Brachial Plexus Injuries

Treatment of Brachial Plexus Injuries Due to Accident

Treatment options depend on the type and severity of the injury:

• Avulsion — the nerve is torn from the spine
• Rupture — the nerve is torn, but not where it attaches to the spine
• Stretch — the nerve has tried to heal itself (forming a neuroma), but scar tissue has grown around the injury, limiting nerve function

Immediately after injury, emphasis is placed upon physiotherapy, including range of motion activities and strengthening and controlling pain.

Independent Recovery

Improvement or recovery occurs in some patients within weeks or several months of the injury.

Surgery

Surgery may be indicated if the patient doesn't recover adequate function within several months. Surgery on the nerves, if required, should ideally occur within three to six months and not later than one year after the injury. When evaluation is delayed beyond six to nine months, treatment options are fewer and more limited, although evaluation and treatment will likely still be of value.

Microsurgical techniques are used to improve brachial plexus function. They include one or more of the following methods:

• Release from scar tissue (neurolysis)
• Nerve grafts — new nerve tissue is inserted to bridge gaps resulting from ruptured or stretched nerves (which may need to be removed). Nerve regeneration is slow, about 1 inch per month.
• Nerve transfer (neurotization) — part of a functioning nerve is transferred to replace irreparably injured nerve roots to allow more rapid recovery of function.
• In severe cases, one or more free muscle transfers may be necessary. In this procedure, a healthy muscle from the leg with its nerve and blood supply is grafted onto the injured area to restore function to the arm.

If surgery is delayed past a year, treatment may include free muscle transfer, tendon transfer and joint fusion.

Results of Surgery

Surgical repair can often restore movement of the shoulder and elbow and a limited ability by the hand to grasp objects. Several operations may be needed to obtain additional function.

When evaluation is delayed beyond six to nine months, treatment options are fewer and more limited, although evaluation and treatment will likely still be of value.