Search Our Scientific Publications & Authors

JBJS Rev 2022 04 15;10(4). Epub 2022 Apr 15.

Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri.

»: Traumatic brachial plexus injuries are relatively rare but potentially devastating injuries with substantial functional, psychological, and economic consequences.

»: Prompt referral (ideally within 6 weeks of injury) to a center with a team of experts experienced in the diagnosis and management of these injuries is helpful to achieving optimal outcomes.

»: Preoperative and intraoperative decision-making to diagnose and plan reconstructive procedures is complex and must take into account a number of factors, including the time from injury, concomitant injuries, preservation of cervical nerve roots, and the availability of intraplexal and extraplexal donor nerves for nerve transfer. Read More

Acta Neurochir (Wien) 2022 May 28;164(5):1317-1328. Epub 2022 Mar 28.

Neurosurgery Department, SARAH Network of Rehabilitation Hospitals, Brasilia, DF, Brazil.

Background: The COVID-19 pandemic and the need for social distancing created challenges for accessing and providing health services. Telemedicine enables prompt evaluation of patients with traumatic brachial plexus injury, even at a distance, without prejudice to the prognosis. The present study aimed to verify the validity of range of motion, muscle strength, sensitivity, and Tinel sign tele-assessment in adults with traumatic brachial plexus injury (TBPI). Read More

Plast Reconstr Surg 2022 May 11;149(5):921e-929e. Epub 2022 Mar 11.

From the Departments of Orthopedic Surgery and Neurosurgery, Mayo Clinic.

Background: Free functioning muscle transfer is a reconstructive option to restore elbow flexion in brachial plexus injuries. The authors determined the impact of body mass index, age, and location of distal tendon attachment on elbow flexion strength after free functioning muscle transfer in traumatic brachial plexus injury patients.

Methods: A retrospective review of patients who underwent free functioning muscle transfer for elbow flexion as part of their brachial plexus injury reconstruction with a minimum 2-year follow-up were evaluated. Read More

PM R 2022 03 9;14(3):403-405. Epub 2022 Feb 9.

Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA.

Neurosurgery 2022 01;90(1):39-50

Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.

Background: Traumatic brachial plexus injuries (BPIs) often lead to devastating upper extremity deficits. Treatment frequently prioritizes restoring elbow flexion through transfer of various donor nerves; however, no consensus identifies optimal donor nerve sources.

Objective: To complete a meta-analysis to assess donor nerves for restoring elbow flexion after partial and total BPI (TBPI). Read More

J Musculoskelet Neuronal Interact 2021 12;21(4):528-532

Department of Orthopaedic, Zuyderland Medisch Centrum, Heerlen, Netherlands.

Objectives: This research aims to analyze the expression of pro-apoptotic proteins (Bax, p53) and anti-apoptotic protein (Bcl-2) in the nerve roots of the brachial plexus following traumatic brachial plexus injury (TBPI) in the early and late stage.

Methods: A total of 30 biopsy samples were taken from the proximal stump of the postganglionic nerve roots of the TBPI patients' brachial plexus from January 2018 until September 2019. The samples were taken from patients within six months of trauma (early stage, group A) and more than six months following trauma (late stage, group B). Read More

Pediatrics 2021 12;148(6)

Section of Plastic and Reconstructive Surgery.

Peripheral nerve injuries in children can result in devastating lifelong deficits. Because of the time-sensitive nature of muscle viability and the limited speed of nerve regeneration, early recognition and treatment of nerve injuries are essential to restore function. Innovative surgical techniques have been developed to combat the regenerative length and speed; these include nerve transfers. Read More

Pacing Clin Electrophysiol 2022 04 30;45(4):574-577. Epub 2021 Dec 30.

Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.

A middle-aged woman presented with symptomatic complete heart block and underwent an uneventful dual chamber pacemaker implantation. Three weeks post procedure, she developed left arm pain and weakness, with neurological localization to the lower trunk of left brachial plexus. Possibilities of traumatic compression by the device/leads or postoperative idiopathic brachial plexopathy were considered. Read More

Pain Rep 2021 Nov-Dec;6(4):e973. Epub 2021 Nov 22.

Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA.

Pain caused by brachial plexopathy (BP) represents a challenging clinical problem with few effective therapeutic options. Here, we present a patient with severe, painful BP after a high-impact motor vehicle accident who failed conservative treatments. A trial of cervical spinal cord stimulation was completed using multiple waveforms (tonic, BurstDR, and 10 kHz) over 14 days with only 30% to 40% pain reduction. Read More

J Am Coll Radiol 2021 11;18(11S):S423-S441

Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia.

Plexopathy may be caused by diverse pathologies, including trauma, nerve entrapment, neoplasm, inflammation, infection, autoimmune disease, hereditary disease, and idiopathic etiologies. For patients presenting with brachial or lumbosacral plexopathy, dedicated plexus MRI is the most appropriate initial imaging modality for all clinical scenarios and can identify processes both intrinsic and extrinsic to the nerves. Other imaging tests may be appropriate for initial imaging depending on the clinical scenario. Read More

Prosthet Orthot Int 2021 Dec;45(6):526-531

Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.

Background: Individuals with brachial plexus injuries (BPIs) can be prescribed assistive devices, including myoelectric elbow orthoses (MEOs), for rehabilitation or functional use after failed treatment for elbow flexion restoration. Although recent case studies indicate potential for clinical improvements after using an MEO after BPI, the patients' perspectives on such use are still unknown.

Objective: To explore patient perspectives on the use of an MEO after surgical treatment for a traumatic BPI. Read More

Prosthet Orthot Int 2021 Dec;45(6):521-525

Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.

Background: Adult traumatic brachial plexus injuries (BPIs) can result in severe impairment following penetrating wounds, falls, and motor vehicle accidents or other high-energy trauma.

Objective: Quantify functional outcomes of adult patients with a BPI using a myoelectric orthosis to restore elbow flexion.

Study Design: Retrospective review. Read More

Eur Radiol 2022 Apr 9;32(4):2791-2797. Epub 2021 Nov 9.

Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands.

Objective: To investigate the diagnostic performance of diffusion-weighted (DW) MR neurography as an adjunct to conventional MRI for the assessment of brachial plexus pathology.

Methods: DW MR neurography scans (short tau inversion recovery fat suppression and b-value of 800 s/mm) of 15 consecutive patients with and 45 randomly selected patients without brachial plexus abnormalities were independently and blindly reviewed by a 5th year radiology resident, a junior neuroradiologist, and a senior neuroradiologist.

Results: Median interpretation times ranged between 20 and 30 s. Read More

J Hand Surg Eur Vol 2022 04 29;47(4):399-404. Epub 2021 Oct 29.

Department of Orthopaedic Surgery, Kikkoman General Hospital, Noda, Japan.

We described a reconstruction method for restoring hook grip function of the fingers in patients with total brachial plexus injury. The paralysed latissimus dorsi muscle was transferred to the upper limb as a pedicle flap and sutured to the flexor digitorum profundus tendons. The muscle was then reanimated with two intercostal donor nerves to the thoraco-dorsal nerve. Read More

Ann Plast Surg 2022 03;88(3):308-312

Department of Plastic Surgery, University of Tennessee Health Science Center (UTHSC), Memphis, TN.

Abstract: Direct neurotization is a method that involves direct implantation of nerve fascicles into a target tissue, that is, muscle fibers, skin, cornea, and so on, with the goal of restoring aesthetic, sensation and or functional capacity. This technique has been implemented since the early 1900s, with numerous experimental and clinical reports of success. Applications have included both sensory and motor neurotization of muscle, as well as protective sensory provision for other organs. Read More

Georgian Med News 2021 Jul-Aug(316-317):30-35

1Peoples' Friendship University of Russia, Moscow; Russia.

Posttraumatic brachial plexopathy - is an actual problem, which is usually seen after shoulder area trauma and is often accompanied with intraarticular pathology. In case of failed conservative treatment, open brachial plexus decompression is an effective procedure, however, it is pretty traumatic and is accompanied by number of complications and recurrences, what explains the necessity of development of low-traumatic, miniinvasive alternative techniques. Purpose - develop a new mini-invasive endoscopic technique of brachial plexus decompression. Read More

Hand Surg Rehabil 2022 02 4;41S:S71-S75. Epub 2021 Oct 4.

Hand, Upper Limb & Peripheral Nerve Surgery Department, Georges-Pompidou European Hospital (HEGP), 20, Rue Leblanc, 75015 Paris, France; University of Paris, Medical School, 12, Rue de L'École de Médecine 75006 Paris, France; Research Unit, Clinique Blomet, 136 Bis, Rue Blomet, 75015 Paris, France. Electronic address:

Hand amputation can be discussed after traumatic brachial plexus injury when the patient's hand is non-functional, painful and/or insensitive. That indication is more common in English-speaking countries than in European or Latin countries. New prostheses are now on the market and can be used after hand amputation to improve the functional prognosis in well-selected patients. Read More

Hand Surg Rehabil 2022 02 2;41S:S16-S22. Epub 2021 Sep 2.

Research Unit, Clinique Blomet, 136 bis Rue Blomet, 75015 Paris, France; University of Paris, Medical School, 12, Rue de l'Ecole de Médecine, 75006 Paris, France; Hand, Upper Limb & Peripheral Nerve Surgery Service, Georges-Pompidou European Hospital (HEGP), 20, Rue Leblanc, 75015 Paris, France.

Imaging has become an essential tool in the study of the posttraumatic paralytic upper limb, in addition to the clinical examination and electroneuromyography. Upper extremity surgeons must be aware of how these different techniques contribute to the initial and preoperative assessment of nervous injuries. We review the appearance of traumatic nerve damage and muscle denervation during the initial injury assessment, focusing on the main aspects of brachial plexus injuries, paralysis after shoulder dislocation and traumatic damage to the radial nerve. Read More

J Hand Surg Eur Vol 2022 01 19;47(1):40-51. Epub 2021 Aug 19.

Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.

An expert opinion study was designed to query five countries and six brachial plexus surgeons regarding the demographics, mechanisms of injury, evaluation, timing of surgery, reconstructive strategies and controversies in adult traumatic pan brachial plexus injuries. Variations in assessing outcomes, management of neuropathic pain and future considerations were elucidated. Clear differences in regional demographics, mechanisms of injury, patient evaluation and treatment strategies were identified. Read More

Hand Surg Rehabil 2022 02 15;41S:S39-S43. Epub 2021 Aug 15.

Institut de la Main, Paris Shoulder Unit, Clinique Bizet, 23, Rue Georges Bizet, 75116 Paris, France. Electronic address:

The lack of active external rotation following a brachial plexus injury in adults is very disabling and very challenging to solve. If direct nerve surgery or nerve transfer fails or if the patient is seen too late, palliative surgery is the last resort. Shoulder fusion can stabilize the joint to increase strength at the elbow, but the patient loses all external rotation. Read More

J Pediatr Orthop 2021 Jul;41(6):374-378

Philadelphia Hand to Shoulder Center.

Introduction: The transfer of intraplexal and extraplexal nerves for restoration of function in children with traumatic and birth brachial plexus palsies has become well accepted. Little has been written about using the long thoracic nerve (LTN) as a donor in reanimation of the upper extremity. The authors present a case series of nerve transfers using the LTN as a donor in brachial plexus injury. Read More

J Reconstr Microsurg 2021 Oct 14;37(8):704-712. Epub 2021 Apr 14.

Department of Orthopedics and Traumatology, Reconstructive Microsurgery Unit, Assiut University Hospitals and School of Medicine, Assiut, Egypt.

Background:  Traumatic brachial plexus injuries in children represent a definite spectrum of injuries between adult and neonatal brachial plexus injuries. Their characteristics have been scarcely reported in the literature. The priority of functional restoration is not clear. Read More

J Hand Surg Am 2021 10 30;46(10):929.e1-929.e7. Epub 2021 Mar 30.

Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.

Purpose: The treatment of traumatic brachial plexus injury (BPI) is time-sensitive, and early nerve reconstruction is associated with superior nerve recovery. The objective of this study was to determine the rate of delayed referral to our centers for traumatic BPI, identifiable causes of delayed referral, and factors associated with delayed referral to a brachial plexus surgeon.

Methods: We identified 84 patients with traumatic BPI referred to and evaluated by brachial plexus surgeons at 2 tertiary care referral centers from 2015 to 2019. Read More

Intern Med 2021 Aug 22;60(15):2511-2512. Epub 2021 Feb 22.

Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan.

Oper Neurosurg (Hagerstown) 2021 05;20(6):521-528

Department of Orthopedics, Traumatology and Neurosurgery, Kliniken Frankfurt Main Taunus, Frankfurt, Germany.

Background: Traumatic brachial plexus injuries cause long-term maiming of patients. The major target function to restore in complex brachial plexus injury is elbow flexion.

Objective: To retrospectively analyze the correlation between the length of the nerve graft and the strength of target muscle recovery in extraplexual and intraplexual nerve transfers. Read More

Orthop Traumatol Surg Res 2021 04 28;107(2):102827. Epub 2021 Jan 28.

Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil. Electronic address:

Introduction: The traumatic lesions of the brachial plexus in adults are devastating injuries causing continuous severe functional impairment for both work and daily living activities. The restoration of elbow flexion is one of the most important movements for patient recovery to previous activities. Free gracilis muscle transfer has good outcomes for cases with late presentation or as a rescue surgery to regain elbow flexion, however, bad results are present in all cohorts with insufficient recovery of muscle strength for elbow flexion. Read More

Acta Neurochir (Wien) 2021 03 28;163(3):829-834. Epub 2021 Jan 28.

Department of Neurosurgery, Mayo Clinic, 200 1st Street South West, Rochester, MN, 55901, USA.

Background: Exploration and grafting of the brachial plexus remains the gold standard for post-ganglionic brachial plexus injuries that present within an acceptable time frame from injury. The most common nerves available for grafting include C5 and C6. During the surgical exposure of C5 and C6, the phrenic nerve is anatomically anterior to the cervical spinal nerves, making it vulnerable to injury while performing the dissection and nerve stump to graft coaptation. Read More

J Hand Surg Am 2021 09 21;46(9):812.e1-812.e5. Epub 2021 Jan 21.

Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery; Weill Medical College of Cornell University, New York, NY. Electronic address:

Purpose: The purpose of the study was to evaluate the utility of the levator scapulae motor nerve (LSN) as a donor nerve for brachial plexus nerve transfer. We hypothesized that the LSN could be transferred to the suprascapular nerve (SSN) or long thoracic nerve (LTN) with a reliable tension-free coaptation and appropriate donor-to-recipient axon count ratio.

Methods: Twelve brachial plexus dissections were performed on 6 adult cadavers, bilaterally. Read More

Eur J Trauma Emerg Surg 2022 Apr 21;48(2):1239-1245. Epub 2021 Jan 21.

Brachial Plexus and Peripheral Nerve Surgery Unit, Mont-Louis Private Hospital, 8 rue de la Folie-Regnault, 75011, Paris, France.

Purpose: To compare functional outcomes of single versus double tendon transfer for foot drop correction and toe drop prevention in posttraumatic common fibular nerve palsy.

Methods: A retrospective study was conducted on data from patients with posttraumatic common fibular nerve palsy treated by tendon transfer between 2001 and 2018. In cases of single tendon transfer (STT) the tibialis posterior (TP) tendon was transferred anteriorly through the interosseous membrane to a new insertion on the lateral cuneiform. Read More

Injury 2021 Apr 31;52(4):855-861. Epub 2020 Dec 31.

Department of Clinical Epidemiology, College of Medicine, University of the Philippines, Manila, Philippines.

Background: Traumatic brachial plexus injuries are devastating injuries with lifelong disability and pain. The objective of this paper was to determine the functional disability of adult patients with traumatic brachial plexus injuries.

Patients And Methods: A cross-sectional study was done to determine the functional disability of patients using the FIL-DASH (Filipino Disability of the Arm, Shoulder and Hand) and the BPI (Brief Pain Inventory) Severity Pain Score (Tagalog version) questionnaires to determine the functional disability and quality of life of patients with traumatic brachial plexus injuries. Read More