Last week, I had a patient come into my clinic complaining of arm pain after slipping and falling off his flatbed trailer.
He reported that two weeks prior, he was walking on the deck of his trailer and slipped on some ice that had formed. As he was falling off, he tried to catch himself by grabbing on to the edge of the trailer. He instantly felt a jolt of pain shoot from his neck all the way down to his fingers. After performing a physical examination, I diagnosed the patient with a brachial plexus injury.
In order to understand brachial plexus injuries, it is important to have a general knowledge of the anatomy of the neck.
The brachial plexus is a bundle of nerves that runs from your spinal cord through your shoulder and all the way into your hand. This vital network of nerves carries signals from your brain to your entire upper body. Injuries to the brachial plexus usually occur when these nerves are stretched or torn. This is a fairly common injury among professional truck drivers due to the demands of their job.
In most cases, brachial plexus injuries happen when your shoulder is pressed down while your head is pushed up and away from that shoulder. This movement causes tension on the nerve bundle and may damage individual nerves. The most common cause of this type of injury I see in my practice is truck drivers raising and lowering the landing gear of a trailer.
Often, the gear will slip, causing the driver’s arm to be forced forward with high velocity. A similar situation occurs to flatbedders when the chain slips as they are securing a load. In both cases, the brachial plexus is stretched and injured. Other less common causes include slips and falls, inflammation and tumors.
The symptoms of a brachial plexus injury vary from person to person. However, usually only one arm is affected. Minor injures to the brachial plexus which are often referred to as ‘stingers,’ cause symptoms such as the feeling of an electrical shock or burning sensation shooting down your arm.
It may also cause paresthesias, which is a sensation of numbing and weakness in the upper limb. These symptoms only last for a few seconds or minutes, but some may persist for days or weeks. Severe injuries to the brachial plexus result from tears and ruptures of the nerves themselves. In this situation, you may lose the ability to move your shoulder, elbow or hand as well as suffering severe pain in the upper limb.
It is important to see your doctor if you suspect you have a brachial plexus injury, as they can lead to permanent weakness or disability. To diagnose the severity of the injury to the brachial plexus, your doctor may order a few tests. The first test is called an electromyogram. This is designed to check the health of the nerves that move your muscles.
The next test is called a nerve conduction study. This test measures how quickly the nerve impulse is conducted through your nerves. Finally, your doctor may order an MRI or CT scan. Both tests will help to visualize the injured nerve structures.
Once your doctor has identified the location and severity of the injured nerves, they will discuss with you the possible treatment options. In less severe cases, in which the nerves have only been stretched, no treatment is required as the nerves will recover on their own.
However, in more severe cases, where the nerves have been torn or severed, surgery is often the treatment of choice. Surgery to repair damaged nerves should be done within three to six months after injury, so as to avoid significant muscle wasting. Recent studies have shown that the success rate drops tremendously if the surgery is performed more than one year after the onset of symptoms. Some medications have been shown to help manage the pain that is associated with this type of injury. Drugs containing opiates, such as codeine, are usually prescribed after the injury.
Antidepressant and anticonvulsant medications have also shown to be effective in some cases.
Although most brachial plexus injuries can not be prevented, professional truck drivers can take a few precautions to help minimize their chances of injuring themselves.
Maintaining concentration and staying focused on the job at hand will help reduce careless mistakes. Using proper form and body postures while performing job tasks is important.
Finally, keeping your muscles and joints flexible will help to reduce the tension of the brachial plexus. This can be accomplished by stretching on a regular basis.