The nerves are stretched but not torn. Symptoms like weakness or tingling improve on their own within weeks to months. Full recovery is common without surgery.
Brachial Plexus Injuries

Dr Jacqueline Tan
MBBS (SG) | MRCS (Edin) | MMed (Surgery) | FAMS (Hand Surgery)
The brachial plexus is a network of nerves that connects the spinal cord to the shoulders, arms, and hands. These nerves control both movement and sensation in the upper limbs. A brachial plexus injury occurs when these nerves are stretched, compressed, or torn due to trauma, repetitive strain, or complications during childbirth.
The severity of the injury varies. Mild injuries, such as temporary stretching of the nerves, may heal on their own. However, severe injuries, like nerve ruptures or detachment from the spinal cord, often require surgical intervention.



Symptoms of Brachial Plexus Injuries
Brachial plexus injuries present with a range of symptoms depending on the location and severity of the damage. Key symptoms include:
- Numbness or Loss of Sensation: Affected areas may feel numb or lose sensation entirely. In some cases, individuals experience burning or tingling sensations near the injury site, especially during repetitive arm movements.
- Weakness or Paralysis: The affected limb may feel weak, or movement may be completely lost, depending on the type of injury.
- Nerve-Related Pain: Individuals may experience sharp, burning, or shooting pain, which can persist for extended periods without treatment.
- Loss of Reflexes: Reflexes in the affected arm or hand may be diminished or absent, indicating significant nerve damage.
- Muscle Shrinkage (Atrophy): Long-term injuries can lead to muscle wasting due to disuse or lack of nerve signals, further reducing arm functionality.
Causes and Risk Factors
Brachial plexus injuries can result from a variety of factors, and identifying these causes is necessary for effective prevention.
- Trauma: Sudden and forceful stretching of the arm can damage the brachial plexus. For example, upper nerves are injured when the shoulder is pushed down while the neck is stretched upward. Lower nerves are damaged when the arm is forced overhead.
- Motor Vehicle Accidents: High-impact crashes, especially motorcycle accidents, are a common cause of severe injuries to the brachial plexus.
- Falls: A fall that overstretches or compresses the arm can result in nerve damage.
- Childbirth Injuries: Excessive pulling or pressure on a baby’s shoulder during delivery, particularly in difficult or breech births, can lead to brachial plexus injuries in newborns.
- Repetitive Movements: Activities involving frequent overhead motion or heavy lifting can strain the brachial plexus over time, increasing the risk of injury.
Types of Brachial Plexus Injuries
The specific symptoms experienced often depend on the type and location of the brachial plexus injury.
Neurapraxia (Stretch Injury)
Rupture
The nerve is torn, but the injury remains outside the spinal cord. Surgery, such as nerve grafting, is often needed to repair the damage and restore function.
Avulsion
The nerve is completely torn away from the spinal cord, causing permanent loss of function. Advanced surgical procedures like nerve transfers may restore partial functionality.
Erb’s Palsy
Affects the upper brachial plexus, leading to weakness or paralysis in the shoulder and upper arm. This is common in newborns and may cause the arm to hang limp.
Klumpke’s Palsy
Affects the lower brachial plexus, causing weakness or paralysis in the hand and wrist. Severe cases may result in a claw-like deformity.
Diagnosis of Brachial Plexus Injuries
Physical Examination
The doctor evaluates strength, reflexes, and sensation in the affected arm and hand to assess nerve function. Signs such as muscle weakness, changes in tone, or atrophy provide indications about the severity and duration of the injury.
Nerve and Muscle Function Tests
Nerve conduction studies measure how well nerves transmit signals, while electromyography tests the muscles’ response to these signals. Together, these tests identify the specific location and severity of nerve damage.
Imaging Studies
Imaging techniques such as MRI or CT myelography create detailed visuals of the brachial plexus. These scans help detect nerve tears, swelling, or compression, providing necessary information for treatment planning.
Treatment Options
Treatment for brachial plexus injuries depends on the severity of the damage. Non-surgical options are typically used for mild injuries or during the initial recovery phase, while surgical interventions are recommended for severe cases where nerves are torn or unlikely to heal on their own.
Non-Surgical Management
Monitoring and Observation
Mild brachial plexus injuries, such as stretched nerves, often heal on their own over several weeks to months. During this time, doctors closely monitor the injury for signs of natural recovery. If significant improvement is not observed within a specified period, further evaluation or surgical intervention may be considered.
Physical Therapy
Physical therapy is necessary for maintaining flexibility and strength in the affected arm and shoulder. It helps prevent joint stiffness and muscle tightening, which can result from reduced movement. Additionally, therapy supports the recovery of nerve function by stimulating the affected area and improving circulation.
Pain Management
Pain associated with nerve damage is managed with anti-inflammatory medications, such as ibuprofen, to reduce swelling and discomfort. For more severe or persistent pain, nerve blocks or corticosteroid injections may be used to provide targeted relief.
Surgical Treatment
Nerve Grafting
Damaged nerves are repaired by replacing injured segments with healthy ones taken from other parts of the body. This helps rebuild the nerve pathway and restore functionality. Recovery can take several months and often requires therapy.
Nerve Transfers
Healthy nerves are rerouted to replace severely damaged ones. This procedure can restore some movement or sensation in the affected limb. Post-surgery therapy is necessary for retraining the body to use the new nerve pathways.
Muscle or Tendon Transfers
When nerve repairs cannot fully restore function, muscles or tendons from other parts of the body are transferred to the arm. This approach improves movement, but recovery involves long-term therapy to adjust to the changes.
Prevention and Management
While not all brachial plexus injuries can be prevented, certain steps can help reduce the risk. Using protective gear during high-risk activities, employing proper techniques in contact sports, and ensuring skilled medical care during childbirth are key preventative measures. For individuals already affected, early diagnosis, regular therapy, and tailored treatment plans are necessary to support recovery and improve outcomes.
Frequently Asked Questions
Can brachial plexus injuries affect both arms?
Yes, but it is uncommon. Bilateral brachial plexus injuries usually occur in cases of severe trauma, such as high-impact motor vehicle accidents or significant falls.
What happens if brachial plexus injuries are left untreated?
If left untreated, brachial plexus injuries can result in chronic pain, permanent weakness, or paralysis of the affected limb. Over time, this may lead to joint stiffness and muscle wasting, further reducing functionality.
Is it possible to regain full function after surgery?
The likelihood of full recovery depends on the severity of the injury and how quickly surgery is performed. Early intervention significantly improves the chances of regaining movement and strength in the affected limb.

Dr Jacqueline Tan
MBBS (SG)
MRCS (Edin)
MMed (Surgery)
FAMS (Hand Surgery)
Dr. Jacqueline Tan is a hand surgeon in Singapore with over 18 years of experience in managing hand, wrist, and nerve conditions. Formerly the Head of Department of Hand and Reconstructive Microsurgery at Singapore General Hospital, she has continued to contribute significantly to her profession.
- Director of Micro-Reconstruction Service and the Director of Peripheral Nerve and Paralytic Upper Limb Service
- Upon the completion of her training as a hand surgeon in Singapore, Dr Tan was awarded the prestigious Health Manpower Development Plan scholarship by the Ministry of Health (MOH).
- Completed a one-year advanced fellowship in Taiwan under the tutelage of internationally-acclaimed Hand and Orthopedic Microsurgeon – Professor Yuan-Kun Tu
- Dr Tan’s field of expertise is in early and late brachial plexus reconstruction, peripheral nerve disorders, reconstructive microsurgery of the extremities and wrist disorders.
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