Rehabilitation treatment of brachial plexus injury

1. Treatment methods in the acute phase

The brachial plexus is composed of the anterior branches of C5~8 and T1 spinal nerves and mainly controls the sensation and movement of the upper limbs. The fibers of the five roots of the brachial plexus first form the upper, middle and lower trunks. The branches of the three trunks surround the axillary artery to form the medial bundle, the lateral bundle and the posterior bundle. The branches from the bundle are mainly distributed in the upper limbs and part of the superficial chest and back. muscle.


2. Clinical manifestations

According to the injured part of the brachial plexus, it is divided into upper brachial plexus, middle brachial plexus, lower brachial plexus and total brachial plexus injuries.

1. Upper brachial plexus injury: more common, composed of C5 and C6 nerve roots, manifested by drooping of the entire upper limb, inability to abduct the shoulder, inability to internally and externally rotate the upper limb, inability to flex the elbow and extend the wrist radially, and sensation on the radial side of the upper limb decrease.

2. Middle brachial plexus injury: The middle brachial plexus comes from the C7 nerve root and is rarely affected alone. It mainly affects the muscles innervated by the radial nerve. It is characterized by limited extension of the forearm, hand and wrist, and a limited sensory impairment area behind the forearm.

3. Lower brachial plexus injury: the lower trunk and medial bundle are affected, namely the C8 and T1 nerve roots. The symptoms include atrophy and weakness of small muscles in the hands, claw-shaped hands, and sensory impairment on the inner side of the upper limbs.

4. Total brachial plexus injury: complete paralysis and drooping of the upper limbs.

3. Auxiliary inspection

1. Electrophysiological examination can help determine the location of the disease.

2. Imaging examination:

①CT combined with myelography (CTM): high sensitivity and specificity, but invasive;

②HRCT (high-resolution CT): can directly display nerve root filaments; helps in early diagnosis

③MRI: simultaneously displays pre- and post-ganglionic images, non-invasive, accurate and reliable.



4. Rehabilitation training for brachial plexus injury

Early rehabilitation treatment: mainly improves blood circulation of damaged nerve tissue and promotes nerve repair; prevents muscle atrophy and maintains joint mobility.

1.Physical factor treatment Transcutaneous neuromuscular electrical stimulation: Electrical stimulation treatment helps promote nerve regeneration and repair, 20 minutes per group of muscles, 2 times a day;


2. Sports therapy therapists perform shoulder joint adduction and abduction, forward flexion and extension, internal rotation and external rotation, elbow joint flexion and extension, wrist joint flexion and extension, arm pronation and supination, and finger flexion and extension movements to prevent joint stiffness and soft tissue contracture.
Passive movement training (schematic)

3. Assistive devices: Shoulder braces are mainly used to protect shoulder joints.

Rehabilitation treatment during the recovery period: mainly enhances the muscle strength of the affected limb, promotes the coordinated movement function of the muscles, promotes sensory recovery, and gradually establishes normal upper limb functions.

1. Muscle strength training: from active and passive training to active training to excessive resistance training to gradually enhance muscle strength;

2. Coordination training emphasizes fine function training of limbs and hands;

3. Sensory recovery training mainly focuses on positioning sense and tactile training, and repeats the intensive training in the order of eyes closed - eyes opened - eyes closed;

4.ADL training trains the affected limb’s functions such as eating, washing, and dressing;