Before depicting what causes a brachial plexus injury we must first understand what the brachial plexus is. “The brachial plexus is a network of nerves formed by the union of cervical vertebrae (C5-C8) to thoracic vertebra (T1)” (McDonald & Pettigrew, 2014, 147). This means the plexus starts at the neck and into the armpit. Because of these nerves, we have feeling and strength from our shoulders to hands. Brachial plexus injuries are more common in males than females. This could be due to the causes of a brachial plexus injury. The main cause of brachial plexus injury is trauma usually by otorcycle or automobile accidents.
However, there has been 89% increase in brachial plexus injuries in military services. Military injuries are caused by penetration, meaning that of a bullet or other sorts (Chambers, Hiles, & Keene, 2014). According to Mayo Clinic (2016), brachial plexus injuries are caused by contact sports such as football. This is due to the brachial plexus being stretched during collisions with other players such as a tackle. Another cause is difficult birth such as prolonged labor. Prolonged birth is caused when the shoulders get wedged ithin the birth canal, there is an increased risk of a brachial plexus palsy (Mayo Clinic, 2016).
The brachial plexus is responsible for innervating most of the muscles of the shoulder complex. The majority of the muscles of the shoulder complex can be classified as either stabilizers (more proximal muscles) or mobilizers (more distal muscles). Stabilizers are muscles that originate from the ribs, spine, and/ or cranium, and insert on the clavicle and/or scapula. The serratus anterior muscle is an example of a stabilizer. Mobilizers are muscles that originate on the clavicle and/or capula, and insert on the humerus (Neumann, 2010). The deltoid muscle is an example of a mobilizer.
Stabilizers and mobilizers must work together for proper function of the shoulder complex to be achieved. For example, if the trapezius and serratus anterior muscles do not stabilize the scapula, the deltoid cannot properly abduct at the glenohumeral joint (Neumann, 2010). The muscles of the scapulothoracic joint can be classified by their actions. Those actions include elevation or depression, protraction (abduction) or retraction (adduction), and upward rotation or downward rotation. The elevating muscles include the rhomboid major and minor, levator scapulae, and upper trapezius.
The lower trapezius, pectoralis minor, latissimus dorsi and subclavius muscles all act as depressing muscles. The serratus anterior affects protraction. The rhomboid major and minor, along with the middle and upper trapezius, are responsible for retraction. The serratus anterior and the upper and lower trapezius are also responsible for upward rotation. Downward rotation is done by the pectoralis minor and the rhomboid major and minor (Neumann, 2010). A daily activity that relies on shoulder and arm ovements is meal preparation.
According to the occupational therapy practice framework, (2014) “meal preparation is planning, preparing, and serving well-balanced, nutritious meals and cleaning up food and utensils after meals” (S20). Due to weakness in arms, one would be unable to lift their arm to reach ingredients out of an overhead cupboard. Lifting heavier items such as flour, pots, and pans would render difficulty. In severe cases, these injuries can lead to paralysis. The patient with this injury would need to relearn how to meal prep by using one arm o reach and prepare meals.
A brachial plexus injury can have a serious impact on an individual’s ability to shower and properly wash themselves. Range of motion (ROM) and strength are important qualities to have when it comes to taking a shower. A brachial plexus injury can affect strength of the arm and hand, which affects grip strength. Grip strength is important when showering because, the individual needs to be able to grip the soap and shampoo bottles. They may also have grab bars in their shower that would require grip strength. Grip strength ould be weakened and their safety in the shower could be compromised.
Patients with a brachial plexus injury often present a lack of full extension of the elbow. This would make it challenging to shower because extension of the elbow is used to wash arms and legs (Kirjavainen et al. , 2011). A brachial plexus injury could also negatively affect an individual’s ability to play a game of basketball. According to the occupational therapy practice framework (2014), play is defined as any spontaneous or organized activity that provides enjoyment, entertainment, amusement, or diversions (S21).
Playing basketball relies on a variety of different shoulder, arm, and hand movements that can be compromised due to a brachial plexus injury. A lack of grip strength in the hands compromises an individual’s ability to dribble, pass, or rebound the ball. Weakness in the arm or shoulder compromises an individual’s ability to pass or shoot the ball. A lack of range of motion in the elbow or shoulder compromises an individual’s ability to pass, shoot, steal, rebound, block, layup, or dunk the ball. An individual with compromised muscle strength or range of muscle would have n extremely difficult time engaging in a game of basketball.
Constraint-induced movement therapy (CIMT) is a treatment method that can be used by an occupational therapist to treat brachial plexus injuries. CIMT involves restricting the non- affected upper extremity along with intensive and repetitive training of the affected arm and hand. During all therapy sessions, and for majority of waking hours, movement of the non-affected arm is supposed to stay restricted. Therapy focuses on tasks that are suitable to the patient’s interests and needs for self-care. An example of a task may include having a atient reach for out for something that is at arm’s length away.
Then, progressively move the object higher making the patient reach up further to grasp the object. The purpose of keeping the non-affected arm restricted is to encourage use of the injured arm. The restriction also helps prevent learned non-use of the injured arm. Interventions have shown that patients who had little to no use of their extremity and chose to go through CIMT have been able to complete up to 15 tasks by the end of 14 weeks of therapy (Vaz et al. , 2010). CIMT is a treatment plan that an be used by an occupational therapist.
A universal treatment of a brachial plexus injury could include a combination of kinesiotape, exercise, and education. A treatment plan using these techniques could be used by physicians, physical therapists, occupational therapists, sports trainers, or the patient’s family members. In a case study by Walsh (2010) a two year old girl was presented who had a severe brachial plexus injury. The first step to treatment was ensuring patient compliance with the kinesiotape. Then, the parent was educated on how to apply and position the tape.
The parent and the patient were instructed on play activities that would facilitate shoulder rotation, two handed activities, and bearing weight with the affected shoulder. The tape was placed in a way that encouraged rotator cuff function. This was done by situating a piece of tape from the origin to the insertion of the deltoid and stretching the tape slightly before pressing it to the skin. Once the parent became comfortable with taping the child, the parent was responsible for taping the child on non-therapy days. At the end of four weeks of taping and exercise the child eld her arm at her side similar to her unaffected arm during play.
She began to initiate activities with other children and she exhibited an increase in fine motor skills. After 20 weeks of taping the child had full range of motion and was able to support her body weight through her upper extremities. The child slowly became less dependent on the tape and follow-ups proved that the improvements had maintained. Kinesiotape works by lifting the skin away from the injured area. Relief from the pressure of the skin on the injury allows for better blood flow and speeds the healing process (Walsh, 2010).