While it is widely accepted that cases of traumatic injury to the brachial plexus benefit from early surgical exploration and repair, with results deteriorating with long delays, policies vary regarding the exact timing of intervention. This is one of a pair of review articles considering the clinical issues, investigations, and surgical factors relating to management of injuries to the supraclavicular brachial plexus, as well as evidence from experimental work and clinical outcomes.
In this article Mr Hems outlines when waiting may be advantageous, allowing for further investigation to help clarify the extent of the injury and thus the best surgical options.
BarnesR. Traction injuries of the brachial plexus in adults. J Bone Joint Surg Br. 1949, 31: 10–6.
2.
BirchR. Traumatic lesions of the brachial plexus. In: BirchRBonneyGWynn ParryCB (Eds.) Surgical disorders of the peripheral nerves. London, Edinburgh, Churchill Livingstone, 1998: 157–207.
3.
BonneyG. Prognosis in traction lesions of the brachial plexus. J Bone Joint Surg Br. 1959, 41: 4–35.
4.
British Orthopaedic Association. The management of nerve injuries: A guide to good practice. British Orthopaedic Association, 2011.
5.
CarlstedtT. Experimental studies on surgical treatment of avulsed nerve roots in brachial plexus injury. J Hand Surg Br. 1991, 16: 477–82.
6.
CarlstedtT. Central nerve plexus injury. London, Imperial College Press, 2007: 139–66.
7.
CarlstedtTGranePHallinRGNorenG. Return of function after spinal cord implantation of avulsed spinal nerve roots. Lancet. 1995, 346: 1323–5.
8.
HartAM, Primary sensory neurons and satellite cells after peripheral axotomy in the adult rat. Timecourse of cell death and elimination. Experimental Brain Research. 2002, 142: 303–18.
9.
HemsTEJ. Nerve transfers for traumatic brachial plexus injury. Advantages and problems. J Hand Microsurg. 2011, 3: 6–10.
10.
HemsTEBirchRCarlstedtT. The role of magnetic resonance imaging in the management of traction injuries to the adult brachial plexus. J Hand Surg Br. 1999, 24: 550–5.
11.
HemsTEJCluttonREGlasbyMA. Repair of avulsed cervical nerve roots: an experimental study in sheep. J Bone Joint Surg Br. 1994, 76: 818–23.
12.
KatoNHtutMTaggartMCarlstedtTBirchR. The effects of operative delay on the relief of neuropathic pain after injury to the brachial plexus. A review of 148 cases. J Bone Joint Surg Br. 2006, 88: 756–9.
13.
KilvingtonB. An investigation on the regeneration of nerves, with regard to the surgical treatment of certain paralysis. Part V. BMJ. 1912, i: 177–9.
14.
KlineDG. Timing for brachial plexus injury: A personal experience. Neurosurg Clin N Am. 2009, 20: 24–6.
15.
KlineDGHudsonAR. Nerve injuries. Operative results for major nerve injuries, entrapments, and tumors. Philadelphia, W.B. Saunders, 1995: 397–460.
16.
LeechavengvongsSWitoonchartKUerpairojkitCThuvasethakulPMalungpaishropeK. Combined nerve transfers for C5 and c6 brachial plexus avulsion injury. J Hand Surg Am. 2006, 31: 183–9.
17.
OchiaiNNaganoASugiokaHHaraT. Nerve grafting in brachial plexus injuries. Results of free grafts in 90 patients. J Bone Joint Surg Br. 1996, 78: 754–8.
18.
OrfG. Critical resection length and gap distance in peripheral nerves. Experimental and morphological studies. Acta Neurochirurgica – Supplementum. 1978, 26: 1–91.
19.
O’SheaKFeinbergJHWolfeSW. Imaging and electrodiagnostic work-up of acute adult brachial plexus injuries. J Hand Surg Eur. 2011, 36: 747–59.
20.
TeboulFKakkarRAmeurNBeaulieuJ-YOberlinC. Transfer of fascicles from the ulnar nerve to the biceps in the treatment of upper brachial plexus palsy. J Bone Joint Surg Am. 2004, 86: 1485–90.
