Current Concepts of the Treatment of Adult Brachial Plexus Injuries

Giuffre, Jennifer L.; Kakar, Sanjeev; Bishop, Allen T.; Spinner, Robert J.; Shin, Alexander Y.

doi:10.1016/j.jhsa.2010.01.021

Cited by 180 publications

(129 citation statements)

References 26 publications

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“…Proximal injuries, such as brachial plexus injuries, show only very limited motor recovery for wrist and finger flexors and none for intrinsic muscles (5,49). Delay in surgery of over 6 months significantly reduces the extent of motor recovery, and it is considered clinically fruitless to expect motor recovery if an operation is delayed for more than a year (50). However, sensation commonly recovers even though the quality may be defective, pointing to a clear difference in functional sensory and motor recovery.…”

Section: Discussionmentioning

confidence: 99%

Accelerating axonal growth promotes motor recovery after peripheral nerve injury in mice

Eddie¹,

Ômura²,

Cobos³

et al. 2011

J. Clin. Invest.

214

239

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Although peripheral nerves can regenerate after injury, proximal nerve injury in humans results in minimal restoration of motor function. One possible explanation for this is that injury-induced axonal growth is too slow. Heat shock protein 27 (Hsp27) is a regeneration-associated protein that accelerates axonal growth in vitro. Here, we have shown that it can also do this in mice after peripheral nerve injury. While rapid motor and sensory recovery occurred in mice after a sciatic nerve crush injury, there was little return of motor function after sciatic nerve transection, because of the delay in motor axons reaching their target. This was not due to a failure of axonal growth, because injured motor axons eventually fully re-extended into muscles and sensory function returned; rather, it resulted from a lack of motor end plate reinnervation. Tg mice expressing high levels of Hsp27 demonstrated enhanced restoration of motor function after nerve transection/resuture by enabling motor synapse reinnervation, but only within 5 weeks of injury. In humans with peripheral nerve injuries, shorter wait times to decompression surgery led to improved functional recovery, and, while a return of sensation occurred in all patients, motor recovery was limited. Thus, absence of motor recovery after nerve damage may result from a failure of synapse reformation after prolonged denervation rather than a failure of axonal growth.

show abstract

Section: Discussionmentioning

confidence: 99%

Accelerating axonal growth promotes motor recovery after peripheral nerve injury in mice

Eddie¹,

Ômura²,

Cobos³

et al. 2011

J. Clin. Invest.

214

239

View full text Add to dashboard Cite

show abstract

“…5,6,17,22,23 Aside from timing and injury issues, other factors affecting patient medical decisions are absent from the literature. These are critical decisions with life-long implications for the small but meaningful number of patients who are injured annually, yet little is known about how and why patients choose surgical intervention and what barriers exist in obtaining information and care.…”

mentioning

confidence: 99%

Medical treatment decision making after total avulsion brachial plexus injury: a qualitative study

Franzblau

Maynard

Chung

et al. 2015

JNS

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OBJECT Complete avulsion traumatic brachial plexus injuries (BPIs) can be treated using nerve and musculoskeletal reconstruction procedures. However, these interventions are most viable within certain timeframes, and even then they cannot restore all lost function. Little is known about how patients make decisions regarding surgical treatment or what impediments they face during the decision-making process. Using qualitative methodology, the authors aimed to describe how and why patients elect to pursue or forego surgical reconstruction, identify the barriers precluding adequate information transfer, and determine whether these patients are satisfied with their treatment choices over time. METHODS Twelve patients with total avulsion BPIs were interviewed according to a semi-structured guide. The interview transcripts were qualitatively analyzed using the systematic inductive techniques of grounded theory to identify key themes related to the decision-making process and long-term satisfaction with decisions. RESULTS Four decision factors emerged from our analysis: desire to restore function, perceived value of functional gains, weighing the risks and costs of surgery, and having concomitant injuries. Lack of insurance coverage (4 patients), delayed diagnosis (3 patients), and insufficient information regarding treatment (4 patients) prevented patients from making informed decisions and accessing care. Three individuals, all of whom had decided against reconstruction, had regrets about their treatment choices. CONCLUSIONS Patients with panplexus avulsion injuries are missing opportunities for reconstruction and often not considering the long-term outcomes of surgery. As more Americans gain health insurance coverage, it is very likely that the number of patients able to pursue reconstruction will increase. The authors recommend implementing clinical pathways to help patients meet critical points in care within the ideal timeframe and using a patient- and family-centered care approach combined with patient decision aids to foster shared decision making, increase access to information, and improve patient satisfaction with decisions. These measures could greatly benefit patients with BPI while reducing costs, improving efficiency, and generating better outcomes.

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“…[2] Clear-cut sharp lacerations of the nerves without tissue loss indicates immediate primary repair. [3,4] Laceration injuries generally transect just some elements of the brachial plexus, but total plexus lacerations are reported scarcely. [2] Outcomes of sharp laceration injury repair for median and radial nerves at various levels are reported to be equally good and better than for the ulnar nerve.…”

Section: Discussionmentioning

confidence: 99%

Long term follow up results of a pediatric brachial plexus laceration

Öksüz¹,

Karagöz²,

Külahçi³

et al. 2013

Ulus Travma Acil Cerrahi Derg

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A rare case of pediatric brachial plexus laceration is presented. A five-year-old boy who sustained a sharp laceration on his right axillary region was immediately operated. The axillary artery, radial, ulnar and musculocutaneous nerve branches of the brachial plexus, and the lateral root of the median nerve were totally lacerated. The medial root of the median nerve was partially transected. All of the lacerated brachial plexus elements and axillary artery were immediately repaired. Significant functional recovery was determined even six months after the repair. Motor and sensory functions of the affected extremity were almost totally restored at the postoperative 21st month, except for the ulnar nerve motor functions. There was no cold intolerance or trophic change at the injured extremity. Primary repair of a brachial plexus laceration injury in the pediatric population can be expected to produce successful functional recovery results, even in a relatively short period after the repair.

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Current Concepts of the Treatment of Adult Brachial Plexus Injuries

Cited by 180 publications

References 26 publications

Accelerating axonal growth promotes motor recovery after peripheral nerve injury in mice

Accelerating axonal growth promotes motor recovery after peripheral nerve injury in mice

Medical treatment decision making after total avulsion brachial plexus injury: a qualitative study

Long term follow up results of a pediatric brachial plexus laceration

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