Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Traumatic Brachial Plexopathy Follow-up

  • Author: Vladimir Kaye, MD; Chief Editor: Robert H Meier, III, MD  more...
 
Updated: Aug 27, 2015
 

Further Outpatient Care

See the list below:

  • Continuation of physical therapy and/or occupational therapy and follow-up with a surgeon and/or orthotist may be needed.
  • Vocational rehabilitation and modifications at home and/or work are also assessed.
  • In some cases, repeated electrodiagnostic evaluations may be required for prognostication and further treatment planning. These tests can be used to detect early signs of muscle reinnervation several months before clinically evident muscle contractions appear.
Next

Further Inpatient Care

See the list below:

  • If physical therapy is not initiated promptly after surgery, denervation can occur and can result in muscle atrophy and fibrosis, joint stiffness, motor endplate atrophy, and trophic skin changes.
  • Grant and colleagues do not advocate the traditional treatment, which involves several weeks of immobilization.[32] Instead, the use of a short period to allow healing and adequate strengthening of the repair site is advised.
  • Repairs (nerve transfer/neurotization, as well as tendon transfer) are protected by means of relaxed joint posturing for about 3 weeks.
  • To prevent disruption of the sutures at the repair site, the patient should avoid strenuous physical activity.
  • In nerve transfers, the extremity is immobilized for 4 weeks after surgery, at which time physical therapy is initiated.
  • Postoperative clinical examinations are performed every 3 months for the first 2 years after surgery and every 6 months after that.
  • At each postoperative visit, the ROM, strength, and sensation in the treated area should be tested, and the results should be documented.
Previous
Next

Inpatient & Outpatient Medications

See the list below:

  • A variety of medications may be required, mainly for the management of associated painful states.
Previous
Next

Transfer

See the list below:

  • When indicated, the patient may be admitted to the hospital for orthopedic or neurosurgical procedures.
Previous
Next

Deterrence

See the list below:

  • Measures that the patient can use to prevent setbacks and further damage include the following:
    • Protecting the damaged limb from repeat injury and extremes of motion
    • Maintaining the functional ROM
    • Strengthening muscles in the cervical region and limbs
    • Making appropriate modifications in the workplace and/or at home
Previous
Next

Complications

See the list below:

  • Late complications may include the following:
    • Pain syndromes, such as persistent neuropathy, neuroma, and CRPS II
    • Skin damage and infection
    • Significant muscle atrophy
    • Contracture and capsulitis
    • Subluxation
    • Sensory loss
    • Osteopenia
    • Heterotopic ossification
    • Myofascial pain
    • Depression and anxiety
Previous
Next

Prognosis

See the list below:

  • The outcome and prognosis of acute injury varies widely, depending on the type and etiology of injury and the timing of therapy.[21]
    • The extent of injury to neural tissue and the age and medical status of the injured patient are important factors that influence the outcome.
    • Patient compliance and motivation for recovery can also have an important effect on the overall success of therapy.
  • With mild neurapraxic lesions, spontaneous recovery may occur only days or weeks after the trauma has occurred; following a gunshot wound, spontaneous recover may occur as late as 11 months later.
  • Recovery from axonotmetic injuries usually occurs over months.
    • In axonotmesis, although axons regenerate, functional recovery depends on the associated injuries, the amount of healthy proximal axon that remains after injury, and the age of the patient.
    • Recovery is usually complete unless the injury is so proximal that atrophy of the motor endplate or sensory receptor occurs before the axon can grow back to these organs.
    • In cases of a coexisting root avulsion, the above scenario of a very proximal lesion, resulting in atrophy of the motor endplate or sensory receptor, may be possible. Therefore, healing may be greatly delayed or incomplete.
  • In neurotmesis, regeneration occurs, but function rarely returns to its preinjury level.
  • Generally, the rate of spontaneous recovery after shotgun wounds is lower than it is with other mechanisms.
  • Neural injuries associated with fractures have a greater incidence of spontaneous resolution; generally, recovery is less common with neural injuries secondary to dislocations.
  • Lesions resulting from shoulder dislocations heal within 12-45 weeks, depending on severity of the dislocation and, consequently, the type and extent of the associated neural injury or injuries.
Previous
Next

Patient Education

See the list below:

  • Educating the patient, family, and rehabilitation team, as well as medical practitioners involved in the patient's postdischarge care, may have several benefits.
    • It facilitates the coordination and planning of services.
    • It hastens the implementation of appropriate interventions.
    • It results in a better recovery.
  • Of equal importance is addressing the associated psychological factors, with the aim of improving the following:
    • The patient's mood stability
    • The patient's coping skills
    • Family functioning
    • Pain management
    • Patient motivation
    • Patient participation in therapy
    • Overall outcome
Previous
 
Contributor Information and Disclosures
Author

Vladimir Kaye, MD Consulting Staff, Departments of Neurology and Psychiatry, Hoag Hospital

Vladimir Kaye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, North American Spine Society, American Academy of Anti-Aging Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Murray E Brandstater, MBBS Chairman and Program Director, Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University School of Medicine

Murray E Brandstater, MBBS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Congress of Rehabilitation Medicine, American Medical Association, Association for Academic Psychiatry, California Society of Physical Medicine and Rehabilitation, Canadian Association of Physical Medicine and Rehabilitation, Canadian Medical Association, Canadian Society of Clinical Neurophysiologists, Catholic Medical Association, National Stroke Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Royal College of Physicians and Surgeons of the United States

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Aishwarya Patil, MD Physiatrist (Rehabilitation Physician), Vice Chair, Immanuel Rehabilitation Center

Aishwarya Patil, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, Association of Physicians of India

Disclosure: Nothing to disclose.

Chief Editor

Robert H Meier, III, MD Director, Amputee Services of America; Active Medical Staff, Presbyterian/St Luke’s Hospital, Spalding Rehabilitation Hospital, Select Specialty Hospital; Consulting Staff, Kindred Hospital

Robert H Meier, III, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Additional Contributors

Teresa L Massagli, MD Professor of Rehabilitation Medicine, Adjunct Professor of Pediatrics, University of Washington School of Medicine

Teresa L Massagli, MD is a member of the following medical societies: Academy of Spinal Cord Injury Professionals, American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

References
  1. Sköld MK, Svensson M, Tsao J, Hultgren T, Landegren T, Carlstedt T, et al. Karolinska institutet 200-year anniversary. Symposium on traumatic injuries in the nervous system: injuries to the spinal cord and peripheral nervous system - injuries and repair, pain problems, lesions to brachial plexus. Front Neurol. 2011. 2:29. [Medline]. [Full Text].

  2. Clancy WG Jr, Brand RL, Bergfield JA. Upper trunk brachial plexus injuries in contact sports. Am J Sports Med. 1977 Sep-Oct. 5(5):209-16. [Medline].

  3. Narakas AO. Traumatic brachial plexus lesions. Dyck PJ, Thomas PK, Lambert EH, et al, eds. Peripheral Neuropathy. Philadelphia, Pa: WB Saunders; 1984. vol 2: 1394.

  4. Crotti FM, Carai A, Carai M, et al. Post-traumatic thoracic outlet syndrome (TOS). Acta Neurochir Suppl. 2005. 92:13-5. [Medline].

  5. Van Alfen N, Malessy MJ. Diagnosis of brachial and lumbosacral plexus lesions. Handb Clin Neurol. 2013. 115:293-310. [Medline].

  6. Kim DH, Murovic JA, Tiel RL, et al. Penetrating injuries due to gunshot wounds involving the brachial plexus. Neurosurg Focus. 2004 May 15. 16(5):E3. [Medline].

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

  8. Hentz VR. Is microsurgical treatment of brachial plexus palsy better than conventional treatment?. Hand Clin. 2007 Feb. 23(1):83-9. [Medline].

  9. Mansukhani KA. Electrodiagnosis in traumatic brachial plexus injury. Ann Indian Acad Neurol. 2013 Jan. 16(1):19-25. [Medline]. [Full Text].

  10. Barman A, Chatterjee A, Prakash H, Viswanathan A, Tharion G, Thomas R. Traumatic brachial plexus injury: electrodiagnostic findings from 111 patients in a tertiary care hospital in India. Injury. 2012 Nov. 43(11):1943-8. [Medline].

  11. Aminoff MJ, Olney RK, Parry GJ, et al. Relative utility of different electrophysiologic techniques in the evaluation of brachial plexopathies. Neurology. 1988 Apr. 38(4):546-50. [Medline].

  12. Date ES, Rappaport M, Ortega HR. Dermatomal somatosensory evoked potentials in brachial plexus injuries. Clin Electroencephalogr. 1991 Oct. 22(4):236-49. [Medline].

  13. Insola A, Caliandro P, Pirrone R, et al. Usefulness of a comprehensive neurophysiological assessment for early diagnosis and prognosis of traumatic brachial plexus injuries. Electromyogr Clin Neurophysiol. 2005 Jun. 45(4):209-17. [Medline].

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

  15. Brunelli GA, Brunelli GR. Preoperative assessment of the adult plexus patient. Microsurgery. 1995. 16(1):17-21. [Medline].

  16. O'Shea K, Feinberg JH, Wolfe SW. Imaging and electrodiagnostic work-up of acute adult brachial plexus injuries. J Hand Surg Eur Vol. 2011 Nov. 36(9):747-59. [Medline].

  17. Chanlalit C, Vipulakorn K, Jiraruttanapochai K, et al. Value of clinical findings, electrodiagnosis and magnetic resonance imaging in the diagnosis of root lesions in traumatic brachial plexus injuries. J Med Assoc Thai. 2005 Jan. 88(1):66-70. [Medline].

  18. West GA, Haynor DR, Goodkin R, et al. Magnetic resonance imaging signal changes in denervated muscles after peripheral nerve injury. Neurosurgery. 1994 Dec. 35(6):1077-85; discussion 1085-6. [Medline].

  19. Brogan DM, Carofino BC, Kircher MF, et al. Prevalence of rotator cuff tears in adults with traumatic brachial plexus injuries. J Bone Joint Surg Am. 2014 Aug 20. 96 (16):e139. [Medline].

  20. 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].

  21. Krishnan KG, Martin KD, Schackert G. Traumatic lesions of the brachial plexus: an analysis of outcomes in primary brachial plexus reconstruction and secondary functional arm reanimation. Neurosurgery. 2008 Apr. 62(4):873-85; discussion 885-6. [Medline].

  22. Tender GC, Kline DG. The infraclavicular approach to the brachial plexus. Neurosurgery. 2008 Mar. 62(3 Suppl 1):180-4; discussion 184-5. [Medline].

  23. Kachramanoglou C, Li D, Andrews P, East C, Carlstedt T, Raisman G, et al. Novel strategies in brachial plexus repair after traumatic avulsion. Br J Neurosurg. 2011 Feb. 25(1):16-27. [Medline].

  24. Dafydd H, Lin CH. Hand reanimation. Curr Rev Musculoskelet Med. 2014 Mar. 7 (1):76-82. [Medline].

  25. Kim DH, Cho YJ, Tiel RL, et al. Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana State University Health Sciences Center. J Neurosurg. 2003 May. 98(5):1005-16. [Medline].

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

  27. Wang SF, Li PC, Xue YH, Yiu HW, Li YC, Wang HH. Contralateral C7 nerve transfer with direct coaptation to restore lower trunk function after traumatic brachial plexus avulsion. J Bone Joint Surg Am. 2013 May 1. 95(9):821-7, S1-2. [Medline].

  28. Sunderland S. Nerves and Nerve Injuries. 2nd ed. London, England: Churchill Livingstone; 1978.

  29. Ali ZS, Heuer GG, Faught RW, et al. Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques. J Neurosurg. 2015 Jan. 122 (1):195-201. [Medline].

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

  31. Wynn Parry CB. Rehabilitation of patients following traction lesions of the brachial plexus. Clin Plast Surg. 1984 Jan. 11(1):173-9. [Medline].

  32. Grant GA, Goodkin R, Kliot M. Evaluation and surgical management of peripheral nerve problems. Neurosurgery. 1999 Apr. 44(4):825-39; discussion 839-40. [Medline].

  33. Hattori Y, Doi K, Ikeda K, et al. Vascularized ulnar nerve graft for reconstruction of a large defect of the median or radial nerves after severe trauma of the upper extremity. J Hand Surg [Am]. 2005 Sep. 30(5):986-9. [Medline].

  34. Jeon IH, Neumann L, Wallace WA. Scapulothoracic fusion for painful winging of the scapula in nondystrophic patients. J Shoulder Elbow Surg. 2005 Jul-Aug. 14(4):400-6.

  35. Kerr AT. The brachial plexus of nerves in man, the variations in its formation and branches. Am J Anat. 1918. 23:285.

  36. Pitt M, Vredeveld JW. The role of electromyography in the management of the brachial plexus palsy of the newborn. Clin Neurophysiol. 2005 Aug. 116(8):1756-61. [Medline].

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

  38. Tagliafico A, Succio G, Serafini G, Martinoli C. Diagnostic accuracy of MRI in adults with suspect brachial plexus lesions: A multicentre retrospective study with surgical findings and clinical follow-up as reference standard. Eur J Radiol. 2011 Nov 7. [Medline].

  39. Trumble TE. Peripheral nerve injury: pathophysiology and repair. Feliciano DV, Moore EE, Mattox KL, eds. Trauma. 4th ed. New York, NY: McGraw-Hill; 2000. 1047-55.

  40. Yilmaz C, Eskandari MM, Colak M. Traumatic musculocutaneous neuropathy: a case report. Arch Orthop Trauma Surg. 2005 Jul. 125(6):414-6. [Medline].

Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.