Skip to main content
SpringerLink
Log in
Book cover

Advances and Technical Standards in Neurosurgery pp 201–231Cite as

Management of brachial plexus injuries

  • Chapter

Part of the book series: Advances and Technical Standards in Neurosurgery ((NEUROSURGERY,volume 33))

Abstract

Most brachial plexus lesions are traction injuries sustained during birth, but in adolescents and older people they are usually caused by traffic accidents or following a fall in the home. A minority are the result of penetrating injury after civilian assault or trauma encountered during wartime.

Birth palsy cases (obstetric brachial plexus palsy) and the remaining cases (traumatic brachial plexus palsy) are viewed differently with regard to treatment and outcome and so these two groups are usually discussed in separate chapters. In this paper we treat both groups in parallel because as far as primary (= nerve) surgery is concerned, many treatment problems and solutions are present in both groups and are therefore comparable.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Al-Qattan MM, Clarke HM, Curtis CG (1995) Klumpke’s birth palsy: does it really exist? J Hand Surg (Br) 20: 19–23

    Article  CAS  Google Scholar 

  2. Alnot J-Y (1988) Traumatic brachial plexus palsy in adults. In: Raoul Tubiana (ed) The hand, vol. III. WB Saunders, Philadelphia, pp 607–644

    Google Scholar 

  3. Bae DS, Waters PM, Zurakowski D (2003) Reliability of three classification systems measuring active motion in brachial plexus birth palsy. J Bone Joint Surg 85: 1733–1738

    PubMed  Google Scholar 

  4. Bager B (1997) Perinatally acquired brachial plexus palsy — a persisting challenge. Acta Paediatr 86: 1214–1219

    Article  PubMed  CAS  Google Scholar 

  5. Berman JS, Birch R, Anand P (1998) Pain following human brachial plexus injury with spinal cord avulsion and the effect of surgery. Pain 75: 199–207

    Article  PubMed  CAS  Google Scholar 

  6. Berthold CH, Carlstedt T, Corneliuson O (1993) Anatomy of the mature transitional zone. In: Dyck PJ, Thomas PK, Griffin JW, Low PA, Poduslo JF (eds) Peripheral neuropathy, 3rd edn. WB Saunders, Philadelphia, pp 75–80

    Google Scholar 

  7. Birch R (1996) Brachial plexus injuries. J Bone Joint Surg 78-B: 986–992

    Article  Google Scholar 

  8. Birch R, Bonney G, Wynn Parry CB (1998) Surgical disorders of the peripheral nerves. Churchill Livingstone, Edinburgh, pp 398–404

    Google Scholar 

  9. Birch R, Ahad N, Kono H, Smith (2005) Repair of obstetric brachial plexus palsy. Results in 100 children. J Bone Joint Surg (Br) 87-B: 1089–1095

    Article  Google Scholar 

  10. Bisinella GL, Birch R, Smith SJM (2003) Neurophysiological prediction of outcome in obstetric lesions of the brachial plexus. J Hand Surg 28B: 148–152

    Google Scholar 

  11. Blaauw G, Pons C (1999) Letsels van de plexus brachialis. Elsevier/Bunge, Maarssen, pp 36–38

    Google Scholar 

  12. Blaauw G, Slooff ACJ (2003) Transfer of pectoral nerves to the musculocutaneous nerve in obstetric upper brachial plexus palsy. Neurosurgery 53: 338–341

    Article  PubMed  Google Scholar 

  13. Blaauw G, Muhlig RS, Kortleve JW, Tonino AJ (2004) Obstetric brachial plexus injuries following breech delivery: an adverse experience in The Netherlands. Semin Plast Surg 18: 301–307

    Article  Google Scholar 

  14. Blaauw G, Sauter Y, Lacroix CLE, Slooff ACJ (2006) Hypoglossal nerve transfer in obstetric brachial plexus palsy. J Plast Reconstr Aesthetic Surg 59: 474–478

    Article  Google Scholar 

  15. Bonnard C, Allieu Y, Alnot J-Y, Brunelli G, Merle M, Santos-Palazzi A, Sedel L, Raimondi PL, Narakas A (1996) Complete palsies and supraclavicular lesions. In: Alnot J-Y, Narakas A (eds) Traumatic brachial plexus injuries, Monographie de la Societé Française de Chirurgie de la Main (GAM). Expansion Scientifique Française, Paris, pp 126–155

    Google Scholar 

  16. Bonney G, Gilliatt RW (1958) Sensory nerve conduction after traction lesion of the brachial plexus. Proc R Soc Med 51: 365–367

    PubMed  CAS  Google Scholar 

  17. Carlstedt T, Anand P, Hallin R, Misra PV, Norén G, Seferlis T (2000) Spinal nerve root repair and reimplantation of avulsed ventral roots into the spinal cord after brachial plexus injury. J Neurosurg Spine 93: 237–247

    CAS  Google Scholar 

  18. Clarke HM, Curtis CG (1995) An approach to obstetrical brachial plexus injuries. Hand Clin 11: 563–581

    PubMed  CAS  Google Scholar 

  19. Colon AJ, Vredeveld JW, Blaauw G, Zandvoort JA (2003) Spontaneous muscle fiber activity appears early in cases of obstetric brachial plexopathy. Muscle Nerve 28: 515–516

    Article  PubMed  CAS  Google Scholar 

  20. Colon AJA, Vredeveld JW, Blaauw G, Slooff ACJ, Richards R (2003) Extensive somatosensory innervation in infants with obstetric brachial palsy. Clin Anat 16: 25–29

    Article  PubMed  CAS  Google Scholar 

  21. Curtis C, Stephens D, Clarke HM, Andrews D (2002) The active movement scale: an evaluative tool for infants with obstetrical brachial plexus palsy. J Hand Surg 27A: 470–478

    Google Scholar 

  22. Doi K (2001) Palliative surgery: free muscle transfers. In: Gilbert A (ed) Brachial plexus injuries. Martin Dunitz, London, pp 137–147

    Google Scholar 

  23. Doi K, Otsuka K, Okamoto Y, Fujii H, Hattori Y, Baliarsing AS (2002) Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography. J Neurosurg 96Suppl 3: 277–284

    PubMed  Google Scholar 

  24. Evans-Jones G, Kay SPJ, Weindling AM, Cranny G, Ward A, Bradshaw A, Hernon C (2003) Congenital brachial palsy: incidence, causes, and outcome in the United Kingdom and republic of Ireland. Arch Dis Child Fetal Neonatal Ed 88: F185–F189

    Article  PubMed  CAS  Google Scholar 

  25. Fairbank HAT (1913) Birth palsy: subluxation of the shoulder-joint in infants and young children. Lancet 1: 1217–1223

    Google Scholar 

  26. Frazier CH, Skillern PF (1911) Supraclavicular subcutaneous lesions of the brachial plexus not asociated with skeletal injuries. J Am Med Ass 57: 1957–1963

    Google Scholar 

  27. Gilbert A, Tassin JL (1984) Réparation chirurgicale du plexus brachial dans la paralysie obstétricale. Chirurgie 110: 70–75

    PubMed  CAS  Google Scholar 

  28. Gilbert A (1995) Long-term evaluation of brachial plexus surgery in obstetrical palsy. Hand Clin 11: 583–594

    PubMed  CAS  Google Scholar 

  29. Gilbert A (2001) Results of repair to the brachial plexus. In: Gilbert A (ed) Brachial plexus injuries. Martin Dunitz, London, pp 211–215

    Google Scholar 

  30. Gilbert A, Pivato G, Kheiralla T (2006) Long-termresults of primary repair of brachial plexus lesions in children. Microsurgery 26: 334–342

    Article  PubMed  Google Scholar 

  31. Gordon M, Rich H, Deutschberger JD, Green M (1973) The immediate and long-term outcome of obstetric birth trauma. Am J Obstet Gynecol 117: 51–56

    PubMed  CAS  Google Scholar 

  32. Gramsbergen A, IJkema-Paassen J, Nikkels PGJ, Hadders-Algra M (1997) Regression of polyneural innervation in the human psoas muscle. Early Hum Dev 49: 49–61

    Article  PubMed  CAS  Google Scholar 

  33. Greenwald AG, Schute PC, Shively JL (1984) Brachial plexus birth palsy: a 10-year report on the incidence and prognosis. J Pediatr Orthop 4: 689–692

    PubMed  CAS  Google Scholar 

  34. Haerle M, Gilbert A (2004) Management of complete obstetric brachial plexus lesions. J Pediatr Orthop 24: 194–200

    PubMed  Google Scholar 

  35. Hoffer MM, Phipps GJ (1998) Closed reduction and tendon transfer for treatment of dislocation of the glenohumeral joint secondary to brachial plexus birth palsy. J Bone Joint Surg 80A: 997–1001

    Google Scholar 

  36. Kline DG, Hudson AR (1995) Nerve injuries. Operative results for major nerve injuries, entrapments, and tumors. W.B. Saunders, Philadelpphia, pp 345–471

    Google Scholar 

  37. Kline DG, Hudson AR, Kim DH (2001) Atlas of peripheral nerve surgery. W.B. Saunders, Philadelphia, pp 1–75

    Google Scholar 

  38. La Scala GC, Rice SB, Clarke HM (2003) Complications of microsurgical reconstruction of obstetrical brachial plexus palsy. Plast Reconstruct Surg 111: 1383–1390

    Article  Google Scholar 

  39. L’Episcopo JB (1934) Tendon transplantation in obstetrical paralysis. Am J Surg 25: 122

    Article  Google Scholar 

  40. Mallet J (1972) Paralysie obstetricale du plexus brachial: traitement des sequelles. Primauté du traitement de l’épaule — Méthode d’expression des résultats. Rev Chir Orthop Reparatrice Appar Mot 58Suppl 1: 166–168

    PubMed  Google Scholar 

  41. Michelow BJ, Clarke HM, Curtis CG, Zuker RM, Seifu Y, Andrews DF (1994) The natural history of obstetrical brachial plexus palsy. Plast Reconstruct Surg 93: 675–681

    CAS  Google Scholar 

  42. Millesi H (1992) Chirurgie der peripheren Nerven. Urban & Schwarzenberg, München, pp 79–120

    Google Scholar 

  43. Mollberg M, Hagberg H, Bager B, Lilja H, Ladfors L (2005) Risk factors for obstetric brachial plexus palsy among neonates delivered by vacuum extraction. Obstetric Gynecol 106: 913–918

    Google Scholar 

  44. Muhlig RS, Blaauw G, Slooff ACJ, Kortleve JW, Tonino AJ (2001) Conservative treatment of obstetrical brachial plexus palsy (obpp) and rehabilitation. In: Gilbert A (ed) Brachial plexus injuries. Martin Dunitz, London, pp 173–187

    Google Scholar 

  45. Murphey F, Hartung W, Kirklin JW (1947) Myelographic demonstration of avulsing injury of the brachial plexus. Am J Roentgenol 58: 102–105

    CAS  Google Scholar 

  46. Narakas AO (1986) Injuries to the brachial plexus. In: Bore FW (ed) The pediatric upper extremity. Diagnosis and management. W. B. Saunders Company, Philadelphia, pp 247–258

    Google Scholar 

  47. Narakas AO (1987) Obstetrical brachial plexus injuries. In: Lamb DW (ed) The paralysed hand. (The hand and upper limb, vol. 2). Churchill Livingstone, Edinburgh, pp 116–135

    Google Scholar 

  48. Narakas AO (1991) Neurotization in the treatment of brachial plexus injuries. In: Gelberman RH (ed) Operative nerve repair and reconstruction. JB Lippincott Company, Philadelphia, pp 1329–1358

    Google Scholar 

  49. Nashold BS Jr, Ostdahl RH (1979) Dosal root entry zone lesions for pain relief. J Neurosurg 51: 59–69

    PubMed  Google Scholar 

  50. Ostdahl RH (1996) DREZ surgery for brachial plexus avulsion pain. In: Nashold BS, Pearlstein RD (eds) The DREZ operation. The American Association for Neurological Surgeons, Illinois, pp 105–124

    Google Scholar 

  51. Pitt M, Vredeveld JW (2005) The role of electromyography in the management of the brachial plexus palsy of the newborn. Clin Neurophysiol 116: 1756–1761

    Article  PubMed  Google Scholar 

  52. Pondaag W, Malessy MJA, Van Dijk JG, Thomeer RTWM (2004) Natural history of obstetric brachial plexus palsy: a systematic review. Dev Med Child Neurol 46: 138–144

    Article  PubMed  Google Scholar 

  53. Rankine JJ (2004) Adult traumatic brachial plexus injury. Clin Radiol 59: 767–774

    Article  PubMed  CAS  Google Scholar 

  54. Rexed D (1952) The cytoarchitectonic organization of the spinal cord in the cat. J Comp Neurol 96: 414–495

    Article  PubMed  CAS  Google Scholar 

  55. Schenker M, Birch R (2001) Diagnosis of the level of intradural rupture of the rootlets in traction lesions of the brachial plexus. J Bone Joint Surg 83-B: 916–920

    Article  Google Scholar 

  56. Seddon H (1972) Surgical disorders of the peripheral nerves. Churchill Livingstone, Edinburgh London, pp 32–36, 174–198

    Google Scholar 

  57. Sever JW (1918) The results of a new operation for obstetrical paralysis. Am J Orthop Surg 16: 248–257

    Google Scholar 

  58. Sindou MP, Fischer G, Goutelle A, Mansuy L (1974) La radicellotomie posterieure selective. Premiers resultats dans la chirurgie de la douleur. Neurochirurgie 20: 391–408

    PubMed  CAS  Google Scholar 

  59. Sindou MP, Blondet E, Emery E, Mertens P (2005) Microsurgical lesioning in the dorsal root entry zone for pain due to brachial plexus avulsion: a prospective series of 55 patients. J Neurosurg 102: 1018–1028

    PubMed  Google Scholar 

  60. Smith SJM (1996) The role of neurophysiological investigation in traumatic brachial plexus lesions in adults and children. J Hand Surg 21: 145–148

    CAS  Google Scholar 

  61. Smith SJM (1998) Electrodiagnosis. In: Birch R, Bonney G, Wynn Parry CB (eds) Surgical disorders of the peripheral nerves. Churchill Livingstone, Edinburgh, pp 482–487

    Google Scholar 

  62. Specht EE (1975) Brachial plexus palsy in the newborn. Incidence and prognosis. Clin Orthop 110: 32–34

    Article  PubMed  Google Scholar 

  63. Steindler A (1918) A muscle plasty for the relief of flail elbow in infantile paralysis. Inter Med J 35: 235–241

    Google Scholar 

  64. Sunderland S (1968) Nerves and nerve injuries. Churchill Livingstone, Edinburgh London, 633 pp

    Google Scholar 

  65. Tan KL (1973) Brachial palsy. J Obstet Gynaecol Br Commonw 80: 60–62

    PubMed  CAS  Google Scholar 

  66. Thomas DGT, Kitchen ND (1994) Long term follow up of dorsal root entry zone lesions in brachial plexus avulsion. J Neurol Neurosurg Psychiatr 57: 737–738

    Article  PubMed  CAS  Google Scholar 

  67. Torode I, Donnan L (1998) Posterior dislocation of the humeral head in association with obstetrical paralysis. J Pediatr Orthop 18: 611–615

    Article  PubMed  CAS  Google Scholar 

  68. Troum S, Floyd WED, Waters PM (1993) Posterior dislocation of the humeral head in infancy associated with obstetrical paralysis. A case report. J Bone Joint Surg 75-A: 1370–1375

    Google Scholar 

  69. Ubachs JHM, Slooff ACJ, Peeters LLM (1995) Obstetric antecedents of surgical treated obstetric brachial plexus injuries. Br J Obstet Gynaecol 102: 813–817

    PubMed  CAS  Google Scholar 

  70. Van Dijk JG, Pondaag W, Malessy MJ (2001) Obstetric lesions of the brachial plexus. Muscle Nerve 24: 1451–1461

    Article  PubMed  Google Scholar 

  71. Van Egmond C, Tonino A, Kortleve JW (2001) Steindler flexorplasty of the elbow in obstetric brachial plexus injuries. J Pediatr Orthop 21: 169–173

    Article  PubMed  Google Scholar 

  72. Vredeveld JW, Blaauw G, Slooff ACJ, Richards R (1997) “Luxury innervation”: does it exist and play a role at the time of birth? Electroencephalogr Clin Neurophysiol 107: 1

    Google Scholar 

  73. Vredeveld JW, Blaauw G, Slooff ACJ, Richards R, Rozeman CAM (2000) The findings in paediatric obstetric brachial palsy differ from those in older patients: a suggested axplanation. Dev Med Child Neurol 42: 158–161

    Article  PubMed  CAS  Google Scholar 

  74. Vredeveld JW, Slooff BCJ, Blaauw G, Richards R (2001) Validation of an electromyography and nerve conduction study protocol for the analysis of brachial plexus lesions in 184 consecutive patients with traumatic lesions. J Clin Neuromusc Dis 2: 123–128

    Article  CAS  Google Scholar 

  75. Wickstrom J, Haslam ET, Hutchinson RH (1955) The surgical management of residual deformities of the shoulder following birth injuries of the brachial plexus. J Bone Joint Surg 27A: 27–36

    Google Scholar 

  76. Wynn Parry CB (1984) Pain in avulsion of the brachial plexus. Neurosurgery 15: 960–965

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital, Maastricht, The Netherlands

    G. Blaauw

  2. Rehabilitation Out-Patient Clinic, S.G.L., Heerlen, The Netherlands

    R. S. Muhlig

  3. Department of Neurophysiology, Atrium Medical Centre, Heerlen, The Netherlands

    J. W. Vredeveld

Authors
  1. G. Blaauw
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. S. Muhlig
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. W. Vredeveld
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Cambridge

    J. D. Pickard

  2. Ankara

    N. Akalan

  3. Roma

    C. Di Rocco

  4. Ljubljana

    V. V. Dolenc

  5. Lisbon

    J. Lobo Antunes

  6. Groningen

    J. J. A. Mooij

  7. Bonn

    J. Schramm

  8. Lyon

    M. Sindou

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer-Verlag/Wien

About this chapter

Cite this chapter

Blaauw, G., Muhlig, R.S., Vredeveld, J.W. (2008). Management of brachial plexus injuries. In: Pickard, J.D., et al. Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 33. Springer, Vienna. https://doi.org/10.1007/978-3-211-72283-1_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-211-72283-1_5

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-72282-4

  • Online ISBN: 978-3-211-72283-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation