Traumatic Brachial Plexus Injury

The brachial plexus is a complex set of nerves originating in the spinal cord at the neck and supplying the muscles of the arm, elbow, wrist and hand. The brachial plexus is derived from 5 roots; 2 upper, 1 middle and 2 lower roots. Injury to the upper roots paralyzes the shoulder and elbow, and a lower root injury predominantly affects the hand.

Most adult injuries to the brachial plexus occur as a result of significant trauma such as during a motor vehicle accident. Motorcycle and all-terrain vehicles are most commonly involved although automobile accidents can also cause the injury. The head and neck are forced away from the shoulder and arm, stretching the nerves of the brachial plexus and resulting in tear, rupture, or avulsion if the force is great enough. Injury can also occur in adults as the result of causes such as inflammation, tumor, or radiation.

Nerve surgery is recommended as early as possible because of the large distance between the neck and hand of an adult and the 1 inch per month rate of regrowth. Muscles begin to atrophy at the time of injury and can lose the ability to respond to regrown nerves. Atrophy of denervated muscles can be delayed using an implantable muscle stimulator or similar technique. The stimulator delivers electrical pulses directly to the paralyzed muscle every minute around the clock to give surgical repairs time to work, and improve the quality of the final muscle function. Surgical strategy depends on the severity of injury to each root.  

Nerve Grafting

Nerves that are ruptured can be repaired by bridging the gap with healthy nerve from another part of the body.  The Sural nerve in the leg is commonly used with no loss of function and only minor changes in sensation.

Nerve Transfer

Nerve transfers take power from uninjured adjacent nerves, bypass the area of injury and override healthy nerve to the paralyzed muscle.  The advantage to transfers is the shorter distance over which the repaired nerve has to renew before function returns to the muscle.

Nerve Decompression

When the nerve is stretched but not torn, scar tissue can form and a simple nerve decompression surgery that releases the scarring can restore function.  Pinching of the nerve is released surgically, and like a garden hose that has been unkinked, the flow improves and results in return of function. 

Other Surgical Options

In some cases tendon transfers are required to transfer functional movement from an injured muscle group to a less injured one.  Free muscle transfer is the transfer of a muscle freed from elsewhere in the body, such as transfer of the gracilis muscle from the leg, to the arm. Generally, a combination of all of these options will be recommended. These and other approaches are being developed all the time, giving reason to hope for restoration of function and appearance of the injured arm.


The number of surgeries and their duration will depend on the injury and the individual patient’s goals. Dr. Nath will discuss options with you after reviewing your medical records and examining your functional abilities. The sooner you contact our office the more favorable the final result of reconstruction. 


  • 1. Evaluation in Houston office (no charge for initial consultation)
  • 2. Telemedicine, submit all medical records to the office with video 
  • 3. Outreach Event evaluation for in person evaluation free of charge( must bring documentation if required for condition)


We also need to see any medical records pertaining to your injury, specifically previous surgical reports, CT or MRI reports and images, and EMG (nerve conduction study) results. The records may be faxed to 713-592-9921, emailed to, or mailed to Texas Nerve & Paralysis Institute, 6400 Fannin St. Ste 2420, Houston, Texas 77030.

Please also fill out, sign and submit the Consent Form .  This must be included with all documentation prior to Dr. Nath's review of the records.

Please send us a video or photos showing your/your child’s current range of motion using the video below and the movement chart shown.  In addition to the movements noted on the chart, Dr. Nath will require anti-gravity movements as well.  All movements should be included with a maximum of 30 seconds time. 
Please have someone film you/your child wearing a tank top or sports bar, so that the shoulder blade is visible.

Videos taken on camera phones may be emailed to Videos taken on regular video cameras may be uploaded to our website due to large file size. 

Click below for video upload: