Coordinated function oriented movements after multiple root avulsion

In the early years of brachial plexus surgery the surgeon was happy if the patient developed voluntary movement of certain muscles especially of the biceps to flex the elbow joint. Degree of flexion and force of flexion were utilized to prove success. For the patient, however, flexion alone is not of much use if he cannot do external rotation. The real goal for evaluation of brachial plexus surgery should be the ability to perform coordinated, complex movements. To achieve complex movements after a peripheral nerve lesion is rather easy if continuity of a nerve defect could be restored. This is much more difficult in cases of root avulsions. In such cases cerebral plasticity plays a decisive role. This is illustrated by typical cases.