Combined dorsal root entry zone lesions and neural reconstruction for early rehabilitation of brachial plexus avulsion injury

Brachial plexus avulsion injury is one of the major complications after traffic, especially motorcycle accidents. During the past 12 years, we have encountered more than 40 brachial plexus avulsion injuries. The neurological deficits included pain and paralysis of the damaged limb. Dorsal root entry zone lesions made by thermocoagulation were performed for intractable pain in 34 cases. The pain relief rate was good in about 75%. Combined neural reconstruction was performed in 15 cases. The reconstruction included neurolysis, nerve graft, nerve transfer, and functioning muscle/tendon transfer etc. There were 13 male and 2 female patients. Age distribution was from 21 to 61 years with a mean age of 41.8 years. Eleven patients were found to have whole brachial plexus injury and 4 with upper brachial plexus injury. Twelve patients had good pain relief. Six patients showed good functional result after reconstruction. Three had no improvement. Combined pain control and reconstruction offer an early rehabilitation for brachial plexus avulsion injury.