A comprehensive JAAOS review covering the evaluation and surgical management of adult traumatic brachial plexus injuries — from anatomy and electrodiagnostic workup through nerve grafting, neurotization, and free muscle transfer — addressing the question of how to select patients, time surgery, and prioritize functional restoration.
When evaluating a brachial plexus injury, a normal SNAP in an insensate distribution localizes the lesion as preganglionic (root avulsion) — ruling out spontaneous recovery and directing you toward nerve transfer rather than grafting.
Prioritize elbow flexion first when planning reconstruction, and recognize that the Oberlin transfer gives the best elbow flexion outcomes when C8-T1 are intact.
A comprehensive JAAOS review covering the evaluation and surgical management of adult traumatic brachial plexus injuries — from anatomy and electrodiagnostic workup through nerve grafting, neurotization, and free muscle transfer — addressing the question of how to select patients, time surgery, and prioritize functional restoration.
When evaluating a brachial plexus injury, a normal SNAP in an insensate distribution localizes the lesion as preganglionic (root avulsion) — ruling out spontaneous recovery and directing you toward nerve transfer rather than grafting.
Prioritize elbow flexion first when planning reconstruction, and recognize that the Oberlin transfer gives the best elbow flexion outcomes when C8-T1 are intact.