Evaluation and surgical repair of brachial plexus injuries

Traumatic injuries of the brachial plexus may result in severe and permanent loss of motor and sensory function of the involved extremity. The neurosurgeon's ability to improve the functional outcome following a plexus injury requires an understanding of the functional anatomy of the brachial plexus, the pathophysiology of nerve injury, and the natural history of these lesions. Primary reanastomosis, neurolysis, and nerve grafting techniques are commonly used to restore normal axonal continuity. When these options are unavailable, muscle and tendon transfers or neurotization techniques have been successful in achieving functional restoration of limb movements.