Where is the brachial plexus?

As we all know, the structure of the human nervous system is very complex. The nervous system includes many components, including the brachial plexus. Clinically, diseases targeting the brachial plexus are also relatively common, such as nerve pain in this area, or nerve dysfunction, etc. These neurological diseases will have a huge impact on the patient's life. If you don't know where the brachial plexus is, let's learn more about this knowledge below.

Where is the brachial plexus?

Brachial plexus problems

The brachial plexus is composed of cervical C5-8 and T1 nerve roots. Its branches are mainly distributed in the upper limbs, and some small branches are distributed to the upper thoracic limb muscles, superficial back muscles and deep neck muscles.

The main branches are: thoracodorsal nerve, long thoracic nerve, axillary nerve, musculocutaneous nerve, median nerve, radial nerve, and ulnar nerve.

The brachial plexus mainly controls sensation and movement of the upper limbs, shoulders, back and chest.

1. General treatment

For common traction brachial plexus injuries, conservative treatment is the main approach in the early stages, and the observation period is generally about 3 months. During the observation period, special attention should be paid to the following issues:

(1) Protection against sensory loss: For C5-7 root injuries, although the hand functions are basically preserved, the thumb and index finger have sensory impairments, which also have a certain impact on the hand's fine functions. For C8-1 root injuries, although the thumb and index finger have basic sensory functions, the hand functions are basically lost, and the sensation of fingers 4-5 also disappears, making the hand vulnerable to further injuries such as bruises or burns. It is difficult to repair the damaged skin after denervation. Therefore, the denervated skin must be protected. Protective gloves can be worn, and the habit of using the healthy hand to test the temperature of the object being touched should be trained. Oily skin cream should be applied regularly.

(2) Treatment of pain: Although patients with brachial plexus injury rarely experience severe pain, once pain occurs, it is difficult to treat. This pain is generally burning pain and is more common in patients with gunshot wounds and partial root avulsion injuries. After removing the bullet from the nerve, cutting off part of the damaged nerve and neuroma, and reconnecting the nerve are the main methods to relieve this type of pain. Brachial plexus nerve block, cervical sympathetic ganglion block and surgical resection, as well as acupuncture and the use of various analgesics can only temporarily relieve pain.

(3) Prevention and treatment of swelling: After the limb muscles of patients with brachial plexus injury lose their motor function, they also lose their squeezing and reflux effects on the limb veins. This is especially true when the limbs are in a drooping position and the joints are extremely flexed, and there is scar contracture in the axilla, which aggravates the venous reflux obstruction of the limbs. Therefore, using a triangular bandage to suspend the limbs, frequently performing passive muscle movements, and changing the joint position to relieve the scar contracture in the axilla (physical therapy or surgical methods) are the main methods for preventing and treating limb swelling.

(4) Building confidence: For most young patients who are in their prime and pursuing their ideals, brachial plexus injuries are extremely painful. Therefore, we should show them a high degree of sympathy and encourage their determination to overcome the pain. We should help them to overcome the pain physically with a high sense of responsibility. We should also solve the world's difficult problem of restoring hand function after brachial plexus injuries with a high degree of enterprising spirit, so that they can return to work and truly become happy members of the big family of society.

(5) Prevention and treatment of muscle and joint capsule contracture: After nerve damage, muscles lose nerve nutrition and suffer from muscle atrophy. As time goes by, the degree of atrophy worsens and eventually leads to irreversible muscle degeneration and fibrosis of muscle tissue. Even if the nerve regenerates and enters the end plate, it cannot control the fibrotic muscle and loses motor function. Therefore, how to prevent and treat muscle atrophy after nerve damage is an important part of treatment. Currently, although passive activities, electrical stimulation, and physical therapy measures have a certain delaying effect, they cannot stop the process of muscle atrophy. Due to the paralysis of the motor muscles, the corresponding joints lose balance and are in a non-functional position. Joint capsule contracture will inevitably occur in the long term, which will hinder the functional recovery after nerve regeneration. Therefore, attention should be paid to functional training of limb joints. It is very important to maintain the functional position of joints before the injury is recovered.

(6) Long-term application of neurotrophic drugs: A series of degeneration and regeneration processes occur after nerve injury. The key change is the increase in protein synthesis, phospholipids and energy supply of neuronal cells during the regeneration of nerve axons. For this purpose, a large amount of B vitamins (vitamins Bl, B6, B12, etc.) and drugs that dilate the microvessels in the nerves (dibutazole) are required. Traditional Chinese medicine prescriptions for promoting blood circulation and regulating qi also have a good effect. Since nerve regeneration is a slow process with a regeneration rate of 1mm/d, these drugs should be used for a long time. Although nerve growth factor (NGF) drugs have a certain effect in promoting nerve regeneration in experiments, the stability of the biological properties of the preparations, the reliability of the application methods and the effectiveness of clinical applications all need to be explored.

2. Surgery

(1) Indications for surgery:

① Open injuries of the brachial plexus, cuts, gunshot wounds, surgical injuries and drug-induced injuries: early exploration and surgical repair are required.

② Brachial plexus collision injury, traction injury and compression injury: If it is confirmed to be a preganglionic injury, surgery should be performed as soon as possible. For closed postganglionic injury, conservative treatment for 3 months can be performed first. Surgical exploration may be considered in the following cases: there is no obvious functional recovery after conservative treatment; there is a jumpy functional recovery, such as the shoulder joint function has not recovered, but the elbow joint function has recovered first; there is no progress in the functional recovery process after 3 months.

③Birth injuries: If there is no obvious functional recovery or only partial functional recovery within 3 months to 6 months after birth, surgical exploration can be performed.

(2) Preoperative preparation: In addition to general preoperative examinations, the following examinations should be performed, including chest X-ray and chest radiograph to understand diaphragm activity and elevation, pulmonary function test and trapezius muscle function status test, etc.