2 The condition, current treatments and procedure

2 The condition, current treatments and procedure

The condition

2.1 The brachial plexus is a network of nerves that carries signals from the spinal cord to the shoulder, arm and hand. These nerves can be damaged by being stretched, compressed or torn from the spinal cord. The most severe brachial plexus injuries are often a result of road traffic accidents. Severe nerve damage can lead to paralysis of an upper limb, with a loss of function and sensation, and severe pain.

Current treatments

2.2 Treatment depends on the type and severity of the injury, and the length of time since the injury. Injuries of the upper brachial plexus roots affect the muscles around the shoulder. Injuries of the lower roots affect the hand. Many injuries affect both upper and lower roots. Current treatments include medicines to treat pain and conservative care (such as physiotherapy). For some people, surgical procedures are needed to restore function. These include direct suture, nerve grafts, nerve transfer, tendon transfer and free-functioning muscle transfer.

The procedure

2.3 This procedure aims to restore the function of the upper limb after brachial plexus injury, improving the patient's ability to carry out daily activities.

2.4 The procedure is done under general anaesthesia, with the patient in a supine position. A functioning gracilis muscle, with its own nerve and blood supply, is dissected from the inner thigh. The gracilis muscle is then transferred and joined to the prepared recipient site of the upper limb. The gracilis muscle's nerve is connected to a functioning nerve in the arm. The transfer is usually to 1 muscle group but transfer to different sites, such as the biceps or the finger flexors, may be needed depending on the nerve injury. The aim is usually to reconstruct a single function, such as elbow flexion.

2.5 After the procedure, the patient needs to wear a cast or splint for about 6 weeks to immobilise the elbow and protect the transferred gracilis muscle. Long-term physiotherapy is needed after the procedure so that the patient can learn to control the transferred muscle.

  • National Institute for Health and Care Excellence (NICE)