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    This document discusses the evaluation and management of adult brachial plexus injuries. It begins by defining brachial plexus injuries as damage to the C5-T1 spinal nerves, with common injury patterns including upper arm type (C5-C6 and C7) and total arm type (C5-T1). It notes that preganglionic avulsion injuries can be suspected based on findings like Horner syndrome and absence of the Tinel sign, and that these injuries have a poor potential for spontaneous recovery. It states that upper arm injuries can be treated through nerve transfers to restore elbow flexion and shoulder control, while total arm injuries require procedures to reestablish shoulder, elbow, and hand function, such

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    This document discusses the evaluation and management of adult brachial plexus injuries. It begins by defining brachial plexus injuries as damage to the C5-T1 spinal nerves, with common injury patterns including upper arm type (C5-C6 and C7) and total arm type (C5-T1). It notes that preganglionic avulsion injuries can be suspected based on findings like Horner syndrome and absence of the Tinel sign, and that these injuries have a poor potential for spontaneous recovery. It states that upper arm injuries can be treated through nerve transfers to restore elbow flexion and shoulder control, while total arm injuries require procedures to reestablish shoulder, elbow, and hand function, such

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    2 views1 page

    First Page PDF

    Uploaded by

    Yadareli Dothé
    This document discusses the evaluation and management of adult brachial plexus injuries. It begins by defining brachial plexus injuries as damage to the C5-T1 spinal nerves, with common injury patterns including upper arm type (C5-C6 and C7) and total arm type (C5-T1). It notes that preganglionic avulsion injuries can be suspected based on findings like Horner syndrome and absence of the Tinel sign, and that these injuries have a poor potential for spontaneous recovery. It states that upper arm injuries can be treated through nerve transfers to restore elbow flexion and shoulder control, while total arm injuries require procedures to reestablish shoulder, elbow, and hand function, such

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    of 1

    A d u l t Br a c h i a l P l e x u s I n j u r y

    Evaluation and Management


    Roongsak Limthongthang, MDa,*, Abdo Bachoura, MDb,
    Panupan Songcharoen, MDa, A. Lee Osterman, MDb

    KEYWORDS
     Adult brachial plexus injury  Pattern of injury  Preoperative evaluation  Intraoperative study
     Nerve transfer  Functioning free muscle transfer

    KEY POINTS
     Brachial plexus injury involves damage to the C5-T1 spinal nerves. Common injury patterns include
    “upper arm type” (C5-6  C7) and “total arm type” (C5-T1).
     Preganglionic avulsion injury is suspected when the following observations are noted: Horner syn-
    drome, winged scapula, absence of Tinel sign over the neck, hemidiaphragm paralysis, and pseu-
    domeningocele. This type of injury infers poor potential for spontaneous recovery.
     The treatment of upper arm type injury involves the restoration of elbow flexion and shoulder con-
    trol. Good results can be achieved by using nerve transfer surgery.
     The treatment of total arm type injury involves the re-establishment of shoulder, elbow, and hand
    function. The use of functioning free muscle transfers or nerve transfers may restore hand function.

    INTRODUCTION patients with a flail arm, today’s outcomes


    following reconstructive surgery have improved
    Traumatic brachial plexus injury (BPI) is regarded to a degree that renders amputation as an anti-
    as one of the most devastating injuries of the up- quated treatment option.
    per extremity. Patients typically lose sensation, The treatment of BPI is based on a combination
    motor power, and may experience disabling of evidence-based principles, practical feasibility,
    neuropathic pain. Several decades ago, combined and the personal philosophy of the surgeon. In
    arm amputation, shoulder arthrodesis, and pros- many instances, dogmatic practices flourish be-
    thetic replacement was a viable treatment option cause of differences in the surgeon’s approach,
    for patients with a flail arm, because this protocol the patient’s injuries and expectations, and the
    resulted in superior functional results compared cultural environment. Over the past few decades,
    with other reconstructive procedures at that time, there has been a fair amount of trial and error in
    which included tenodesis, bone block, and BPI surgery and some techniques have developed
    arthrodesis.1 However, advances in peripheral a reputation for consistent and encouraging re-
    nerve surgery over the last few decades have sults, whereas others have become of historical in-
    significantly changed the image and outcomes of terest. This article provides an overview of the
    brachial plexus treatment. Today, one can expect anatomy, diagnosis, and treatment of posttrau-
    good to excellent functional results in patients with matic adult BPI. In addition, some of the contro-
    upper arm deficits.2 Although there remains much versial topics surrounding the management of
    room for optimizing the functional results in this complex injury are addressed.
    orthopedic.theclinics.com

    a
    Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok
    Road, Bangkoknoi District, Bangkok 10700, Thailand; b The Philadelphia Hand Center, Thomas Jefferson
    University Hospital, 834 Chestnut Street, Suite G114, Philadelphia, PA 19107, USA
    * Corresponding author.
    E-mail addresses: droongsak@gmail.com; roongsak.lit@mahidol.ac.th

    Orthop Clin N Am 44 (2013) 591–603


    http://dx.doi.org/10.1016/j.ocl.2013.06.011
    0030-5898/13/$ – see front matter Ó 2013 Elsevier Inc. All rights reserved.

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