The Orthobullets Podcast Trauma⎪Brachial Plexus Injuries
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Dec 9, 2019 Dive into the world of brachial plexus injuries, where you'll learn about the differences between supraclavicular and infraclavicular types. Explore the mechanisms behind these traumatic injuries and their epidemiology. Discover the nuances of preganglionic versus postganglionic injuries, along with muscle involvements and clinical implications. Uncover key diagnostic methods like EMG and the importance of nerve function assessments. Get insights into recovery prognosis and the various surgical and management options available.
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Nerve Grafting and Transfers
- Use nerve grafts for traction postganglionic injuries, preferring upper/mid trunk for better proximal muscle reinnervation.
- Nerve transfers (neurotization) assign working nerves to restore function in denervated muscles.
Repair Priorities and Muscle Transfers
- Prioritize restoring elbow flexion, shoulder stability, pinch strength, and wrist/finger function in reconstruction.
- Use free muscle transfers, like gracilis, when intrinsic hand recovery is unlikely.
Diagnostic Hallmarks and Modalities
- Horner's syndrome (eyelid droop) strongly suggests C8-T1 root avulsion.
- Physical exam and nerve conduction studies outperform MRI in diagnosing brachial plexus injury location.