Partial Brachial Plexus Injuries are typically the result of accidents where the arm is forcefully stretched, pulled, or injured. These injuries often involve damage to the C5, C6 nerve roots, sometimes accompanied by injury to the C7 nerve root, in the neck. This results in weakness, numbness, or reduced mobility in the affected shoulder and elbow.
The timing of surgical intervention is crucial in cases of partial injuries, with the adage “sooner the treatment, better the outcome” holding true. Surgery aims to restore movement in the shoulder and elbow joints and involves exploring, repairing, and transferring nerves. In cases of sharp open injuries, immediate surgery is performed. Conversely, for blunt closed injuries, which are more common, observation is carried out for the initial 2-3 months, allowing for spontaneous recovery. If no recovery is observed after 3 months post-accident, nerve transfer surgery is conducted as early as possible.
For injuries occurring within 9 months to 1 year, surgery is still an option, although the chances of recovery are somewhat reduced compared to surgeries performed within 3 months. However, after 1 year post-accident, attempting nerve transfer surgery is observed to have significantly lower chances of success due to inadequate time for nerve regeneration. In such cases, specific targeted muscle and tendon transfers are preferred over nerve transfer surgery beyond 1 year post-accident.
The optimal timing for this procedure is within a “golden” window of 3-5 months following the injury. This time frame ensures early and effective reactivation of paralyzed muscles, leading to muscle strength of grade 4.
The primary targets of surgery are restoring shoulder abduction and elbow flexion. The procedure is conducted under General Anesthesia, with patients admitted a day before surgery.
Routine blood investigations are performed, a pre-anesthetic check-up is conducted, and an informed written consent form is signed. In many cases, nerves are harvested from the leg to repair partial Brachial Plexus injuries. This procedure does not create any deficit in the leg, apart from mild sensory abnormalities in the outer aspect of the ankle region, which typically resolve over time.
Nerve repair is performed in cases of nerve rupture. The Brachial Plexus is explored to identify ruptured nerves, remove scarred nerve segments, and repair the nerves using grafts harvested from various parts of the body. Nerve repair is usually possible in upper Brachial Plexus ruptures. An incision is made in the neck region above the clavicle, muscles are dissected, and nerves are explored.
Neuromas are excised, and nerves are repaired using grafts from the leg if the proximal nerve roots are healthy. Additionally, the spinal accessory nerve is transferred to the supra-scapular nerve to restore the initiation of shoulder abduction movement, a critical transfer in all Brachial Plexus Injuries.
b) Nerve TransferNerve transfer involves intentionally dividing a physiologically active nerve (with minimal donor-related complications) and transferring it to a more important yet irreparable paralytic nerve of the Brachial Plexus.
The most commonly used nerve transfer technique for elbow flexion in upper arm-type BPI is the Oberlin transfer. The biceps muscle, responsible for elbow flexion, is supplied by the musculocutaneous nerve. An incision is made on the inside of the arm, and nerves are explored. One or two nerve fascicles are taken from the ulnar nerve and directly joined with the motor branch of the biceps muscle of the musculocutaneous nerve (MCN).
The preferred nerve transfer technique for shoulder abduction in upper arm-type BPI is the Susan Mackinnon method. The deltoid muscle, responsible for shoulder abduction, is supplied by the axillary nerve. An incision is made on the backside of the arm, and nerves are explored underneath the triceps and deltoid muscles. Nerve fascicles from the triceps nerve branch are taken and directly joined with the axillary nerve.
The results of surgery for partial brachial plexus injuries are generally positive but remain somewhat unpredictable. Even in the best centers worldwide, success rates typically range from 70% to 80%.
The maximum result that a patient with full effort and physiotherapy gets incomplete brachial plexus injury is that he can-
So that he can use his paralyzed hand as a supportive hand.
Nerve regeneration occurs slowly at a rate of approximately 1 mm/day. Recovery from a brachial plexus injury takes time, and patients may not experience results for several months even after successful surgery.
The patient is advised for regular physiotherapy and TENS therapy (transcutaneous electric nerve stimulation) after the surgery.
A positive mindset and the support of family, friends, and healthcare professionals are important to recovery and rehabilitation.
Patients are advised to undergo regular physiotherapy and Transcutaneous Electric Nerve Stimulation (TENS) therapy following surgery. Maintaining a positive mindset and receiving support from family, friends, and healthcare professionals are crucial for recovery and rehabilitation. If functional recovery is not achievable despite all efforts after 1-1.5 years of surgery, the next stage of surgery is planned.
The results of surgery for partial brachial plexus injuries can be somewhat unpredictable, with success rates of approximately 70% to 80% even in top-tier centers worldwide. In cases of ongoing muscle weakness or when specific arm functions need to be restored, patients may require additional surgeries in the future.
If more than one year has passed since the accident, it is advisable to consider muscle or tendon transfers for Partial Brachial Plexus Injuries (C5678T1). This approach helps optimize functional restoration when the window for nerve repair or transfer has closed.
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A Partial BPI involves damage to some but not all of the nerves in the brachial plexus. Kayakriti Clinic specializes in diagnosing and treating Partial BPI cases that have occurred within the first year of injury, with a focus on nerve repair and transfers.
Kayakriti Clinic can provide information about common causes of Partial BPI, such as trauma or accidents, and discuss preventive measures to reduce the risk of such injuries.
Kayakriti Clinic employs advanced diagnostic techniques, including physical examinations and imaging studies like MRI, to accurately diagnose Partial Brachial Plexus Injuries in individuals with recent injuries.
Kayakriti Clinic offers specialized treatment options, including nerve repair and transfers, to address Partial Brachial Plexus Injuries in individuals who have been injured within the first year. They can explain the potential benefits of these procedures.
Kayakriti Clinic can emphasize the critical role of early intervention and provide insights into the expected outcomes, functional improvements, and potential for nerve regeneration when treatment is initiated promptly.
Kayakriti Clinic can describe the post-operative rehabilitation process, including the types of therapies and exercises involved in helping individuals regain arm function and maximize the benefits of nerve repair and transfers.
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