Upper trunk brachial plexus palsy is fairly common . It is around 30% of all brachial plexus palsy. Most common cause are automobile accident eg; motorcycle accident .
Patient typically has lost shoulder and elbow function. Cervical roots involved are C5, 6 or C5,6,7. It is commonly known as upper trunk palsy with good hand or upper trunk palsy with poor hand.
MRI and nerve conduction studies are done to localise lesion. Ideal time to operate is around 3-6 months. Though upto one year people have operated with good results especially in young patients.
Patients have shoulder and elbow function deficit and focus of surgery is to restore these functions.Three nerve transfer are done to restore shoulder and elbow function.These patients are examined to check their functional deficit as well as they're functioning muscles esp triceps,trapezius and hand flexors.
If these are intact then patient under go three nerve transfer to yield good results. In most of cases it results in restoration of near normal extremity function. For shoulder we plan two nerve transfer and for elbow one nerve transfer is planned . For shoulder we usually do Spinal accessory to supra scapular nerve and Somsack transfer . For elbow single fascicular or double fascicular nerve transfer done .
Spinal accessory is a pure motor nerve that supply sternocleidomastoid and trapezius , usually lower of nerve supplying lower part of trapezius is used , Suprascapular nerve is taken of just after erbs point is taken , a posterior approach is also described.But I think it is less relevant.
Somsacarek transfer is transfer of functioning fascicle of radial nerve supplying triceps and transfer to axillary nerve.
Elbow function can be restored by nerve transfer , various donor nerve are available. Phrenic nerve, fascicle from median , fascicular transfer from ulnar nerve and intercostal nerve are common donor nerve used .
Oberlin transfer single or double fascicular transfer to musculocutaneous nerve or nerve to biceps or brachialis. It has success rate of excess of 85%. For intercostals usually 3 nerve are taken and results of intercostal transfer are guarded at best.
These patients may have wrist drop and pronator contracture . These problems are tackled as they come . Since brachial plexus may variable presentation in hand paresis , tendon transfer are done as per need. Tendon transfer are typically done after 2 years of nerve surgery when recovery is complete.
Physiotherapy can restore joint suppleness , prevent contracture , but it cannot restored broken nerves. So surgery along with physiotherapy play important in restoring function of the extremity.
Dr Adhishwar Sharma
MBBS ,MS Gen Surgery PGIMER
Mch Plastic Surgery
Fellowship in Hand and Microvascular surgery
8860650846, adhishwar7@gmail.com
Patient typically has lost shoulder and elbow function. Cervical roots involved are C5, 6 or C5,6,7. It is commonly known as upper trunk palsy with good hand or upper trunk palsy with poor hand.
MRI and nerve conduction studies are done to localise lesion. Ideal time to operate is around 3-6 months. Though upto one year people have operated with good results especially in young patients.
Patients have shoulder and elbow function deficit and focus of surgery is to restore these functions.Three nerve transfer are done to restore shoulder and elbow function.These patients are examined to check their functional deficit as well as they're functioning muscles esp triceps,trapezius and hand flexors.
If these are intact then patient under go three nerve transfer to yield good results. In most of cases it results in restoration of near normal extremity function. For shoulder we plan two nerve transfer and for elbow one nerve transfer is planned . For shoulder we usually do Spinal accessory to supra scapular nerve and Somsack transfer . For elbow single fascicular or double fascicular nerve transfer done .
Spinal accessory is a pure motor nerve that supply sternocleidomastoid and trapezius , usually lower of nerve supplying lower part of trapezius is used , Suprascapular nerve is taken of just after erbs point is taken , a posterior approach is also described.But I think it is less relevant.
Somsacarek transfer is transfer of functioning fascicle of radial nerve supplying triceps and transfer to axillary nerve.
Elbow function can be restored by nerve transfer , various donor nerve are available. Phrenic nerve, fascicle from median , fascicular transfer from ulnar nerve and intercostal nerve are common donor nerve used .
Oberlin transfer single or double fascicular transfer to musculocutaneous nerve or nerve to biceps or brachialis. It has success rate of excess of 85%. For intercostals usually 3 nerve are taken and results of intercostal transfer are guarded at best.
These patients may have wrist drop and pronator contracture . These problems are tackled as they come . Since brachial plexus may variable presentation in hand paresis , tendon transfer are done as per need. Tendon transfer are typically done after 2 years of nerve surgery when recovery is complete.
Physiotherapy can restore joint suppleness , prevent contracture , but it cannot restored broken nerves. So surgery along with physiotherapy play important in restoring function of the extremity.
Dr Adhishwar Sharma
MBBS ,MS Gen Surgery PGIMER
Mch Plastic Surgery
Fellowship in Hand and Microvascular surgery
8860650846, adhishwar7@gmail.com
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