Brachial plexus surgery: A new technique in panbrachial plexus injury

In total brachial plexus injury when ipsilateral spinal accessory nerve is also traumatized we offer the use of contralateral SAN as an additional option in the reinnervation of suprascapular nerve. Technique- Through a transverse incision over the spine of scapula, the distal part of suprascapular nerve (SSN) is dissected up to the suprascapular notch. SSN…

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Recent advances in brachial plexus surgery

Traditionally, spinal accessory to suprascapular nerve transfers have been performed by anterior approaches. However transection of spinal accessory nerve at proximal level leads to denervation of upper trapezius, which plays an important role in shoulder function. Distal transection spares the important branches to trapezius and preserves its function of shoulder stabilization and elevation. Dorsal/ Posterior…

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Brachial plexus surgery: Its past, present and future

Background-Traumatic brachial plexus injury is a devastating condition resulting   mainly from motor cycle accidents and primarily affecting the young adults. In the past there was a pessimistic attitude in the management of these injuries. However in last two decades with the introduction of microsurgical techniques and advancements in imaging modalities, these injuries are being explored…

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Surgery for brachial plexus injury: Clinical examination

A patient with brachial plexus injury is likely to have sustained other concomitant injuries; head injury, fractures in the cervical spine, clavicle, scapula, and extremities, chest and abdominal trauma and vascular injuries. The neurological examination should determine the specific motor and sensory deficits. The British Medical Research Council grading system is used to measure the…

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Surgery for brachial plexus injury: Management strategy

C5 – C6 and upper truncal injury An upper truncal injury with intact nerve roots is amenable to nerve graft repair. In C5-C6 root avulsion injury nerve transfers offer far superior results over tendon/ muscle transfers or shoulder arthrodesis . Nerve transfer between the distal spinal accessory nerve and the suprascapular nerve through the posterior…

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Surgery for brachial plexus injury: Upper root avulsions

In C5,C6 root avulsions the proximal root stumps are not available for grafting, hence repair is based on nerve transfer or neurotization. Restoration of elbow flexion takes priority in functional reconstruction, followed by shoulder abduction and external rotation. Reinnervation of musculocutaneous nerve has been achieved with transfer of a variety of donor nerves; the spinal…

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