Treatment of BPI depends heavily upon the classification grade of the injury. These are as follows:. Following BPI injury, a number of factors will determine the speed and extent of recovery 13 :.
The recovery of nervous tissue can occur either by axonal regeneration from proximal to distal, or by rein nervation through terminal collateral sprouting. For athletes awaiting spontaneous recovery, intervention helps manage pain and maintain function in the upper limb. Here are a few points regarding injury management in this time-period:. The reader is directed to references for a detailed description on how to use PNF techniques in muscle strengthening, but the basics are as follows:.
The rhythmic initiation technique involves a progression of initial passive, then active-assistive, followed by active movement against resistance. Through the agonist pattern, movement is slow, goes through the available range of motion, and avoids activation of a quick stretch.
Two movement directions are used:. This is the easiest and less aggressive of the PNF techniques are used for patients who areunable to initiate movement and who have a limited range of motion because of increased tone. It may also be used to teach the patient a movement pattern.
Repeated contraction is useful when a patient has weakness either at a specific point or throughout the entire range. It is used to correct imbalances that occur within the range by repeating the weakest portion of the total range. Using the same D1 or D2 as mentioned above, the patient moves isotonically against maximal resistance repeatedly until fatigue is evidenced in the weaker components of the motion. A stretch at that point in the range should facilitate the weaker muscles and result in a smoother, more coordinated motion.
Slow reversal involves an isotonic contraction of the agonist followed immediately by an isotonic contraction of the antagonist. The initial contraction of the agonist muscle group facilitates the succeeding contraction of the antagonist muscles.
To help diagnose the extent and severity of a brachial plexus injury, you may have one or more of the following tests:. Our caring team of Mayo Clinic experts can help you with your brachial plexus injury-related health concerns Start Here.
Treatment depends on several factors including the severity of the injury, the type of injury, the length of time since the injury and other existing conditions. Your doctor may recommend physical therapy to keep your joints and muscles working properly, maintain range of motion, and prevent stiff joints.
Surgery to repair brachial plexus nerves should generally occur within six months after the injury. Surgeries that occur later than that have lower success rates. Nerve tissue grows slowly, so it can take several years to know the full benefit of surgery. During the recovery period, you must keep your joints flexible with a program of exercises.
Splints may be used to keep your hand from curling inward. Nerve tissue can be removed from other parts of your body to replace the damaged portions of your brachial plexus nerves. Nerve transfers are particularly helpful in the most serious types of brachial plexus injuries, called avulsions, when the nerve root has been torn out of the spinal cord.
They may also be used when surgeons are trying to speed up muscle recovery. Because the nerve reconstruction is often close to the muscle, nerve recovery may be faster and perhaps better than other techniques. If your arm muscles have atrophied from lack of use, a muscle transfer may be needed. The most commonly used donor muscle is in the inner thigh. A section of skin and tissue attached to the donor muscle may also be removed. This skin flap can help the surgeons monitor whether the muscle is getting enough blood after it has been transferred to its new location.
Pain from the most severe types of brachial plexus injuries has been described as a debilitating, severe crushing sensation or a constant burning. This pain resolves for most people within three years. If medications can't control the pain, your doctor might suggest a surgical procedure to interrupt the pain signals coming from the damaged part of the spinal cord.
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. A number of tests may be used to help diagnose the type and severity of brachial plexus injuries.
When you make your appointment, be sure to ask whether you need to prepare for these tests. For instance, you may need to stop taking certain medications for a few days or avoid using lotions the day of the test.
If possible, take along a family member or friend. Sometimes it can be difficult to absorb all the information you're given during an appointment. Someone who accompanies you may remember something that you forgot or missed. Stretching can occur when the head and neck are forced away from the shoulder, such as during a motorcycle fall or car accident.
If severe enough, the nerves can tear out of the spinal cord in the neck. Pressure could occur from the crushing of the brachial plexus between the collarbone and first rib, which can happen during a fracture or dislocation. Swelling in this area from excessive bleeding or injured soft tissues can also cause an injury. Nerve injuries can stop signals to and from the brain, preventing the muscles of the arm and hand from working properly, and causing loss of feeling in the area.
Many adult injuries will not recover on their own, and early evaluation by physicians who have experience treating these problems is essential. Some injuries can recover with time and therapy. The time for recovery can be weeks or months. When an injury is unlikely to improve, several surgical techniques can be used to improve the recovery.
To help decide which injuries are likely to recover, your physician will rely upon multiple examinations of the arm and hand to check the strength of muscles and presence of feeling in different areas. In some cases, when nerve recovery will not happen, a tendon transfer surgery may be performed.
The patient must do several things to keep up muscle activity and prevent the joints from getting stiff. Your doctor may recommend therapy to keep these joints flexible.
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