Brachial plexus is a network of several vital nerves that control movement of shoulder, arm, and hand. Located on either side of body, these nerves are interconnected with spinal cord in neck of an individual. Any physical trauma or injury that affects normal functioning of these nerves are referred to as ‘brachial plexus injury’ (BPI). Compression and stretching while playing contact sports, high-speed accidents, prolonged labor time during birth of child and severe inflammation due to underlying tumor are the most prominent reasons behind occurrence of brachial plexus injury. Brachial plexus injury may lead to stiffness around joints, nerve damage and even permanent disabling conditions such as paralysis in affected shoulder and arm. Therefore, patients must seek prompt treatment for retaining a healthy body.
Conditions Calling for Brachial Plexus Surgery
Doctors may recommend patients to undergo brachial plexus surgery when they are struggling with the following conditions.
- Avulsion – Condition of avulsion comes into existence when nerves protrude outwards from spinal cord due to serious physical trauma and cause severe pain. Generally, patients struggling with such condition cannot recover easily. In such cases, brachial plexus surgery may prove beneficial.
- Stretch (Neuropraxia) – Neuropraxia occurs when nerve gets stretched slightly but does not detach completely from spinal cord. Patients suffering from neuropraxia have greater chances of recovery if they undergo surgical procedure within a short interval.
- Rupture – As the name itself indicates, rupture occurs when nerve gets detached partially from spinal cord. In such instances, brachial plexus surgery becomes necessary to help patients recover safely.
- Neuroma – Neuroma is a kind of tumor that may start to grow and press the healthy nerve interconnected to spinal cord. Surgical removal of tumor is necessary to retain functioning of particular nerve.
- Axonotmesis and Neurotmesis – In clinical terms, nerve fibers are called as ‘axons’. Condition of axonotmesis arises when axon gets severed or damaged. Whereas, neurotmesis condition appears when axons get impaired completely. Chances of recovery with brachial plexus procedure are moderate in case of axonotmesis and extremely less in case of neurotmesis.
Preparing for Brachial Plexus Surgery
Patients will need to search a well-versed surgeon in order to ensure good results following their brachial plexus surgical procedure. During initial consultation, respective doctors may ask patients regarding the event which has resulted in pain around their shoulder or arm area. They may also ask them about primary treatments that they might have taken. After that, respective doctors may request patients to undergo the following inspection tests. It will help them understand the severity of patient’s condition.
- Electromyography – Electromyography (EMG) is a simple procedure in which doctors will insert thin medical tools called as ‘probe’ into patient’s arm. Probe is capable of determining the severity of injury by measuring electrical activity of patient’s muscles. During EMG, patients may feel slightly uneasy when doctors will insert the probe. However, the pain will go away after some time.
- Computerized Tomography – During computerized tomography or CT scan, patients will need to lie comfortably. They will be exposed to a huge scanning device which will emit x-rays and generate high-quality pictures of patient’s affected shoulder or arm. These pictures will help surgeons to understand the severity of brachial plexus injury.
- Magnetic Resonance Imaging – Magnetic resonance imaging or MRI scan is a procedure which is approximately similar to CT scan test. MRI scan uses magnets and radio waves instead of x-rays. This procedure gives better quality of images as compared to other scanning procedures. Patients are exposed to a device that helps doctor identify the root source of problem along with its current status.
- Angiogram Test – Angiogram test involves use of x-rays and contrast dye-like material for identification of exact location and extent of brachial plexus injury. During angiogram test, patients will need to lie in a comfortable position while the doctors will inject a dye-like substance through their veins. X-rays will create images that will help in confirming the exact internal condition.
In addition to these tests, patients should freely ask regarding all their doubts prior to signing consent form. For example, they may ask regarding potential complications associated with brachial plexus surgery and their solutions. It will help them understand the procedure in a better way.
Procedure for Brachial Plexus Surgery
The following list gives out three main types of brachial plexus surgeries. Respective surgeons will choose the most appropriate procedure based on patient’s requirement and their general health condition.
- Nerve Graft Surgery – Nerve graft surgery is performed when patients meet a serious brachial plexus injury that has resulted in loss of sensation and movement around affected area. During nerve graft surgery, respective doctors use general anesthesia in order to make patients sleepy. After that, they carefully remove a portion of healthy nerve from other body parts of patients. This obtained nerve is referred to as ‘graft’ in medical terms. Doctors implant the healthy nerve in place of damaged brachial plexus nerve and take off the impaired nerve from patient’s body. Nerve graft procedure is known to considerably improve functionality of patient’s arms.
- Nerve Transfer Surgery – Nerve transfer surgery is performed when respective injured nerve no longer serves the purpose. During nerve transfer surgery, doctors search for a nerve with less important functionality that is present around the area of injury. They interconnect the new nerve with the damaged one without taking it out. They simply transfer the new nerve to ruptured nerve. In this way, transferred nerves start to play the role of affected nerve and restore its functions in a smooth manner. Respective doctors may advise wearing splints after completion of nerve transfer surgery in order to aid a safe and fast recovery.
- Muscle Transfer Surgery – Muscle transfer surgery is similar to that of nerve transfer However, muscle transfer surgery involves transfer of a muscle or tendon with less functionality from another part of body instead of nerves. Respective doctors take out a muscle most probably from thigh or leg area of patient’s body and interconnect it with the injured muscle in arm or shoulder. The new muscle can significantly restore motor functions and other vital functionalities and help patients recover speedily. Results following muscle transfer surgery are quite good when patients undergo this medical procedure within twelve months of getting brachial plexus injury.
Risks and Complications Associated with Brachial Plexus Surgery
The given points depict some of the general risks and complications associated with different surgical procedures for brachial plexus injury.
- Severe Pain – Patients may experience severe pain around the operated site. Respective doctors may prescribe drugs and medicines to help such patients.
- Infection – There lies a risk of infection that may result in poor wound healing. Patients may be asked to take antibiotics in order to minimize likelihood of infection.
- Clotting of Blood – Condition of clotting of blood may occur in postoperative period. In such cases, patients need to stay alert and report a doctor immediately on observing any abnormality.
- Heart Attack or Stroke – Patients may get a heart attack or stroke after completion of brachial plexus surgery. Immediate medical care can help treat such conditions effectively.
- Surgical Failure – In some cases, surgery may fail to restore back the movement of patient’s affected shoulder, arm or hand. It may result in permanent disability.
Recovery Following Brachial Plexus Surgery
Recovery will be dependent on various factors such as patient’s general health, type of brachial plexus surgery involved, and postoperative care. Patients may encounter pain around their operated region during initial recovery phase. Doctors may advise patients to intake several medicines and drugs for reducing their postsurgical pain. Respective doctors may also suggest them to undergo physical therapy sessions to regain the lost muscular strength. Most importantly, attending follow-up sessions is extremely necessary for a patient. It will help decrease the chances of complications and boost healing process.
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