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    Adult Partial & Complete Brachial Plexus Injuries

    Adult Partial & Complete Brachial Plexus Injuries

    Adult Partial and complete brachial plexus injuries

    What is Brachial Plexus?

    The upper limb is supplied by a group of nerves coming from the spinal cord at the level of the neck, and conducts signals from the spinal cord, to shoulder, arm and hand. This group of nerves is called Brachial plexus. These nerves originate from cervical (C5-C8), and first thoracic (T1) spinal nerves, and give nerve supply to the muscles and skin of the chest, shoulder, arm and hand.

    What is Brachial Plexus Injury?

    Any mode of injury which causes violent stretch of nerve between the neck and the shoulder has the risk of injuring Brachial plexus.

    What are the common causes of Brachial Plexus injury?

    The most common cause is high velocity injury road traffic accident leading fall from the motor bikes. The brachial plexus may be injured by falls from a height on to the side of the head and shoulder, and plexus are violently stretched. The brachial plexus may also be injured by direct violence or gunshot injury, and involved by any tumour.

    What happen in Brachial Plexus injury?

    When total plexus injured leads to tear off of all roots from the spinal cord and resulting into the whole of the upper limb may become flail with no sensation or a group of muscles may not work, and resulting in permanent paralysis to that side of the limb . Sometimes only part of brachial plexus get injured, and it lead to only a group of  muscle get paralysed, sparing rest of upper limb muscle function normal.

    How to diagnose brachial plexus injury?

    It is based on thorough clinical evaluation and special investigations to know the exact level of the injury. There are Electrophysiological test e.g. EMG and NCV help in diagnosis. CT myelography or MRI of cervical spine to be done to see spinal nerve roots changes which help in support of diagnosis.

    When you should do surgery?

    In open trauma to brachial plexus, it needs immediate surgery.

    In closed Brachial Plexus injury, you need to wait for at least 3 month to localize the lesion, to see how much recovery of injury and to stabilize patient from previous trauma.

     Whatare the different types of nerve surgery?

    Direct Nerve repair: If the level of Brachial Plexus injury is outside the bony spinal canal (Nerve Rupture), or open injury, direct nerve repair is possible in such patients.

    Nerve transfer : If direct repair not possible, the injury happens inside the  bony spinal canal (Nerve Avulsion), then there are various nerve which can borrowed/ rerouted without jeopardizing its function and directly connect to nerve just before entering to muscle, called nerve transfer so recovery of function can be faster.

    What kind of surgery you offer in delayed presentation of Brachial Plexus injury?

    Microsurgical Free Functioning muscle transfer (FFMT): can be done by transferring muscle from other part of body to upper limb to restore particular function by using microsurgical technique.

    Multiple tendon transfers: can be offered to restore function by transferring healthy muscle to paralysed muscle with minimal disability at donor area. 

    What do you expect from surgery?

     In most cases it is possible to stabilize the shoulder, restore elbow flexion, to establish protective sensation. Nerve recovery may proceed for many months.  Regular physiotherapy is very important till recovery, which may take 9 months to two year in most cases.

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