Mechanisms of Injury

Most injuries of the brachial plexus are related to traction forces.

Four situations leading to brachial plexus injuries can be distinguished:

• Most frequently, a motorcycle accident leads to violent lengthening of the region between the shoulder and the cervical spine and stretching of the roots. In the cases that the arm is abducted in 90° with shoulder

retropulsion the stretching of all roots is maximal, leading to complete brachial plexus injury (with avulsion of the roots). A traction injury in a fully abducted arm is most commonly responsible for C8-T1 palsies.

• Less frequently, a dislocation of the glenohumeral joint leads to injuries of the posterior trunk and sometimes of the terminal branches (axillary nerve, suprascapular or musculocutaneous nerves).

• An open sectioning injury can cut all the nerve structures: epineurium, perineurium, basal lamina and the axon.

• Finally, in a crush injury, all the degrees of lesions of Sunderland's classification can occur.

For traction injuries two mechanisms have been described:

• A peripheral mechanism of traction related to lateral flexion of the cervical spine and lowering of the shoulder girdle.

• A central mechanism related to violent injury of the cervical spine causing rupture of the rootlets from their spinal origin without lesion of the dura.

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