Operative Brachial Plexus Surgery

Alexander Y. Shin, MD, Professor of Orthopedic Surgery and Neurosurgery, Department of Orthopedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, Rochester, MN, USANicholas Pulos, MD, Assistant Professor of Department of Orthopedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, Rochester, MN, USA

• Adult Brachial Plexus Injuries: A Historical Perspective.- Part 1 SURGICAL ANATOMY.- Surgical Anatomy of the Brachial Plexus.- Mechanisms of Injury.- Biology of Nerve Injury.- Epidemiology of Adult Traumatic Brachial Plexus Injuries.- Associated Concomitant Injuries.- EVALUATION.- Examination of the Adult Brachial Plexus Patient.- Neurodiagnostic Evalution:  EMG and NCS.- Neurodiagnostic Evalution:  Intraoperative Monitoring.- Adult Brachial Plexus Injuries: Evaluation—Radiologic Evaluation.- ADULT BRACHIAL PLEXUS INJURIES: DETERMINANTS OF TREATMENT (TIMING, INJURY TYPE, INJURY PATTERN).- Priorities of Treatment and Rationale in Adult BPI.- TREATMENT OPTIONS IN ADULTS Root Grafting in Adult Brachial Plexus Injuries.- Nerve Transfers to Shoulder and Elbow.- Free-Functioning Muscle Transfer.- Tendon Transfers of the Shoulder, Elbow, Wrist and Hand.- Glenohumeral arthrodesis in brachial plexus palsy.- Reconstructive Options for the Thumb Axis in a Brachial Plexus Injury.- Wrist arthrodesis in the adult brachial plexus patient.- SURGICAL APPROACHES.- Supraclavicular Exposure of the Brachial Plexus.- Infraclavicular Exposure of the Brachial Plexus.- Posterior Approach for Spinal Accessory to Suprascapular Nerve.- Surgical Approach: Axillary Posterior.- Anterior Approach for Axillary Nerve Reconstruction.- Upper brachium approach: the “Ulnar-Biceps Median-Brachialis” double nerve transfer.- Intercostal nerve harvest in brachial plexus injuries.- Sural Nerve Harvest.- Contralateral C7 nerve transfer in the Treatment of Adult Brachial plexus Injuries and Spastic Hemiplegia.- The harvest of a free innervated functional gracilis muscle and its use in brachial plexus injuries.- MANAGEMENT OF SPECIFIC INJURY PATTERNS.- Management of C5-6 Injuries.- Management of C5-7 Injuries.-Strategies for Pan Brachial Plexus Reconstruction:  The Mayo Clinic Brachial Plexus Team Approach.- Lower type injuries of the brachial plexus (C6-T1, C7-T1 and C8-T1 root involvement).- RESTORATION OF HAND FUNCTION IN PAN PLEXUS INJURY.- Restoration of Hand Function in Pan Plexus Injury - Double Free Functioning Muscle Transfer.-Restoration of hand function in total brachial plexus avulsion injury.- Intercostal nerve transfer for sensory reconstruction of the hand following complete avulsion of the brachial plexus.- Management of Neuropathic Pain Role of Amputation and Prosthetic Fitting.- The Role of Therapy: Pre and Post-Surgery Protocols.- PEDIATRIC BRACHIAL PLEXUS INJURY.- Historical Perspectives.- Mechanism of Injury.- The Biology of Brachial Plexus Birth Injuries.- Epidemiology of Obstetrical Brachial Plexus Injuries.- Associated Concomitant Injuries.- Clinical Examination of the Child with Brachial Plexus Birth Injury.- Operative Brachial Plexus Surgery: Brachial Plexus Birth Injury - Neurodiagnostic Evaluation.- Pediatric Brachial Plexus Injuries: Evaluation—Radiologic Evaluation.- Priorities of Treatment and Rationale (Babies Are Not Small Adults).- Treatment Options in Babies.- Surgical Approaches.- Management of Specific Patterns of Injury-Erbs and Extended Erbs Palsy.- Management of Specific Patterns of Injury-Pan Plexus.- Expected Outcomes.- Late Complications and Treatmen.