Chapter 27 - Traumatic Brachial Plexus Injuries

Question 1

If the serratus anterior and rhomboids are intact, what does that indicate with regard to BPI location

Answer 1

Most likely this is a post-ganglionic injury rather than a pre-ganglionic injury

Question 2

What does horner syndrome indicate in a BPI?

Answer 2

pathognomonic for a preganglionic T1 avulsion - ptosis, miosis, anhydrosis

Question 3

what does a transverse process fracture in the c spine indicate with relation to BPI?

Answer 3

possible nerve root avulsion at the corresponding level

Question 4

what does an elevated hemidiaphragm on chest XR indicate as it relates to BPI?

Answer 4

diaphragmatic paralysis, high likelihood of C5 nerve root avulsion

Question 5

what finding on CT myleogram indicates nerve root avulsion

Answer 5

do not do ct myelogram until 3-4 weeks later, and pseudomeningocele on CT myelo suggests nerve root avulsion

Question 6

how long does denervation take to appear on NCVs after BPI?

Answer 6

3-4 weeks to allow time for wallerian degeneration to occur

Question 7

optimal timeline for baseline electrodiagnostic testing after injury?

Answer 7

4-6 weeks

Question 8

what are denervation changes on EMG?

Answer 8

fibrillations and sharp waves - can be seen as early as 10-14 days post injury

Question 9

relative contraindication to brachial plexus reconstruction?

Answer 9

Isolated C8-T1 injury - more predictable results with distal nerve and/or tendon transfer

Question 10

timing of reconstruction/exploration: nerve root avulsion (pre-ganglionic) suspected

Answer 10

3-6 weeks post in jury

Question 11

timing of reconstruction/exploration: postganglionic injury (rupture, stretch)

Answer 11

3-6 months

Question 12

do upper or lower trunk injuries respond better to cable grafting?

Answer 12

upper trunk - the time to reinnervation is more favorable in the proximal musculature