Brachial Plexus Surgery For more information, please visit our Peripheral Nerve Neurosurgery Program site What does it do? The brachial plexus is a complex of nerves, originating from the spine, giving branches through the neck, the axilla, to the shoulder, arm, forearm, and hand. Nerves are like electrical cables that connect our brain to various parts of the body, carrying signals to and from the brain. The brachial plexus provides the wiring (innervation) for the upper limb. Abnormalities affecting the integrity of the brachial plexus, such as injury or tumor growth can severely impair the function of the arm, forearm, and hand. What causes a brachial plexus injury? After significant trauma, such as in penetrating injuries, motor vehicle accidents and extreme sporting accidents the nerves in the complex of the brachial plexus may sustain disruption or extreme stretch/displacement with temporary or permanent loss of function. Similar injuries can occur to newborns at birth. Can it be cured? As each patient is different in terms of the extend of injury, the spontaneous recovery from a brachial plexus injury could vary significantly. Only about 40–50 years ago, treatment of brachial plexus injuries was not considered feasible even amongst leaders of the field. However, advances in surgical techniques and increased knowledge of the nerve physiology have led to improved outcomes. The purpose of surgical intervention is to promote the recovery of the nerves, or to improve the function of the affected limb. Unfortunately, the complete recovery of function would not be possible in certain types of injury. How is it treated? A multidisciplinary team would evaluate the patient, aiming to support his needs throughout his usually prolonged course of initial therapy. The mechanism of injury and the neurological examination would provide an initial estimation of the extend of injury and would dictate the need for additional radiological or electrophysiological tests, as well as the need for emergent or delayed intervention. An observational period of 3-6 months may be indicated in certain cases, in order to optimize the final outcome. Once surgical intervention is considered, the exact location and extend of injury will guide the specific indicated technique. Several option are available such as nerve grafting, nerve transfers, muscle transfers, tendon transfers, and a combination of these techniques. All surgical interventions are performed with the patient under general anesthesia. An anterior approach is used for most brachial plexus lesions, however, a posterior procedure can be used in some patients. Recovery period could be quite lengthy in some cases.