Highlights & Basics
- Brachial plexus injuries most commonly result from motor vehicle accidents, gunshot or stab wounds, contact sports accidents, or falls.
- Injury may involve a portion of the plexus (partial injury) or all 5 nerve roots (pan-plexus injury). Partial and pan-plexus brachial plexus injuries both have potential surgical treatment options; however, the prognosis for pan-plexus injuries is limited. More extensive injuries may require multiple major operations, while partial injuries can often be corrected in a single operation.
- Brachial plexus injuries can be ruptures (roots still connected to the spinal cord) or avulsions (roots detached from the spinal cord). Nerve transfer techniques, which can be successfully applied to both ruptures and avulsions, are often the treatment of choice for microsurgical repair. However, there are situations in which graft repair of brachial plexus injuries is indicated, particularly in pan-plexus injuries where there are limited nerve transfer options.
- An injury that does not show signs of improvement within 3 months will often require major surgical reconstruction. The speed of nerve regeneration after spontaneous recovery or nerve repair is about 1 mm per day (1 inch per month).
- Given the time frame to permanent paralysis (about 1-2 years), surgical repair is best carried out by 3-6 months after injury.
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Citations
Hill JR, Lanier ST, Brogan DM, et al. Management of adult brachial plexus injuries. J Hand Surg Am. 2021 Sep;46(9):778-88.[Abstract][Full Text]
American College of Radiology. ACR appropriateness criteria: plexopathy. 2021 [internet publication].[Full Text]
National Institute for Health and Care Excellence. Free-functioning gracilis transfer to restore upper limb function in brachial plexus injury. Mar 2021 [internet publication].[Full Text]
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