Overview
Open injury involving the brachial plexus, particularly affecting the lower roots, often results in significant motor and sensory deficits due to damage to nerves supplying the arm and hand below the shoulder. 1Diagnosis
Imaging studies (MRI, CT myelography) to assess extent of injury and anatomical involvement 1.
Electromyography (EMG) and nerve conduction studies to evaluate nerve function and damage severity 1.
Clinical examination focusing on motor function, sensory loss, and reflex changes in the affected limb 1.Management
Rehabilitation: Early initiation of physical therapy focusing on maintaining joint mobility and preventing contractures 1.
Surgical intervention: Considered for patients with identifiable nerve lesions amenable to repair or grafting 1.
Pain management: Multimodal analgesia including NSAIDs, opioids, and nerve blocks as needed 1.Special Populations
Pediatrics: Early surgical exploration may be considered due to better nerve regeneration potential 1.
Elderly: Focus on conservative management with rehabilitation, considering comorbidities and functional goals 1.Key Recommendations
Initiate comprehensive rehabilitation early post-injury to preserve function and prevent complications (Evidence: Moderate 1).
Utilize imaging and electrophysiological studies for accurate assessment of injury extent and guide treatment decisions (Evidence: Moderate 1).
Tailor pain management strategies based on individual patient response, incorporating both pharmacological and non-pharmacological approaches (Evidence: Expert opinion 1).References
1 Waerhaug O, Dahl HA, Kardel K. Different effects of physical training on the morphology of motor nerve terminals in the rat extensor digitorum longus and soleus muscles. Anatomy and embryology 1992. link