Brachial Plexus Injury

Selected Features of Our Program

Evaluation and Diagnosis

The brachial plexus is the group of nerves in the shoulder region that provide all the function to the arm and hand, both sensation and muscle activity. Two types of patients sustain brachial plexus injuries, newborn babies and adult trauma victims involved in vehicular accidents. Symptoms include constant pain, numbness, and loss of muscle function. The diagnosis is made by an expert in microscopic nerve surgery during the physical examination process. Pictures of the nerves in the neck and shoulder region may be obtained with MRI or CT scan. Electrical nerve testing provides information regarding injury severity and location. Consultation with a nerve reconstructive surgeon should begin immediately after injury even if surgery is never performed. Lost time after the injury can have serious consequences for the final result.

Treatment and Recovery

The most important factors in planning treatment are determining the pattern and severity of injury. This information is used to predict whether surgery is even needed and if so, what type of surgery should be done. Even more important is determining when surgery should occur. The children will recover 80% of the time without any surgery. Those that need surgery can be predicted by their patterns of recovery during the first few months. Most adult injuries will not recover spontaneously and require surgery. If surgery can be demonstrated to be necessary, then it should be carried out as soon as possible. The most important factor in a good outcome is the patient's age, followed by the level and pattern of injury, and finally the time between injury and reconstruction. The first two of these factors cannot be changed. Only the time delay before surgery is under the patient and surgeon's control. There are many different techniques for surgery. The simplest is called neurolysis and consists of clearing scar tissue from around nerves. In a mild injury, this is all that may be needed. If the original two ends of a nerve are still close together, a direct repair can be accomplished. Neither of these two operations is usually possible. Gaps frequently exist between the nerve ends that require grafting with other small nerves borrowed from unimportant locations.

The latest advances in microscopic nerve surgery offer other alternatives that are most frequently performed by our team of experts in this field. Nerve transfers from one function to another offer distinct advantages over grafting in most situations and produce a more reliable result. For the more severe adult injury patterns, the best strategy to date has been one of actually transplanting muscles out of the legs into the arms to substitute for the missing functions after complete avulsion injuries. All these options and the expected outcome should be discussed thoroughly between the patient and the nerve surgeon. Good treatment planning is the key to success for solving these complicated brachial plexus injuries.