Adult traumatic brachial plexus injury involves injury of the C5-T1 spinal nerves. Common patterns of injury include “upper arm” and “total arm” types. The specific signs of preganglionic avulsion injury infer a poor prognosis for spontaneous recovery and surgery may be needed. Detailed preoperative evaluation is recommended for localization of the lesions. The treatment of upper arm type injury comprises restoration of elbow flexion and shoulder control. Good functional results may be achieved after multiple nerve transfers. The treatment of total arm type includes hand function reconstruction, in addition to shoulder and elbow treatment. Current options for hand function reconstruction include functioning free muscle transfers and nerve transfers.
Key points
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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).
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Preganglionic avulsion injury is suspected when the following observations are noted: Horner syndrome, winged scapula, absence of Tinel sign over the neck, hemidiaphragm paralysis, and pseudomeningocele. This type of injury infers poor potential for spontaneous recovery.
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The treatment of upper arm type injury involves the restoration of elbow flexion and shoulder control. Good results can be achieved by using nerve transfer surgery.
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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.
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