Surgical Treatment Of Brachial Plexus Injuries

Healthcare providers typically recommend surgical treatment for brachial plexus injuries when the nerves don’t heal on their own or don’t recover enough to restore necessary function to your arm and hand.

It’s important to know that depending on the severity of the injury, surgery may not be able to return your arm or hand to its abilities before the injury.

Neurosurgeons use several different techniques to treat nerve injuries, depending on the type and severity of the injury and the amount of time that has passed since the injury.

Types of surgical procedures include:

• Nerve repair: In this procedure, your surgeon reattaches the two torn edges of a severed nerve. Surgeons typically perform this type of procedure immediately for sharp lacerations to your nerves, such as from a knife wound.
• Nerve graft: In this procedure, your surgeon takes a healthy nerve from another part of your body and sews it in between the two ends of a lacerated (severed) nerve. Your healthy, transplanted nerve functions as a scaffold to support your injured nerve ends as they grow back together.
• Nerve transfer: Surgeons perform this procedure when there are no functioning nerve stumps in your neck to which nerve grafts can be connected. In this procedure, the surgeon cuts and reconnects a healthy donor nerve to the injured nerve to provide a signal to a paralyzed muscle.

Treatments

Surgical Treatment Of Brachial Plexus Injuries
Healthcare providers typically recommend surgical treatment for brachial plexus injuries when the nerves don’t heal on their own or don’t recover enough to restore necessary function to your arm and hand. It’s important to know that depending on the severity of the injury, surgery may not be able to return your arm or hand to its abilities before the injury. Neurosurgeons use several different techniques to treat nerve injuries, depending on the type and severity of the injury and the amount of time that has passed since the injury. Types of surgical procedures include: • Nerve repair: In this procedure, your surgeon reattaches the two torn edges of a severed nerve. Surgeons typically perform this type of procedure immediately for sharp lacerations to your nerves, such as from a knife wound. • Nerve graft: In this procedure, your surgeon takes a healthy nerve from another part of your body and sews it in between the two ends of a lacerated (severed) nerve. Your healthy, transplanted nerve functions as a scaffold to support your injured nerve ends as they grow back together. • Nerve transfer: Surgeons perform this procedure when there are no functioning nerve stumps in your neck to which nerve grafts can be connected. In this procedure, the surgeon cuts and reconnects a healthy donor nerve to the injured nerve to provide a signal to a paralyzed muscle. View

Surgical Treatment Of Brachial Plexus Injuries

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Types of Brachial Plexus Surgery
The goal of brachial plexus surgery is to relieve your pain and restore sensation and motor function to your shoulder, arm and hand. Surgical approaches consider the type, location and extent of nerve injury, as well as your overall health and the impact of injury on your ability to work and quality of life. Procedures your surgeon might recommend include: Brachial Plexus Nerve Repair: When a nerve has been cut or torn, the surgeon may be able to re-connect it by sewing the ends back together. This is performed with the help of a microscope and small, specialized instruments. Brachial Plexus Decompression and Neurolysis: When a nerve is compressed but otherwise intact, a decompression surgery can help relieve the pressure on the nerve and address related symptoms and loss of function. This can be done by removing scar tissue or adhesions (a procedure called neurolysis) from around the injured nerve. Nerve Grafting Surgery for Brachial Plexus Injuries: When a nerve has been injured or scarred severely, it may no longer be able to carry signals from the brain to the arm and hand, leading to paralysis. In this case, surgeons can remove the damaged nerve segment and replace it with a segment of an expendable sensory nerve from another part of the body, such as the sural nerve in the leg. This procedure, called a nerve graft, helps create a bridge that replaces the injured portion of the nerve and provides a pathway for nerve regeneration. Brachial Plexus Nerve Transfer Surgery: During a nerve transfer, a nearby functioning nerve that is performing a noncritical function is connected to the injured nerve. This creates a framework for new growth and a pathway for signals. In many cases, a nerve transfer procedure provides the best chance of restoring movement and sensation to the muscles and skin. Nerves that can be transferred this way to treat brachial plexus injuries include the medial pectoral nerve in the front of the shoulder, the intercostal nerve under the ribs, the musculocutaneous nerve in the arm, and many other nerves in the forearm and hand. The optimal nerve to use for a transfer depends on which nerve is injured and the location of the injury. As with all types of brachial plexus surgery, time is of the essence for nerve transfers because there is a limited window for restoring nerve supply to the affected muscles before irreversible atrophy occurs. Tendon Transfer Surgery for Brachial Plexus Injuries: During a tendon transfer, a functioning and expendable tendon is attached to a tendon that is paralyzed as a result of brachial plexus injury. After tendon transfer, the functioning tendon will pull on the once paralyzed tendon to restore lost movement in an upper extremity. In some cases, a tendon transfer offers the best option for restoring movement after a brachial plexus injury. The most common reason for the procedure is that too much time has passed after the injury and nerve grafting or transfers are no longer options. Unlike nerve transfers, tendon transfers can take place any time after the brachial plexus injury. Functional Muscle Transplant for Brachial Plexus Injuries: Functional muscle transplant is another option to restore movement when too much time has passed after the brachial plexus injury and when nerve repair, grafting or transfer is no longer possible. A nonessential muscle, such as the gracilis muscle of the inner thigh, is transplanted to replace a nonfunctioning muscle in the shoulder, upper arm or hand. Blood flow is restored to the transplanted muscle by connecting tiny blood vessels under a microscope. A nearby nerve in the upper extremity is used to provide motor function for the transplanted muscle. Like tendon transfers, functional muscle transplantation can take place any time after the brachial plexus injury. View

Types of Brachial Plexus Surgery

The goal of brachial plexus surgery is to relieve your pain and restore sensation and motor function to your shoulder, arm and hand. Surgical approaches consider the type, location and extent of nerve injury, as well as your overall health and the impact of injury on your ability to work and quality of life.

Procedures your surgeon might recommend include:

Brachial Plexus Nerve Repair:

When a nerve has been cut or torn, the surgeon may be able to re-connect it by sewing the ends back together. This is performed with the help of a microscope and small, specialized instruments.

Brachial Plexus Decompression and Neurolysis:

When a nerve is compressed but otherwise intact, a decompression surgery can help relieve the pressure on the nerve and address related symptoms and loss of function. This can be done by removing scar tissue or adhesions (a procedure called neurolysis) from around the injured nerve.

Nerve Grafting Surgery for Brachial Plexus Injuries:

When a nerve has been injured or scarred severely, it may no longer be able to carry signals from the brain to the arm and hand, leading to paralysis. In this case, surgeons can remove the damaged nerve segment and replace it with a segment of an expendable sensory nerve from another part of the body, such as the sural nerve in the leg. This procedure, called a nerve graft, helps create a bridge that replaces the injured portion of the nerve and provides a pathway for nerve regeneration.

Brachial Plexus Nerve Transfer Surgery:

During a nerve transfer, a nearby functioning nerve that is performing a noncritical function is connected to the injured nerve. This creates a framework for new growth and a pathway for signals. In many cases, a nerve transfer procedure provides the best chance of restoring movement and sensation to the muscles and skin.

Nerves that can be transferred this way to treat brachial plexus injuries include the medial pectoral nerve in the front of the shoulder, the intercostal nerve under the ribs, the musculocutaneous nerve in the arm, and many other nerves in the forearm and hand. The optimal nerve to use for a transfer depends on which nerve is injured and the location of the injury. As with all types of brachial plexus surgery, time is of the essence for nerve transfers because there is a limited window for restoring nerve supply to the affected muscles before irreversible atrophy occurs.

Tendon Transfer Surgery for Brachial Plexus Injuries:

During a tendon transfer, a functioning and expendable tendon is attached to a tendon that is paralyzed as a result of brachial plexus injury. After tendon transfer, the functioning tendon will pull on the once paralyzed tendon to restore lost movement in an upper extremity.

In some cases, a tendon transfer offers the best option for restoring movement after a brachial plexus injury. The most common reason for the procedure is that too much time has passed after the injury and nerve grafting or transfers are no longer options. Unlike nerve transfers, tendon transfers can take place any time after the brachial plexus injury.

Functional Muscle Transplant for Brachial Plexus Injuries:

Functional muscle transplant is another option to restore movement when too much time has passed after the brachial plexus injury and when nerve repair, grafting or transfer is no longer possible. A nonessential muscle, such as the gracilis muscle of the inner thigh, is transplanted to replace a nonfunctioning muscle in the shoulder, upper arm or hand. Blood flow is restored to the transplanted muscle by connecting tiny blood vessels under a microscope. A nearby nerve in the upper extremity is used to provide motor function for the transplanted muscle. Like tendon transfers, functional muscle transplantation can take place any time after the brachial plexus injury.

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During Brachial Plexus Surgery
• Most surgical procedures to repair brachial plexus nerves are performed with the patient under general anesthesia. • As the surgeon works, the team monitors your nerve function using a technology called evoked potentials. • The specific procedures performed during brachial plexus surgery often depend on what the surgeon discovers when he or she examines the injury up close. These findings provide detail on the extent and severity of the nerve injury. View

During Brachial Plexus Surgery

• Most surgical procedures to repair brachial plexus nerves are performed with the patient under general anesthesia.
• As the surgeon works, the team monitors your nerve function using a technology called evoked potentials.
• The specific procedures performed during brachial plexus surgery often depend on what the surgeon discovers when he or she examines the injury up close. These findings provide detail on the extent and severity of the nerve injury.

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