Βλάβες Βραχιονίου Πλέγματος-Brachial plexus injury

Οι περισσότεροι τραυματισμοί στο βραχιόνιο πλέγμα συμβαίνουν όταν το χέρι ή ο αυχένας τραβιέται ή διατείνεται βίαια, δηλαδή όταν το χέρι τραβιέται προς τα κάτω και το κεφάλι πιέζεται προς την αντίθετη κατεύθυνση.

 

Το βραχιόνιο πλέγμα είναι υπεύθυνο για την αισθητηριακή και κινητική νεύρωση ολόκληρου του άνω άκρου. Οι βλάβες του βραχιονίου πλέγματος μπορεί να οδηγήσουν σε σοβαρή λειτουργική βλάβη. Η μαιευτική παράλυση είναι ένας ειδικός τύπος πάρεσης βραχιονίου πλέγματος που μπορεί να προκύψει κατά τη διαδικασία του τοκετού και επηρεάζει ολόκληρο ή μέρος του βραχίονα και του χεριού του βρέφους. Τα άτομα με πάρεση βραχιονίου πλέγματος ή τα παιδιά με μαιευτική παράλυση τείνουν να αποφεύγουν ασυνείδητα τη χρήση του προσβεβλημένου χεριού και σταδιακά μαθαίνουν να αντισταθμίζουν χρησιμοποιώντας τεχνικές μονόπλευρης λειτουργίας των χεριών κατά τις καθημερινές δραστηριότητες. Αυτή η αντιστάθμιση οδηγεί σε περαιτέρω λειτουργικές μειώσεις, καθώς οι μύες χάνουν περισσότερο τη δύναμή τους, επειδή χρησιμοποιούνται ελάχιστα.

Οι περισσότεροι τραυματισμοί στο βραχιόνιο πλέγμα συμβαίνουν όταν το χέρι ή ο αυχένας τραβιέται ή διατείνεται βίαια, δηλαδή όταν το χέρι τραβιέται προς τα κάτω και το κεφάλι πιέζεται προς την αντίθετη κατεύθυνση.

Περιστατικά που μπορεί να προκαλέσουν κάκωση στο πλέγμα είναι οι πτώσεις, τα τροχαία ατυχήματα, ο τραυματισμός από μαχαίρι ή σφαίρα, και η πιο συχνή αιτία, η σύγκρουση μοτοσικλέτας.

Οι τραυματισμοί του βραχιονίου πλέγματος ποικίλουν ανάλογα με τη σοβαρότητα και εξαρτώνται από τον τύπο της κάκωσης και την ποσότητα της δύναμης που τέθηκε στο πλέγμα.

•Αποκόλληση. Αυτός είναι ο πιο σοβαρός τραυματισμός, η νευρική ρίζα αποκολλάται από τον νωτιαίο μυελό.

•Διάταση (Νευροαπραξία). Όταν τα νεύρα διατείνονται ήπια, μπορεί να θεραπευτούν και από μόνα τους ή απαιτούν απλές μη χειρουργικές θεραπευτικές μεθόδους για να επιστρέψουν στην φυσιολογική τους λειτουργία.

•Ρήξη. Μια πιο δυνατή διάταση στο νεύρο μπορεί να το κόψει μερικώς ή πλήρως.

Συμπτώματα

Τα συμπτώματα ποικίλουν ανάλογα με τον τύπο και την τοποθεσία της κάκωσης στο βραχιόνιο πλέγμα, καθώς και αν το άτομο φέρει άλλα τραύματα.

Τα πιο συχνά συμπτώματα της κάκωσης του βραχιονίου πλέγματος είναι:

•Αδυναμία ή μούδιασμα

•Απώλεια αισθητικότητας

•Απώλεια κίνησης (παράλυση)

•Πόνος

Ο πόνος από κάκωση του βραχιονίου πλέγματος συμβαίνει εξαιτίας του τραυματισμού του νωτιαίου μυελού, εκεί όπου οι ρίζες των νεύρων προσφύονται στον μυελό.

 

Brachial plexus injury

The brachial plexus is the group of nerves that sends signals from the spinal cord to the shoulder, arm and hand. A brachial plexus injury happens when these nerves are stretched, squeezed together, or in the most serious cases, ripped apart or torn away from the spinal cord.

Minor brachial plexus injuries, called stingers or burners, are common in contact sports, such as football. Babies sometimes get brachial plexus injuries when they're born. Other health issues, such as inflammation or tumors, may affect the brachial plexus.

The most serious brachial plexus injuries happen during car or motorcycle accidents. Bad brachial plexus injuries can leave the arm paralyzed, but surgery may help.

Symptoms of a brachial plexus injury can differ depending on how serious the injury is and where it's located. Usually only one arm is affected.

Less severe injuries

Minor damage often happens during contact sports, such as football or wrestling, when the brachial plexus nerves get stretched or squeezed together. These are called stingers or burners. Some of the symptoms are:

• A feeling like an electric shock or a burning sensation shooting down the arm.
• Numbness and weakness in the arm.

These symptoms usually last only a few seconds or minutes, but in some people the symptoms may last for days or longer.

More-serious injuries

More-serious symptoms happen when an injury seriously damages or even tears or ruptures the nerves. The most serious brachial plexus injury is when the nerve root is cut or torn from the spinal cord.

Symptoms of serious injuries can include:

• Weakness or not being able to use certain muscles in the hand, arm or shoulder.
• Loss of feeling in the arm, including the shoulder and hand.
• Intense pain.

When to see a doctor

Brachial plexus injuries can cause lasting weakness or disability. Even if yours seems minor, you may need medical care. See your healthcare provider if you have:

• Burners and stingers that keep coming back, or symptoms that don't go away quickly.
• Weakness in the hand or arm.
• Neck pain.
• Symptoms in both arms.

Causes

Brachial plexus injuries in the upper nerves happen when the shoulder is forced down on one side of the body and the head is pushed to the other side in the opposite direction. The lower nerves are more likely to be injured when the arm is forced above the head.

These injuries can happen in many ways, including:

• Contact sports. Many football players have burners or stingers. These are caused when the brachial plexus nerves get stretched past their limit during clashes with other players.
• Birth. Newborns can have brachial plexus injuries. This is more common in babies with a high birth weight, a very long labor and a bottom-first, also called breech, presentation. If a baby's shoulders get stuck in the birth canal, brachial plexus palsy is more likely. Most often, the upper nerves are injured. This is called Erb palsy.
• Injuries. Many injuries — including those from motor vehicle accidents, motorcycle accidents, falls or bullet wounds — can damage the brachial plexus.
• Tumors and cancer treatments. Tumors can grow on their own. Rarely, they can form because of a health condition, such as neurofibromatosis, or after radiation treatment.

Risk factors

Playing contact sports, especially football and wrestling, or being in high-speed motor vehicle accidents increases the risk of brachial plexus injury.

Complications

Many mild brachial plexus injuries heal over time with few to no issues. But some injuries can cause short-term or lasting problems, such as:

• Stiff joints. If you have hand or arm paralysis, the joints can get stiff. This can make it hard to move, even if you are able to use your hand or arm again. For that reason, your healthcare professional may suggest ongoing physical therapy during your recovery.
• Pain. This is caused by nerve damage and may be lifelong.
• Numbness. If you lose feeling in the arm or hand, you're at risk of burning or injuring yourself without knowing it.
• Muscle atrophy. Nerves regrow slowly and can take many years to heal after injury. During that time, not using your muscles may cause them to break down.
• Permanent disability. How well you recover from a serious brachial plexus injury depends on many things, such as your age and the type, location and seriousness of the injury. Even with surgery, some people have muscle weakness or paralysis that lasts for the rest of their lives.

Prevention

Although a brachial plexus injury can't always be avoided, you can take steps to reduce your risk of complications after getting hurt:

• For yourself. If you can't use the hand or arm for a short time, daily range-of-motion exercises and physical therapy can help prevent joint stiffness. Avoid burns or cuts, as you may not feel them if you have numbness.

  If you're an athlete with a brachial plexus injury, your healthcare professional may suggest that you wear padding to protect the area when you play sports.

• For your child. If your child has brachial plexus palsy, it's important to exercise your child's joints and working muscles every day. You can start when your baby is just a few weeks old. This helps stop the joints from becoming permanently stiff. It also keeps your child's working muscles strong and healthy.

Diagnosis

To diagnose your condition, your healthcare professional checks your symptoms and does a physical exam. To know how serious your brachial plexus injury is, you may need one or more of the following tests:

• X-ray. An X-ray of the shoulder and neck can show fractures or other related injuries.
• Electromyography (EMG). During an EMG, a healthcare professional places a needle electrode through the skin into different muscles. The test looks at the electrical activity of the muscles when they tighten and when they're at rest. You may feel a little pain when the electrodes are put in, but most people can finish the test without much discomfort.
• Nerve conduction studies. These tests are usually done as part of EMG. They measure how fast and how well electrical signals travel down the nerves. This provides information about how well the nerve is working.
• Magnetic resonance imaging (MRI). This test uses a powerful magnetic field and radio waves to make very detailed images of the organs and tissues in the body. It can show how much damage there is to the brachial plexus after an injury. It also can show any artery damage in the limb, which is important for reconstruction. New types of high-resolution MRI, such as magnetic resonance neurography or diffusion tensor imaging, may be used.
• Computerized tomography (CT) myelography. Computerized tomography uses a series of X-rays to create images of the body. CT myelography uses contrast dye, injected during a spinal tap, to look for issues in the spinal cord and nerve roots. This test is sometimes done when MRIs don't give enough information.

SOURCES:Mayo Clinic,AAP, Boston Childrens Hospital