Rehabilitation after partial brachial plexus palsy

1. Plastic Surgeon at the Hospital Sarah Brasília, Full Member of the Sociedade Brasileira de Cirurgia Plástica (Brazilian Society of Plastic Surgery – SBCP), President of the Regional do Distrito Federal da SBCP, Brasília, DF, Brazil 2. Plastic Surgeon at the Hospital Sarah Brasília, Full Member of the SBCP, Brasília, DF, Brazil. ABSTRACT A variety of muscle transfer techniques have been proposed to restore motion of the upper extremities following severe brachial plexus palsy. Paralysis of the deltoid and supraspi­ natus muscles can be treated with transfer of the trapezius muscle. Paralysis of the wrist, hand, and digital extensor muscles can be corrected using the pronator teres, flexor carpi ulnaris, and palmaris longus muscles if the median nerve is preserved. Here we describe the rehabilitation of a patient with an old partial injury to the right brachial plexus that primarily involved the upper trunk from the C6 root to the posterior cord. Weakness of the deltoid muscle, wrist, and digital extensor muscles was observed. Microsurgical repair of the brachial plexus had not been performed. Tendon transfer surgery was performed to improve wrist, hand, and digital extension. One year later, transfer of the trapezius muscle was performed to stabilize the shoulder. The success of muscle transfer in the treatment of the brachial plexus palsy required the surgeon’s specialization, the patient’s motivation, and a rehabilitation program.