What are the current guidelines for the rehabilitation of patients with brachial plexus injuries in primary care?

Rehabilitation management of patients with brachial plexus injuries in primary care should follow these key principles:

• Be vigilant for nerve injury signs, especially in patients with multiple injuries or cognitive impairments, and assess the peripheral nerves of the affected limb to identify involved nerves and functional deficits. Early surgical decisions are made by specialists, but primary care should be aware of these assessments ¹.
• Start rehabilitation therapy promptly to maintain range of movement and regain function. This includes splinting, passive and active exercises, pain management, sensory interventions (such as mirror therapy and electrical stimulation), and functional or vocational therapy ¹.
• Regularly monitor for signs of nerve recovery and adjust therapy accordingly. If no recovery is evident by 6 weeks or recovery is slower than expected, consider referral for nerve conduction studies or specialist opinion ¹.
• Be aware of risks to tissue viability due to sensory or motor loss and provide appropriate care to prevent complications ¹.
• Recognise the psychological impact of nerve injury, including low mood and anxiety, and consider psychological support. Ensure access to practitioners with expertise in physical trauma and rehabilitation ¹.
• Involve occupational therapy early to assess how physical impairments affect daily living and to provide advice on aids, equipment, and adaptations ¹.
• For patients with poor prognosis after rehabilitation and investigations, consider referral to specialist peripheral nerve injury services for further management, including surgery ¹.

Primary care's role is to support early rehabilitation initiation, monitor progress, manage complications, provide psychological support, and coordinate timely referrals to specialist services as needed.