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Brachial Plexus >>Introduction
Introduction: The increased incidence of road traffic accidents in our city roads has resulted in higher frequency of brachial plexus injuries. The highly convenient means of transportation in our overcrowded cities, the scooter and motorcycles are the main cause of these injuries. Though it is neither practical or sensible to attempt to restrict their use, safe driving and due precautions can bring down the incidence of this devastating injuries. For those unfortunate few who end up with these injuries microsurgery offers a ray of hope. The Hand and Microsurgery Department of Ganga Hospital is happy to dedicate itself to the care of this challenging problem. The team of physicians is headed by Dr S Raja Sabapathy and comprises of one dedicated senior consultant Dr Hari Venkatramani and Senior registrar Dr Praveen Bharadwaj . The team is ably supported by dedicated hand therapists.
What is Brachial Plexus Injury? The
hand is supplied by a group of nerves coming from the spinal cord at the
level of the neck. This group of nerves is called Brachial plexus .It is fairly fixed at the site where they leave
the spinal cord and below where they enter into the arm. Any injury
which increases the distance between the neck and the shoulder has the
risk of injuring the plexus of nerves. This commonly happens when
people fall off the motor cycles. Sudden deceleration with high kinetic
energy can cause severe brachial plexus injuries.
Total plexus lesions tear off all roots from the spinal cord (Fig).
THE RESULT COULD BE DEVASTATING- the whole of the upper limb may become
flail with no sensation or a group of muscles may not work, thereby resulting
in permanent paralysis to that side of the limb . The
diagnosis of brachial plexus is based on clinical and special
investigations to know the exact level of the lesion. Microsurgical
techniques, have improved the prognosis of nerve injuries dramatically.
It has brought about a more aggressive attitude in brachial plexus
management. The injury could be stretch of the nerves or total rupture. If the level of injury is outside the bony spinal canal it is called Nerve Rupture, repair of the nerves may be possible in such patients. If the injury happens inside the bony spinal canal, it is called Nerve Avulsion, direct repair of the nerves is not possible. Even in such cases salvage of function by rerouting of nerves (neurotisation),microsurgical Free Functioning muscle transfer (FFMT) or tendon transfers may be done. The field of Brachial plexus injuries is one of the newer frontiers of Hand Surgery. The advent of microsurgery has dramatically improved the results in many patients. From a situation of uniform gloom, we have now reached the stage of guarded optimism. The Hand unit of Ganga Hospital is actively involved in managing such problems. When should the patient be first seen? It is better to be under the care of the expert team from the beginning. If it could be confirmed that the injury is inside the bony spinal canal, rehabilitative surgery could be done early. Good clinical examination and investigations like CT myelogram and nerve conduction studies are usually done. Otherwise a waiting period of 3 to 4 months is appropriate. Then a detailed clinical examination is done followed if necessary by a fresh set of investigations. Better results are obtained if nerve surgery is done within 6 months from injury. If the patient is seen later, tendon transfers or free muscle transfers after nerve grafts can be done. Are operations worthwhile? In most cases yes. As a general rule, one can recommend the repair of nerve lesions as early as possible, as this ensures better outcome. There is a saying, ‘For those who have nothing, a little is a lot’. Results of Brachial Plexus surgery must be evaluated on those lines. In most cases it is possible to stabilize the shoulder, restore elbow flexion, to establish protective sensation. It is a marked improvement for the patient and beyond any expectation even a few years ago. Nerve recovery may proceed for many months. It is important to have regular physiotherapy till recovery , which is around 9 months to one year in most cases. What are the types of Surgery ? 1.
Direct Nerve Surgery
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