Traumatic Brachial Plexopathy Follow-up

Updated: Mar 08, 2021
  • Author: Vladimir Kaye, MD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Follow-up

Further Outpatient Care

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  • 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.

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Further Inpatient Care

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  • 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. [38] 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.

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Inpatient & Outpatient Medications

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

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Transfer

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

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Deterrence

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  • 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

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Complications

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  • 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

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Prognosis

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  • The outcome and prognosis of acute injury varies widely, depending on the type and etiology of injury and the timing of therapy. [5]

    • 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.

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Patient Education

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  • 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

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