Brachial plexus injury is a serious peripheral nerve injury. With the development of the transportation industry, the growth of vehicles is much greater than the expansion of roads, and the lack of compliance with traffic rules, brachial plexus injuries have been on a significant rise in recent years. Most of the patients are motorcycle accidents, and some of them also have a history of drunk driving. Therefore, we must pay enough attention to it. Once the brachial plexus injury is caused, the consequences are still relatively serious and can cause functional impairment to the affected limb, especially total brachial plexus avulsion injury, the efficacy of which is currently very limited internationally and far from the patient’s requirements. So the best treatment is prevention!
First of all we recommend to always obey traffic rules, wear a helmet even on a motorcycle and do not drink alcohol. All brachial plexus patients show signs of disobedience. Secondly, once the brachial plexus injury occurs, the first task is to save lives, such patients are often accompanied by coma, fractures and other organ damage, so saving lives is the first; followed by the treatment of fractures, if necessary, need to perform surgery for internal fixation; for brachial plexus injury patients are very anxious but do not have to be too anxious, brachial plexus injury can be divided into root injury, bundle branch injury; incomplete injury, complete injury ( avulsion injury), nerve shock, etc. Nerve shock does not require treatment, mild injuries can be treated conservatively, and radicular avulsion injuries must be operated on as soon as possible. Therefore, the earliest time for patients to be seen is three weeks after the injury, and only at this time can we determine whether there is a brachial plexus injury or simple nerve shock by doing EMG testing; if EMG testing at this time indicates a radical avulsion injury, we should operate immediately, if systemic conditions allow; if it is a radical partial or bundle branch partial injury, we can observe conservative treatment for three months, and if there is no functional recovery, then If there is no functional recovery, then surgery should be considered.
Every time I see a patient with a brachial plexus injury, I will introduce what a brachial plexus injury is, because only when the patient understands what a brachial plexus injury is, will he or she cooperate well with the treatment and improve compliance, thus improving the outcome. The so-called brachial plexus injury is the upper arm nerve injury, why is it called brachial plexus? Because there are as many nerves innervating the upper arm as there are jungles, one tree cannot be called a jungle, only many trees can be called a jungle, so how many nerves innervate the human upper limb? In short, there are five nerves: the first one directs the abduction and supination of the shoulder joint; the second one is in charge of the elbow flexion; the third one controls the elbow extension, wrist extension and finger extension; the fourth one controls the wrist and finger flexion; and the fifth one is in charge of the fine movements of the hand (similar to lesbian sweaters, etc.). Therefore, when the entire upper limb movement can not do means the whole brachial plexus injury – that is, all five nerves are damaged, if it is an avulsion injury that is the most serious brachial plexus injury. In the case of shoulder and elbow dysfunction, it means injury to the first, second, and third nerves, also known clinically as upper and middle brachial plexus injury. If it is hand dysfunction, it means the fourth and fifth nerves are involved, which is also known as lower brachial plexus injury. Therefore, these three types of injuries are common in clinical practice. Patients can make preliminary judgments based on what I have said, but they still need to come to the hospital for electromyography, MRI and ultrasound testing for accurate diagnosis. The prognosis for upper and middle trunk injuries can still reach 80% left to go, for lower trunk injuries the efficacy is only 50% to 60%, and the efficacy of whole brachial plexus radicular avulsion injury is a little worse, so once the diagnosis is clear, we still recommend early surgical treatment. The main surgical procedures are nerve release, nerve graft repair and nerve transposition repair. For brachial plexus injury, the most important is nerve transposition, and the common ones are: paramedian nerve transposition, healthy cervical 7 transposition, intercostal nerve transposition, Oberlin procedure, brachialis muscle branch transposition, and posterior rotator muscle branch transposition. Different grafts are used depending on the injury, which I will describe in detail in a separate article.
The prognosis of brachial plexus injuries depends not only on the extent of the injury, but also on the quality of the surgery and the postoperative rehabilitation. One of the three is indispensable: the more severe the injury, the worse the outcome; the surgery is not in place, the effect will be reduced; poor exercise and rehabilitation is lacking, and the outcome will be affected. Therefore, preventing the occurrence or reducing the traumatic energy of the limb can reduce the degree of injury; finding the right hospital and doctor can ensure the success of the surgery; and I personally think that the postoperative rehabilitation is the most important, as our academician Gu proposed the postoperative three treasures: active exercise + nerve electrical stimulation therapy + neurotrophic drug application. Adhering to these three magic words will greatly improve our efficacy and allow patients to return to work and improve their quality of life by restoring limb function. I also hope that patients can correctly understand brachial plexus injury, correctly treat brachial plexus injury, and correctly exercise to rehabilitate the injured limb.