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A very nasty biker injury...

24 December 2013

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 December 24, 2013
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Brachial Plexus Avulsion

This is a medical condition that you have probably never heard of and has a name you probably can’t even pronounce. However, it may be of interest because 70-80% of the guys who present with this condition received this injury in a motorcycle accident. The syndrome is mostly the result of high impact trauma in male adults. Interestingly (or bizarrely, depending on your point of view), the only other sizeable group of humans who experience this condition are new born babies following a difficult delivery!

All too often during an off, the shoulder region hits an immoveable object at speed and inertia carries the head and body just that little bit further forward. The sudden jarring effect results in the characteristic outcome of a brachial plexus injury. This is where the arm and shoulder are forcefully pulled away from the neck or trunk. Such an event can result in what is known as nerve root avulsions i.e. the nerves are literally ripped from their normal position.

Traumatic brachial plexus injury is regarded as one of the most unpleasant injuries of the upper extremity. It is characterized by the sudden onset of shoulder girdle and arm pain, followed by weakness of the shoulder and arm muscles. The injury involves damage to spinal nerves within the C5 (cervical or neck level) to T1 (upper-back level) regions. In addition to the neurologic impairments, nerve-type pain in the arm/hand area is the main complaint of up to 90% of people with such an injury. In patients where the nerves are disconnected from the spinal cord (root avulsion), the pain is often described as “burning”, “shooting” or “stabbing” in quality.

Depending on which nerve roots have been affected, the resulting neurologic problems can differ. C5-6 nerve root damage is associated with shoulder abduction and elbow flexion problems; C5-7 nerve root damage with shoulder abduction, elbow flexion/extension and wrist extension problems whilst C5-T1 nerve root damage is associated with shoulder abduction, elbow flexion/extension and global hand function difficulties.

Extensive physical therapy is the first-line treatment strategy for a traumatic strain or avulsion injury. Alongside this, surgical treatment usually involves multiple reconstructive procedures e.g. nerve replacement and transfers.  The timing of surgery is one of the most important aspects of the treatment process. If the delay is too long, the muscles with nerves no longer attached will begin to waste away. Unfortunately, it appears that no single procedure is capable of guaranteeing a return to pre-injury status. Therefore, the mainstay of treatment tends to be medication for managing the ongoing pain experience.

In the early days (decades ago thankfully!), if the patient had a flail or non-usable arm following the injury, the treatment of choice was amputation.  Positively for us current bikers, advances in reconstructive surgery and neurological approaches have resulted in amputation becoming much less common.