A brachial plexus injury is an injury to the nerves that travel from the neck and down the arm. These peripheral nerves are called the brachial plexus nerves. They leave the spinal cord and travel between the vertebrae and the back and into the shoulder, giving the arm its ability to function.

The brachial plexus is formed as the nerves to the arm, hand, and fingers pass from the spinal cord between the bones (vertebrae) of the neck and go into the arm. Along the side of neck, these nerves merge together. From there, they branch out to form a "highway system," or "plexus," of nerves.

Pain in the cervical and shoulder area is common and may reflect a multitude of conditions. However, when a patient develops neurologic deficits, the list of differential diagnoses becomes shorter. Cervical radiculopathy is the most common condition. Patients with cervical radiculopathy present with cervical pain and neurologic deficits resulting from a herniated nucleus pulposus or an osteophyte. Acute brachial plexus neuritis mimics cervical radiculopathy in several aspects, but the treatments are significantly different.

Patients with acute brachial plexus neuritis are often misdiagnosed as having cervical radiculopathy. Acute brachial plexus neuritis is an uncommon disorder characterized by severe shoulder and upper arm pain followed by marked upper arm weakness. The temporal profile of pain preceding weakness is important in establishing a prompt diagnosis and differentiating acute brachial plexus neuritis from cervical radiculopathy.

Causes
Brachial plexus dysfunction (brachial plexopathy) is a form of peripheral neuropathy. It occurs when there is damage to the brachial plexus, an area where a nerve bundle from the spinal cord splits into the individual arm nerves.
Damage to the brachial plexus is usually related to direct injury to the nerve, stretching injuries, pressure from tumors in the area, or damage that results from radiation therapy.

Symptoms
Malfunction of the brachial plexus causes pain, weakness, and loss of sensation in an arm. All or part of the arm (such as the forearm or biceps) may be affected. If the cause is an injury, recovery tends to occur slowly, over several months, although some severe injuries cause permanent weakness.

Treatment depends on the type of injury:

Laceration
Nerves damaged by clean, sharp, relatively fresh lacerations, such as those from a knife wound, should be surgically reconnected within 72 hours. Penetrating injuries with severe or complete loss of sensation should be explored as soon as the primary wound heals.
Gunshot wounds
Gunshots usually damage the nerves dues to the vibratory effect of the bullet and rarely divide the nerves. Surgery is of little benefit to these lesions and chances of full or partial recovery is small.

Recovery and rehabilitation
Rehabilitation for BPI primarily entails physical therapy (PT) during the entire treatment course (acute, recovery, and maintenance treatment phases). The focus of PT during the acute phases primarily involves early mobilization and icing. Patients attempt to improve cervical range of motion to strengthen cervical muscles. During the recovery phases, special PT programs attempt to strengthen cervical muscles to a level of performance prior to injury. Special focus on muscles supporting the injured brachial plexus nerve (i.e., cervical and shoulder regions) is emphasized.

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