Brachial Plexus Injury Types

Chapter 4 Brachial Plexus Injury Types



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Figure 4-1 A, Preganglionic C5 and C6 injury. B, Repair with nerve transfers of cranial nerve (CN) XI to the suprascapular nerve (SCN), of the descending cervical plexus to the posterior division of the upper trunk, and of the medial pectoral nerve to the musculocutaneous nerve.


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Figure 4-2 A, Patient’s photo. B, Myelogram. C, Postmyelogram computed tomography. D, Intraoperative photo of a preganglionic avulsion injury. Black arrow, normal rootlet; white arrow, avulsed rootlets.


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Figure 4-3 A, C5 preganglionic and C6 postganglionic injury. B, Repair with nerve transfer of CN XI to the SCN and direct C6 graft repair to the anterior and posterior divisions of the upper trunk. C, C5 preganglionic and C6 postganglionic injury and repair with nerve transfer of CN XI to the SCN and Oberlin procedure (split interfascicular ulnar nerve transfer repair to the biceps branch).


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Figure 4-4 Intraoperative photos of a spinal accessory nerve (CN XI) to suprascapular nerve transfer. SCN, suprascapular nerve.


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Figure 4-5 A, C5 preganglionic and C6 and C7 postganglionic injuries. B, Repair with nerve transfer of CN XI to the SCN, C6 graft repair to the anterior and posterior divisions of the upper trunk, and C7 graft repair to the anterior and posterior divisions of the middle trunk.


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Figure 4-6 A, C5 preganglionic and C6 to C8 postganglionic injuries. B, Repair with nerve transfers of CN XI to the SCN and of the descending cervical plexus to the posterior division of the upper trunk, C6 graft repair to the anterior and posterior divisions of the upper trunk, and C7 graft repair to the anterior and posterior divisions of the middle trunk. If there is enough graft left after constructing C5 to C7, C8 can be repaired, as well.


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Figure 4-7 A, C5 preganglionic and C6 to T1 postganglionic injuries. B, Repair with nerve transfers of CN XI to the SCN, of the descending cervical plexus to the posterior division of the upper trunk, C6 graft repair to the anterior and posterior divisions of the upper trunk, C7 graft repair to the anterior and posterior divisions of the middle trunk, and C8 and T1 graft repair to the anterior and posterior divisions of the lower trunk.


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Figure 4-8 Intraoperative photo of nerve transfer of the intercostal nerve to the musculocutaneous nerve.


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Figure 4-9 A, C5 and C6 preganglionic and C7 to T1 postganglionic injuries. B, Repair with nerve transfers of CN XI to the SCN, of the descending cervical plexus to the musculocutaneous nerve, of C7 to the anterior and posterior divisions of the middle trunk, and of C8 to the anterior and posterior divisions of the lower trunk. If there is enough graft left after constructing C5 to C8, T1 can be repaired, as well.


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Figure 4-10 A, C5 to C7 preganglionic injuries. B, Repair with nerve transfers of CN XI to the SCN, of an intercostal nerve to the axillary nerve, and of the medial pectoral nerve to the musculocutaneous nerve.


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Figure 4-11 A, C5 to T1 preganglionic injuries. B, Repair with nerve transfers of CN XI to the SCN and of the descending cervical plexus to the posterior division of the upper trunk, and phrenic nerve to musculocutaneous nerve graft repair.


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Figure 4-12 C5 to T1 preganglionic injuries and repair. Another method of repair for this injury is nerve transfer of CN XI to the SCN, and contralateral C7 split graft to the musculocutaneous nerve.

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Jul 16, 2016 | Posted by in NEUROLOGY | Comments Off on Brachial Plexus Injury Types

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