Factors Affecting Shoulder and Elbow Functions in Traumatic Brachial Plexus Surgery

Traumatic brachial plexus palsy (TBPP) is a debilitating condition that commonly affects young adults and results in severe functional loss in the upper extremity. Surgical intervention plays a critical role in restoring function, yet outcomes are influenced by multiple clinical and technical variables. This study aimed to evaluate the impact of injury etiology and surgical techniques on shoulder and elbow functions in patients undergoing surgical treatment for adult TBPP.

A retrospective cohort study was conducted on 57 consecutive adult patients treated surgically for traumatic brachial plexus palsy at a single tertiary center between April 2015 and January 2023. Injuries were classified anatomically (C5-6, C5-6-7, pan-plexus) and by mechanism (motorcycle accidents, motor vehicle collisions, gunshot wounds, falls, crush injuries). Surgical strategies included neurolysis, primary nerve repair, nerve grafting, and four types of nerve transfers- Somsak technique, Oberlin technique, transfer of the spinal accessory nerve to the suprascapular nerve, and transfer of intercostal nerves to the musculocutaneous nerve with humeral shortening employed when necessary. Functional recovery was assessed at a median follow-up of 24 months using the Gilbert-Raimondi scale and joint-specific measurements for shoulder abduction, shoulder external rotation, elbow flexion, and elbow extension. Categorical variables were analyzed using Pearson's chi-square test, Fisher's exact test, and McNemar test, with a significance level set at p < 0.05.

Of the 57 patients, 91.2% were male. The most common injury mechanisms were motorcycle accidents (54.4%) and motor vehicle collisions (22.8%). Lesion distribution included C5-6 (14.0%), C5-6-7 (42.1%), and pan-plexus (43.9%) injuries. Surgical procedures included neurolysis in 19 patients (20.0%), primary nerve repair in 12 (12.6%), nerve grafting in 19 (20.0%), and nerve transfer in 45 (47.4%). Sural nerve grafts were used in 64.9% of patients, and humeral shortening was performed in 10.5%. Postoperative functional outcomes improved significantly across all parameters. Recovery rates were highest in C5-6 lesions (87-100%), moderate in C5-6-7 (50-72%), and lowest in pan-plexus injuries (25-40%). Neither injury mechanism nor adjunct procedures significantly influenced outcomes, and no single surgical technique demonstrated overall superiority.

Anatomical injury severity remains an important prognostic factor in traumatic brachial plexus surgery. The examined techniques were associated with meaningful recovery; however, selection is generally guided by lesion extent and individual patient factors rather than injury mechanism or the use of adjunctive procedures.

The online version contains supplementary material available at 10.1007/s43465-025-01531-1.