A Friday morning teaching session
The Orthopaedic Department at Cairns Base Hospital held a Friday morning teaching session on examination of the brachial plexus, in which the trainees demonstrated how to examine a patient with a brachial plexus injury.
Why it is a hard examination
The brachial plexus is the network of nerves running from the neck into the arm, and examining it is a difficult skill to master. Working out where along that network an injury sits requires testing individual muscles and areas of sensation in a systematic order and interpreting the pattern. It is the kind of examination that is only learned by doing it repeatedly under supervision, which is what sessions of this kind are for.
How brachial plexus injuries happen
The nerves of the brachial plexus leave the spinal cord in the neck, join and divide through the region above the collarbone, and continue into the arm as the nerves that supply its muscles and skin. Injuries occur when the arm or the neck is forced beyond its range, most often in motorcycle and other high energy accidents, in some sporting injuries, in association with a dislocated shoulder or a fractured collarbone, and at birth.
The consequences depend on which parts of the network are damaged and on whether a nerve has been stretched, torn across, or pulled away from the spinal cord itself. Some injuries recover as the nerve regenerates, which takes months. In others the weakness and numbness persist.
Why early and repeated assessment matters
Because nerve recovery is slow and the period in which reconstruction is possible is limited, a brachial plexus injury has to be assessed carefully and then followed over time rather than observed indefinitely. The examination is repeated at intervals and compared, usually alongside imaging and nerve conduction studies, to establish whether recovery is occurring. Where it is not, options include exploring the plexus to establish what has been damaged, repairing or grafting nerve, and transferring a working nerve or muscle to restore a particular movement. Individual results vary.
This is why the examination is taught as carefully as it is. The decision about whether to operate, and when, rests largely on what the examination shows across successive reviews, and a junior doctor who can perform it reliably contributes directly to that decision.
Related information
See our shoulder anatomy and shoulder injuries pages, along with our brachial plexus exploration and rehabilitation pages.