Traumatic Brachial Plexus Injury

1. Adult Traumatic
Brachial Plexus Injuries
Ade Wijaya, MD – November 2020

2. Introduction
• Devastating life-altering injuries that result in notable physical disability,
psychological distress, and socioeconomic hardship.
• Most are closed injuries involving the supraclavicular region.
Noland SS, Bishop AT, Spinner RJ, Shin AY. Adult traumatic brachial plexus injuries. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2019 Oct 1;27(19):705-16.

3. Mayo Foundation for Medical Education and Research, Rochester

4. Mayo Foundation for Medical Education and Research, Rochester

5. Mayo Foundation for Medical Education and Research, Rochester

6. Noland SS, Bishop AT, Spinner RJ, Shin AY. Adult traumatic brachial plexus injuries. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2019 Oct 1;27(19):705-16.

7. Timing of Surgery
• Immediate exploration and primary repair is indicated in sharp open injuries
with acute nerve deficits
• With blunt open injuries with rupture of the nerve(s), the ends of the torn nerve
should be tagged and a delayed repair performed 3 to 4 weeks later to allow the
zone of injury to demarcate
• Low-velocity gunshot wounds should be observed as most of these injuries are
neurapraxic injuries
• High-velocity gunshot wounds are associated with notable soft-tissue damage
and usually mandate surgical exploration
• Close injuries: Early exploration and reconstruction (such as, between 3 and 6
weeks) is indicated when there is a high suspicion of root avulsion
Kim DH, Cho YJ, Tiel RL, Kline DG: Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana state university health sciences center. J Neurosurg 2003;98:1005-1016.

8. Post-operative Management
• Immobilized for 3 weeks after nerve reconstruction
• If intercostal nerves are used as donor nerves, the patients will have a lifetime
abduction/external rotation restriction to prevent rupture of the repair
• Neuropathic pain management
Davis G, Curtin CM: Management of pain in complex nerve injuries. Hand Clin 2016;32:257-262.
Kanpolat Y, Tuna H, Bozkurt M, Elhan AH: Spinal and nucleus caudalis dorsal root entry zone operations for chronic pain. Neurosurgery 2008;62(3 suppl 1):235-242.
Noland SS, Bishop AT, Spinner RJ, Shin AY. Adult traumatic brachial plexus injuries. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2019 Oct 1;27(19):705-16.

9. Summary
• Devastating
• Identification
• Timing of surgery and type of surgery
• Post-operative management

10. THANK YOU