Neurotization of Brachial Plexus Palsy

INTRODUCTIONBrachial plexus root avulsion injuries, which are devastating, usually result from high-speed accidents. Nerve transfer provides hope for successful treatment of this difficult set of injuries (1).The most violent trauma will result in a lesion at all levels. Rupture of the cords and/or individual infraclavicular nerves will be produced by traction; fractures of the skull, cervical spine, clavicle, first rib or arm yield further data on the mechanism of trauma that has produced the brachial plexus palsy. Heavy impact or crush lesions are caused by direct trauma to the (supra) clavicular region and are nearly always associated with fracture of the clavicle (2).The incidence of obstetric brachial plexus palsy is not declining. Heavy birth weight of the infant and breech delivery are considered two important risk factors and Caesarean section delivery seems to be a protective factor. There are three clinical presentations, that is, paralysis of the upper roots , of total roots, and Klumpke’s palsy involving the C8 and T1 roots which is rarely seen. Computed tomography myelography is still the best way of visualizing nerve roots. Surgical intervention is needed for 20-25% of all patients and clinical information is decisive for the indication of surgery (3).Neurotization for brachial plexus root avulsion injuries