Brachial Plexus Injury

The brachial plexus is a network of nerves that arise from the cervical spinal cord and provide motor, IntraOP-US-Plexussensory and vegetative supply the entire upper extremity including muscles attaching the upper extremity (scapula) to the torso.

Brachial plexus injuries occur as a rule after motorcycle, snowboard, skiing and other high velocity accidents and cause total or partial loss of function of the arm plus spontaneous pain associated with avulsion of cervical spinal nerve roots. The loss of function and pain can be devastating. They require special consideration in treatment because of the complex anatomy, the probability that some of the injury is due to avulsion of spinal nerve roots Brachial plexus decompression and resultfrom the spinal cord rather than disruption of peripheral nerves, and the propensity to severe chronic pain.

Evaluation of the injury and decisions regarding treatment are through clinical examination, MR imaging (particularly to detect spinal nerve root avulsions) and electrophysiological testing both pre-operatively and intra-operatively.

Three surgical strategies are available to restore function after brachial plexus injury: (a) direct nerve repair with or without grafts, (b) nerve transfers and (c) a combination of both.

Direct repair of disrupted elements of the brachial plexus is best undertaken within weeks of the injury. Nerve transfer, with sacrifice of a dispensable or compensable nerve to regain an important movement such as shoulder abduction or elbow flexion is usually undertaken 3-6 months after injury but may sometimes be successful after a year or more.
Some examples are as follows:

Plexus-Reconstruction-Sketches Triceps branch to CAN-Nerve Transfer Nerve-Transfer Obere-Armplexus-Rekon-Ergebnis Zancolli-Correction

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Secondary functional reconstruction with tendon transfer, muscle transfer, or free muscle transfer can be undertaken years or even decades after the initial injury. Such surgery on tendons and muscles is necessary in 50-60% of cases to improve the results of nerve surgery. The principle of secondary functional reconstruction is to regain a completely lost, important function (e.g., elbow flexion) by providing a new motor across that joint, either using functionally intact muscles of the anatomical neighborhood (e.g., the flexor pronator group of the forearm) or from distant places of the human body (free functional muscle transfer). An essential condition for the success of any secondary functional reanimation is the maintenance of a supple joint, which can be mobilized passively through a full range of movement.

gracilis-elbow-flexion Gracilis-dorsal GracilisSS

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The results of surgery take months to years to evaluate. in general, it is much easier to regain movement of the shoulder or elbow than of the hand. Intensive and prolonged physical therapy is an important measure to optimise motor function after surgery.

“Following brachial plexus injury, it is almost always possible to restore some useful function from nerve repair, nerve transfer, and/or secondary repair but almost never possible to restore full function”

Comperssionneuropathy Nerve-injury-en Nerventumors-en
Neonates-kids Facial-Palsy-en Nervenpain-en about-the-Author