Brachial Plexus Palsy
Types of Brachial Plexus Injuries
There are different types of brachial plexus injuries. Children with
brachial plexus palsy are all affected in different ways. The variations
are that some
children will not have any muscle control or feeling in the arm or hand while
some children can move their arms but have little control over the wrist and
hand with other children able to use their hands well but cant use their
shoulder or elbow muscles. Different types of nerve damage in brachial plexus
palsy children range from mild to severe. A brachial plexus injury has four
different types of nerve injuries, including:
- avulsion: the nerve is torn from the spine
- rupture: meaning the nerve is torn but not where it attaches
to the spine,
- neuroma: meaning the nerve has tried to heal but scar tissue
has grown around the injury and the scar tissue puts pressure on the
injured nerve
- praxis: meaning that the nerve has been damaged but not torn
but improvement should be seen within 3 months.
Neuropraxia is the mildest form of a nerve injury. Neuropraxia,
the most common form of brachial plexus palsy is only at the specific
place where the injury occurs, and is a physiologic block of nerve conduction
within an axon without any anatomical interruption. Many infants born
with brachial plexus palsy have neuropraxia and sometimes recover spontaneously
because it sometimes disappears within 4-6 weeks.
Axonotmesis nerve damage in brachial plexus palsy injuries is
characterized by axonal and myelin sheath damage that ends with partial
interruption of the connective tissue framework. This form of brachial
plexus palsy requires a re-growth of the axon to the target muscle. A
complete absence of sensory modalities should be expected though recovery
is fairly good.
Neurotmesis is the greatest degree of nerve injury in brachial
plexus palsy. There is complete disruption of the axon and supporting
connective tissue. At birth brachial plexus palsy is associated to neurotmesis
and has no recovery.
One or more of the nerves in the brachial plexus may be affected and
injured and may be the same type of injuries or different. Due to the
fact that the injuries cause the same symptoms it is hard to distinguish
what type of injury has occurred.
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