Adult Total Brachial Plexus Injury

Total brachial plexus injury (BPI) typically results from high-energy vehicular accidents, affects mostly young adult males, and produces a flail, insensate limb. Because of the association of total BPI with head and cervical spine injuries, diagnosis might be delayed. Recognizing patients with total BPI and using electrodiagnostic and imaging tests in a timely fashion are critical. Advances in microsurgical techniques, primary nerve transfer, appropriate nerve graft utilization from a remaining intact (often C5) spinal nerve root, and free muscle transfers have improved outcomes. However, limited recovery even after reconstruction and severe deafferentation pain both remain challenging problems that further advancements will need to overcome.