BRACHIAL PLEXUS AVULSION:
Incidence: Frequent
A common neurologic injury from trauma (such as being hit by a car) is that of brachial
plexus avulsion. The brachial plexus is susceptible to injuries that produce abduction of the
thoracic limb from the body wall or a direct blow to the lateral surface of the scapula.
The
cardinal signs of brachial plexus avulsion are a monoplegia of one front leg, Horner’s syndrome
on the affected side, lack of panniculus response on the side of the lesion and a Babinski’s sign
in the ipsilateral rear leg.
The nerve roots are stretched or torn from their origin by this trauma,
since the meningeal coverings of the nerve roots are thinner than those in the peripheral nerve.
The epineurium of the peripheral nerve is contiguous with the dural mater, providing extra
support to the peripheral nerves. In cases where the nerve roots have been torn, recovery in
unlikely without new experimental surgical techniques.
The diagnosis may be confirmed by EMG examination in 5-7 days. The evidence of
denervation will be evident. If there is no nerve conduction 72 hours after the injury, then
avulsion is most likely.
Treatment is with time, physical therapy and protection from injury.
If there is no
problem with the leg, then amputation is not warranted until, at least, 6 months of time has past.
On the other hand, if the leg gets infected or troubles the patient, amputation may help the
patient. Serial neurologic assessments and EMG examinations may help determine the ultimate
prognosis.
Some patients experience “tingling” of the foot as healing occurs. These patients can
attack the foot causing considerable self-mutilation, even months after the initial injury. |
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