Brachial Plexus Injury: Recent Diagnosis and Management

Authors

  • Tito Sumarwoto Doctoral Program, Faculty of Medicine, Airlangga University, Surabaya, Indonesia; Department of Orthopedics and Traumatology, Faculty of Medicine, Sebelas Maret University, Orthopedic Hospital Prof. Dr. R. Soeharso, Surakarta, Indonesia
  • Heri Suroto Department of Orthopedics and Traumatology, Faculty of Medicine, Airlangga Universitym, Regional General Hospital Dr. Soetomo, Surabaya, Indonesia
  • Ferdiansyah Mahyudin Abdelrahid
  • Dwikora Novembri Utomo Department of Orthopedics and Traumatology, Faculty of Medicine, Airlangga Universitym, Regional General Hospital Dr. Soetomo, Surabaya, Indonesia
  • Seti Aji Hadinoto Department of Orthopedics and Traumatology, Faculty of Medicine, Sebelas Maret University, Orthopedic Hospital Prof. Dr. R. Soeharso, Surakarta, Indonesia
  • Muhammad Abdulhamid Department of Orthopedics and Traumatology, Faculty of Medicine, Sebelas Maret University, Orthopedic Hospital Prof. Dr. R. Soeharso, Surakarta, Indonesia
  • Pamudji Utomo Department of Orthopedics and Traumatology, Faculty of Medicine, Sebelas Maret University, Orthopedic Hospital Prof. Dr. R. Soeharso, Surakarta, Indonesia
  • Romaniyanto Romaniyanto Department of Orthopedics and Traumatology, Faculty of Medicine, Sebelas Maret University, Orthopedic Hospital Prof. Dr. R. Soeharso, Surakarta, Indonesia
  • R. Andhi Prijosedjati Department of Orthopedics and Traumatology, Faculty of Medicine, Sebelas Maret University, Orthopedic Hospital Prof. Dr. R. Soeharso, Surakarta, Indonesia
  • Sholahuddin Rhatomy Department of Orthopaedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia; 5Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2021.5578

Keywords:

Brachial plexus injury, Diagnosis, Current management

Abstract

Brachial plexus injury is known to be one of the most serious upper limb injuries, causes paralysis of the upper limbs and changes in activity of daily living, with the consequence disruption of activity of daily living, socio-economic problems, depression, and hopelessness. Management must be done properly. The evaluation and examination consist of detailed anamnesis on chronological events, complete physical examination, imaging studies, and electrophysiology study. Management can be done nonsurgically and surgically. Knowledge of the history of injury, timing of surgery, priority in restoring function, and managing patient expectations are important concepts in treating patient with brachial plexus injury. Timing is a very important thing. The results of these interventions vary depending on several parameters. Recognizing the basic principles of managing brachial plexus injuries is indispensable for all clinicians who treat these injuries.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Sakellariou VI, Badilas NK, Stavropoulos NA, Mazis G, Kotoulas HK, Kyriakopoulos S, et al. Treatment options for brachial plexus injuries. ISRN Orthop. 2014;2014:314137. https://doi.org/10.1155/2014/314137 PMid:24967125

Thatte MR, Babhulkar S, Hiremath A. Brachial plexus injury in adults: Diagnosis and surgical treatment strategies. Ann Indian Acad Neurol. 2013;16(1):26-33. https://doi.org/10.4103/0972-2327.107686 PMid:23661959

Alolabi N, Lovy AJ, Kircher MF, Spinner RJ, Bishop AT, Shin AY. Distal nerve transfers to the triceps brachii muscle: Surgical technique and clinical outcomes. J Hand Surg. 2020;45(2):155. e1-8. https://doi.org/10.1016/j.jhsa.2019.05.005 PMid:31221517

Alrabai HM, Gesheff MG, Hammouda AI, Conway JD. Trapezius muscle transfer for restoration of elbow extension in a traumatic brachial plexus injury. J Hand Surg. 2018;43(9):872.e1-6. https://doi.org/10.1016/j.jhsa.2018.02.005 PMid:29650376

Augustine HF, Coroneos CJ, Choi M, Bain JR. Adjunctive dorsal scapular nerve transfer to suprascapular nerve for brachial plexus birth injuries: Case series. J Hand Surg Am. 2019;44(10):902. e1-9. https://doi.org/10.1016/j.jhsa.2018.12.008 PMid:30737063

Bertelli JA, Ghizoni MF. Reconstruction of complete palsies of the adult brachial plexus by root grafting using long grafts and nerve transfers to target nerves J Hand Surg Am. 2010;35(10):1640-6. https://doi.org/10.1016/j.jhsa.2010.06.019 PMid:20843615

Bauer AS, Rabinovich RV, Waters PM. The anterior approach for transfer of radial nerve triceps fascicles to the axillary nerve. J Hand Surg Am. 2019;44(4):345.e1-6. https://doi.org/10.1016/j.jhsa.2018.10.019 PMid:30502016

Bhandari PS, Deb P. Posterior approach for both spinal accessory nerve to suprascapular nerve and triceps branch to axillary nerve for upper plexus injuries. J Hand Surg Am. 2013;38(1):168-72. https://doi.org/10.1016/j.jhsa.2012.10.024 PMid:23261196

Carlsen BT, Kircher MF, Spinner RJ, Bishop AT, Shin AY. Comparison of single versus double nerve transfers for elbow flexion after brachial plexus injury. Plast Reconstr Surg. 2011;127(1):269-76. https://doi.org/10.1097/prs.0b013e3181f95be7 PMid:20871484

Chim H, Kircher MF, Spinner RJ, Bishop AT, Shin AY. Free functioning gracilis transfer for traumatic brachial plexus injuries in children. J Hand Surg Am. 2014;39(10):1959-66. https://doi.org/10.1016/j.jhsa.2014.06.020 PMid:25064624

Chuang DC, Hernon C. Minimum 4-year follow-up on contralateral C7 nerve transfers for brachial plexus injuries. J Hand Surg Am. 2012;37(2):270-6. https://doi.org/10.1016/j.jhsa.2011.10.014 PMid:22173004

Kodama N, Doi K, Hattori Y. Force recovery assessment of functioning free muscle transfers using ultrasonography. J Hand Surg Am. 2014;39(11):2269-76. https://doi.org/10.1016/j.jhsa.2014.06.120 PMid:25085046

Kosiyatrakul A, Jitprapaikulsarn S, Durand S, Oberlin C. Recovery of brachial plexus injury after shoulder dislocation. Injury. 2009;40(12):1327-9. https://doi.org/10.1016/j.injury.2009.05.015 PMid:19540487

Lam WL, Fufa D, Chang NJ, Chuang DC. Management of infraclavicular (Chuang Level IV) brachial plexus injuries: A single surgeon experience with 75 cases. J Hand Surg Eur Vol. 2015;40(6):573-82. https://doi.org/10.1177/1753193414553753 PMid:25294737

Landers ZA, Jethanandani R, Lee SK, Mancuso CA, Seehaus M, Wolfe SW. The psychological impact of adult traumatic brachial plexus injury. J Hand Surg Am. 2018;43(10):950.e1-6. https:// doi.org/10.1016/j.jhsa.2018.02.019 PMid:29678427

Malungpaishrope K, Leechavengvongs S, Witoonchart K, Uerpairojkit C, Boonyalapa A, Janesaksrisakul D. Simultaneous intercostal nerve transfers to deltoid and triceps muscle through the posterior approach. J Hand Surg Am. 2012;37(4):677-82. https://doi.org/10.1016/j.jhsa.2011.12.034 PMid:22381948

Spinner RJ, Shin AY, Elhassan BT, Bishop AT. Traumatic brachial plexus injury. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS, editors. Green’s Operative Hand Surgery. 7th ed., Vol. 7. Philadelphia, PA, United States: Elsevier; 2017. p. 1146-207. https://doi.org/10.1016/b978-1-4160-5279-1.00038-1

Middleton AH, Roffers J, Ziegler DW. Complete brachial plexus palsy following shoulder dislocation due to sneeze: A case report. Int J Emerg Med. 2019;12(1):28. https://doi.org/10.1186/s12245-019-0245-8 PMid:31519168

Elzinga KE, Curran MW, Morhart MJ, Chan KM, Olson JL. Open anterior release of the superior transverse scapular ligament for decompression of the suprascapular nerve during brachial plexus surgery. J Hand Surg Am. 2016;41(7):e211-5. https://doi.org/10.1016/j.jhsa.2016.03.005 PMid:27113908

Gadinsky NE, Smolev ET, Ricci MJ, Mintz DN, Wellman DS. Two cases of brachial plexus compression secondary to displaced clavicle fractures. Trauma Case Rep. 2019;23:100219. https://doi.org/10.1016/j.tcr.2019.100219 PMid:31467966

Goubier JN, Teboul F, Khalifa H. Reanimation of elbow extension with intercostal nerves transfers in total brachial plexus palsies. Microsurgery. 2010;31(1):7-11. https://doi.org/10.1002/micr.20822 PMid:21207492

Grossman JA, Price A, Chim H. Complications in surgery for brachial plexus birth injury: Avoidance and treatment. J Hand Surg Am. 2018;43(2):164-72. https://doi.org/10.1016/j.jhsa.2017.11.008 PMid:29421066

Gutkowska O, Martynkiewicz J, Stȩpniewski M, Gosk J. Analysis of patient-dependent and trauma-dependent risk factors for persistent brachial plexus injury after shoulder dislocation. Biomed Res Int. 2018;2018:4512137. https://doi.org/10.1155/2018/4512137 PMid:29546059

Gutkowska O, Martynkiewicz J, Mizia S, Bąk M, Gosk J. Results of operative treatment of brachial plexus injury resulting from shoulder dislocation: A study with a long-term follow-up. World Neurosurg. 2017;105:623-31. https://doi.org/10.1016/j.wneu.2017.06.059 PMid:28624567

Hems TE, Mahmood F. Injuries of the terminal branches of the infraclavicular brachial plexus: Patterns of injury, management and outcome. J Bone Joint Surg Br. 2012;94(6):799-804. https://doi.org/10.1302/0301-620x.94b6.28286 PMid:22628595

Ho ES, Davidge K, Curtis CG, Clarke HM. Sensory outcome in children following microsurgery for brachial plexus birth injury. J Hand Surg Am. 2019;44(2):159.e1-8. https://doi.org/10.1016/j.jhsa.2018.05.009 PMid:30042027

Impastato DM, Impastato KA, Dabestani P, Ko JH, Bunnell AE. Prognostic value of needle electromyography in traumatic brachial plexus injury. Muscle Nerve. 2019;60(5):595-7. https://doi.org/10.1002/mus.26684 PMid:31452215

Kaiser R, Haninec P. The influence of seatbelts on the types of operated brachial plexus lesions caused by car accidents. J Hand Surg Am. 2012;37(8):1657-9. https://doi.org/10.1016/j.jhsa.2012.05.019 PMid:22763056

Moran SL, Steinmann SP, Shin AY. Adult brachial plexus injuries: Mechanism, patterns of injury, and physical diagnosis. Hand Clin. 2005;21(1):13-24. https://doi.org/10.1016/j.hcl.2004.09.004 PMid:15668062

Daly MC, Bauer AS, Lynch H, Bae DS, Waters PM. Outcomes of late microsurgical nerve reconstruction for brachial plexus birth injury. J Hand Surg Am. 202045(6):555.e1-9. https://doi.org/10.1016/j.jhsa.2019.10.036 PMid:31928798

Johnson GJ, Denning S, Clark SL, Davidson C. Pathophysiologic origins of brachial plexus injury. Obstet Gynecol. 2020;136(4):725- 30. https://doi.org/10.1097/aog.0000000000004013 PMid:32925630

Raducha JE, Cohen B, Blood T, Katarincic J. A review of brachial plexus birth palsy: Injury and rehabilitation. R I Med J (2013). 2017;100(11):17-21. PMid:29088569

Kaya Y, Sarikcioglu L. Sir Herbert Seddon (1903-1977) and his classification scheme for peripheral nerve injury. Childs Nerv Syst. 2015;31(2):177-80. https://doi.org/10.1007/ s00381-014-2560-y PMid:25269543

Waldram M. Peripheral nerve injuries. Trauma. 2003;5(2):79-96.

Campbell WW. Evaluation and management of peripheral nerve injury. Clin Neurophysiol. 2008;119(9):1951-65. PMid:18482862

Grinsell D, Keating CP. Peripheral nerve reconstruction after injury: A review of clinical and experimental therapies. Biomed Res Int. 2014;2014:698256. https://doi.org/10.1155/2014/698256 PMid:25276813

Sunderland SS. The anatomy and physiology of nerve injury. Muscle Nerve. 1990;13(9):771-84. https://doi.org/10.1002/mus.880130903 PMid:2233864

Yang J, Qin B, Fu G, Li P, Zhu Q, Liu X, et al. Modified pathological classification of brachial plexus root injury and its MR imaging characteristics. J Reconstr Microsurg. 2014;30(3):171-8. https://doi.org/10.1055/s-0033-1357498 PMid:24163228

Flores LP. The importance of the preoperative clinical parameters and the intraoperative electrophysiological monitoring in brachial plexus surgery. Arq Neuropsiquiatr. 2011;69(4):654-9. https://doi.org/10.1590/s0004-282x2011000500015 PMid:21877036

Shafi M, Hattori Y, Doi K. Surgical technique of harvesting vascularized superficial radial nerve graft. J Hand Surg Am. 2010;35(2):312-5. https://doi.org/10.1016/j.jhsa.2009.11.018 PMid:20141903

Smania N, Berto G, La Marchina E, Melotti C, Midiri A, Roncari L, et al. Rehabilitation of brachial plexus injuries in adults and children. Eur J Phys Rehabil Med. 2012;48(3):483-506. PMid:23075907

O’Shea K, Feinberg JH, Wolfe SW. Imaging and electrodiagnostic work-up of acute adult brachial plexus injuries. J Hand Surg Eur Vol. 2011;36(9):747-59. https://doi.org/10.1177/1753193411422313 PMid:21921067

Russo SA, Killelea CM, Zlotolow DA, Kozin SH, Rodriguez LM, Chafetz RS, et al. Scapular stabilization limits glenohumeral stretching in children with brachial plexus injuries. J Hand Surg Am. 2019;44(1):63.e1-9. https://doi.org/10.1016/j.jhsa.2018.04.025 PMid:29934088

Sarac C, Hogendoorn S, Nelissen RG. A new surgical technique for internal shoulder contractures secondary to obstetric brachial plexus injury: An anterior coracohumeral ligament release. J Brachial Plex Peripher Nerve Inj. 2019;14(1):E35-8. https://doi.org/10.1055/s-0039-1693746 PMid:31413723

Sakellariou VI, Badilas NK, Mazis GA, Stavropoulos NA, Kotoulas HK, Kyriakopoulos S, et al. Brachial plexus injuries in adults: Evaluation and diagnostic approach. ISRN Orthop. 2014;2014:726103. https://doi.org/10.1155/2014/314137 PMid:24967130

Nagano Y, Kawamura D, Terkawi A, Urita A, Matsui Y, Iwasaki N. Minimum ten-year outcomes of partial ulnar nerve transfer for restoration of elbow flexion in patients with upper brachial plexus injury. J Hand Surg Asian Pac Vol. 2019;24(3):283-8. https://doi.org/10.1142/s2424835519500358 PMid:31438804

Ramalho BL, Rangel ML, Schmaedeke AC, Erthal FS, Vargas CD. Unilateral brachial plexus lesion impairs bilateral touch threshold. Front Neurol. 2019;10:872. https://doi.org/10.3389/fneur.2019.00872 PMid:31456738

Neal SL, Fields KB. Peripheral nerve entrapment and injury in the upper extremity. Am Fam Physician. 2010;81(2):147-55. PMid:20082510

Noland SS, Bishop AT, Spinner RJ, Shin AY. Adult traumatic brachial plexus injuries. J Am Acad Orthop Surg. 2019;27(19):705-16. PMid:30707114

Rhee PC, Pirola E, Hébert-Blouin MN, Kircher MF, Spinner RJ, Bishop AT, et al. Concomitant traumatic spinal cord and brachial plexus injuries in adult patients. J Bone Joint Surg Am. 2011;93(24):2271-7. https://doi.org/10.2106/jbjs.j.00922 PMid:22258773

Terzis JK, Vekris MD, Soucacos PN. Outcomes of brachial plexus reconstruction in 204 patients with devastating paralysis. Plast Reconstr Surg. 1999;104(5):1221-40. https://doi.org/10.1097/00006534-199910000-00001 PMid:10513901

Kokatnur L, Rudrappa M. Diaphragmatic palsy. Diseases. 2018;6(1):16. PMid:29438332

Doi K, Otsuka K, Okamoto Y, Fujii H, Hattori Y, Baliarsing AS. Cervical nerve root avulsion in brachial plexus injuries: Magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography. J Neurosurg. 2002;96 Suppl 3:277-84. https://doi.org/10.3171/spi.2002.96.3.0277 PMid:11990835

Fuzari HK, de Andrade AD, Vilar CF, Sayão LB, Diniz PR, Souza FH, et al. Diagnostic accuracy of magnetic resonance imaging in post-traumatic brachial plexus injuries: A systematic review. Clin Neurol Neurosurg. 2018;164:5-10. https://doi.org/10.1016/j.clineuro.2017.11.003 PMid:29145043

Yoshikawa T, Hayashi N, Yamamoto S, Tajiri Y, Yoshioka N, Masumoto T, et al. Brachial plexus injury: Clinical manifestations, conventional imaging findings, and the latest imaging techniques. Radiographics. 2006;26 Suppl 1:S133-43. https://doi.org/10.1148/rg.26si065511 PMid:17050511

Chin B, Ramji M, Farrokhyar F, Bain JR. Efficient imaging: Examining the value of ultrasound in the diagnosis of traumatic adult brachial plexus injuries, a systematic review. Neurosurgery. 2018;83(3):323-32. https://doi.org/10.1093/neuros/nyx483 PMid:29040777

Mazal AT, Faramarzalian A, Samet JD, Gill K, Cheng J, Chhabra A. MR neurography of the brachial plexus in adult and pediatric age groups: Evolution, recent advances, and future directions. Expert Rev Med Devices. 2020;17(2):111-22. https://doi.org/10.1080/17434440.2020.1719830 PMid:31964194

Mansukhani KA. Electrodiagnosis in traumatic brachial plexus injury. Ann Indian Acad Neurol. 2013;16(1):19-25. https://doi.org/10.4103/0972-2327.107682 PMid:23661958

Ferrante MA. Electrodiagnostic assessment of the brachial plexus. Neurol Clin. 2012;30(2):551-80. PMid:22361374

Rich JA, Newell A, Williams T. Traumatic brachial plexus injury rehabilitation using neuromuscular electrical muscle stimulation in a polytrauma patient. BMJ Case Rep. 2019;12(12):e232107. https://doi.org/10.1136/bcr-2019-232107 PMid:31874847

Dy CJ, Peacock K, Olsen MA, Ray WZ, Brogan DM. Frequency and risk factors for prolonged opioid prescriptions after surgery for brachial plexus injury. J Hand Surg Am. 2019;44(8):662-8. e1. https://doi.org/10.1016/j.jhsa.2019.04.001 PMid:31078338

Monreal R, Gómez D, Osinaga G, Monreal E. Surgical options for brachial plexus injury in adults. Orthop Rheumatol. 2017;6(3):1-5.

Tu Y, Kakinoki R, Leechavengvongs S, Shin AY, Tan JS. Current trends in management of adult brachial plexus palsy Part I: Upper arm type. In: IFSSH Scientific Committee on Brachial Plexus Injury; 2015. p. 1-30.

Coulet B, Boretto JG, Lazerges C, Chammas M. A comparison of intercostal and partial ulnar nerve transfers in restoring elbow flexion following upper brachial plexus injury (C5-C6+/-C7). J Hand Surg Am. 2010;35(8):1297-303. https://doi.org/10.1016/j.jhsa.2010.04.025 PMid:20638201

Srinivasan RC, Pederson WC, Morrey BF. Distal biceps tendon repair and reconstruction. J Hand Surg Am. 2020;45(1):48-56. https://doi.org/10.1016/j.jhsa.2019.09.014 PMid:31901332

Zlotolow DA, Low SL, Lin IC, Williamson C, Tinsley B, Kozin SH. Suprascapular ligament release from an anterior approach: An anatomic feasibility study. J Hand Surg Am. 2019;44(10):900. e1-4. https://doi.org/10.1016/j.jhsa.2018.12.005 PMid:30733096

Soldado F, Ghizoni MF, Bertelli J. Injury mechanisms in supraclavicular stretch injuries of the brachial plexus. Hand Surg Rehabil. 2016;35(1):51-4. https://doi.org/10.1016/j.hansur.2015.09.001 PMid:27117025

Song J, Qiu WJ, Chen L, Hu SN, Wu JX, Gu YD. Transfers of the ipsilateral C7 plus the spinal accessory nerve versus triple nerve transfers for treatment of C5-C6 avulsion of the brachial plexus. J Hand Surg Am. 2020;45(4):363.e1-6. https://doi.org/10.1016/j.jhsa.2019.09.010 PMid:31718845

Elhassan BT, Wagner ER, Spinner RJ, Bishop AT, Shin AY. Contralateral trapezius transfer to restore shoulder external rotation following adult brachial plexus injury. J Hand Surg Am. 2016;41(4):e45-51. https://doi.org/10.1016/j.jhsa.2015.12.026 PMid:26787407

Suroto H. Masa depan penanganan lesi pleksus brakialis. In: Mahyudin F, editor. Lesi Pleksus Brakialis Tata Laksana Komprehensif. 1st ed. Surabaya, Indonesia: Pusat Penerbitan dan Percetakan Universitas Airlangga; 2019. p. 1-142.

Carey SL, Lura DJ, Highsmith MJ, CP, FAAOP. Differences in myoelectric and body-powered upper-limb prostheses: Systematic literature review. J Rehabil Res Dev. 2015;52(3):247- 62. https://doi.org/10.1682/jrrd.2014.08.0192 PMid:26230500

Downloads

Published

2021-01-12

How to Cite

1.
Sumarwoto T, Suroto H, Mahyudin F, Utomo DN, Hadinoto SA, Abdulhamid M, Utomo P, Romaniyanto R, Prijosedjati RA, Rhatomy S. Brachial Plexus Injury: Recent Diagnosis and Management. Open Access Maced J Med Sci [Internet]. 2021 Jan. 12 [cited 2024 Mar. 28];9(F):13-24. Available from: https://oamjms.eu/index.php/mjms/article/view/5578

Issue

Section

Narrative Review Article

Categories

Most read articles by the same author(s)

1 2 3 > >>