Prognosis at brachial plexus

Perusal of the surgical literature leaves one with the impression that most traction
injuries of the plexus are hopeless surgical problems. So gloomy a view is not supported by
this survey, for many lesions of the plexus recovered satisfactorily provided only that
meticulous attention was given to the details of conservative treatment. Non-degenerative lesions of the plexus always recover quickly and completely. They
are distinguished easily from degenerative lesions by persistence of normal electrical reactions
for longer than eighteen days after injury and by absent, or no more than patchy, sensory
loss in the areas normally innervated by the damaged nerve roots (Seddon 1943). In this
series, thirteen of the sixty-three injuries of the plexus could be described as non-degenerative
lesions and, as one would expect, they were more common when the damage was confined to C.5, 6 nerve roots. In degenerative lesions the pattern of recovery was fairly constant; lesions of C.5, 6
recovered well, whereas some residual palsy was inevitable in lesions of the whole plexus.
The prognosis of lesions of the upper roots of the plexus was not influenced by the level of
the lesion, nor by involvement of the third and fourth cervical nerves in addition to the
main roots of the plexus (Table I). Lesions of C.5, 6 nerve roots-There were fourteen patients with lesions of C.5, or C.5, 6
roots (Table I). Eleven patients regained flexion of the elbow, abduction of the shoulder,
and external rotation of the shoulder, against gravity and resistance, though not all were
capable of sustained effort. Two cases were rated as failures although, in fact, the follow-up
VOL. 31 B, NO. 1, FEBRUARY 194914 R. BARNES period was not sufficient for final assessment. In one patient there was incomplete recovery
in the flexors of the elbow joint. In all cases rated as satisfactory, weak contraction was noted In the paralysed muscles within nine months of injury.
Lesions of C.5, 6, 7 nerve roots-In so far as lesions of C.5, 6, 7 are usually caused by
greater violence, the results of conservative treatment are less satisfactory than in lesions of
C.5, 6 (Table I). Even so, eleven of the nineteen patients in this group regained extension
of the wrist and fingers, flexion of the elbow, and abduction of the shoulder against gravity
and some resistance. In six patients there was incomplete recovery of function in the paralysed
muscles; and two were failures. The residual paralysis in the six incomplete recoveries was interesting. Half the patients
had residual paralysis of the abductors and external rotators of the shoulder; these injuries
of the plexus were apparently caused by forcible depression of the shoulder with the limb
by the side. The other three patients had residual paralysis of the extensors of the wrist
and fingers, the plexus injury being caused by the abducted limb being forced behind the
trunk.