Brachial plexus surgery

The cost of brachial plexus surgery with Circle Health Group depends on a variety of factors, including the type of surgery you have and where you have it. Your healthcare team will ensure you know the cost of your treatment at every stage of your journey with them, including information on how and when to pay it.

Fixed-price packages

Our fixed-price packages include the cost of your surgery and all appropriate aftercare appointments. However, any pre-surgery diagnostic tests and your consultant's outpatient appointment consultation fee are charged separately.

Spread the cost of your payment

Our flexible payment options help you spread the cost of your payment across a time period that suits you. We offer fixed-term monthly payment plans over 10 months to five years with no deposit required. If you decide to pay over 10 months, you will pay interest-free. If you are paying for a longer period, you will pay 14.9% APR.

Private health insurance

If you have private medical insurance, your treatment will usually be covered by your provider. Speak to your insurer directly to find out more information on this.

Your brachial plexus tends to become damaged when your arm is forcefully pulled or stretched. If a sudden movement means your shoulder is forced downwards while your neck stretches upwards, it can cause the nerves in your brachial plexus be stretched and/or ruptured. This can happen as a result of:

Traumatic injuries

Most cases of brachial plexus injury occur through a severe blow or stretching movement while performing a physical activity, such as contact sports (football, rugby etc). Your nerves in your brachial plexus may be pulled beyond their limit during a collision or twisting movement with your upper body. This can happen as a result of several kinds of trauma, including vehicle accidents, falls, or gunshot wounds.

Difficult births

The nerves in your brachial plexus are vulnerable during birth, happening in one or two births per 1,000, with larger babies being more at risk. This is because they have an increased chance of their head being stretched away from the shoulder, causing injury to the brachial plexus nerves underneath. Babies born in the breech position (the bottom end comes out first) and/or have a long delivery time are also at risk of experiencing an injury to their brachial plexus.

Cancer

If you receive radiation treatment for your chest and/or neck, it can cause a tumour (an abnormal mass of tissue that forms when cells grow and divide more than they should) to grow in or along your brachial plexus, or put pressure on the nerves in your brachial plexus.

There are many different kinds of brachial plexus injuries; some are more severe than others. Your consultant will decide on what kind of surgery you should have based on your specific type of brachial plexus injury.

Stretching

Also known as neuropraxia, this injury occurs when your nerves are stretched. The nerve root in your brachial plexus (which starts at your neck and goes down to your shoulder) becomes compressed, usually through rotating your head, or is pulled downward. This type of brachial plexus injury is known as a 'burner' or 'stinger' because of its burning and/or stinging sensation.

Rupture

One of the nerves in your brachial plexus becomes torn, either partially or totally, leading to feelings of weakness in your shoulder, arm, or hand, and can mean that some muscles become non-functional. This injury may also cause severe pain, and generally requires brachial plexus surgery to fix.

Neuroma

A neuroma is a technical term for scar tissue. When your nerve tissue is injured, perhaps during a cut in surgery, scar tissue can form as the nerve tries to repair itself. The result is that one of your brachial plexus nerves becomes knotted and causes pain and/or numbness.

Neuritis

This is a rare kind of brachial plexus injury. Also known as a Parsonage Turner syndrome, brachial neuritis causes sudden and intense shoulder and/or upper arm pain, going rapidly from pain to weakness to muscle loss, and potentially even loss of sensation. The cause of brachial neuritis remains unclear, but it has been suggested that it occurs due to how your immune system handles infections or injury.

Avulsion

An avulsion is when the root of one of the nerves in your brachial plexus becomes completely separated from your spinal cord. This usually happens as a result of trauma, such as a sports injury or vehicle accident, causing you severe pain. Reattaching the root to your spinal cord is usually impossible, so you might have permanent weakness and loss of feeling as a result.

To confirm what kind of brachial plexus surgery you may need, your consultant will take time to understand which nerves have been affected, along with the severity of your injury.

Medical history

The first step will be taking a detailed history of your symptoms, such as how and when the injury occurred and to what extent they impact your daily activities, along with taking a note of your general health. Learning about weakness, paralysis, or the nature of your pain (stinging, stabbing, dull, etc) can help them find out the location and severity of your brachial plexus injury.

Physical examination

Your consultant may perform a physical examination, which involves comparing motor function, sensation, and pain in your affected limb, in contrast with your unaffected side. They will do this by asking you to do certain movements with your arms and note where and when you feel pain and/or numbness.

Imaging studies

To gain a clear understanding of your injury and the kind of brachial plexus surgery best suited to you, your consultant may do a series of imaging tests, which can involve:

Electromyography

During an electromyography test (EMG), your consultant inserts a small needle into various muscles, allowing them to assess the electrical activity of your muscles when they contract and then rest. If the electrical activity is different to normal, it helps them know where you may have a damaged nerve. This is usually carried out alongside nerve conduction studies, which measure the speed of conduction in your nerve and shows your consultant how well your nerve is functioning.

MRI

This test uses powerful magnetic field and radio waves to produce detailed images of the soft tissues (tendons, ligaments, muscles, cartilage) and the status of the arteries that are important for the functioning of your arm.

CT scan

This scan uses a series of complex X-rays that capture images of your body and generate detailed pictures of your spinal cord and nerve roots, allowing them to see whether there has been any damage to the nerves in your brachial plexus.

If your brachial plexus injury is mild (your nerves have only been stretched, rather than ruptured), your symptoms may go away naturally over a period of weeks or months. If your problem isn't severe, your consultant may simply monitor your injury or prescribe a series of physical therapy exercises to keep your joints and muscles working properly, prevent stiffness, and encourage range of motion.

In cases where your brachial plexus injury is severe, on the other hand, your consultant may recommend surgery. They will speak to you about how you can prepare for the procedure beforehand.

Plan for a short hospital stay

After your brachial plexus surgery, you may need to stay in hospital for a night, as this gives us time to give you pain relief and monitor how you've recovered from the procedure. So be sure to bring anything that might make your stay with us more comfortable, such as loose-fitting clothing or a laptop to keep you entertained.

Stock up on supplies

For the first few weeks following your procedure, the movement of your arm will be severely limited, so making quick trips to the shops won't be possible. Ahead of coming to hospital, then, make sure you have everything you need at home and within easy reach. If possible, have a friend or relative nearby who can assist you with daily activities.

Remove any tripping hazards

Take care to remove anything in your home that might cause you to trip and lead to further damage to your shoulder and arm, such as loose flooring, general mess, or furniture.

Discuss medications with your consultant

If you're taking warfarin, aspirin, anti-inflammatory medications, or any other medications that are blood thinners, your consultant may ask you to stop taking these two weeks before your brachial plexus surgery to ensure against unwanted bleeding during and after your surgery.

Stop smoking

Smokers need more general anaesthetic during surgery, which can cause breathing problems. You may also be more at risk of having heart issues if you smoke, and your overall recovery may be affected if you keep smoking after your surgery. As a result, we always recommend that you stop smoking at least one week beforehand.

Food and drink

Like before any operation involving general anaesthetic, don't eat or drink anything after midnight on the day of your procedure, and avoid alcohol for 48 hours prior to visiting hospital.

Due to the varying types and levels of severity of brachial plexus injuries, different surgical treatments are used depending on your situation. Your procedure will be performed under general anaesthetic, so you'll be asleep for the entire time and won't feel anything.

Nerve repair or neurolysis

If your nerve has been torn, your surgeon may be able to reconnect it by sewing the ends of some nerves back together. On the other hand, if your nerve has been compressed but remains intact, your surgeon may perform neurolysis - a decompression surgery that removes scar tissue from around the affected nerve, which in turn relieves pressure on this area.

Nerve graft

In cases where your nerve has been injured or badly scarred, your surgeon may choose to perform a nerve graft surgery. This involves removing the damaged nerve segment and replacing it with a piece of an expendable sensory nerve from another part of your body. Doing this creates a channel that replaces the injured part of your nerve and allows for a pathway for nerve regeneration.

Nerve transfer

This procedure is performed when your nerve root has been torn from your spinal cord. Your surgeon will take a nerve from nearby that isn't critical (from under your ribs, or perhaps a nerve in your hand) and connect it to the nerve that is no longer working, creating a foundation for new nerve growth in this area.

Muscle transfer

This form of brachial plexus surgery is usually only chosen when too much time has passed after your injury, meaning repair or nerve grafting and/or transfer isn't an option. During this procedure, your gracilis muscle in your inner thigh (a long, thin muscle in the middle of your thigh that is nonessential) will be carefully removed and transplanted to replace a non-functioning muscle in your shoulder, upper arm, or hand, with your surgeon connecting tiny blood vessels under a microscope to restore blood flow.

While your tissues may heal relatively quickly after brachial plexus surgery, full nerve function and mobility can take months to return. Everyone's rate of recovery is different; your exact recovery timeline might be influenced by a range of factors, including:

• The type of brachial plexus surgery you received
• Your fitness levels
• Your everyday activities
• The nature of your job
• General health
• Your age

Recovering in hospital after brachial plexus surgery

When you wake up after brachial plexus surgery, you may feel quite groggy, but this is normal as your general anaesthetic wears off. You will be transferred to a private post-operative room and given time to rest, with pain relief provided by your nurse. Usually, we require you to stay the night at hospital to check on how you've responded to surgery and provide information about aftercare and physiotherapy, which is a crucial aspect of recovery from brachial plexus surgery.

Your arm will be placed in a protective dressing and a splint or sling. How long you'll need to wear this for depends on the type of brachial plexus surgery you received.

Two days to three weeks after brachial plexus surgery

You will need to rest your arm, keeping it in an elevated position to enable faster healing, and take care to avoid any rapid twisting movements in the early stages of your recovery. You shouldn't feel much discomfort after brachial plexus surgery. If you do, take painkillers whenever needed.

If you had a nerve repair, transfer, or graft, you may only need to wear a sling or splint for around two weeks. For muscle or tendon transfer, on the other hand, it could be required for one to three months.

When you can return to work depends on the nature of your job. If you have a sedentary role (one that doesn't require manual tasks, such as a desk job), you should be able to resume light activities at work after two weeks. If your job does require manual exertion, recovery will take longer. Please speak to your consultant about an appropriate time to return to tasks such as heavy lifting. It is possible that you will have a less functional arm and/or hand after brachial plexus surgery, which may mean you have to make adjustments in terms of employment and daily activities.

Once your sling or splint has been removed and you don't have any pain and mobility in your arm, you should be able to return to driving. Getting to this stage typically takes two to four weeks. A follow up with your consultant shall be arranged for three weeks after surgery to check on how your wound has healed.

Three weeks to one year after brachial plexus surgery

After your sling or splint has been removed and you return to normal activities, you will need to see your consultant for regular check-ups and to manage your pain every three months. This is particularly important for babies, and could be required for up to two years.

During this time, your physiotherapist will provide you with a programme of physical exercises designed to prevent muscle atrophy and contractures (a fixed tightening of muscle, tendons, ligaments, or skin), as well as promote nerve regeneration, which is key for improving movement and sensation. The exact type of therapy and how long you need to do it for will depend on what brachial plexus surgery you received. In some cases, physiotherapy may need to last for up to two years.

Complications can occur with brachial plexus surgery, but these are rare. All risks will be explained to you by your consultant ahead of your surgery and you'll be given the chance to ask them any questions.

General complications of any operation

• Pain
• Bleeding
• Infection in the surgical wound
• Unsightly scarring
• Blood clots
• Difficulty passing urine
• Chest infection
• Heart attack or stroke

Specific complications of brachial plexus surgery

• Damage to your nerves
• Your symptoms don't improve, limiting future treatment options
• Injury to your donor nerve, leading partial loss of function
• You require further surgery

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations that fits your schedule
• The freedom to choose which hospital and consultant best suits your needs
• Personalised, consultant-led treatment plans adapted to your requirements
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private cosy ensuite rooms as standards and delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about elbow replacement surgery, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in December 2022. Next review due December 2025.

1. Brachial plexus injuries, OrthoInfo
2. Brachial plexus surgery, Mayo Clinic
3. Tumour, NIH
4. Brachial plexus surgery, John Hopkins Medicine
5. Brachial plexus injury, John Hopkins Medicine
6. Nerve transfer, John Hopkins Medicine