Brachial plexus injuries in adults

Han-Vit Kang; Joo-Yup Lee

doi:10.5124/jkma.2017.60.12.971

J Korean Med Assoc > Volume 60(12); 2017 > Article

Kang and Lee: Brachial plexus injuries in adults

Focused Issue of this Month

Common peripheral neuropathies of the upper extremity

Journal of the Korean Medical Association 2017; 60(12): 971-977.

Published online: December 14, 2017

DOI: http://dx.doi.org/10.5124/jkma.2017.60.12.971

Brachial plexus injuries in adults

Han-Vit Kang, MD

, Joo-Yup Lee, MD

Department of Orthopedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea.

Corresponding author: Joo-Yup Lee. jylos1@gmail.com

Received October 10, 2017 Accepted October 25, 2017

Korean Medical Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

As the number of survivors of motor vehicle accidents and extreme sporting accidents increases, more people must live with brachial plexus injuries. Brachial plexus injuries also occur in multiple trauma patients and can be debilitating. Although the injured limb will never return to normal, an improved understanding of the pathophysiology of nerve injury and repair, as well as advances in microsurgical techniques, have provided the upper extremity reconstructive surgeons with opportunities to improve function in patients with these life-altering injuries. The purpose of this review is to present in detail some of the current concepts in the treatment of adult brachial plexus injuries and to give the reader an understanding of the nuances of the timing of treatment, the available treatment options, and the outcomes of treatment.

Brachial plexus; Injury; Reconstruction

References

1. Hentz VR, Narakas A. The results of microneurosurgical reconstruction in complete brachial plexus palsy: assessing outcome and predicting results. Orthop Clin North Am 1988;19:107-114.

2. Sunderland S. Mechanisms of cervical nerve root avulsion in injuries of the neck and shoulder. J Neurosurg 1974;41:705-714.

3. Kim DH, Murovic JA, Tiel RL, Kline DG. Mechanisms of injury in operative brachial plexus lesions. Neurosurg Focus 2004;16:E2.

4. James MA. Use of the Medical Research Council muscle strength grading system in the upper extremity. J Hand Surg Am 2007;32:154-156.

5. Bertelli JA, Ghizoni MF. Use of clinical signs and computed tomography myelography findings in detecting and excluding nerve root avulsion in complete brachial plexus palsy. J Neurosurg 2006;105:835-842.

6. Nagano A, Ochiai N, Sugioka H, Hara T, Tsuyama N. Usefulness of myelography in brachial plexus injuries. J Hand Surg Br 1989;14:59-64.

7. Nakamura T, Yabe Y, Horiuchi Y, Takayama S. Magnetic resonance myelography in brachial plexus injury. J Bone Joint Surg Br 1997;79:764-769.

8. Bowles AO, Graves DE, Chiou-Tan FY. Distribution and extent of involvement in brachial plexopathies caused by gunshot wounds, motor vehicle crashes, and other etiologies: a 10-year electromyography study. Arch Phys Med Rehabil 2004;85:1708-1710.

9. Aminoff MJ. The clinical role of somatosensory evoked potential studies: a critical appraisal. Muscle Nerve 1984;7:345-354.

10. Kline DG. Timing for brachial plexus injury: a personal experience. Neurosurg Clin N Am 2009;20:24-26.

11. Millesi H. Surgical management of brachial plexus injuries. J Hand Surg Am 1977;2:367-378.

12. Narakas A. Brachial plexus surgery. Orthop Clin North Am 1981;12:303-323.

13. Millesi H. Interfascicular grafts for repair of peripheral nerves of the upper extremity. Orthop Clin North Am 1977;8:387-404.

14. Songcharoen P, Mahaisavariya B, Chotigavanich C. Spinal accessory neurotization for restoration of elbow flexion in avulsion injuries of the brachial plexus. J Hand Surg Am 1996;21:387-390.

15. Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P. Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases. J Hand Surg Am 2003;28:633-638.

16. Oberlin C, Beal D, Leechavengvongs S, Salon A, Dauge MC, Sarcy JJ. Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg Am 1994;19:232-237.

17. Liverneaux PA, Diaz LC, Beaulieu JY, Durand S, Oberlin C. Preliminary results of double nerve transfer to restore elbow flexion in upper type brachial plexus palsies. Plast Reconstr Surg 2006;117:915-919.

18. Mackinnon SE, Novak CB, Myckatyn TM, Tung TH. Results of reinnervation of the biceps and brachialis muscles with a double fascicular transfer for elbow flexion. J Hand Surg Am 2005;30:978-985.

19. Chuang DC, Yeh MC, Wei FC. Intercostal nerve transfer of the musculocutaneous nerve in avulsed brachial plexus injuries: evaluation of 66 patients. J Hand Surg Am 1992;17:822-828.

20. Gu YD, Chen DS, Zhang GM, Cheng XM, Xu JG, Zhang LY, Cai PQ, Chen L. Long-term functional results of contralateral C7 transfer. J Reconstr Microsurg 1998;14:57-59.

21. Doi K, Sakai K, Ihara K, Abe Y, Kawai S, Kurafuji Y. Reinnervated free muscle transplantation for extremity reconstruction. Plast Reconstr Surg 1993;91:872-883.

22. Bertelli JA, Ghizoni MF. Transfer of the accessory nerve to the suprascapular nerve in brachial plexus reconstruction. J Hand Surg Am 2007;32:989-998.

23. Suzuki K, Doi K, Hattori Y, Pagsaligan JM. Long-term re-sults of spinal accessory nerve transfer to the suprascapular nerve in upper-type paralysis of brachial plexus injury. J Reconstr Microsurg 2007;23:295-299.

24. Cardenas-Mejia A, O'Boyle CP, Chen KT, Chuang DC. Evaluation of single-, double-, and triple-nerve transfers for shoulder abduction in 90 patients with supraclavicular brachial plexus injury. Plast Reconstr Surg 2008;122:1470-1478.

25. Chuang DC, Lee GW, Hashem F, Wei FC. Restoration of shoulder abduction by nerve transfer in avulsed brachial plexus injury: evaluation of 99 patients with various nerve transfers. Plast Reconstr Surg 1995;96:122-128.

26. Malessy MJ, de Ruiter GC, de Boer KS, Thomeer RT. Evaluation of suprascapular nerve neurotization after nerve graft or transfer in the treatment of brachial plexus traction lesions. J Neurosurg 2004;101:377-389.

27. Uerpairojkit C, Leechavengvongs S, Witoonchart K, Malungpaishorpe K, Raksakulkiat R. Nerve transfer to serratus anterior muscle using the thoracodorsal nerve for winged scapula in C5 and C6 brachial plexus root avulsions. J Hand Surg Am 2009;34:74-78.

28. Bahm J, Noaman H, Becker M. The dorsal approach to the suprascapular nerve in neuromuscular reanimation for obstetric brachial plexus lesions. PlastReconstrSurg 2005;115:240-244.

29. Zuker RM, Manktelow RT. Functioning free muscle transfers. Hand Clin 2007;23:57-72.

30. Barrie KA, Steinmann SP, Shin AY, Spinner RJ, Bishop AT. Gracilis free muscle transfer for restoration of function after complete brachial plexus avulsion. Neurosurg Focus 2004;16:E8.

31. Kay S, Pinder R, Wiper J, Hart A, Jones F, Yates A. Microvascular free functioning gracilis transfer with nerve transfer to establish elbow flexion. J Plast Reconstr Aesthet Surg 2010;63:1142-1149.

32. Coulet B, Boch C, Boretto J, Lazerges C, Chammas M. Free Gracilis muscle transfer to restore elbow flexion in brachial plexus injuries. Orthop Traumatol Surg Res 2011;97:785-792.