Brachial/Lumbar Plexus Avulsion Pains

What Are Brachial and Lumbar Plexus Avulsion Pains?

Brachial and lumbar plexus avulsion pains are debilitating forms of nerve pain caused by the tearing or detachment of nerve roots from the spinal cord. The brachial plexus refers to a network of nerves in the neck and shoulder area, while the lumbar plexus serves the lower back and legs.

When these nerve roots are traumatically injured or avulsed, it can lead to severe, persistent pain alongside weakness, numbness, or even paralysis in the affected area. This condition is often associated with trauma, such as high-impact accidents or sports injuries, and requires specialised care for effective management.

Types of Brachial and Lumbar Plexus Avulsion Pains

The pain associated with plexus avulsions can be classified into different types based on its origin and presentation:

Brachial Plexus Avulsion Pain: This occurs when the nerves of the brachial plexus are damaged, leading to symptoms in the upper body, such as:

• Neuropathic Pain: A burning, stabbing, or shooting pain in the shoulder, arm, or hand due to nerve damage.

• Phantom Limb Pain: Pain that feels like it originates from a missing or paralysed arm.

• Weakness and Paralysis: Inability to move or control the affected limb.

Lumbar Plexus Avulsion Pain: This type of pain involves the nerves in the lumbar region, affecting the lower back, legs, or pelvis:

• Radicular Pain: Sharp or shooting pain radiating from the lower back to the thighs or legs.

• Muscle Weakness: Difficulty walking or maintaining balance due to nerve impairment.

• Numbness or Tingling: A loss of sensation or "pins-and-needles" feeling in the affected area.

Causes and Symptoms of Plexus Avulsion Pains

Causes: Brachial and lumbar plexus avulsions are typically caused by severe trauma, but other factors may contribute, including:

• Motor Vehicle Accidents: High-impact collisions can stretch or tear nerve roots from the spinal cord.

• Sports Injuries: Contact sports or falls can lead to significant nerve damage.

• Birth Trauma: In infants, excessive pulling during delivery can cause brachial plexus injuries.

• Tumours or Infections: Rarely, tumours or infections can compress or damage the nerve roots.

• Surgical Complications: Nerve damage may occur during procedures involving the neck, spine, or pelvis.

Symptoms: The symptoms of plexus avulsion pains can vary but often include:

• Severe, persistent pain in the shoulder, arm, lower back, or legs.

• Burning or stabbing sensations in the affected region.

• Numbness, tingling, or "electric shock" feelings.

• Loss of movement or strength in the arm or leg.

• Muscle atrophy over time due to prolonged nerve damage.

Diagnosis and Treatment Options

Diagnosis: A thorough evaluation is crucial to confirm a plexus avulsion and to develop an effective treatment plan. Diagnostic steps may include:

• Medical History and Physical Examination: To assess symptoms, identify the extent of nerve damage, and evaluate mobility and strength.

• Imaging Studies: MRI or CT myelography is used to visualise the nerve roots and detect avulsion injuries.

• Electrodiagnostic Tests: Electromyography (EMG) or nerve conduction studies measure electrical activity in muscles and nerves, providing insights into the extent of damage.

Treatment: The treatment of brachial and lumbar plexus avulsion pains typically involves a combination of medical, surgical, and therapeutic approaches tailored to the individual’s needs. Options include:

• Medications:

  • Pain relievers such as paracetamol or ibuprofen for mild discomfort.

  • Anticonvulsants or antidepressants to manage neuropathic pain.

  • Nerve blocks or corticosteroid injections to reduce inflammation and pain.

• Surgical Interventions:

  • Nerve Grafting: Transferring healthy nerves to the damaged area to restore function.

  • Nerve Transfers: Redirecting functional nerves to replace damaged ones.

  • Spinal Cord Stimulation (SCS): Implanting a device to deliver electrical impulses, disrupting pain signals.

• Physical and Occupational Therapy:

  • Strengthening exercises and rehabilitation to maintain muscle function and improve mobility.

  • Adaptive techniques and assistive devices to enhance independence and quality of life.

• Alternative Therapies:

  • Acupuncture or biofeedback for pain relief and stress management.

  • Cognitive Behavioural Therapy (CBT) to address the psychological impact of chronic pain.

Conclusion

Brachial and lumbar plexus avulsion pains are severe and life-altering conditions that require a multidisciplinary approach for effective management. With the right combination of medical treatments, surgical interventions, and rehabilitation, it is possible to alleviate pain and improve function. If you or a loved one are dealing with plexus avulsion pain, schedule a consultation with us today.