Clinical problem-solving: Brachial plexus closed injury and reconstruction

OBJECTIVE: Current management of severe brachial plexus injury has undergone recent modifications, and surgical options have expanded. METHODS: The case of a man with a severe closed brachial plexus injury resulting from a motorcycle accident is presented. The patient is found to have upper root avulsions that deprive him of function in the proximal arm. RESULTS: Pre-, intra-, and postoperative decision making is reviewed by an expert in peripheral nerve surgery. Attention is paid to both diagnosis and management. A brief review of the literature pertaining to these points follows. CONCLUSION: The recent expansion of surgical options for the management of severe brachial plexus injury has introduced significant controversy into this field.