Treatment of adult and obstetrical brachial plexus injuries

Twenty-five percent of patients with injuries to the plexus require surgical intervention for optimal results. Patients with loss of serratus and rhomboids, Horner's syndrome, positive myelogram, or negative evoked potentials have a high incidence of lower root avulsions and a probability of upper root ruptures. These should be explored early. Results depend on the amount of remaining axonal input available for grafting. Using intraoperative electrical studies, elements which will recover spontaneously may be saved and improved function obtained by grafting only damaged elements. Obstetrical palsy patients should be immobilized for several weeks; passive stretching should then be done. Recovery within 2 months yields a normal arm; if recovery of the biceps or arm occurs within 3 months, the arm will be good. If biceps recovery has not begun by the third month, surgical intervention with appropriate repair will yield at least one grade higher function than in conservatively treated patients.