Traumatic brachial plexus lesions in the adult: Indications and results

Abstract

While numerous situations may produce a traumatic brachial plexus palsy, these injuries are characteristic of young adults aged 18 -20 who have had a motorcycle accident. '-lo Lesions can be situated at any level from the base of nerve roots to the divisions of the brachial plexus in the axillary region, and several types of lesions can be differentiated: Supraclavicular lesions at the root level (75% of cases) Infra-and retroclavicular lesions of secondary trunks and of terminal branches (25% of cases)The lesions are most often due to traction and stretching of the brachial plexus. The seventy of the lesions can be graded from 1 to 5 on the Sunderland scale.' At the root level, medullary avulsion constitutes a particular type.Our experience is based on 8 10 cases operated on from 1975 to 1994 at the H6pital Bichat (Paris, France). PALSIES AT ROOT LEVEL DUE TO SUPRACLAVICULAR LESIONSSupraclavicular lesions which account for 75% of all cases (with 15% occurring at two levels) may be grouped as follows:C5-C6 or C5-C6-C7 palsies which occur in 20-25% C8-T1 palsies which occur in 2-3% of cases C5-C6-C7-CS-T1 lesions which are the most frequent of cases and occur in 75-80% of cases It is important to determine the exact site of the lesion as this will weigh heavily on the prognosis and future of the patient. A careful clinical examination and special investigations should be rapidly undertaken in order to obtain an exact diagnosis and permit intervention within a period of 6 weeks to 2 months after the trauma.

Sensory disturbances and pain complaints after brachial plexus root injury: A prospective study involving 150 adult patients

“…Interestingly, drawing from both the literature [11][12][13] and our previous results, 3 we also estimate that, on average, roughly three in four (78%) of patients with total palsy have at least one nonavulsed root. Therefore, it seems plausible to suggest that, in total palsy, pain is related to the presence of a nonavulsed root, rather than avulsion of the lower roots, which has occurred in 100% of these patients.…”

Expression of activating transcription factor 3 (ATF3) in uninjured dorsal root ganglion neurons in a lower trunk avulsion pain model in rats

“…In almost 80 % of patients with complete brachial plexus palsy, at least one root is not avulsed [6,7]. Hence, it is believed that brachial plexus pain is not generated by avulsed roots, but rather by non-avulsed roots.…”

Collateral sprouting axons of end-to-side nerve coaptation in the avulsion of ventral branches of the C5-C6 spinal nerves in the brachial plexus

“…Our results indicated that a better outcome could be attained by coapting grafts distal to the lateral or posterior cord to achieve more distal coaptation near the distal objective (i.e., the musculocutaneous nerve). On the other hand, Alnot [3] and Terzis [55] have reported that the use of nerve grafts is more successful when coapting nerve grafts distal to the peripheral nerve rather than distal to the proximal plexus elements (i.e., the cords). At this point most of the nerve fibers would not be lost in fortuitous reinnervation, which would result in achievement of the desired goal.…”