Brachial Plexus Injury in Adults

Brachial plexus injury (BPI) is a severe peripheral nerve injury affecting upper extremities, causing functional damage and physical disability. The most common cause of adult BPI is a traffic accident, and the incidence has steadily increased since the 1980s. BPIs can be divided into three types; preganglionic lesion, postganglionic lesion, and a combination of both. Whether the continuation of the root and the spinal cord is preserved is a critical factor in determining the treatment strategy. The level of lesion can be analogized by clinical manifestations. But imaging studies including computed tomography (CT) myelography and magnetic resonance imaging (MRI) as well as electrodiagnostic studies are helpful in diagnosis of BPI. If diagnostic electromyography suggests that the damage is nondegenerative, conservative management is indicated. However, a reconstructive plan should be formulated, when there is no evidence of spontaneous recovery within 6 months of injury. Operative options used in BPI include nerve grafting, neurotization (nerve transfer), and other brachial plexus reconstructive techniques including the transplantation of various structures. In this review article, the mechanism and classification of injury, clinical manifestations, updated diagnostic studies, recent treatment strategies, and pain after BPI would be discussed.