الفهرس 
Cervical supply to the brachial plexusOnly 14 pages are availabe for public view
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Abstract
Prior to evaluating a patient with a brachial plexus injury the surgeon must have a firm grasp of the relevant anatomy to asses the locus and extent of the injury, the plexus is formed of the anterior primary rami of the lower 4 cervical nerves and the first thoracic nerve, five stages of the plexus could be identified, roots, trunks, divisions, cords and terminal branches.
Brachial plexus lesions frequently lead to significant physical disability, psychological distress, and socioeconomic hardship. These lesions can result from a variety of etiologies, including birth injuries, penetrating
injuries, falls, and motor vehicle trauma. Most are closed injuries involving the supraclavicular region rather than the retroclavicular or infraclavicular level.
Brachial plexus injury can be caused by a wide
variety of circumstances. These etiologic factors can be categorized according to their causative mechanisms Closed injuries as traction, compression, combined lesion and Open injuries as sharp, gunshot, Radiation.
The mechanism of injury producing the plexopathy is important, because some injuries have the potential for recovery, whereas others are less likely to recover on their own. Early surgery on all, especially if suture or graft repairs are done, might preclude spontaneous recovery,
which, in the author’s experience, almost always exceeds, when graded properly, what can be gained by repair. Conversely, neglect of repair or greatly delayed repair is equally deleterious, because, many useful outcomes can now be gained by nerve repair or transfer.
Diagnosis can be made on the basis of the patient’s medical history and neurological examination. Imaging studies such as plain X-ray computed tomography, and magnetic resonance imaging together with electrodiagnostic studies nerve conduction, electromyography, nerve action potential and somatosensory evoked potential are essentially useful.
Management of the plexus injury is influenced by many factors including the patient’s age, the exact anatomical element of the plexus disrupted, and the type as well as the severity of injury. In general, if there is an open injury with clean sharp nerve transaction, immediate repair can be done. If we have an open injury with blunt nerve transection then repair of these elements should be delayed for 3 months, at which time nerve conduction studies and inspection will help discern the extent of the injury Brachial plexus surgery can be divided into primary and secondary reconstruction. Primary reconstruction is
The initial surgical management and may include nerve surgery/reconstruction (eg, direct repair, neurolysis, nerve grafting, nerve transfers) and/or soft-tissue procedures (eg, free functioningmuscle transfer). Secondary reconstruction may be necessary to improve function, either to augment
partial recovery or to obtain function when none has been
achieved. This may include softtissue reconstruction (eg, tendon/ muscle transfer, free muscle transfer) and bony procedures (eg, arthrodesis, osteotomy), but typically not nerve surgery. Often a combination of these techniques can be used, necessitating a broad surgical armamentarium.