CLINICAL FEATURES OF BRACHİAL PLEXUS

Traction injuries of the brachial plexus may be divided into four main groups: 1) lesions
of C.5 and 6; 2) lesions of C.5, 6, and 7; 3) lesions of the whole plexus; 4) lesions of C.7,
C.8, and T. 1. The distribution of anaesthesia and muscular paralysis in each of these groups
is too well-known to require description. The muscular branches are not always derived
from the same roots of the plexus and for this reason there is some variation in the extent of paralysis in each group. Sometimes the third and fourth cervical roots are involved.
in the traction injury, in which case the area of anaesthesia extends over the shoulder on to the side of the neck.
Paralysis is always most extensive immediately after injury. Study of these cases has produced no evidence to support the contention of Davis, Martin, and Perret
(1947) that “subsequent extensive scar tissue formation tends to impair to various degrees
many originally uninjured portions of the plexus, and gives rise to disseminated and
incomplete motor and sensory disturbances.” This view is still widely held and it is
responsible for much futile and even mischievous surgery.
It is impossible by clinical examination to determine the prospects of recovery in
degenerative lesions of the nerve roots. The clinical picture of a degenerative lesion of the
axons, a lesion with rupture of axons and intraneural scarring, and a complete rupture of
the nerve root, are identical. Early operation is often advised in order to discover the exact nature of the lesion but unless the nerve roots are ruptured, which as we have seen is
infrequent, there is nothing to be gained. If the nerve is in continuity it is quite impossible
by naked-eye examination to give a satisfactory prognosis.