Brachial plexus injury

• Accuracy and Reliability of Video-Based Range-of-Motion Assessments in Postreconstruction Brachial Plexus Patients
• Tale of two approaches to ultrasound-guided interscalene brachial plexus block: a pro-con
• Double Supinator Branch Transfer to Posterior Interosseous Nerve May Confer Superior Hand Opening Restoration Outcomes in Brachial Plexus and Spinal Cord Injury Compared to Single Branch
• Axillary Artery Approach for Ductal Stenting in Neonates and Infants
• Coracohumeral Ligament Sectioning in Teres Major versus Latissimus Dorsi Tendon Transfer in Brachial Plexus Birth Palsy
• C5 is shoulder, C6 is elbow flexion, C7 is elbow extension, C8 and T1 are hand functions-Is there a need for MRI and EMG/NCS in adult traumatic brachial plexus injuries?
• Ultrasound-Guided Nerve Blocks Improve Success Rate of Closed Reduction of Colles' Fractures: A Randomised Controlled Trial
• Degenerated nerve grafts provide similar quality and outcome in reconstructing critical nerve defects as compared to fresh nerve grafts

Brachial plexus injury occurs when these nerves are stretched, compressed, or in the most serious cases, ripped apart or torn away from the spinal cord.

Yang et al. described a modified pathological classification (PC) of brachial plexus injury (BPI) and its magnetic resonance (MR) imaging characteristics. The reliability and diagnostic accuracy of MR imaging for detecting nerve injury was discussed. Between 2006 and 2010, 86 patients with BPI were managed surgically in our department. Their preoperative MR images and surgical findings were analyzed retrospectively. The PC of BPI was classified into five types: (I) nerve root injury in continuity (including Sunderland grade I-IV injury); (II) postganglionic spinal nerve rupture with or without proximal stump; (III) preganglionic root injury (visible); (IV) preganglionic nerve root injury and postganglionic spinal nerves injury; (V) preganglionic root injury (invisible). The main MR imaging characteristics of BPI included traumatic meningocele, displacement of spinal cord, the absence of nerve root, “Black line” sign, nerve root/trunk injury in continuity, and thickening and edema of nerve root. The accuracy of MR imaging for detecting C5, C6, C7, C8, and T1 nerve roots injury were 93.3, 95.2, 92.3, 84, and 74.4%, respectively. The modified PC provides a detailed description of nerve root injury in BPI, and MR imaging technique is a reliable method for detecting nerve root injury ¹⁾.

see Upper brachial plexus injury.

see also Bilateral brachial plexus injury.

Brachial plexus injury etiology.

see Brachial plexus injury epidemiology.

The COVID-19 pandemic and the need for social distancing created challenges for accessing and providing health services. Telemedicine enables prompt evaluation of patients with traumatic brachial plexus injury, even at a distance, without prejudice to the prognosis. A study by Gushikem et al. aimed to verify the validity of a range of motion, muscle strength, sensitivity, and Tinel sign tele-assessment in adults with traumatic brachial plexus injury (TBPI).

A cross-sectional study of twenty-one men and women with TBPI admitted for treatment at a Rehabilitation Hospital Network was conducted. The participants were assessed for range of motion, muscle strength, sensitivity, and Tinel sign at two moments: in-person assessment (IPA) and tele-assessment (TA).

The TA muscle strength tests presented significant and excellent correlations with the IPA (the intra-rater intraclass correlation coefficient, ICC ranged between 0.79 and 1.00 depending on the muscle tested). The agreement between the TA and IPA range of motion tests ranged from substantial to moderate (weighted kappa coefficient of 0.47-0.76 (p < 0.05) depending on the joint), and the kappa coefficient did not indicate a statistically significant agreement in the range of motion tests of supination, wrist flexors, shoulder flexors, and shoulder external rotators. The agreement between the IPA and TA sensitivity tests of all innervations ranged from substantial to almost perfect (weighted kappa coefficient 0.61-0.83, p < 0.05) except for the C5 innervation, where the kappa coefficient did not indicate a statistically significant agreement. The IPA versus TA Tinel sign test showed a moderate agreement (weighted kappa coefficient of 0.57, p < 0.05).

The present study demonstrated that muscle strength tele-assessment is valid in adults with TBPI and presented a strong agreement for many components of TA range of motion, sensitivity, and Tinel sign tests ²⁾

Initial exam seeks to differentiate preganglionic injury (proximal to dorsal root ganglion) which cannot be repaired surgically, from postganglionic injuries.

see Clues to preganglionic injury.

see Postganglionic injury.

Brachial Plexus Injury Treatment

see Brachial plexus injury outcome.

see Brachial plexus injury case series.

A middle age male presented a right total brachial plexus injury after motorcycle accident one year ago. Subsequent electromyographic evaluation was consistent with C5, C6, C7, C8 and T1 root avulsion. The patient was submitted to a right Phrenic nerve transfer to the musculocutaneous nerve , using sural nerve graft ³⁾.