Brachial Plexus Injury Types

Published on 08/03/2015 by admin

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Last modified 22/04/2025

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Chapter 4 Brachial Plexus Injury Types

Figure 4-1 A, Preganglionic C5 and C6 injury. B, Repair with nerve transfers of cranial nerve (CN) XI to the suprascapular nerve (SCN), of the descending cervical plexus to the posterior division of the upper trunk, and of the medial pectoral nerve to the musculocutaneous nerve.

Figure 4-2 A, Patient’s photo. B, Myelogram. C, Postmyelogram computed tomography. D, Intraoperative photo of a preganglionic avulsion injury. Black arrow, normal rootlet; white arrow, avulsed rootlets.

Figure 4-3 A, C5 preganglionic and C6 postganglionic injury. B, Repair with nerve transfer of CN XI to the SCN and direct C6 graft repair to the anterior and posterior divisions of the upper trunk. C, C5 preganglionic and C6 postganglionic injury and repair with nerve transfer of CN XI to the SCN and Oberlin procedure (split interfascicular ulnar nerve transfer repair to the biceps branch).

Figure 4-4 Intraoperative photos of a spinal accessory nerve (CN XI) to suprascapular nerve transfer. SCN, suprascapular nerve.

Figure 4-5 A, C5 preganglionic and C6 and C7 postganglionic injuries. B, Repair with nerve transfer of CN XI to the SCN, C6 graft repair to the anterior and posterior divisions of the upper trunk, and C7 graft repair to the anterior and posterior divisions of the middle trunk.

Figure 4-6 A, C5 preganglionic and C6 to C8 postganglionic injuries. B, Repair with nerve transfers of CN XI to the SCN and of the descending cervical plexus to the posterior division of the upper trunk, C6 graft repair to the anterior and posterior divisions of the upper trunk, and C7 graft repair to the anterior and posterior divisions of the middle trunk. If there is enough graft left after constructing C5 to C7, C8 can be repaired, as well.

Figure 4-7 A, C5 preganglionic and C6 to T1 postganglionic injuries. B, Repair with nerve transfers of CN XI to the SCN, of the descending cervical plexus to the posterior division of the upper trunk, C6 graft repair to the anterior and posterior divisions of the upper trunk, C7 graft repair to the anterior and posterior divisions of the middle trunk, and C8 and T1 graft repair to the anterior and posterior divisions of the lower trunk.

Figure 4-8 Intraoperative photo of nerve transfer of the intercostal nerve to the musculocutaneous nerve.

Figure 4-9 A, C5 and C6 preganglionic and C7 to T1 postganglionic injuries. B, Repair with nerve transfers of CN XI to the SCN, of the descending cervical plexus to the musculocutaneous nerve, of C7 to the anterior and posterior divisions of the middle trunk, and of C8 to the anterior and posterior divisions of the lower trunk. If there is enough graft left after constructing C5 to C8, T1 can be repaired, as well.

Figure 4-10 A, C5 to C7 preganglionic injuries. B, Repair with nerve transfers of CN XI to the SCN, of an intercostal nerve to the axillary nerve, and of the medial pectoral nerve to the musculocutaneous nerve.

Figure 4-11 A, C5 to T1 preganglionic injuries. B, Repair with nerve transfers of CN XI to the SCN and of the descending cervical plexus to the posterior division of the upper trunk, and phrenic nerve to musculocutaneous nerve graft repair.

Figure 4-12 C5 to T1 preganglionic injuries and repair. Another method of repair for this injury is nerve transfer of CN XI to the SCN, and contralateral C7 split graft to the musculocutaneous nerve.

Figure 4-13 A, Bilateral skin incisions. B, An intraoperative photo of a nerve graft involving a contralateral graft to the musculocutaneous nerve.

Figure 4-14 A, C6 preganglionic and C5 postganglionic injury. B, Repair with nerve transfers of CN XI to the SCN and of C5 to the anterior and posterior divisions of the upper trunk.

Figure 4-15 Intraoperative photo of nerve transfers from CN XI to the SCN and of C5 to the anterior and posterior divisions of the upper trunk.

Figure 4-16 C5 interfascicular graft repair to the anterior and posterior divisions of the upper trunk.

Figure 4-17 C5 graft repair to the anterior and posterior divisions of the upper trunk.

Figure 4-18 C5 graft repair to the anterior and posterior divisions of the upper trunk and of CN XI to the SCN.

Figure 4-19 A, C6 preganglionic and C5 to C7 postganglionic injuries. B, Repair with nerve graft repairs of CN XI to the SCN, of C5 to the anterior and posterior divisions of the upper trunk, and of the medial pectoral nerve by means of a split (end to side) to the musculocutaneous nerve.

Figure 4-20 A, C7 preganglionic and C5 and C6 postganglionic injuries. B, Repair with C5 graft repair to the SCN, C5 graft repair to the anterior and posterior divisions of the upper trunk, and C6 graft repair to the anterior and posterior divisions of the upper trunk.

Figure 4-21 A, C6 to T1 preganglionic and C5 postganglionic injuries. B, Repair with nerve transfers of CN XI to the SCN, of the descending cervical plexus to the posterior division of the upper trunk, and of C5 to the anterior and posterior divisions of the upper trunk.

Figure 4-22 A, C8 to T1 preganglionic injury. B, Repair with an intercostal nerve transfer to the ulnar nerve.

Figure 4-23 A, C7 to T1 preganglionic and C5 and C6 postganglionic injuries. B, Repair with nerve transfer of CN XI to the SCN, of the descending cervical plexus to the posterior division of the middle trunk, of C5 to the posterior division of the upper trunk, and of C6 to the anterior division of the upper trunk.

Figure 4-24 A, C5 and C6 postganglionic injury. B, C5 and C6 postganglionic injury is repaired with a C5 graft repair to the suprascapular nerve, a C5 graft repair to the posterior division of the upper trunk, and a C6 transfer to the anterior divisions of the upper trunk.

Figure 4-25 A, C5 to C7 postganglionic injuries. B, C5 to C7 postganglionic injury is repaired with a C5 graft repair to the suprascapular nerve, a C5 graft repair to the posterior division of the upper trunk, a C6 graft repair to the anterior divisions of the upper trunk, and a C7 graft repair to the middle trunk.

Figure 4-26 A, Injury of the lateral cord, the musculocutaneous nerve, and the median nerve. B, Repair with lateral cord graft repairs to the musculocutaneous and median nerves.

Figure 4-27 A, Injuries of the posterior cord and the axillary and radial nerves. B, Repair with posterior cord graft repairs to the axillary and radial nerves.

Figure 4-28 A, Posterior cord to axillary nerve injury. B, Repair with posterior cord graft repairs to the axillary nerve.

Figure 4-29 A, Axillary nerve and suprascapular nerve injury (C5 intact). B, Repair with combined suprascapular and axillary nerve graft repairs.

Figure 4-30 A, Posterior cord to radial nerve injury. B, Repair with a posterior cord graft repair to the radial nerve.

Figure 4-31 A, Medial cord to ulnar nerve injury. B, Repair with a medial cord graft repair to the ulnar nerve.

Figure 4-32 A, Intraoperative photo of a medial cord to ulnar nerve injury. B, The medial cord to ulnar nerve injury is repaired with a medial cord graft repair to the ulnar nerve.

Figure 4-33 A, Lateral and medial cord injury. B, Repair with lateral cord graft repair to the musculocutaneous and median nerves, with a medial cord graft repair to the ulnar and median nerves.

Figure 4-34 A, Total cord to nerve injury. B, Repair with lateral, posterior, and medial cord graft repairs to the musculocutaneous, radial, median, and ulnar nerves.

Figure 4-35 Intraoperative photo of a nerve grafting of C5 to the posterior and lateral cord.

Figure 4-36 Spinal accessory nerve graft repair to the suprascapular nerve.

Figure 4-37 A nerve transfer between the medial pectoral nerve and the musculocutaneous nerve.

Figure 4-38 Nerve transfer of the medial pectoral nerve to the biceps branches of the musculocutaneous nerve.

Figure 4-39 The musculocutaneous and median nerves are exposed.

Figure 4-40 The ulnar nerve is exposed.

Figure 4-41 The ulnar and musculocutaneous nerves are prepared for nerve transfer.

Figure 4-42 The ulnar nerve is split for transfer to the musculocutaneous nerve.

Figure 4-43 A, Intraoperative photo of exposure of the phrenic nerve. B, The phrenic nerve is prepared for nerve transfer.

Figure 4-44 A, An intercostal nerve is dissected and prepared. B, Intercostal nerve graft repair to the musculocutaneous nerve.

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