Brachial Plexus Injuries in Sport Medicine: Clinical Evaluation, Diagnostic Approaches, Treatment Options, and Rehabilitative Interventions

Abstract

The brachial plexus represents a complex anatomical structure in the upper limb. This "network" of peripheral nerves permits the rearrangement of motor efferent fibers, coming from different spinal nerves, in several terminal branches directed to upper limb muscles. Moreover, afferent information coming from different cutaneous regions in upper limb are sorted in different spinal nerves through the brachial plexus. Severe brachial plexus injuries are a rare clinical condition in the general population and in sport medicine, but with dramatic consequences on the motor and sensory functions of the upper limb. In some sports, like martial arts, milder injuries of the brachial plexus can occur, with transient symptoms and with a full recovery. Clinical evaluation represents the cornerstone in the assessment of the athletes with brachial plexus injuries. Electrodiagnostic studies and imaging techniques, like magnetic resonance and high-frequency ultrasound, could be useful to localize the lesion and to define an appropriate treatment and a functional prognosis. Several conservative and surgical techniques could be applied, and multidisciplinary rehabilitative programs could be performed to guide the athlete toward the recovery of the highest functional level, according to the type of injury.

Keywords: brachial plexus; nerve injuries; rehabilitation; sport medicine.

Figure 1

Anatomy of a spinal nerve and its branching pattern.

Figure 2

Schematic representation of brachial plexus. UT: Upper Trunk. MT: Middle Trunk. LT: Lower Trunk. LC: Lateral Cord. PC: Posterior Cord. MC: Medial Cord. N: Nerve.

Figure 3

3D T2 STIR SPACE sequence—coronal images of normal Brachial Plexus. (a) Dotted rectangle includes cervical spinal nerves emerging from the intervertebral foramina in the supraclavicular laterocervical region; (b) dotted rectangle includes the brachial plexus structures passing through the cervicoaxillary canal.

Figure 4

Ultrasound image of the interscalene groove in supraclavicular laterocervical region. Cervical spinal nerves (ventral rami) forming the brachial plexus pass through the anatomical space between anterior and middle scalene muscles, before they merge to form the upper, middle, and lower trunks. (a) Ultrasound image. White arrows indicate cervical spinal nerves (ventral rami); (b) schematic representation of the interscalene groove. C5 is the most superficial cervical spinal nerve, immediately below the sternocleidomastoid muscle. C5: cervical spinal nerve 5. C6: cervical spinal nerve 6. C7: cervical spinal nerve 7. C8: cervical spinal nerve 8. T1: thoracic spinal nerve 1. SCM: sternocleidomastoid muscle, AS: anterior scalene muscle, MS: middle scalene muscle.