Brachial Plexus Injuries

A/Prof Ferris has a long-standing practice in brachial plexus and peripheral nerve injuries and is known internationally for pioneering more reliable techniques. He treats patients every week in his private practice, as well as at the Alfred hospital where he heads the brachial plexus service within the plastic surgical department. A/Prof Ferris chairs Victoria’s only dedicated adult brachial plexus multidisciplinary meeting.

The brachial plexus is an anatomical structure in the lower neck. It consists of the nerves which have emerged from the spinal cord, then join and branch to become the nerves descending under the collarbone and through the arm pit. They travel down to give power and feeling to the upper limb.

This collection of nerves is injured most commonly with high energy trauma, such as road traffic or industrial accidents. It may also be injured in falls, and can be associated with dislocated or fractured shoulders. While these injuries are relatively uncommon, they require prompt investigation and assessment in order to determine whether reconstruction will be required.

All brachial plexus injuries require detailed assessment for accurate diagnosis and then formulation of the best reconstruction. Often the injury is restricted to the upper part of the brachial plexus, which means a person is unable to move their shoulder and unable to flex their elbow, but wrist and finger function is preserved. Another common pattern of injury is where the entire brachial plexus is involved and the arm hangs powerless and without sensation by the patients side.

Modern techniques are now reliable in restoring function for most patients with a brachial plexus injury. The level of function which can be restored depends on the pattern of injury and the time between injury and reconstruction.

There are many techniques available to treat patients with brachial plexus injury. These are tailored to each patient’s individual circumstances. Interventions include:

  • Nerve transfers using healthy nerves to replace the function of the paralysed nerves
  • Regional tendon and muscle transfers
  • Distant muscle free flap transfers
  • Joint fusions
  • Nerve grafts.

A brachial plexus injury should be reviewed as soon as possible. It is helpful (although not mandatory) that any nerve conduction tests, EMG’s, or MRI scans are forwarded prior to consultation. The most common outcome following a brachial plexus consultation is that reliable procedures can be offered which significantly restore or improve limb function.

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