Adult brachial plexus injuries: mechanism, patterns of injury, and physical diagnosis

      Brachial plexus lesions frequently lead to significant physical disability, psychologic distress, and socioeconomic hardship. Adult brachial plexus injuries can be caused by various mechanisms, including penetrating injuries, falls, and motor vehicle trauma. Often the diagnosis is delayed or ignored as the practitioner waits for some recovery. Expedient diagnosis and testing is the best means of maximizing functional return. Evaluators must remember that muscles will begin to undergo atrophy and lose motor end plates as soon as the proximal injury occurs. Thus, early surgical intervention is the best predictor of a successful outcome.
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        • Allieu Y.
        • Cenac P.
        Is surgical intervention justifiable for total paralysis secondary to multiple avulsion injuries of the brachial plexus?.
        Hand Clin. 1988; 4: 609-618
        • Azze R.J.
        • Mattar Jr., J.
        • Ferreira M.C.
        • Starck R.
        • Canedo A.C.
        Extraplexual neurotization of brachial plexus.
        Microsurgery. 1994; 15: 28-32
        • Brandt K.E.
        • Mackinnon S.E.
        A technique for maximizing biceps recovery in brachial plexus reconstruction.
        J Hand Surg. 1993; 18A: 726-733
        • Brunelli G.
        • Monini L.
        Direct muscular neurotization.
        J Hand Surg. 1985; 10A: 993-997
        • Doi K.
        • Muramatsu K.
        • Hattori Y.
        • et al.
        Restoration of prehension with the double free muscle technique following complete avulsion of the brachial plexus. Indications and long-term results.
        J Bone Joint Surg. 2000; 82A: 652-666
        • Doi K.
        • Kuwata N.
        • Muramatsu K.
        • Hottori Y.
        • Kawai S.
        Double muscle transfer for upper extremity reconstruction following complete avulsion of the brachial plexus.
        Hand Clin. 1999; 15: 757-767
        • Malone J.
        • Leal J.
        • Underwood J.
        • et al.
        Brachial plexus injury management through upper extremity amputation with immediate postoperative prostheses.
        Arch Phys Med Rehabil. 1982; 63: 89-91
        • Allieu Y.
        Evolution of our indications for neurotization. Our concept of functional restoration of the upper limb after brachial plexus injuries.
        Chir Main. 1999; 18 ([in French]): 165-166
        • Dubuisson A.S.
        • Kline D.G.
        Brachial plexus injury: a survey of 100 consecutive cases from a single service.
        Neurosurgery. 2002; 51 ([discussion: 682–3]): 673-682
        • Narakas A.
        The treatment of brachial plexus injuries.
        Int Orthop. 1985; 9: 29-36
        • Seddon H.J.
        Three types of nerve injury.
        Brain. 1943; 66: 238-288
        • Mackinnon S.E.
        Nerve grafts.
        in: Goldwyn R.M. Cohen M.N. The unfavorable result in plastic surgery. Lippincott, Williams & Wilkins, Philadelphia2001: 134-160
        • Narakas A.
        • Bonnard C.
        Anatomopathological lesions.
        in: Alnot J.Y. Narakas A. Traumatic brachial plexus injuries. Expansion Scientifique Francaise, Paris1996: 72-91
        • Songcharoen P.
        • Shin A.Y.
        Brachial plexus injury: acute diagnosis and treatment.
        in: Berger R.A. Weis A.P.C. Hand surgery. Lippincott, Williams & Wilkins, Philadelphia2004: 1005-1025
        • Mackinnon S.E.
        • Dellon A.L.
        Brachial plexus injuries.
        in: Mackinnon S.E. Dellon A.L. Surgery of the peripheral nerve. Thieme, New York1988: 423-454
        • Nagano A.
        • Ochiai N.
        • Sugioka H.
        • Hara T.
        • Tsuyama N.
        Usefulness of myelography in brachial plexus injuries.
        J Hand Surg [Am]. 1989; 14B: 59-64
        • Nagano A.
        Treatment of brachial plexus injury.
        J Orthop Sci. 1998; 3: 71-80
        • Mansat M.
        • Bonnevialle P.
        Mechanisms of traumatic plexus injuries.
        in: Alnot J.Y. Narakas A. Traumatic brachial plexus injuries. Expansion Scientifique Francaise, Paris1996: 68-71
        • Horowitz S.H.
        Brachial plexus injuries with causalgia resulting from transaxillary rib resection.
        Arch Surg. 1985; 120: 1189-1191
        • Sinow J.D.
        • Cunningham B.L.
        Postmastectomy brachial plexus injury exacerbated by tissue expansion.
        Ann Plast Surg. 1994; 27: 368-370
        • Luosto R.
        • Ketonen P.
        • Harjola P.T.
        • Jarvinen A.
        Extrathoracic approach for reconstruction of subclavian and vertebral arteries.
        Scand J Thorac Cardiovasc Surg. 1980; 14: 227-231
        • Carvalho G.A.
        • Nikkhah G.
        • Matthies C.
        • Penkert G.
        • Samii M.
        Diagnosis of root avulsions in traumatic brachial plexus injuries: value of computerized tomography myelography and magnetic resonance imaging.
        J Neurosurg. 1997; 86: 69-76
        • Walker A.T.
        • Chaloupka J.C.
        • de Lotbiniere A.C.
        • Wolfe S.W.
        • Goldman R.
        • Kier E.L.
        Detection of nerve rootlet avulsion on CT myelography in patients with birth palsy and brachial plexus injury after trauma.
        AJR Am J Roentgenol. 1996; 167: 1283-1287
        • Doi K.
        • Otsuka K.
        • Okamoto Y.
        • Fujii H.
        • Hattori Y.
        • Baliarsing A.S.
        Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography.
        J Neurosurg. 2002; 96: 277-284
        • Gupta R.K.
        • Mehta V.S.
        • Banerji A.K.
        • Jain R.K.
        MR evaluation of brachial plexus injuries.
        Neuroradiology. 1989; 31: 377-381
        • Nakamura T.
        • Yabe Y.
        • Horiuchi Y.
        • Takayama S.
        Magnetic resonance myelography in brachial plexus injury.
        J Bone Joint Surg [Br]. 1997; 79: 764-769
        • Tiel R.L.
        • Happel Jr., L.T.
        • Kline D.G.
        Nerve action potential recording method and equipment.
        Neurosurgery. 1996; 39: 103-108
        • Burkholder L.M.
        • Houlden D.A.
        • Midha R.
        • Weiss E.
        • Vennettilli M.
        Neurogenic motor evoked potentials: role in brachial plexus surgery. Case report.
        J Neurosurg. 2003; 98: 607-610