Partial Brachial Plexus Injuries involve the injury of C5, C6 nerve roots with or without C7 nerve root in the neck, leading to weakness, numbness, or loss of movement in the affected shoulder and elbow. Hand function remains good in cases of partial Brachial Plexus injuries. Deficits include shoulder stability, abduction (outward movement), external and internal rotation, elbow flexion (inner bending of the elbow), and forearm supination (rotating the forearm outward). If C7 is involved, there may also be variable weakness in the extension of the elbow, wrist, and fingers (straightening of elbow, wrist, and finger joints). This type of injury is often seen more frequently in men aged between 15-25 years.
Similar to Complete BPI, one of the major challenges in treating Brachial Plexus Injuries is delayed presentation due to limited awareness about these injuries. Patients often seek medical attention late after the injury has occurred. This highlights the importance of consulting plastic surgeons specialized in Brachial Plexus surgery for the management of such cases. Dr. Amit Agarwal specializes in this field with over 14 years of expertise, making him well-equipped to handle all aspects of treatment.
In Brachial Plexus injuries, the principle of “sooner the treatment, better the outcome” holds true. Surgery involves exploring, repairing, and transferring nerves. If no recovery is observed within 3 months of the accident, nerve transfer surgery is performed as early as possible. While surgery can still be considered for injuries occurring within 9 months to 1 year of the accident, the chances of recovery diminish compared to surgeries performed within the first 3 months.
Attempting nerve transfer surgery after 1 year of the accident is associated with significantly reduced chances of success. There is insufficient time left for nerve regeneration. Consequently, specific targeted muscle and tendon transfers become the preferred option instead of nerve transfer surgery beyond 1 year of the accident.
If the patient presents to us after one year of the accident, and no surgery has been performed during that time, or no recovery is seen after the initial nerve repair, targeted muscle and tendon transfers are carried out. These procedures aim to achieve acceptable movements in the shoulder and elbow joints.
After one year of the accident, specific investigations like MR Neurography and NCV studies are not typically performed. However, a thorough examination of the brachial plexus, muscle movements, sensory return, history of previous surgeries, fracture assessments, and evaluations of the patient’s vocational abilities are essential before proceeding with reconstruction.
In partial Brachial Plexus injuries, there is usually good recovery after nerve surgery (70-80%), but the results can be unpredictable in some patients.
For late presentations of Partial Brachial Plexus Injuries, targeted muscle and tendon transfers are the primary surgical approach. These procedures are also recommended when initial nerve repair surgeries fail to yield any response even after one and a half years.
The LD muscle, located in the back, is typically preserved in upper partial Brachial Plexus injuries. It is innervated by the thoracodorsal nerve, which is mostly preserved in patients with C5-6 injury. In cases of C5-6-7 complete injury, the LD muscle may not be available for transfer. Therefore, careful pre-operative evaluation of muscle function is crucial for the success of surgery. This muscle is harvested from the back and transferred to the arm to replicate the action of the biceps muscle, restoring elbow flexion.
This surgery is usually done when the LD muscle is weak or not working, or the patient has not consented to the harvest of muscle from their back. The restoration of elbow flexion is achieved using the reinnervated free-muscle transfer technique.
In cases where there is combined C7 palsy with C5-6 palsy, wrist and finger extensors can be paralyzed, leaving the wrist unstable. While some hand function remains in flexion, tendon transfer surgery stabilizes the wrist joint to enhance finger function and grip strength. This procedure also places the wrist in a stable functional position and can improve movement and power in the elbow.
In partial Brachial Plexus injuries, there is complete loss of movement of the shoulder. Partial restoration of shoulder joint abduction can be achieved through either shoulder joint fusion or trapezius muscle transfer.
In this surgery, the trapezius muscle, situated at the back, is transferred to the side of the arm to mimic the action of the deltoid muscle, partially restoring the outward movement (abduction) of the shoulder joint.
For patients seen after a year of the accident, the first surgery is typically performed to restore elbow flexion. Surgery to restore shoulder joint movement can be considered as a second-stage procedure.
The trapezius muscle is a large muscle of the upper back. It is usually spared due to its innervation by the spinal accessory nerve, in addition to contributions from C3 and C4 neck nerves. Moreover, it often increases in bulk after deltoid muscle paralysis, making trapezius transfer the most commonly performed tendon transfer for shoulder abduction movement in adult brachial palsy.
If less than one year has passed since the accident, nerve repair or transfers are advised in Partial Brachial Plexus Injuries (C5678T1).
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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 more than one year after the injury, often involving muscle and tendon transfers.
Kayakriti Clinic can provide insights into common causes and discuss the options available for managing Partial BPI when the injury occurred more than one year ago.
Kayakriti Clinic employs a comprehensive evaluation process, including physical examinations and imaging studies like MRI, to accurately diagnose and assess the condition of individuals with Partial BPI after more than one year.
Kayakriti Clinic offers specialized treatment options, including muscle and tendon transfers, to address the challenges posed by Partial BPI when it has been present for more than one year. They can discuss the potential benefits of these procedures.
Kayakriti Clinic can provide insights into the expected outcomes, functional improvements, and potential for enhanced arm function resulting from muscle and tendon transfers in individuals with Partial BPI after an extended period.
Kayakriti Clinic can describe the rehabilitation process, including the types of therapies and exercises involved in helping individuals maximize the benefits of muscle and tendon transfer procedures and regain arm function.
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