Current treatment of traumatic brachial plexus and peripheral nerve injuries

Abstract

Brachial plexus and peripheral nerve injuries are complex and suppose a great functional deficit. An early diagnostic and surgical exploration and reconstruction is essential in some cases. Muscular atrophy generated by the chronic denervation limits surgical treatments that can not be performed once overcoming a specific time frame. Radiologic and neurophysiological tests are essential to perform a correct diagnostic and follow-up of these injuries, and rehabilitation is crucial to achieve a good postsurgical outcome. Surgical treatments include primary nerve repair, repair with nerve grafts, nerve transfers, free functional muscle transfers and tendon transfers. Each technique should be adequate to the clinic and evolution time of the injury. Once muscle atrophy is established, nerve repair and nerve transfers do not achieve a good functional result. Due to the high complexity of these injuries and the need for different medical specialists, these patients must be treated in multidisciplinary units to achieve the best possible result.