Brachial Plexus Injury - Symptoms, Diagnosis And Treatment

When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

OKCancelBrachial plexus injuryView PDF Menu Close

• Overview 
• Theory 
• Diagnosis 
• Management 
• Follow up 
• Resources 

• Overview
  • Summary
• Theory

  • Epidemiology

  • Etiology

  • Case history

• Diagnosis

  • Approach

  • History and exam

  • Tests

  • Differentials

  • Criteria

• Management

  • Approach

  • Treatment algorithm

  • Prevention

  • Patient discussions

• Follow up

  • Monitoring

  • Complications

  • Prognosis

• Resources

  • Guidelines

  • Images and videos

  • References

  • Patient information

Log in or subscribe to access all of BMJ Best PracticeLast reviewed: 12 Nov 2025Last updated: 28 Jan 2022

Summary

Brachial plexus injuries most commonly result from motor vehicle accidents, gunshot or stab wounds, contact sports accidents, or workplace accidents during heavy physical labor.

Injury may involve the upper 2 or 3 nerve roots (partial injury) or all 5 nerve roots (complete injury). Partial and complete brachial plexus injuries can both be repaired successfully. Complete injuries require multiple major operations over the course of several years, while partial injuries can often be corrected in a single operation.

Complete injuries can be ruptures (roots still connected to the spinal cord) or avulsions (roots detached from the spinal cord). Nerve transfer techniques, which can be successfully applied to both ruptures and avulsions, are the treatment of choice for microsurgical repair.

An injury that does not resolve within a few days will often require major surgical reconstruction. The speed of nerve regeneration after spontaneous recovery or nerve repair is about 1 mm per day (1 inch per month).

Given the time frame to permanent paralysis (about 1 year), surgical repair is best carried out by 4 to 6 months after injury.

Definition

Brachial plexus injuries are usually caused by trauma to the roots of the plexus as they exit the cervical spine.[1]Nath RK, Lyons AB, Bietz G. Physiological and clinical advantages of median nerve fascicle transfer to the musculocutaneous nerve following brachial plexus root avulsion injury. J Neurosurg. 2006;105:1-5. http://www.ncbi.nlm.nih.gov/pubmed/17405252?tool=bestpractice.com This most commonly occurs in road traffic accidents and falls from height. Inflammatory, neoplastic, and compressive causes are also possible.[2]Moghekar AR, Moghekar AR, Karli N, et al. Brachial plexopathies: etiology, frequency, and electrodiagnostic localization. J Clin Neuromuscul Dis. 2007;9:243-7. http://www.ncbi.nlm.nih.gov/pubmed/17989587?tool=bestpractice.com The effects of the injury can include paralysis, loss of sensation, and pain. The specific clinical presentation will depend on the roots involved and the degree of injury to each root.[Figure caption and citation for the preceding image starts]: Left brachial plexusFrom the collection of the Texas Nerve and Paralysis Institute, Dr Rahul Nath, Founder and Medical Director; used with permission [Citation ends].

History and exam

Key diagnostic factors

• presence of polytrauma/multiple injury
• paralysis of shoulder
• paralysis of bicep
• numbness of radial digits of hand and shoulder
• paralysis of triceps
• paralysis of wrist/finger extensors
• flail/insensate extremity
• absent tendon reflexes

Full details

Risk factors

• motor vehicle accident
• neurofibromatosis
• improper positioning during surgery
• age <50 years
• male sex
• Parsonage-Turner syndrome
• tumors (primary and metastatic tumors)
• rib abnormalities
• metabolic disorders

Full detailsLog in or subscribe to access all of BMJ Best Practice

Diagnostic tests

1st tests to order

• Electromyography

Full details

Tests to consider

• MRI
• CT/myelography

Full details

Emerging tests

• Ultrasound

Log in or subscribe to access all of BMJ Best Practice

Treatment algorithm

ACUTE

upper (C5-6) with or without middle (C7) root injury

isolated lower root (C8-T1) injury

total root avulsion (C5-T1) injury

Log in or subscribe to access all of BMJ Best Practice

Contributors

VIEW ALLAuthors

Authors

Rahul K. Nath, MD

Director

Texas Nerve and Paralysis Institute

Houston

TX

Disclosures

RKN is an author of a number of references cited in this topic.

VIEW ALLPeer reviewers

Peer reviewers

Abdelouahed Amrani, MD

Professor

Children's Hospital

Rabat

Morocco

Disclosures

AA declares that he has no competing interests.

S. Raja Sabapathy, MS, MCh, DNB, FRCS, MAMS

Director and Head

Department of Plastic, Hand and Reconstructive Microsurgery and Burns

Ganga Hospital

Coimbatore

India

Disclosures

SRS declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Nath RK, Lyons AB, Bietz G. Physiological and clinical advantages of median nerve fascicle transfer to the musculocutaneous nerve following brachial plexus root avulsion injury. J Neurosurg. 2006;105:1-5. Abstract

American College of Radiology. ACR appropriateness criteria: plexopathy. 2021 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

• 

• Differentials

  • Functional or psychogenic weakness (e.g., unilateral loss of motor function or psychogenic parkinsonism)
  • Amyotrophic lateral sclerosis (ALS)
  • Brain or spinal cord injury
  More Differentials

• Guidelines

  • ACR appropriateness criteria: plexopathy
  More Guidelines

• Patient information

  Rotator cuff injury

  Whiplash

  More Patient information
• Log in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer

Log in or subscribe to access all of BMJ Best Practice

See all options×

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice

personpersonal subscriptionor user profileAccess through your institutionORSUBSCRIPTION OPTIONS

Help us improve BMJ Best Practice

Close ×

Please complete all fields.

NameEmail

Page:

I have some feedback on:

Feedback on: This page The website in general Something elseI have some feedback on:

We will respond to all feedback.

Submit Feedback

For any urgent enquiries please contact our customer services team who are ready to help with any problems.

Phone:+44 (0) 207 111 1105

Email: [email protected]

Thank you

Your feedback has been submitted successfully.

 FEEDBACK