Brachial Plexus Problems After Arthroscopic Shoulder Surgery

When the brachial plexus, a complex set of nerves that send messages directly from the spinal cord to the arm, suffers damage, the arm and hand may lose some or all ability to function. Arthroscopic shoulder surgery can cause nerve damage in this area, either from the procedure itself or from a nerve block procedure used in anesthesia. Reversing brachial plexus damage may require a combination of surgery and therapy.

The Brachial Plexus

• The brachial plexus, a dense bundle of nerve fibers that control function in the arm and hand, resemble a thick tangle of branches as they extend from the spinal cord through the upper part of the shoulder. The nerves run all the way down the arm to the fingers. The nerve bundles form a series of trunks, each attached to a different vertebra (spinal bone) or pair of vertebrae.

Brachial Plexus Injuries

• An impact to the arm or shoulder from a fall or other accident can damage the brachial plexus, as can certain illnesses or genetic defects. In some cases, the injury occurs during childbirth if the newborn's brachial plexus gets stretched or torn during a difficult delivery.

  Damage to the brachial plexus can cause a variety of symptoms, from pain or burning sensations in the arm to numbness. The patient may experience weakness in the arm and may lose the ability even to move it. As the body develops, the afflicted arm may remain abnormally short. Even in adult cases of brachial plexus injury, the afflicted limb's appearance may change over time.

Arthroscopic Shoulder Surgery

• Arthroscopic surgery aims to cause as little additional trauma to an injury as possible by working through a few small cuts. The surgeon uses a miniature camera to watch the procedure on a monitor. Arthroscopic shoulder surgery can repair injuries to muscles and tendons, remove damaged tissues and restore stability to the joint.

Risks

• According to the National Institutes of Health, arthroscopic shoulder surgery poses a risk of nerve damage. Ongoing arm weakness or shoulder stiffness following the procedure may indicate such an injury. In some cases, an anesthetic procedure called an interscalene brachial plexus block (ISB) may harm the brachial plexus during surgery.

Treatment

• In milder cases of brachial plexus, the affected area may eventually heal on its own. If, however, the bronchial plexus has sustained too much damage, surgeons may have to graft or transfer nerves to repair the damage. Physical and occupational therapy can help the patient keep the arm limber and retrain it to perform everyday tasks.