Clinical problem-solving: brachial plexus closed injury and reconstruction

Current management of severe brachial plexus injury has undergone recent modifications, and surgical options have expanded.

The case of a man with a severe closed brachial plexus injury resulting from a motorcycle accident is presented. The patient is found to have upper root avulsions that deprive him of function in the proximal arm.

Pre-, intra-, and postoperative decision making is reviewed by an expert in peripheral nerve surgery. Attention is paid to both diagnosis and management. A brief review of the literature pertaining to these points follows.

The recent expansion of surgical options for the management of severe brachial plexus injury has introduced significant controversy into this field.