Brachial Plexus and Nerve Surgery in Delhi

The brachial plexus is a network of nerves running from the neck to the shoulder, arm, and hand. Damage from trauma, accidents, birth complications, or surgery can cause weakness, numbness, pain, or even paralysis of the arm.

When the injury is too severe to heal on its own, surgery may help restore function. The best approach depends on the type and extent of damage, timing, and affected movements, making accurate diagnosis as important as surgical expertise.

Dr. Vikas Gupta, Senior Consultant Neurosurgeon and Neurointerventionalist at Kailash Deepak Hospital, Delhi, provides specialist evaluation and surgical management for brachial plexus and peripheral nerve injuries, applying microsurgical techniques to deliver the best realistic outcome for each patient’s specific injury.

Understanding the Brachial Plexus

The brachial plexus is formed by five nerve roots, C5, C6, C7, C8, and T1, that emerge from the cervical and upper thoracic spinal cord, merge and branch in the neck and shoulder region, and fan out to supply the entire upper limb. Every movement you make with your arm, and every sensation you feel from fingertip to shoulder, passes through this structure.

Brachial plexus injuries are classified as follows by the mechanism and location of damage:

• Neuropraxia: The mildest form; the nerve is stretched but not torn. Most neuropraxia injuries recover on their own, often within weeks to a few months.
• Axonotmesis: The nerve fibres inside are damaged, but the outer sheath remains intact. Recovery is possible, but slower, and incomplete recovery is common in more severe cases.
• Neurotmesis: The nerve is completely severed. Without surgical repair, there is no pathway for regeneration.
• Avulsion: The most severe type; the nerve root is torn away from the spinal cord itself. Avulsion injuries cannot be repaired directly and require nerve transfer techniques to restore any function.

Symptoms That Warrant an Early Specialist Opinion

Seek a neurosurgical evaluation promptly if you or someone you know experiences any of the following after a neck, shoulder, or arm injury:

• Weakness or inability to lift the arm, bend the elbow, or grip objects
• Numbness or loss of sensation in the shoulder, arm, or hand
• A burning, electric, or shooting pain running down the arm
• A completely limp arm with no voluntary movement
• Horner’s syndrome; drooping eyelid, small pupil, and reduced sweating on one side of the face, which can indicate a root-level avulsion
• Progressive weakness in the arm after a tumour diagnosis in the neck or shoulder region
• Arm symptoms in a newborn following a difficult or assisted delivery

Early evaluation keeps more treatment options open. The longer a decision is delayed, the narrower the surgical window becomes.

Who May Need Brachial Plexus Surgery?

Brachial plexus surgery is considered when nerve damage is severe enough that natural recovery is unlikely, or when there has been no meaningful improvement after a period of observation and rehabilitation.

The following situations typically require surgical assessment:

• High-speed road accidents; motorcyclists and cyclists are particularly vulnerable to traction injuries
• Falls from height where the shoulder is forced downward while the head is pulled to one side
• Birth-related brachial plexus injuries (obstetric brachial plexus palsy) in neonates
• Penetrating injuries, such as stab wounds or lacerations that directly cut nerves
• Nerve damage occurring during surgery in the neck, shoulder, or axillary region
• Tumours of the brachial plexus, including schwannomas and neurofibromas, cause progressive weakness or pain
• Persistent, debilitating pain after a brachial plexus injury, even where function has partially returned

Timing matters considerably. For most nerve repair and grafting procedures, surgery is most effective when performed within 6 to 9 months of injury. Beyond that window, the options shift towards nerve transfer and muscle transplantation techniques.

How Is a Brachial Plexus Injury Evaluated?

A thorough assessment is carried out before any surgical plan is made. The goal is to determine exactly which nerve roots are affected, whether the injury is pre- or postganglionic, and which muscles retain any residual function.

• Clinical examination: Assesses strength, sensation, and reflexes to map nerve involvement
• MRI: Visualises nerve roots, detects avulsions, and soft tissue changes
• CT myelography: Used when MRI is unclear to identify root avulsions
• EMG & nerve studies: Confirm injury level, type, and recovery
• Intraoperative monitoring: Guides surgical decisions in real time

Surgical Treatment Options for Brachial Plexus Injuries in Delhi

There is no single standard operation for a brachial plexus injury. The procedure, or combination of procedures, is chosen based on the injury type, its age, the nerves involved, and what functional outcomes are realistically achievable. Procedure options include:

Nerve Repair (Direct Neurorrhaphy)

A cleanly cut nerve is reconnected under a microscope using fine sutures. Best done early, it restores the natural pathway and offers the highest chance of recovery.

Nerve Grafting

Used when a gap prevents direct repair. A donor nerve (often the sural nerve) bridges the defect, allowing fibres to regrow slowly over months to years.

Nerve Transfer (Neurotisation)

When roots are avulsed, nearby functioning nerves are redirected to reinnervate paralysed muscles.

Tendon Transfer

Used when nerve recovery is no longer possible. A working muscle’s tendon is reassigned to restore movement, with faster results than nerve surgery.

Free Functional Muscle Transfer

A muscle (usually the gracilis) is transplanted and reconnected to restore function in severe or late cases.

Neurolysis

Scar tissue is released from an intact nerve to improve function and relieve pain.

Tumour Excision

Nerve tumours are removed, with reconstruction if needed, depending on the extent of involvement.

What Are the Benefits of Brachial Plexus and Nerve Surgery?

The goal of brachial plexus and nerve surgery is to restore as much function as possible while reducing pain and improving overall quality of life. Benefits include:

• Restores function: Can improve movement in the shoulder, arm, and hand, depending on the injury
• Pain relief: May significantly reduce neuropathic pain caused by nerve damage
• Targeted repair: Microsurgical techniques focus precisely on the affected nerves
• Personalised approach: Procedures are tailored to the type, level, and timing of injury
• Improved independence: Helps patients regain daily activities and quality of life

What Are the Risks of Brachial Plexus and Nerve Surgery?

As with any complex surgery, brachial plexus procedures carry certain risks. Understanding these helps set realistic expectations and allows for informed decision-making before proceeding with treatment. Risks include:

• Variable recovery: Functional improvement may be partial and takes time
• Slow nerve regeneration: Recovery can take months to years
• Donor nerve impact: Some weakness or sensory loss may occur at the donor site
• Surgical risks: Includes infection, bleeding, or scarring
• Additional treatment: Physiotherapy or further procedures may be required

What Should You Expect After Brachial Plexus Surgery?

Recovery from brachial plexus surgery is a long-term process. Here is what most patients can expect at each stage:

• Immediately after surgery: A sling is worn for two weeks after nerve repairs and grafts. Tendon transfers and muscle transplants require a sling and/or splint for one to three months to protect the repair while it heals.
• Early rehabilitation: Gentle physiotherapy typically begins within the first day or two after surgery. Initially, this is passive; a therapist or family member moves the limb, progressing to active exercises as recovery allows.
• Nerve regeneration takes time: Nerves regrow at roughly one millimetre per day. For injuries high in the neck, the nerve must travel a considerable distance before reaching the target muscle. First signs of recovery, a flicker of movement or returning sensation, may not appear for three to nine months.
• Continued improvement over the years: Strength and coordination continue improving for twelve to twenty-four months after surgery, sometimes longer. Patience and consistent rehabilitation are as important as the operation itself.
• Retraining the brain: After a nerve transfer, the brain must learn to send signals along a new pathway. A patient whose intercostal nerve has been rerouted to power the bicep may initially need to take a deep breath to trigger elbow flexion, and over time, that connection becomes natural.
• Follow-up and monitoring: Regular clinical reviews and repeat EMG studies are scheduled to track nerve regeneration and adjust rehabilitation accordingly.

Cost of Brachial Plexus Surgery in Delhi

The cost of brachial plexus surgery in Delhi varies by case and typically ranges from ₹1,50,000 to 5,00,000. The cost varies considerably depending on the nature and complexity of the procedure required.

Factors that influence the overall cost include:

• Type of surgery: nerve repair, grafting, transfer, tendon transfer, or free muscle transplant
• Number of nerve roots or peripheral nerves involved
• Whether intraoperative nerve monitoring is required
• Duration of surgery and anaesthesia
• Pre-operative imaging (MRI brachial plexus, CT myelography, EMG studies)
• Length of hospital stay and post-operative rehabilitation
• Whether surgery is a single procedure or staged across multiple operations

A detailed cost estimate is provided at the initial consultation, once the full clinical picture has been reviewed.

Why Patients Trust Dr. Vikas Gupta for Brachial Plexus and Nerve Surgery in Delhi?

Choosing the right surgeon for a brachial plexus injury is one of the most consequential decisions a patient or family can make. Patients across Delhi NCR consult Dr. Vikas Gupta for nerve surgery because of:

• 30+ Years of Neurosurgical and Microsurgical Experience
• Specialist expertise in peripheral nerve injuries, nerve grafting, and nerve transfer procedures
• Advanced microsurgical training enabling precise nerve repair under high magnification
• Thorough pre-operative evaluation; the right diagnosis before any surgical decision is made
• Personalised surgical planning based on injury type, timing, and realistic functional goals
• Close coordination with physiotherapy and rehabilitation teams throughout recovery
• Trusted name in complex brain and nerve surgery across East Delhi and Delhi NCR

His approach prioritises honest assessment and long-term functional recovery, not just technical completion of a procedure.

Book a Consultation for Brachial Plexus and Nerve Surgery in Delhi

If you or a family member has sustained a brachial plexus injury or is living with unexplained arm weakness, pain, or paralysis that has not been properly investigated, a specialist consultation is the right next step.

During the consultation, you can expect:

• A thorough review of your injury history, symptoms, and any existing imaging or EMG results
• A detailed neurological examination of the affected limb
• An honest discussion of which surgical options are appropriate, given the injury type and timing
• A clear explanation of what each procedure involves, what recovery looks like, and what functional outcomes are realistic
• Transparent discussion of costs and what the treatment course entails
• Answers to your questions, without being rushed

You may speak with Dr. Vikas Gupta for an informed evaluation and treatment recommendations tailored to your case. Early consultation opens the door to more treatment options. Book your appointment today for expert brachial plexus and nerve surgery in Delhi.