Effects of Timing of Nerve Injury and Repair in Neonatal and Adult Brachial Plexus Injury Models

Abstract

Brachial plexus Injury causes severe and long-term upper limb deficits at any age. The outcome from current reconstructive options depends on the severity of nerve injury and timing of intervention. This chapter summarises the differing biological responses to nerve injury that occur during neonatal, young adult and mature adult life. The central and peripheral reactions to nerve injury, the effects of timing of repair on both motor and sensory neuronal survival and basic science evidence to support early intervention are discussed.

Updates in diagnostic tools for diagnosing nerve injury and compressions

“…Nonetheless, we are often left with a choice of early surgery for evaluation of injury versus a non-operative watch-and-wait policy. Surveillance after repair and prediction of nerve recovery also remains a clinical challenge (Bourke et al., 2021). MRI is currently the most valuable test we can use to assess injuries to the nerves and associated pathologies.…”

“…In brachial plexus injury, we now have evidence that early exploration and reconstruction yield better outcomes; however, even with this approach, we cannot always be certain of the extent of nerve injury, particularly if we do not have visibility proximal to the foramina (Bourke et al., 2021; Jivan et al., 2009; Wade et al., 2018a, 2018b, 2019). Specifically in adults with traumatic brachial plexus injuries, each month of delay from the time of injury to reconstruction reduces the probability of achieving ≥M4 elbow flexion by 7% (Vernon Lee et al., 2023) Given that early reconstruction is associated with more favourable outcomes, medical tests for diagnosing nerve injury should be accurate enough to differentiate those who need early intervention from those who may recover spontaneously.…”

Accidentes en el recién nacido/Trauma al nacimiento

“…La reparación temprana de esta lesión se ha asociado con propiedades neuroprotectoras, siendo particularmente benéficas para la preservación de función sensitiva y motora. 22 La presentación clínica en la parálisis de Erb-Duchenne (patología del plexo braquial superior) se presenta como caída de la muñeca la cual se asocia con debilidad a nivel del hombro y del codo, generando aducción y rotación interna del hombro, en algunas ocasiones se puede asociar a parálisis hemidiafragmática ipsilateral. La parálisis de Klumpke (patología del plexo braquial inferior) se presenta como debilidad en el tríceps, la muñeca y los flexores de los dedos, se asocia a síndrome de horner (Ptosis palpebral, miosis pupilar y anhidrosis) ipsilateral.…”