Traumatic Brachial Plexus Injuries in Adults

Although the first surgical procedure for brachial plexus laceration is dated back in the beginning of the 20th century, only in the last thirty years with the advent of reconstructive Microsurgery, a significant progress has been made in the operative management of brachial plexus injuries by A. Narakas (1977),1 H. Millesi (1984)2 and J.Y. Alnot (1987)3 and others.

Knowledge of the anatomy of the brachial plexus and of the pathological changes of peripheral nerve lesions allows better understanding of the clinical symptoms and the findings of paraclinical diagnostic examination. Classification of nerve injuries on the other hand, is essential for the therapeutic approach and for the evaluation of the results. In the majority of cases, the injury is the result of motorcycle accidents involving young adults and the lesions are usually more severe. Although a small number of patients spontaneously recover in the early months following trauma, the majority of cases with total palsies diagnosed in the emergency department, do not recover spontaneously.

Practically, any patient showing no signs of recovery 30 days after a brachial plexus palsy of traumatic etiology must undergo additional diagnostic investigations [CT-myelography and electromyography (EMG)], so that the lesions can be classified and the best therapeutic approach can be selected. Surgical reconstruction is necessary for fourth and fifth degree nerve lesions according to Sunderland's clas-sification4 whereas conservative treatment is recommended for the remaining lesions.

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