Current Methods of Treatment of Traumatic Brachial Plexus Palsy

Abstract

Background: Traumatic brachial plexus palsy is a severe peripheral nerve injury that may result in substantial motor, sensory, and functional impairment of the upper limb. Management depends on the mechanism, anatomical level, severity, and timing of injury, as well as the potential for spontaneous neurological recovery. Early clinical assessment, electrodiagnostic studies, and imaging are essential for selecting the appropriate treatment strategy. Current surgical options include neurolysis, direct nerve repair, nerve grafting, and nerve transfers, with priority given to restoring shoulder stability and movement, elbow flexion, forearm supination, and protective hand sensation. Distal nerve transfers, including double fascicular, medial pectoral, intercostal, and phrenic nerve transfers, have expanded the reconstructive possibilities and may permit earlier reinnervation of target muscles. Appropriate patient selection and timely intervention remain the main determinants of functional outcome. This review summarizes the current principles, timing, indications, and surgical techniques used in the treatment of traumatic brachial plexus palsy.