eMedicine Specialties > Orthopedic Surgery > Trauma

Brachial Plexus Injuries, Traumatic: Follow-up

Author: Mark R Foster, MD, PhD, FACS, President and Orthopaedic Surgeon, Orthopaedic Spine Specialists of Western Pennsylvania, PC
Coauthor(s): Christopher Chaput, MD, Assistant Professor of Orthopedic Surgery, Texas A&M Health Science Center; Consulting Surgeon, Department of Orthopedic Surgery, Scott and White Memorial Hospital; Robert A Probe, MD, Associate Professor of Orthopedic Surgery, Texas A&M University Health Science Center; Chairman, Department of Orthopedic Surgery, Scott and White Clinic and Memorial Hospital
Contributor Information and Disclosures

Updated: Sep 26, 2008

Outcome and Prognosis

The prognosis is highly variable. It depends not only on the nature of the injury but also on the age of the patient and the type of procedure performed. Doi et al reported achieving reliable grasping of the hand and voluntary control of the shoulder and elbow after complete avulsion of the brachial plexus.21  They achieved these impressive results using a double free muscle transfer technique. Kandenwein et al presented 134 cases that were treated surgically for traumatic brachial plexus lesions.22  In this group, the percentage of patients with grade 3 or better motor strength progressed from 2% preoperatively to 52% postoperatively, an enormous improvement over historical results; graft reconstruction performed better than neurotization.

Future and Controversies

Clear consensus regarding surgical timing and surgical indications is lacking. However, sural nerve grafting has been shown to be better than neurotization, and surgery between 3 and 6 months has become more common and preferred, with better outcomes. There is some difficulty in obtaining a significant series of comparable patients. More research is needed to demonstrate the efficacy of most of the procedures currently available.

The future may bring further advances in nerve rootlet replantation for preganglionic injuries and in free muscle transfer techniques. Research into growth factors that promote nerve regeneration may make nerve grafting and transfers more appealing in the future.

 


More on Brachial Plexus Injuries, Traumatic

Overview: Brachial Plexus Injuries, Traumatic
Workup: Brachial Plexus Injuries, Traumatic
Treatment: Brachial Plexus Injuries, Traumatic
Follow-up: Brachial Plexus Injuries, Traumatic
Multimedia: Brachial Plexus Injuries, Traumatic
References
Further Reading
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References

  1. Shin AY, Spinner RJ, Steinmann SP, Bishop AT. Adult traumatic brachial plexus injuries. J Am Acad Orthop Surg. Oct 2005;13(6):382-96. [Medline].

  2. Blaauw G, Muhlig RS, Vredeveld JW. Management of brachial plexus injuries. Adv Tech Stand Neurosurg. 2008;33:201-31. [Medline].

  3. Rovak JM, Tung TH. Traumatic brachial plexus injuries. Mo Med. Nov-Dec 2006;103(6):632-6. [Medline].

  4. Akita S, Wada E, Kawai H. Combined injuries of the brachial plexus and spinal cord. J Bone Joint Surg Br. May 2006;88(5):637-41. [Medline].

  5. Webb JC, Munshi P, Saifuddin A, Birch R. The prevalence of spinal trauma associated with brachial plexus injuries. Injury. Sep 2002;33(7):587-90. [Medline].

  6. Goldie BS, Coates CJ. Brachial plexus injury: a survey of incidence and referral pattern. J Hand Surg [Br]. Feb 1992;17(1):86-8. [Medline].

  7. Narakas AO. The treatment of brachial plexus injuries. Int Orthop. 1985;9(1):29-36. [Medline].

  8. Leffert RD. Green's Operative Hand Surgery. 4th ed. New York, NY:. Churchill Livingstone;1999:1557-1587.

  9. Rohde RS, Wolfe SW. Nerve transfers for adult traumatic brachial plexus palsy (brachial plexus nerve transfer). HSS J. Feb 2007;3(1):77-82. [Medline].

  10. Moiyadi AV, Devi BI, Nair KP. Brachial plexus injuries: outcome following neurotization with intercostal nerve. J Neurosurg. Aug 2007;107(2):308-13. [Medline].

  11. Suzuki K, Doi K, Hattori Y, Pagsaligan JM. Long-term results of spinal accessory nerve transfer to the suprascapular nerve in upper-type paralysis of brachial plexus injury. J Reconstr Microsurg. Aug 2007;23(6):295-9. [Medline].

  12. Millesi H. Brachial plexus injuries. In: Chapman MW, Szabo RM, Mann RA, et al, eds. Chapman's Orthopaedic Surgery. Philadelphia, Pa:. Lippincott Williams & Wilkins;2001:1703-1720.

  13. Boome RS. The hand and upper extremity. In: Boome RS, ed. The Brachial Plexus. Vol 14. Philadelphia, Pa:. WB Saunders Co;1997:1-18.

  14. Amrami KK, Port JD. Imaging the brachial plexus. Hand Clin. Feb 2005;21(1):25-37. [Medline].

  15. Burge P. Diagnostic investigations. In: Boome RS, ed. The Brachial Plexus. Vol 14. Philadelphia, Pa:. WB Saunders Co;1997:19-29.

  16. Carlstedt TP. Spinal nerve root injuries in brachial plexus lesions: basic science and clinical application of new surgical strategies. A review. Microsurgery. 1995;16(1):13-6. [Medline].

  17. Jivan S, Kumar N, Wiberg M, Kay S. The influence of pre-surgical delay on functional outcome after reconstruction of brachial plexus injuries. J Plast Reconstr Aesthet Surg. May 15 2008;[Medline].

  18. Ahmed-Labib M, Golan JD, Jacques L. Functional outcome of brachial plexus reconstruction after trauma. Neurosurgery. Nov 2007;61(5):1016-22; discussion 1022-3. [Medline].

  19. Parry CB. Management of Deafferentation Pain. In: Boome RS, ed. The Brachial Plexus. Vol 14. Philadelphia, Pa:. WB Saunders Co;1997:165-168.

  20. Thomas DG, Sheehy JP. Dorsal root entry zone lesions (Nashold's procedure) for pain relief following brachial plexus avulsion. J Neurol Neurosurg Psychiatry. Oct 1983;46(10):924-8. [Medline].

  21. Doi K, Muramatsu K, Hattori Y, et al. Restoration of prehension with the double free muscle technique following complete avulsion of the brachial plexus. Indications and long-term results. J Bone Joint Surg Am. May 2000;82(5):652-66. [Medline].

  22. Kandenwein JA, Kretschmer T, Engelhardt M, Richter HP, Antoniadis G. Surgical interventions for traumatic lesions of the brachial plexus: a retrospective study of 134 cases. J Neurosurg. Oct 2005;103(4):614-21. [Medline].

  23. Birche R. Surgical Disorders of the Peripheral Nerves. 1st ed. Churchill Livingstone:1998:157-207.

  24. Miller MD. Review of Orthopedics. 3rd ed. Philadelphia, Pa:. WB Saunders Co;2000:519-527.

  25. Tavakkolizadeh A, Saifuddin A, Birch R. Imaging of adult brachial plexus traction injuries. J Hand Surg [Br]. Jun 2001;26(3):183-91. [Medline].

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Further Reading

For a further review of adult traumatic brachial plexus injuries, see Shin et al. 1

Plexopathy .
American College of Radiology.  2006.  13 pages.  NGC:005539
 

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Keywords

traumatic brachial plexus injury, lesions of the brachial plexus, supraclavicular injuries, upper plexus injuries, lower plexus injuries, shoulder injuries

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Contributor Information and Disclosures

Author

Mark R Foster, MD, PhD, FACS, President and Orthopaedic Surgeon, Orthopaedic Spine Specialists of Western Pennsylvania, PC
Mark R Foster, MD, PhD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Physical Society, Christian Medical & Dental Society, Eastern Orthopaedic Association, North American Spine Society, Orthopaedic Research Society, and Pennsylvania Orthopaedic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Christopher Chaput, MD, Assistant Professor of Orthopedic Surgery, Texas A&M Health Science Center; Consulting Surgeon, Department of Orthopedic Surgery, Scott and White Memorial Hospital
Christopher Chaput, MD is a member of the following medical societies: Texas Medical Association
Disclosure: Nothing to disclose.

Robert A Probe, MD, Associate Professor of Orthopedic Surgery, Texas A&M University Health Science Center; Chairman, Department of Orthopedic Surgery, Scott and White Clinic and Memorial Hospital
Robert A Probe, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, AO Foundation, Orthopaedic Trauma Association, and Texas Medical Association
Disclosure: Stryker Orthopaedics Consulting fee Consulting

Medical Editor

Jeffrey L Visotsky, MD, Assistant Professor, Department of Clinical Orthopedic Surgery, Northwestern University
Jeffrey L Visotsky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American College of Physician Executives, American College of Surgeons, American Medical Association, American Society for Surgery of the Hand, Arthroscopy Association of North America, Chicago Medical Society, and Illinois State Medical Society
Disclosure: Depuy Consulting fee Speaking and teaching; Pegasus Honoraria Board membership

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Samuel Agnew, MD, FACS, Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center
Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Mary Ann E Keenan, MD, Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania
Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association
Disclosure: Nothing to disclose.

 
 
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