Types of Brachial Plexus Injuries
The brachial plexus is a complex network of nerves that originates from the spinal cord in the neck and extends through the shoulder into the arm and hand. These nerves control muscle movement and sensation of the upper limb. When the brachial plexus is injured, the type and severity of the condition depend on which nerves are affected, how extensive the damage is, and whether the injury occurs at birth or later in life. Understanding the different types of brachial plexus injuries helps guide diagnosis, treatment, and recovery planning.
Classification Based on Nerve Involvement
1. Upper Brachial Plexus Injury (C5–C6)
Upper brachial plexus injury is the most common type and is often referred to as Erb’s palsy. It affects the upper nerve roots (C5 and C6), which are responsible for shoulder movement and elbow flexion.
People with this type of injury may have difficulty lifting the arm, rotating the shoulder, or bending the elbow. The hand and finger movements are usually preserved. Upper brachial plexus injuries can occur during childbirth or as a result of trauma in adults.
2. Extended Upper Brachial Plexus Injury (C5–C7)
This type involves damage to the C5, C6, and C7 nerve roots. In addition to shoulder and elbow weakness, patients may also experience weakness in wrist extension.
The injury is more severe than classic Erb’s palsy and may result in limited arm control. Surgical intervention may be required if there is no spontaneous recovery.
3. Lower Brachial Plexus Injury (C8–T1)
Lower brachial plexus injury, also known as Klumpke’s palsy, affects the lower nerve roots (C8 and T1). These nerves control hand and finger movements.
Patients with this type may experience weak grip strength, difficulty with fine motor skills, and clawing of the fingers. Lower brachial plexus injuries are less common and often associated with severe trauma.
4. Total Brachial Plexus Injury (C5–T1)
Total brachial plexus injury is the most severe form, involving all nerve roots from C5 to T1. This results in complete paralysis of the arm, including the shoulder, elbow, wrist, and hand.
This type is commonly seen in severe birth injuries and high-impact trauma such as motorcycle accidents. Surgical reconstruction is often required to restore any meaningful function.
Classification Based on Age at Injury
1. Brachial Plexus Birth Palsy
Brachial plexus birth palsy occurs during childbirth due to excessive stretching of the baby’s neck and shoulder. Depending on the extent of nerve damage, it may present as upper, extended, or total palsy.
Some infants recover naturally, while others require early physiotherapy or surgical intervention to prevent long-term disability.
2. Adult Brachial Plexus Injury
Adult brachial plexus injuries are usually caused by trauma such as road traffic accidents, falls, or sports injuries. These injuries are often more complex and may involve nerve rupture or avulsion.
Adult injuries often require advanced imaging, surgical repair, and long-term rehabilitation.
Classification Based on Severity of Nerve Damage
1. Neuropraxia
Neuropraxia is the mildest form of nerve injury, where the nerve is stretched but not torn. Symptoms may include temporary weakness or numbness, and recovery usually occurs without surgery.
2. Axonotmesis
In axonotmesis, the nerve fibers are damaged but the outer covering remains intact. Recovery is possible but may take longer and may not be complete without treatment.
3. Neurotmesis
Neurotmesis is a complete nerve tear, leading to loss of nerve continuity. Surgical repair is usually required to restore function.
4. Nerve Root Avulsion
Nerve root avulsion is the most severe type, where the nerve is pulled away from the spinal cord. This type cannot be repaired directly and often requires nerve transfer surgery.
Functional Classification
1. Partial Brachial Plexus Injury
Partial injuries involve some nerves while others remain intact. Patients may retain partial arm function depending on which nerves are affected.
2. Complete Brachial Plexus Injury
Complete injuries involve total loss of nerve function in the affected arm. These cases require comprehensive treatment and rehabilitation.
The brachial plexus can be affected in different ways depending on which nerves are involved and how severe the injury is. Types include upper brachial plexus injury (C5–C6), which mainly affects shoulder and elbow movement; extended upper brachial plexus injury (C5–C7), which also impacts wrist function; lower brachial plexus injury (C8–T1), affecting hand and finger movements; and total brachial plexus injury (C5–T1), causing complete paralysis of the arm. Injuries are further classified by severity, such as neuropraxia (temporary nerve stretch), axonotmesis (partial nerve damage), neurotmesis (complete nerve tear), and nerve root avulsion, the most severe form where the nerve is pulled from the spinal cord.
The brachial plexus is a network of nerves that controls movement and sensation in the shoulder, arm, and hand. Learn more
A good candidate for brachial plexus treatment is someone with ongoing arm weakness or paralysis from nerve injury that has not improved naturally. Learn more
The exact cost can only be determined after a detailed clinical evaluation and imaging studies, as each brachial plexus injury is unique. Learn more
Brachial plexus injuries can arise from a wide range of causes. Learn more
Common symptoms of brachial plexus injuries include weakness or paralysis of the arm, loss of sensation, nerve pain, and difficulty moving the shoulder, elbow, or hand. Learn more
Brachial plexus injuries vary in type and severity, ranging from mild nerve stretching to complete paralysis of the arm depending on which nerves are affected. Learn more
During a brachial plexus consultation, the doctor evaluates symptoms, reviews imaging and nerve studies, examines arm function, and discusses possible treatment options. Learn more
You should ask about the type of nerve injury, surgical options, expected recovery time, risks, and realistic functional outcomes. Learn more
Risks may include incomplete nerve recovery, muscle weakness, stiffness, pain, infection, or complications related to anesthesia. Learn more
The procedure usually involves preoperative evaluation, nerve exploration, repair or grafting, postoperative care, and structured rehabilitation. Learn more
Results may include gradual improvement in muscle strength, sensation, and arm function, with recovery progressing over months. Learn more
Before-and-after images typically demonstrate changes in arm position, muscle bulk, and functional improvement following treatment. Learn more