Brachial Plexus

Arnaud
May 1, 2025
3 min read

The brachial plexus is a network of nerves located in the neck and shoulder, essential for mobility and sensation in the arm and hand. A brachial plexus injury can have serious consequences, such as partial or complete loss of upper limb function. These injuries are often caused by trauma, such as road traffic accidents or falls, but they can also occur during obstetric complications at birth. The management of these injuries is complex, and physiotherapy plays a crucial role in the patient's functional recovery.

Anatomical description of the brachial plexus. Set of nerve roots that compose it. — Anatomie du plexus brachial

Role of physiotherapy in recovery

Physical therapy is one of the essential elements in maximizing recovery after a brachial plexus injury. It aims to restore mobility, strength, and function to the arm and hand. The physical therapist's job is to maintain joint mobility, prevent contractures, and strengthen compensatory muscles. Without proper management, complications such as joint stiffness, muscle atrophy, and permanent functional loss can occur.

In addition to physical rehabilitation, physiotherapy also provides psychological support to patients. Loss of upper limb function can be devastating, affecting quality of life and the ability to perform daily activities. Physiotherapy follow-up helps alleviate this anxiety by providing clear steps toward recovery and gradually improving functional capacity.

Physiotherapeutic assessments

The initial assessment is a fundamental step in the management of a brachial plexus injury. The physiotherapist performs a series of tests to assess the extent of the injury, mobility, muscle strength, and sensory deficits.

Joint mobility testing: The range of motion in the affected joints is measured to determine restrictions. Instruments such as the goniometer are often used for accurate measurement.
Muscle strength assessment: The physiotherapist often uses the Medical Research Council (MRC) Muscle Strength Scale to assess the strength of affected muscles. This scale ranges from 0 (no muscle contraction) to 5 (normal muscle strength).
Sensory tests: The brachial plexus also controls the sensitivity of the arm, an assessment of sensations (touch, temperature, pain) is carried out.
Electromyogram (EMG): This test is sometimes recommended to determine if the muscles are receiving adequate nerve signals, which helps assess the severity of nerve damage.

Exercises used in brachial plexus rehabilitation

Rehabilitation after a brachial plexus injury relies on a variety of exercises, tailored to each patient's condition. Here are some examples of common exercises:

Passive and active mobility exercises: The early stages of rehabilitation often involve passive movements, where the physiotherapist guides the arm to maintain joint flexibility and prevent contractures. Gradually, active movements are introduced, where the patient attempts to use the affected muscles to move the arm. This includes arm elevation, abduction, and internal and external rotation of the shoulder.
Muscle strengthening: As recovery progresses, strengthening exercises are added. Using resistance bands, light weights, or even gravity to target specific muscles helps restore strength to affected muscles. These exercises include movements such as elbow curls, wrist extensions, and fist clenches.
Proprioception and coordination exercises: In addition to restoring strength and mobility, it is crucial to reestablish movement coordination and proprioception (awareness of limb position in space). Balance exercises and specific functional tasks, such as grasping or manipulating objects, are introduced to improve these abilities.
Awareness exercises and nerve stimulation: Patients with sensory loss may benefit from exercises that stimulate the nerves, such as tactile stimulation (with fabrics of different textures) or blind object recognition exercises.

Conclusion

Physiotherapy is a key pillar in the management of brachial plexus injuries. It helps improve mobility, restore upper limb function, and reduce long-term complications. Through careful assessment and tailored exercise programs, patients can expect optimal functional recovery, although the process is often lengthy and requires patience. Collaboration with other members of the medical team, particularly surgeons, is often necessary to ensure the best possible results.