For too long, patients with brachial plexus injuries in the South West faced a difficult journey — long distances out of region, unfamiliar teams, and fragmented care. SWePT was established to change that.

Based at Southmead Hospital, we bring together surgeons, therapists, radiologists, neurophysiologists and specialist nurses under one coordinated service — working hand-in-hand with your regional hospital and therapy team.

We value transparency and partnership. Every patient and family is kept informed and involved at every step. Recovery is a shared effort, and we believe in your active role in your own care.

We also lead and collaborate in national and international research, so that the latest evidence always reaches the patients who need it most.

The brachial plexus is a complex network of nerves running from your spine, through your neck and shoulder, and down into your arm and hand. These nerves control everything your arm and hand does — movement, sensation, temperature, and pain.

When the brachial plexus is injured — through a road traffic accident, a fall, surgery, or another cause — it can result in weakness or paralysis, loss of sensation, and neuropathic pain. Recovery depends on the severity and location of the injury.

Nerves regenerate slowly — at roughly 1mm per day — so recovery is measured in months and years, not days or weeks. This can be difficult to live with, and we are here to support you throughout.

Neuropathic pain is one of the most challenging aspects of a brachial plexus injury. It is caused by damage to the nerves themselves — and can feel very different from ordinary pain: burning, shooting, stabbing, electric, or like a deep ache that does not go away.

Importantly, neuropathic pain does not mean your recovery is going badly. It is a sign that your nervous system is active — though that does not make it any less real or difficult to live with.

What helps?

• Medicines prescribed by your doctor (amitriptyline, gabapentin, or pregabalin)
• Guided movement and exercise with your therapist
• Pacing — balancing activity and rest
• Mindfulness, relaxation, and pain psychology
• TENS machines and other physical modalities
• Specialist pain clinic input — our colleague Dr Jim Dunham

Always discuss any new or worsening pain with SWePT.

Scar care

• Apply a hypoallergenic moisturising cream twice daily
• Massage gently in circular and along-the-scar movements for 5–10 minutes
• Protect with SPF 50+ — scar tissue is more sensitive to UV
• Avoid extremes of heat and cold to the scar area

Our SWePT therapists — Hazel Brown (Consultant Therapist), Antonia Hook (Physiotherapist), Fiona Powell (Occupational Therapist), and Cat Rolls (Academic Physiotherapist) — work closely alongside the surgical and nursing team.

Your local therapy team plays a vital role too. SWePT provides detailed post-operative guidelines and works in communication with your regional therapists so your rehabilitation is joined up, wherever you are in the South West.

In September 2024, the NIHR James Lind Alliance (JLA) Priority Setting Partnership in Adult Traumatic Brachial Plexus Injury — led by the team now constituting SWePT together with the UCL Centre for Nerve Engineering, with input from all major UK plexus centres and the TBPI patient community — published the Top 10 research priorities for this condition.

These priorities were identified from more than 600 responses from patients, carers, and clinicians. SWePT was central to delivering this work and every study we undertake is designed to address these priorities directly, in partnership with the patients who will benefit from the answers.

Our research is conducted in collaboration with leading academic institutions:

We work with the University of Bristol Biomedical Research Unit (BRU), the UCL Centre for Nerve Engineering, and NDORMS Oxford to translate research findings into benefits for patients.

Brachial plexus injury affects approximately 0.17 to 1.6 per 100,000 people per year in England — comparable in scale to ovarian or stomach cancer, but with consequences that are frequently lifelong. Yet it has received relatively little research attention.

There is currently no single diagnostic test that can confirm the severity of a nerve injury; no blood test that tells us how well a patient will recover; and no medication that helps nerves regenerate. REPAIR and our partner studies are designed to change this.

The NIHR JLA Top 10 research priorities — which SWePT helped deliver — identified establishing a national registry and biobank as a top priority. REPAIR is the direct response to that call, and provides the infrastructure through which all 10 priorities can be systematically addressed over the coming decades.

The thoracic outlet is a named anatomical region — like the carpal tunnel — that sits at the base of the neck, between the collarbone and the first rib. Running through this corridor are the brachial plexus (the network of nerves controlling all movement and sensation in the arm and hand), and the subclavian artery and vein.

Thoracic outlet syndrome (TOS) occurs when these structures are compressed, stretched, or tethered within this space. It is not one condition — it is three, grouped by which structure is affected.

In most patients, nTOS arises from a congenital predisposition — the way the nerves, muscles, and surrounding structures developed during embryology. A precipitating event — often a whiplash injury, fall, or period of repetitive overhead activity — then brings the underlying susceptibility to the surface.

nTOS is more common in women aged 20–50, though it can affect anyone. The wide range of reported prevalence (3–80 per 1,000 people) reflects the genuine difficulty in diagnosis rather than true epidemiological uncertainty.

Neuropathic pain is caused by damage to or abnormal signalling within the nerves themselves — not by injury to the tissues around them. This makes it feel very different from ordinary pain, and means that ordinary painkillers such as paracetamol or ibuprofen often provide little benefit.

People describe it as burning, shooting, stabbing, electric, or like a deep ache that does not go away. It can be constant or come in waves. It is often worse at night, when you are tired, or when you are stressed. Cold can make it worse; warmth sometimes helps.

Importantly: neuropathic pain does not mean your recovery is going badly. It is a sign that your nervous system is active — though that does not make it any less real or less difficult to live with.

SWePT works closely with Dr Jim Dunham, Consultant in Pain Management at North Bristol NHS Trust. For patients whose pain is not adequately controlled through the approaches above, referral to the pain service can provide:

• Detailed pain assessment and medication review
• Nerve blocks and other interventional pain procedures
• Access to the pain psychology team
• Specialist input for complex or refractory cases

If you feel your pain is not well controlled, please tell us. We can arrange a referral to the pain service alongside your ongoing surgical and therapy care.

The word tumour is alarming — but in medicine it simply means a lump or growth. Nerve tumours are lumps that arise from within a nerve. The overwhelming majority are benign: they are not cancer, they do not spread, and they are not dangerous to life.

The most common type is called a Schwannoma. It grows from a Schwann cell — a specialised cell that normally wraps around nerve fibres to insulate them. The lump develops inside the outer lining of the nerve, pushing the normal nerve fibres aside rather than destroying them, which is why surgery can usually remove it without lasting damage to the nerve.

A less common type is a neurofibroma, which is more intimately woven into the nerve fibres themselves. The vast majority of these are also benign.

As a general principle, biopsy is not required when clinical and radiological findings collectively indicate a benign peripheral nerve tumour. Percutaneous biopsy of neurogenic tumours risks damage to intact uninvolved fascicles, frequently fails to return sufficient tissue for a firm diagnosis, and creates intraneural scarring that causes patient morbidity and complicates any subsequent open surgery.

The exception is borderline FDG PET uptake in a plexiform neurofibroma, where percutaneous biopsy may be appropriate to guide the decision between continued surveillance and radical excision.