BRACHIAL PLEXUS INJURY

• Injury to the upper and lower trunk of brachial plexus
• Patients complain of weakness or numbness, loss of sensation, loss of movements and pain along the upper limb often with a history of trauma to the shoulder
• The lesion in the brachial plexus may be either complete or partial
• Complete – It is rare and occurs only after severe injury. It damages all the roots of brachial plexus and is often fatal
• Incomplete - It may be due to stabs or cuts and may affect any of the roots. But the common injury is due to traction or pressure which affects either the upper or lower portion of the plexus
• Upper brachial lesion (Erb -duchenne palsy) - Injury affects the new born babies or adults. Nerve roots involved are C5 and sometimes C6
• Lower brachial lesion (Klumpke palsy) - Nerve root involved is T1

Erb -duchenne palsy

• Excessive depression of the shoulder or displacement of the head or both
• Fall of weight on the shoulder
• Birth injury

Klumpke palsy

• When a falling person clutches at an object and hyper-abducts his arm
• Failing to obtain foothold on a passing bus

Erb -duchenne palsy

• Injury to the upper trunk of the brachial plexus C5-C6
• Affects biceps, brachialis, brachioradialis, supinator and deltoid muscles
• Limb becomes internally rotated, extended at the elbow and pronated in the well-known position of ‘policeman taking a tip’
• If only C5 root is affected, there will not be any sensory change
• If C6 is involved – anaesthesia over the outer side of the arm and upper part of the outer side of the forearm

Klumpke palsy

• Injury to the lower trunk of the brachial plexus C8- T1
• Paralysis of the intrinsic muscles of the hand with anaesthesia of the inner one and half fingers
• With claw hand and combined features of median and ulnar nerve palsy

• Electromyography (EMG)
• Nerve conduction studies
• MRI
• CT myelography

Erb -duchenne palsy

• Conservative – for functional improvement
• Functioning of the limb can be best restored by arthrodesis of the elbow and shoulder joints
• Transplantation of the muscles from pectoral group to the humerus

Klumpke palsy

• Conservative
• Recovery of the function may occur when the lesion is due to neurapraxia

Ayurvedic Treatment

Internal medicines

Initially

• Musthadi marma Kashaya
• Punarnavadi Kashaya
• Laksha guggulu
• Chandraprabha Gutika

Later

• Prasaranyadi Kashaya
• Ashtavarga Kashaya
• Danadanayanadi Kashaya
• Maharasnadi Kashaya
• Bala +Atibala+ Masha+ Nagara Kashaya
• Bala Kashaya Yavagu
• Kaishora guggulu
• Maharaja prasarani taila

Procedures

Initially

• Arm sling
• Lepa - Nagaradi , Kottamchukkadi
• Murivenna bandage

Later

• Udwarthana - Kolakulathadi choorna
• Dashamoola Ksheera Dhara
• Taila Dhara - Karpasasthyadi Thaila, Mahamasha Taila
• Jambeera pinda sweda
• Shashtika Pinda Sweda
• Pratimarsha Nasya - Karpasasthyadi Taila, Maharajaprasaranyadi Taila