Patterns of Brachial Plexus Stretch Palsy in a Prospective Series of 565 Surgically Treated Patients

Purpose To report the distribution of the different patterns of stretch brachial plexus injuries (BPIs) in a retrospective cohort of patients operated at our institution during an 11-yearTeriod. Methods From September 2002 to June 2012, we evaluated and operated on 565 patients with traction injuries of the brachial plexus. Average age was 26.8 years (SD +/- 9.3 years); the interval between the injury and surgery was 5.4 months (SD +/- 2.8 months). The pattern of injury was defined based on data obtained from a standardized clinical examination, preoperative helical computed tomography myelography after intradural contrast injection, surgical findings, and intraoperative electric stimulation. Results Supraclavicular injuries accounted for 91% of all cases (N = 512) whereas 9% of injuries were infraclavicular. Within the supraclavicular injuries, 50% of cases involved the entire plexus and in 12% there was avulsion of all 5 roots. Among them, 94% involved the upper plexus (C5 to C6 +/- C7 +/- C8), and 6% the lower plexus (C8 to T1 +/- C7). C5 to C6 injuries accounted for 23% of partial BPI, C5 to C7 19%, C5 to C8 52%, C7 to T1 4%, and C8 to T1 2%. Conclusions The most relevant findings of this study were that most panplexal BPIs showed at least one graftable root, there was a high prevalence of C5 to C8 BPI, C7 to T1 root injury was the most common pattern of lower type of injury, and infraclavicular BPI was uncommon. Copyright (C) 2017 by the American Society for Surgery of the Hand. All rights reserved.