Conditions

The peripheral nervous system is the part of the nervous system outside your brain and spine. Its job is to relay information back and forth between your brain and areas of your body such as the hands, feet and arms.

When these nerves become damaged, either as the result of a trauma or, occasionally, from previous surgeries, the subsequent effects can include loss of function, lack of feeling, paralysis and, in some cases, severe pain.

Common symptoms include:

• Pain – either a burning, stabbing or shooting sensation
• Muscle weakness/paralysis
• Numbness and tingling 
• Pain

The brachial plexus is a collection of nerves located high in the spinal cord at the neck. Its job is to connect the brain and spinal cord to the nerves in the arms and shoulders, allowing you to move and feel sensation. Brachial plexus injuries occur when the arm is pulled or stretched in the opposite direction of the neck with force. Falls, impact injuries such as motorbike and car accidents, or wounds from weapons are all potential causes.

A brachial plexus injury in adults can involve each individual root, resulting in either avulsion (where the root is torn away from the spinal cord), rupture (where the nerve is torn into two pieces at root level), or stretching of the nerve.

Symptoms of brachial plexus injury can include:

• A loss of sensation
• Pain
• Paralysis
• Weakness or numbness

Neuropathic pain (stabbing, crushing, burning or tingling) could indicate that the root has been torn from the spinal cord.

If you feel a tingling pins and needles sensation down the arm when the side of the neck is tapped (Tinel's sign), then Mr Sinisi may suggest carrying out an urgent nerve repair operation, as surgery is more successful the sooner after injury it can be carried out.

In most cases, the first stage is a consultation, during which Mr Sinisi will talk to you about your symptoms. If the injury is the result of accident, however, you’ll have an urgent diagnosis.

Mr Sinisi will carry out a physical exam to look for symptoms. If he suspects brachial plexus injury, then you'll have access to the following:

• An MRI of the neck, chest and spine to help pinpoint the injury site
• A CT scan, during which dye is injected into your spinal cord and neck to highlight possible avulsion injuries
• An electrodiagnostic test to help highlight the full extent of any nerve damage

If you’ve had an injury and there’s a Tinel’s sign (tingling pins and needles sensation down the arm) then we may suggest urgent surgery, as this indicates there is a degenerative lesion to the nerve that needs to be treated.

Surgery might also be considered in less urgent cases, if the nerve isn’t healing on its own. You can find out more about nerve repair surgery here. 
The process of the nerve healing itself takes time and your doctor may recommend physiotherapy to prevent joint and muscle stiffness.

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As mentioned, the brachial plexus is a collection of nerves that connect the brain and spinal cord to the nerves in the arms and shoulders, allowing sensation and enabling movement of certain muscle groups.

An obstetric brachial plexus lesion (also known as Erb’s palsy) is an injury that affects newborn babies when tension is applied to the baby's head during labour (as can happen with difficult deliveries). The nerves can become damaged, causing weakness in the baby's hand, arm and shoulder.

Recovery can vary substantially from patient to patient, it can lead to growth abnormalities in the whole of the upper limb, particularly the shoulder.

The symptoms vary according to the severity and nature of the injury. Symptoms are evident soon after birth and can include:

• Muscle paralysis
• Limited movement of the arm and hand

At your consultation, Mr Sinisi will talk to you about your baby’s symptoms to help the diagnosis. He will assess your baby's motor function and check their range of movement for certain muscles.

If required, you’ll also have access to our X-ray facilities to make sure there are no fractures to the clavicle.

Once these tests have been done, Mr Sinisi will work with you to develop a personalised treatment plan.

Loss of function caused by brachial plexus in children can be treated in several ways depending on the severity of the injury:

• Physical therapy: in mild cases, gentle and regular exercise can help improve movement.
• Nerve graft repair: where a section of healthy nerve is taken and used to bridge the gap in the injured nerve to restore movement and avoid stiffness.
• Nerve transfer: where the end of an injured nerve is reattached using a healthy nerve to restore function.

However, the treatment of obstetric brachial plexus lesions is a specific field of interest for Mr Sinisi. In 2011, having operated on hundreds of children with shoulder abnormalities, he came up with a new approach to dealing with the deformity that has radically improved outcomes in more severe cases.

In all cases, early treatment increases the chances of your baby regaining full arm function.

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Nerve compression syndrome (trapped nerves) is a condition resulting from nerves being put under direct and chronic pressure. In some cases it causes pain and can even lead to loss of nerve function.

It’s a common condition, often occurring in the elbow (known as cubital tunnel syndrome) and the wrist (known as carpal tunnel syndrome). Patients can experience nerve compression in their legs, but this tends to be rarer.

Typically, symptoms include: 

• Loss of function
• Numbness
• Radiating pain 
• Tingling 

With carpal tunnel syndrome, the median nerve becomes trapped in the central part of the wrist, leading to specific symptoms, including tingling or numbness in your fingers, weakness and a tendency to drop objects.

Cubital tunnel syndrome occurs when the ulnar nerve becomes trapped at the elbow. Specific symptoms include tingling, numbness, pain and weakness in the wrist, hand and fingers.

At your consultation, Mr Sinisi will discuss your symptoms with you, including any numbness or lack of function you may be experiencing.

Based on his findings, he may suggest further tests. You’ll have fast access to state-of-the-art diagnostic tools, including  ultrasound scans and nerve conduction studies – both effective ways to diagnose nerve compression.

Carpal and cubital tunnel syndrome can also be treated with surgery, but Mr Sinisi will discuss all the options with you.

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As mentioned, most nerve tumours are benign. They tend to grow slowly within the nerve, pressing on the nerve fibres. The associated symptoms include:

• A lump (palpable or unpalpable)
• Pain at the site of the lump, which radiates within the distribution of the involved nerve

In the rare cases of a malignant (cancerous) tumour, the symptoms are more likely to include loss of function in addition to excruciating pain.

The first step to diagnosis is your consultation, where Mr Sinisi will discuss your symptoms with you, examine the lump and order further tests. This will include:

An MRI scan: This offers a detailed picture of the affected site, allowing Mr Sinisi to evaluate the full impact of the tumour on your nerves.

Nerve tumours are normally removed via surgery.

If the tumour is benign, it’s unlikely that it will come back once removed.

If the tumour is malignant, then you’ll get prompt surgery, plus follow-up care from our dedicated oncology team, including access to radiotherapy and chemotherapy treatments. Mr Sinisi will discuss all the options with you before deciding on a treatment pathway.

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