The anatomy, investigations and management of adult brachial plexus injuries

Brachial plexus injuries have increased in numbers since the turn of the twentieth century in line with the increased use of motorcycles. Advances in microsurgical and tissue transfer techniques have seen the management of such injuries change dramatically during this time period. As a result, surgery for plexus injuries is now considered a legitimate option. Such injuries require extensive medical input in a multidisciplinary environment. All patients should be thoroughly investigated to establish the exact extent of the injury and managed on an individual basis. The options available are conservative or surgical. Conservative options include physiotherapy, orthotics and pain control. Surgical reconstruction of the plexus may involve neurolysis, nerve grafting, nerve transfer and late peripheral reconstruction including arthrodesis, tendon transfers, free muscle transfers and amputation. Despite many advances in the field, injuries still result in considerable disability and loss of working days.