Patterns of Brachial Plexus Stretch Palsy in a Prospective Series of 565 Surgically Treated Patients.

PURPOSE: To report the distribution of the different patterns of stretch brachial plexus injuries (BPIs) in a retrospective cohort of patients operated at our institution during an 11-year period.

METHODS: From September 2002 to June 2012, we evaluated and operated on 565 patients with traction injuries of the brachial plexus. Average age was 26.8 years (SD ±9.3 years); the interval between the injury and surgery was 5.4 months (SD ±2.8 months). The pattern of injury was defined based on data obtained from a standardized clinical examination, preoperative helical computed tomography myelography after intradural contrast injection, surgical findings, and intraoperative electric stimulation.

RESULTS: Supraclavicular injuries accounted for 91% of all cases (N = 512) whereas 9% of injuries were infraclavicular. Within the supraclavicular injuries, 50% of cases involved the entire plexus and in 12% there was avulsion of all 5 roots. Among them, 94% involved the upper plexus (C5 to C6 ± C7 ± C8), and 6% the lower plexus (C8 to T1 ± C7). C5 to C6 injuries accounted for 23% of partial BPI, C5 to C7 19%, C5 to C8 52%, C7 to T1 4%, and C8 to T1 2%.

CONCLUSIONS: The most relevant findings of this study were that most panplexal BPIs showed at least one graftable root, there was a high prevalence of C5 to C8 BPI, C7 to T1 root injury was the most common pattern of lower type of injury, and infraclavicular BPI was uncommon.

TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.