A brachial plexus injury is damage to the network of nerves from the neck that controls the shoulder, arm and hand, often from motorcycle accidents or difficult births. Mild injuries may recover on their own; surgery such as nerve grafting or nerve transfer is generally considered when paralysis shows no recovery within about 6 weeks.
- AnaesthesiaGeneral
- DurationTypically several hours
- Hospital stayUsually a few days
- Back to routineRecovery of function typically over 1 to 2 years
What is brachial plexus injuries?
The brachial plexus is a network of nerves leaving the spinal cord in the neck that controls movement and sensation in the shoulder, arm, elbow, wrist and hand. Injury can cause weakness, paralysis or numbness. Mild injuries often recover within weeks, while severe injuries may need surgery and can cause lasting disability.
Most cases result from trauma: high-speed road accidents, especially motorcycle crashes, blunt trauma, stab or gunshot wounds, and birth injuries such as shoulder dystocia or forceps delivery. Other causes include inflammation (brachial plexitis), compression by a tumour and neuropathies.
Injuries range from neurapraxia (the nerve is stretched but intact, with an excellent outlook) and axonotmesis (moderate outlook) to neurotmesis (the nerve is fully divided) and avulsion, where the nerve root is pulled from the spinal cord and cannot recover on its own. A neuroma is a tangle of failed regeneration. Outcomes depend on the mechanism, type and complexity of the injury and the time since injury.
Who is brachial plexus injuries for?
- Complete or partial paralysis of the arm that shows no signs of recovery within about 6 weeks
- Injuries from motorcycle or other high-speed accidents
- Open injuries such as stab wounds affecting the nerves
- Babies with birth-related brachial plexus palsy who are not recovering
- People with realistic expectations who are willing to commit to long rehabilitation
How is it done?
- Detailed examination and nerve studies or imaging to locate and grade the injury
- Nerve repair: torn ends are stitched together, mainly for clean cuts
- Nerve grafting: a nerve segment from another body site bridges the damaged area
- Neurotisation (nerve transfer): a working donor nerve is connected to a paralysed nerve when the original root cannot be repaired
- Before surgery: take prescribed medicines, stop blood thinners if advised, stop smoking and alcohol, and follow fasting instructions
What is recovery like?
- The arm is protected in a sling after surgery
- Physical rehabilitation is part of recovery in all cases, including range-of-motion exercises
- Nerve recovery is slow; useful return of movement typically takes many months to a year or more
- Pain medication as prescribed
- Long-term follow-up tracks recovery and may lead to further procedures such as tendon transfers
What are the risks?
- Bleeding, haematoma or seroma
- Wound infection
- Tingling or weakness in the arm
- Failure to improve despite surgery
- Weakness or numbness related to the donor nerve
Why choose Dr. Jithendran?
- Dual training in orthopaedics (MS) and plastic surgery (MCh, DNB), with hand and microsurgery experience from Ganga Hospital, Coimbatore
- Consults at five hospitals across Bengaluru, with 24×7 availability for emergencies
- Clear explanations in English, Tamil, Hindi and Telugu, and time to answer every question
- Strict sterilisation and patient-privacy standards
Frequently asked questions
Can a brachial plexus injury heal on its own?
Some can. Mild stretch injuries (neurapraxia) often recover fully within weeks, and some more severe injuries improve partially over months. Root avulsions, where the nerve is torn from the spinal cord, do not recover without surgery. Regular examination over the first weeks helps decide whether surgery is needed.
When is surgery needed for a brachial plexus injury?
Surgery is generally considered when paralysis, complete or partial, shows no signs of recovery within about 6 weeks of injury, or earlier for open, sharp injuries. Timing matters because muscles become less able to recover the longer they remain without a nerve supply.
What is a nerve transfer?
A nerve transfer, also called neurotisation, connects a working nerve, or part of one, that has a less important role to a paralysed nerve close to its muscle. It is used when the injured nerve root cannot be repaired, and can help restore key movements such as elbow bending or shoulder lifting.
How long does recovery take after brachial plexus surgery?
Recovery is slow because nerves regrow gradually. Early signs of muscle activity may appear after several months, and improvement often continues for one to two years. Physiotherapy throughout this period is essential to keep joints supple and strengthen muscles as they recover.
