Brachial Plexus Injury

Overview

Brachial plexus injury is a traumatic peripheral nerve injury affecting the thoracic limb, most commonly involving C6–T2. Clinical presentation depends on the location and severity of injury and may include paresis or paralysis, sensory and reflex deficits, denervation-related muscle atrophy, abnormal paw placement, reduced weight bearing, contracture, neuropathic pain, and skin injury.

The rehabilitation strategy is shaped by the potential for neurologic recovery: preserve the limb and its functional capacity while viable neural pathways recover, or transition toward protection and compensation when meaningful recovery remains limited.

Key Clinical Points

• Motor return matters. Preservation or return of voluntary motor function—particularly triceps and carpal/digital extensor function—is associated with greater potential for functional recovery.

• Protect the limb while neurologic status evolves. Sensory loss and dysesthesia increase the risk of dragging injuries, skin breakdown, and self-mutilation.

• Watch for secondary impairment. Denervation and disuse contribute to muscle atrophy, loss of joint mobility, soft tissue contracture, abnormal limb positioning, and progressive loss of functional use.

• Time alone should not drive rehabilitation. Clinical progression is based on motor function, limb position, weight-bearing ability, joint mobility, gait quality, skin integrity, pain, fatigue, and response to loading.

• Complete avulsion changes expectations. Rehabilitation cannot restore conduction across completely avulsed nerve roots, and complete avulsion has substantially less potential for functional recovery than incomplete peripheral nerve injury.

Rehabilitation Priorities

• Protect an insensate or poorly controlled limb from trauma and self-injury.

• Preserve joint mobility and soft tissue extensibility and minimize flexor contracture.

• Monitor denervation-related muscle atrophy and secondary musculoskeletal dysfunction.

• Track voluntary motor recovery, especially triceps activation, elbow extension, and carpal/digital extensor function.

• Maintain opportunities for safe functional positioning and weight bearing when motor control permits.

• Monitor compensatory dysfunction involving the cervical region, shoulder girdle, trunk, and contralateral limb.

• Shift toward protective and compensatory management when meaningful motor recovery does not occur.

Evidence Snapshot

Available literature supports early multimodal rehabilitation and repeated functional reassessment, but the evidence base remains limited.

Published evidence consists largely of retrospective veterinary studies, small case series/reports, peripheral nerve physiology, and extrapolation from other species.

There are no standardized large canine clinical trials establishing a single rehabilitation protocol or optimal dosing for brachial plexus avulsion.

Veterinary electrodiagnostic findings can provide useful medical context regarding denervation, preserved innervation, and potential reinnervation.

Direct canine evidence establishing optimal electrical-stimulation parameters remains limited.

Clinical Pearls

• Serial examination is essential. A change in voluntary motor function may be more clinically useful than simply counting time since injury.

• Follow the pattern of motor return. Proximal and distal function should be documented separately rather than treating the limb as a single neurologic unit.

• Skin is an outcome measure. Paw and limb integrity can determine whether functional loading or external support remains safe.

• Know when the goal has changed. Persistent nonfunctional limb use, recurrent wounds,self-mutilation, uncontrolled pain, or inability to safely protect the limb warrants veterinary reassessment.

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References

• References

  1. Menchetti M, Gandini G, Bravaccini B, et al. Clinical, electrodiagnostic findings and quality of life of dogs and cats with brachial plexus injury. Vet Sci. 2020;7(3):101. doi:10.3390/vetsci7030101.

  2. Molle S, Pressanto MC, Beccati F. Multimodal approach to rehabilitating a traumatic brachial plexus lesion in a Thoroughbred yearling. J Equine Rehabil. 2024;2:100014. doi:10.1016/j.eqre.2024.100014.

  3. Terruzzi I, Mariani M. Conservative physiotherapy treatment in 4 patients with brachial plexus avulsion (3 dogs and 1 cat). Energy Health. 2022;22:24-26.

  4. Troupel T, Van Caenegem N, Jeandel A, et al. Epidemiological, clinical, and electrophysiological findings in dogs and cats with traumatic brachial plexus injury: a retrospective study of 226 cases. J Vet Intern Med. 2021;35(6):2837-2845. doi:10.1111/jvim.16254.

  5. Varejão ASP, Maurício AC, Ferreira A, Martins Â. The role of early rehabilitation and functional electrical stimulation in rehabilitation for cats with partial traumatic brachial plexus injury: a pilot study on domestic cats in Portugal. Animals (Basel).2024;14(2):323. doi:10.3390/ani14020323.

Brachial Plexus Injury Rehabilitation FAQ

• When should rehabilitation begin for brachial plexus injury?

  DescriptioRehabilitation should begin following veterinary evaluation and diagnosis and referral or medical clearance for rehabilitation. Early priorities include protecting the affected limb, preserving joint mobility and soft tissue extensibility, and minimizing secondary complications associated with denervation and disuse.

• Can dogs recover from a brachial plexus injury?

  Yes, depending on the severity of the nerve injury. Incomplete injuries have greater potential for functional recovery, particularly when voluntary motor function returns. Complete nerve root avulsion has substantially less potential for functional recovery.

• What complications should be monitored during rehabilitation?

  Can dogs recover from a brachial plexus injury?Yes, depending on the severity of the nerve injury. Incomplete injuries have greater potential for functional recovery, particularly when voluntary motor function returns. Complete nerve root avulsion has substantially less potential for functional recovery.What complications should be monitored during rehabilitation?Important complications include muscle atrophy, loss of joint mobility, flexor contracture, paw dragging, skin injury, neuropathic pain or dysesthesia, and self-mutilation. An insensate or poorly controlled limb requires particularly careful protection and skin monitoring.

• How long does rehabilitation take?

  Recovery cannot be predicted by a fixed timeline. Peripheral nerve recovery and reinnervation may occur over many months, and meaningful recovery may not occur with severe injuries. Rehabilitation progression should therefore be based on neurologic and functional findings rather than time alone.

• What is the primary goal of rehabilitation?

  The goal is to preserve the musculoskeletal and functional capacity of the limb while neurologic recovery occurs. When motor function returns, rehabilitation shifts toward restoring active functional use. When meaningful recovery remains limited, the emphasis shifts toward limb protection, mobility preservation, compensation, comfort, and functional adaptation.

To learn more, download the Brachial Plexus Treatment Protocol Workbook today for complete rehabilitation guidelines and clinical decision-making resources.