Traumatic injuries to the brachial plexus.

Transient lesions of the brachial plexus are fairly common but are difficult to recognize early because of other associated severe injuries of the brain and skeleton. They often cause hand edema, producing stiffness. In recent years, the understanding of the role of afferent sensory impulses and the application of microsurgical technique has helped in development of newer methods for surgical rehabilitation of the arm and hand. However, repair of the brachial plexus has to be supplemented by sequential reconstruction designed to restore the function of the shoulder, elbow, and hand. Although the diagnosis and treatment have to be individualized, the reconstruction must begin with the hand, in which time is of the essence and the sequelae of untreated edema, stiffening of the joint, and immobility of gliding tissues may result in irreversible rigidity. The methods used in restoration of prehension and moving grip of the hand, as well as various procedures for reconstruction of the elbow and the shoulder, have been presented with their application in four patients, illustrating the different approaches and final function.