BRACHIAL PLEXUS INJURIES, TREATMENT AND OPERATION
The brachial plexus is a neural plexus structure, which is formed by the contribution of C5-T1 spinal nerves and is the source of the motor and sensory nerves of the upper extremity, i.e. the arm and the hand. The main nerves of the brachial plexus are the nervus ulnaris, the nervus medianus and the nervus radialis. However, there are other nerves coming out of the plexus, providing the motor and sensory innervations of the shoulder and arm region. Brachial plexus injuries can easily be classified as obstetric paralysis caused by difficult births or traumatic brachial plexus injuries, which occur in increased ages due to various causes, particularly traffic accidents. In these injuries, a decrease in the movements of the arm and hand and loss of sensation can be seen. Brachial plexus injury may result in weakness in shoulder movements, same side posterior displacement of the eyeball (enophthalmos), low eyelid, and small pupil of the eye (miosis) depending on the level and severity of the injury.
The risk of brachial plexus injury increases with difficult births, due to causes such as severely overweight birth, the mother’s narrow birth canal, breech birth, cord entanglement. This injury is caused by an increase in the angle between the child’s head and shoulder and excessive tension of the nerves during birth. Although it is generally unilateral, bilateral cases can also be seen. This damage is usually understood by the family recognizing the immobility of the child’s hand and arm. Congenital arm paralysis can be seen as Erb-Duchenne type paralysis (c5-C6) affecting the upper part, Klumpke Paralysis affecting the lower part and full-nerve injury affecting all nerves. There is a waiter’s hand asking for a tip in Erb’s paralysis type, while the shoulder and elbow movements preserved with no hand movement in very rare Klumpke Paralysis. In the total nerve injury, there is a dangling arm finding.
Fortunately, most of these damages (high rates of up to 90% in some scientific publications) are recovering spontaneously. For this unfortunate minority, what is to be done in the first months of life is a strict follow-up. These children are followed by plastic surgeons and paediatric neurologists.
If the muscle movements are not at the desired level in the first 3 months of life, or first 6 months according to some cults, the procedure to be performed is to provide surgical repair of nerves and in some cases, to repair nerves with nerve grafts taken from the leg. In neurotisation operations, the upper end of an undamaged nerve can be sewn to the injured nerve and nerve transfer can be performed. In the following years, tendon transfer operations, enabling tendons to fulfil the functions of non-working muscles, and bone corrective interventions are performed.
TRAuMATıc BRAchıAL PLEXUS ınjurıes
These are nerve injuries, occurring as a result of shoulder over-pressing, the head’s exposure to force in a way that it would be separated from the shoulder, which is caused by traffic accidents, particularly motorcycle accidents. It can also be caused by firearm and sharp object injuries. Upper and lower nerve roots or total nerve injury may occur. These patients should be considered to have associated vessel injuries and bone fractures and necessary examinations should be made. The clinical image is similar to obstetric palsy. A pulse check must definitely be performed and a necessary surgical intervention should be performed, in case there is a vascular injury. In these patients, immediate exploration and nerve repair can be performed depending on the surgeon’s preference, or surgical intervention can also be performed after a 6-month waiting period. Preoperative and postoperative physiotherapy is an indispensable part of the healing process.