What’s New in Physiotherapy and Brachial Plexus Injuries?

Damage to the Brachial Plexus affects many injured bikers. You can often be left with reduced strength, reduced movement, pain and reduced sensation in the affected arm. This will probably have a massive impact upon your daily life including work, routine activities such as washing, dressing and cooking, and of course biking.

The brachial plexus is the name given to the intricate network of nerves that leave the spinal cord at the lower part of the neck, pass down the side of the neck and into the shoulder. After this the nerves travel down the arm supplying the muscles and skin with feeling and movement.

Bikers usually damage their brachial plexus by over stretching it when they collide with another vehicle or hit the ground. It is this over stretching beyond its natural elasticity that damages the nerves resulting in either partial damage or complete rupture of the nerves from the neck. Nerves do not like being over stretched and after their injury they complain like mad, which is where the pain comes from. Noxious chemicals are released from the damaged nerves and you feel pain. Often if the affected arm is bumped or moved you will feel an exaggerated pain response.

The arm muscles will waste with brachial plexus damage so that your previously beefy muscly arm can appear withered. This starts to happen within days of the injury. The affected arm starts to feel heavy and the natural reaction is to want to support it. Without the nerves firing the muscles, the arm is unable to move and stiffness soon sets in.

Brachial Plexus

What a gloomy picture!  But there is hope….

The damage can sometimes be temporary, lasting 6-12 weeks and then the movement can return. If the nerves are severed then surgery to reattach the 2 ends of a nerve or graft the area can be successful.

But what about the group of people left with a weak painful arm that isn’t much use?

Do not fear- help is at hand! Physiotherapy has traditionally concentrated upon damage limitation, which prevents secondary complications such as a frozen shoulder. Patients are then often told by their doctor or therapist “to wait and see” what recovery takes place. When patients are seen at hospital physiotherapy outpatient departments they are given exercises to maintain the flexibility of the arm. Sometimes strengthening exercises are also provided. The lucky patients are offered a course of hydrotherapy- the opportunity to exercise in warm water where movement is easier and more comfortable.

More recently, physiotherapists are getting excellent results with patients using trophic electrical stimulators. These look like a TENS unit, which readers may be familiar with for use in pain management. However they are not the same. A trophic electrical stimulator is designed to treat poorly nerves and muscles by inputting a very gentle electrical current to the affected muscles. The TES unit is basically doing what the nerve would normally do, i.e., artificially applying a false nerve supply, directly to the muscle, via sticky pads on the skin. It was originally designed for the treatment of facial palsy in the 1980’s. More recently it has been further developed to treat any type of peripheral nerve problem, including dropped foot.  There is a growing body of evidence that low frequency electrical stimulation, such as TES, is beneficial in treating peripheral nerve injuries.

Essential to the success of TES as a treatment for nerve injuries is the initial physiotherapy assessment of the patient with Surface Electromyography (SEMG). SEMG is recognised as an effective measure of nerve and muscle function and can indicate your prognosis.  SEMG is a painless, non-invasive test whereby self-adhesive electrodes (identical to the ones used for ECGs) are applied to the affected muscles and the patient is asked to move the arm in various ways. The SEMG equipment detects electrical activity at the end of the nerve as it enters the muscle. This is measured and compared with the reading from the healthy arm. The results are examined immediately and the patient can be informed of just how well the damaged nerve is working. After this the patient can be setup with the TES treatment which they carry out daily at home. Often it can be beneficial to have physiotherapy concurrently to maximise the improvements in muscle strength, movement or pain.

The patient is reviewed every 2-4 months and treatment progressed.

So, when is the best time to carry out this treatment? The sooner the better. TES can be used within a few weeks of the injury and can limit muscle wasting. It can speed up your rehabilitation progress so that you make a more complete recovery more quickly. But, because nerves lie dormant and in a hibernation state after injury, it can also be used months or years after the initial injury. Results are often not as dramatic but improvements can still be made.

The treatment of brachial plexus injuries is a highly specialised area. There are very few physiotherapists in the UK with the expertise to treat them effectively. They are usually based in hospitals with a peripheral nerve injury, or sometimes, plastic surgery unit. SEMG is sometimes carried out when neurophysiology tests are performed at the hospital. So, if you are seeing a physiotherapist for your brachial plexus injury, it may be worth asking if she/he considers it appropriate to have SEMG testing or if TES would be appropriate.

And lastly, do not give up. Chronic brachial plexus injuries do change- they can improve or develop new problems over time.

A review with a specialist physiotherapist can be useful even years after your accident. And we are getting better at treating nerve injuries all the time! So if you would like to arrange a consultation contact us today

Trophic Stimulator on a patient