Brachial Plexus Neuralgia

　　There are many factors that can cause brachial plexus injury, mainly physical injuries. Brachial plexus injury is mostly caused by: ① Traction injury: such as the upper limb being caught by a belt; ② Collision injury: such as being struck by a fast-moving car or being hit by flying stones; ③ Cut or gunshot wounds; ④ Compression injury: such as clavicle fracture or compression of the shoulder acromial area; ⑤ Birth injury: abnormal fetal position during delivery or injury caused by traction during labor.

　　The most common cause of brachial plexus injury is traction injury. The majority of adult brachial plexus injuries (about 80%) are caused by traffic accidents. For example, when a motorcycle collides with a car, or a motorcycle hits roadside obstacles or a large tree, the driver is injured and falls to the ground, the head and shoulders collide with obstacles or the ground, causing the head and shoulders to separate, and the brachial plexus is over-stretched. The injury may range from mild neural concussion and temporary dysfunction to severe axonal rupture and root rupture, leading to functional loss. In the worst cases, the rupture of the origin of five nerve roots from the spinal cord can occur. Workers may suffer brachial plexus injury when their upper limbs are accidentally caught by machinery, belts, or conveyors due to instinctive reflexes, causing traction injury. Upward retraction can cause injury to the lower trunk, and horizontal retraction can cause total brachial plexus injury. Mining collapses or high-altitude heavy objects falling and crashing onto the shoulder, or the shoulder being struck during high-speed movement can also injure the brachial plexus. Neonatal brachial plexus injury occurs during difficult childbirth when the baby's weight is generally over 4kg, with the head presenting first, using a vacuum extractor or forceps, causing the baby's head and shoulders to separate and over-stretched, leading to brachial plexus injury, usually incomplete injury.

　　Brachial plexus injury also occurs in firearm贯通 injuries or blind injuries such as gunshot or shrapnel wounds in the shoulder and neck, knife stab wounds, glass cutting injuries, drug-induced injuries, and surgical accidents. Such injuries are often localized but severe, usually involving rupture of the root of the nerve. It may be accompanied by injuries to the subclavian artery and vein. Fractures of the clavicle, anterior dislocation of the shoulder joint, cervical rib, anterior scalene muscle syndrome, primary or metastatic tumors near the brachial plexus can also compress and injure the brachial plexus.

　　Brachial plexus injury is often caused by traction injuries, collisions, cuts, gunshot wounds, compression injuries, birth injuries, and other causes, mainly causing the inability to use the arm normally. To date, no complications have been found.

　　The brachial plexus contains various stimulating nerves, and the symptoms of injury vary depending on the affected nerve. The presence of brachial plexus injury may lead to the following injuries: ① Any two groups of the five major nerves of the upper limb (axillary, musculocutaneous, median, radial, and ulnar nerves) suffer from combined injury (not from a cut injury on the same plane). ② Any one of the three major nerves of the hand (median, radial, and ulnar nerves) is associated with shoulder or elbow joint dysfunction (passive movement is normal). ③ Any one of the three major nerves of the hand (median, radial, and ulnar nerves) is associated with injury to the medial cutaneous nerve of the forearm (not a cut injury). Among the five major nerve injuries, the clinical manifestations are as follows:

　　(1) Axillary nerve injury: Atrophy of the deltoid muscle, limitation of shoulder abduction. Pure axillary nerve injury, injury level below the branch; with radial nerve injury, injury level at the posterior bundle; with musculocutaneous nerve injury, injury level at the upper trunk; with median nerve injury, injury level at the C5 root.

　　(2) Musculocutaneous nerve injury: Atrophy of biceps brachii, limitation of elbow flexion. Pure musculocutaneous nerve injury, injury level below the branch; with axillary nerve injury, injury level at the upper trunk; with median nerve injury, injury level at the lateral bundle; with radial nerve injury, injury level at the C6 nerve root.

　　(3) Radial nerve injury: Atrophy and functional limitation of triceps brachii, brachioradialis, wrist extensors, thumb extensors, and finger extensors. Pure radial nerve injury, injury level below the branch; with axillary nerve injury, injury level at the posterior bundle; with musculocutaneous nerve injury, injury level at the C6 nerve root; with median nerve injury, injury level at the C8 nerve root.

　　(4) Median nerve injury: Atrophy of the flexor carpi radialis and flexor digitorum profundus, atrophy of the thenar muscle, thumb and finger flexion and thumb opposition function limited, sensory impairment of the first to third fingers. Pure median nerve injury, injury level below the branch; with musculocutaneous nerve injury, injury level at the lateral bundle; with radial nerve injury, injury level at the C8 nerve root; with ulnar nerve injury, injury level at the lower trunk or lateral bundle.

　　(5) Ulnar nerve injury: Atrophy of the flexor carpi ulnaris, hypothenar muscle, intrinsics including interosseous muscles and lumbricals, and adductor pollicis atrophy, finger adduction, abduction limited, interphalangeal joint extension limited, fine hand function limited, sensory impairment of the fourth to fifth fingers. Pure ulnar nerve injury, injury level below the branch; with median nerve injury, injury level at the lower trunk or lateral bundle; with radial nerve injury, injury level at the C1 nerve root.

　　In addition to incision injuries, gunshot wounds, surgical injuries, drug-induced injuries, and traumatic injuries such as collision injuries, traction injuries, and crush injuries to the brachial plexus, it is also very easy to suffer from this disease during childbirth.

　　For injuries caused by trauma, the main concern is safety and avoiding the occurrence of trauma. For the prevention of minor injuries, attention should be paid to the following points:

　　1. Correctly estimate the fetal weight

　　When the fetal head circumference is large, the shoulder circumference needs to be measured, and shoulder dystocia should be vigilant. Pregnant women with diabetes, tall pregnant women, post-term pregnancy, and women who have delivered macrosomic infants should be vigilant. For non-diabetic pregnant women, if the estimated fetal weight is ≥4500g, and for diabetic pregnant women, if the estimated fetal weight is ≥4000g, cesarean section should be performed. Therefore, it is important to accurately estimate the fetal weight before delivery, and to be cautious in choosing the mode of delivery when considering macrosomia.

　　2. Strictly observe the labor process

　　Fetal macrosomia in pregnancy with diabetes can lead to a small head and wide shoulders, which is prone to shoulder dystocia; for non-macrosomic infants with an abnormal pelvis and flat pelvic inlet, the first and second stages of labor may be prolonged, especially when the second stage is prolonged or the presenting part is obstructed. The incidence of shoulder dystocia increases. For prolonged second stage of labor, obstructed or slow descent of the presenting part, especially when the estimated fetal weight before delivery is >4000g, one should be vigilant about the occurrence of shoulder dystocia and relax the indications for cesarean section.

　　3. Properly handle shoulder dystocia

　　Once shoulder dystocia occurs, it should be treated immediately to prevent neonatal severe asphyxia and death. Routine lateral incision is performed to increase the space for the fetus to be delivered.

　　Brachial plexus nerve injury must be treated in a hospital, and before treatment, the diagnosis of the disease must be made so that appropriate medication can be prescribed. Common examination items for brachial plexus nerve injury include:

　　1. Neuroelectrophysiological examination

　　Electromyography (EMG) and nerve conduction velocity (NCV) are of great reference value for determining whether there is nerve injury and the degree of injury, and are generally checked 3 weeks after the injury. Sensory nerve action potential (SNAP) and somatosensory evoked potential (SEP) are helpful in distinguishing pre-ganglionic and post-ganglionic injuries. In pre-ganglionic injuries, SNAP is normal (the reason is that the sensory nerve cell bodies of the posterior root are located outside the spinal cord, and the injury occurs exactly at its proximal side, pre-ganglionic, without Wallerian degeneration, which can induce SNAP), SEP disappears; in post-ganglionic injuries, both SNAP and SEP disappear.

　　2. Imaging examinations

　　When there is a root avulsion injury of the brachial plexus, CTM (myelography combined with computed tomography) can show that the contrast agent has leaked into the interstitial space of surrounding tissues, hard meningeal sac rupture, meningocele, spinal cord displacement, and so on. Generally speaking, meningocele mostly means a tear of the nerve root, or although there is partial continuity of the nerve root, the internal injury is very serious and has extended to a very close plane, often indicating that a sufficiently large force has caused the tearing of the arachnoid membrane. Similarly, MRI (magnetic resonance imaging) can not only show the tearing of the nerve root but also simultaneously show the coexisting meningocele, cerebrospinal fluid leakage, spinal cord hemorrhage, edema, and so on. Hematomas are hyperintense on T1WI and T2WI, cerebrospinal fluid and edema are hyperintense on T2WI and hypointense on T1WI. MRI water imaging technology is clearer in showing the subarachnoid space and the leakage of cerebrospinal fluid, at this time water (cerebrospinal fluid) is hyperintense, while other tissue structures are hypointense.

　　A reasonable diet plays a very important role in the recovery from illness. An unreasonable diet may likely worsen the condition, even cause lesions, and bring spiritual and physical trauma to patients and their families. The diet of patients with brachial plexus neuropathy should pay attention to the following aspects:

　　Drink more water and eat more fruits and vegetables

　　Patients should increase their water intake and avoid irritants such as coffee, soda, and cigarettes. Eat more fruits, vegetables, nuts, seeds, and grains that are beneficial to health.

　　Eat more oatmeal

　　Regular consumption of oatmeal can improve the overall condition of the nervous system. Boil chopped oat straw in warm water for 2 minutes and filter it to make a supplement; drink 1-4 grams a day. To alleviate skin itching, wrap oatmeal pieces in fine cotton cloth and hang them under the showerhead, then bathe with the water passed through the oatmeal.

　　Third, supplementing nutrients

　　1, Lecithin

　　Dosage according to product labeling, take with meals. It can protect and repair nerves.

　　2, Comprehensive Vitamins and Minerals

　　Contains vitamin A and thiamine (B1), and nerve inflammation is often the first sign of malnutrition. Nerve inflammation patients often lack thiamine. Therefore, supplementing the above vitamins helps prevent the occurrence and development of the disease.

　　3, Vitamin B Complex with Vitamin B1

　　More than 100 milligrams per day, injection is the best. Nerve pain patients often lack vitamin B.

　　4, Vitamin E

　　Take 400 international units of vitamin E twice a day. Used for neuralgia after measles.

　　5, Calcium Chelate

　　2000 milligrams per day, assisting in the conduction of nerve impulses.

　　6, Protein (including various single amino acids)

　　Dosage according to product instructions. It is essential for repairing nerves and maintaining nerve function, and amino acids are quickly absorbed and utilized by the body.

　　7, Proteinase

　　Take three times a day on an empty stomach. Effective anti-inflammatory agent.

　　Traditional Chinese medicine has a poor effect on brachial plexus injury, and Western medical treatment is generally adopted. However, for patients with mild symptoms caused by non-traumatic factors, especially children with brachial plexus injury, it is considered to use acupuncture and massage therapy for recovery and relief.

　　Brachial plexus injury in children is a common injury in obstetrics. Modern medical treatment emphasizes self-repair, and advocates for elective surgical treatment. Clinically, the effect of self-repair is poor, leading to disabilities. Surgical treatment has the disadvantages of trauma and high cost, and some may require multiple surgeries. Traditional Chinese medicine is not convenient for children to take, while massage therapy is non-invasive and easy for families to accept, with satisfactory efficacy. Acupuncture points mainly include Da Zhui, Jian Jing, Jian Yu, Qu Chi, Shou San Li, He Gu, etc., with local acupoints. During massage, follow the principles of gentleness, uniformity, persistence, and strength, using the fingers as needles to penetrate the internal Qi. After long-term treatment, combined with rehabilitation training, the therapeutic effect is very significant. The treatment of brachial plexus injury in children by massage techniques is far superior to other methods.