Complete Brachial Plexus Injury

About Complete Brachial Plexus Injury

Chronic complete brachial plexus injury describes a flail, insensate arm where motor end-plates in distant muscles have largely degenerated. Severe nerve injury arm cases at this stage rarely benefit from nerve repair or transfer alone. Treatment instead concentrates on what is still functional, redirecting living muscles and using free transfers to power priority targets such as elbow flexion.

Assessment maps every active muscle, joint range, sensation and skin condition. We document scapular control, shoulder stability and any residual hand activity. Imaging identifies bone, joint or vascular issues, and pre-anaesthetic review confirms fitness for major reconstructive surgery. Goals are agreed before surgery so that patients understand what each procedure can realistically achieve.

Functional reconstruction usually starts with elbow flexion, the single most useful gain for daily activity. Free functioning gracilis transfer powered by intercostal or contralateral C7 nerves is a workhorse in complete chronic injuries. Pectoralis major or latissimus transfers may be considered if usable. Shoulder stability is restored through trapezius transfer or selected arthrodesis, depending on scapular control and pain.

Hand function is the most difficult target. Selected patients benefit from free muscle transfer to power finger flexion or wrist function, combined with tendon transfers and joint fusions. Sensory transfers, where feasible, protect the hand from injury. Complete nerve damage treatment in this setting is intentionally staged so each phase can be rehabilitated before the next is added.

Surgery is performed under general anaesthesia with careful microsurgical technique for free muscle transfer. Postoperative care includes immobilisation, vascular monitoring and gradual reactivation of the transferred muscle. Smoking is strictly avoided, as it threatens flap survival and nerve healing. Hospital stay typically lasts five to ten days depending on the complexity of the brachial plexus reconstruction.

Rehabilitation runs over many months and is essential to outcome. Physiotherapy retrains transferred muscles, gradually integrating them into purposeful activity. Reviews continue for one to two years, with additional procedures planned only after earlier ones have matured. Our aim is a stable shoulder, useful elbow flexion and a protected, partially functional hand that supports independence in daily life.

What to expect

• Detailed mapping of active muscles, joints and sensation
• Free functioning muscle transfer for elbow flexion in selected cases
• Tendon transfers and joint fusions for shoulder stability
• Staged hand procedures where useful function is achievable
• Strict smoking and lifestyle counselling to support healing
• Long-term physiotherapy and structured surgical reviews

Recovery

• Immobilisation and vascular monitoring after free muscle transfer
• Hospital stay of five to ten days for complex reconstructions
• Gradual reactivation of transferred muscles starting around six weeks
• Months of physiotherapy to integrate new movements into daily life
• Periodic review for possible secondary procedures over one to two years