The brachial plexus (BRAY-key-el PLEK-sis) is a network of nerves that provides movement and feeling to the shoulder, arm and hand. The nerves supporting the arm exit the spinal column high in the neck; those that support the hand and fingers exit lower in the neck.
This nerve complex is composed of four cervical nerve roots (C5-C8) and the first thoracic nerve root (T1). These roots combine to form three trunks. C5-C6 form the upper trunk, C7 continues as the middle trunk and C8-T1 form the lower trunk.
Each trunk splits into a division. Half the divisions globally supply flexor muscles (that lift and bend the arm). The others supply the extensor muscles (that straighten the arm and bring it down)
Patients with a stretch neurapraxia may be able to regenerate healthy nerve tissue. However, recovery is unpredictable. In such cases, the orthopedic surgeon conducts frequent and thorough examinations over the first three to six months following the injury and performs additional imaging and electro-diagnostic tests, as needed. If there is no recovery, the patient is assessed for internal damage to the nerve, and surgery may become necessary.
Although nerve repairs and nerve grafts have been used in the past to reconstruct disrupted nerves in the brachial plexus, these surgeries have met with variable success, and were often inadequate to restore function in patients with severe injuries.
For the past decade, orthopedic surgeons at HSS have used nerve transfers - in addition to nerve grafts and nerve repair - to restore function in these complex cases. While the concept of nerve transfer is not new – it was pioneered in the early 1900’s – novel techniques of nerve transfer have accelerated the pace and extent of recovery of shoulder and elbow function.