, an increase in shoulder and arm complaints can be expected. The physical performance level continues to decrease.
Prevention
Accidental arm plexus palsy can be prevented only by exercising adequate caution in dangerous situations. Extensive training for obstetricians reduces the risk of nerve damage during delivery; however, paresis of the fetal brachial plexus occurs in some cases, especially in spontaneous deliveries or complications. Because brachial plexus paresis results from strong traction or pressure on the exiting nerve fibers, care must be taken to ensure proper positioning, especially in bedridden individuals or even during prolonged surgery.
Aftercare
Because arm plexus paresis has caused relatively severe damage to the nerves in the shoulder and arm, the patient’s arm must be completely unloaded after the accident. This means that the affected person must also no longer expose himself to unnecessary stress and must take care of his entire body. Only through complete rest can the functioning of the arm be restored. After a surgical intervention, the affected person must also recover and allow the wound to heal properly. Furthermore, in the case of an arm plexus paresis, physiotherapy measures are also necessary to get the arm used to a load again and to restore the movement of the arm. If the arm plexus paresis already occurs in a child, the parents must motivate the child to undergo physiotherapy and to do the various exercises. Only through regular exercises can the condition be completely cured. Often, those affected are also dependent on taking medication to promote healing. Contact with others affected by the disease can also have a positive effect on the course of the disease and possibly prevent psychological discomfort. If arm plexus paresis also leads to paralysis, those affected are dependent on help in everyday life, with help from friends and family proving particularly beneficial.
What you can do yourself
Patients can usually do little about the causes of paralysis in the case of arm plexus paresis. However, they can help speed recovery. In particular, it is important to completely unload the affected limb to prevent renewed pressure or traction on the damaged nerve fibers. If the doctor prescribes an abduction splint, it should be worn without fail. The splint optimally supports the affected arm and the damaged nerves, thus accelerating regeneration. It is imperative that the affected limb be spared. Patients should not perform heavy physical work under any circumstances and, if still possible, should not use the affected arm to type on keyboards or cell phones. Physiotherapeutic exercises can prevent muscle deterioration and also keep the joints mobile. Patients should have an exercise plan created and exercise consistently. The healing of an arm plexus paresis is a lengthy affair, so rapid progress is not to be expected. If the paralysis was caused by an accident, great care must be taken in the future when playing sports and performing work that involves a risk. Regulations on work safety must be observed at all costs. If these are inadequate, those affected should point this out to their supervisor and, if necessary, involve the works council.
