Contents



Chapter 5 **Current Concept in the Management of Brachial Plexus Birth Palsy 81** Maulin Shah and Dhiren Ganjwala

#### **Section 5 Treatment of Brachial Plexus Long Term Consequences 101**

Chapter 6 **Treatment of Neuropathic Pain in Brachial Plexus Injuries 103** Nieves Saiz-Sapena, Vicente Vanaclocha-Vanaclocha, José María Ortiz-Criado, L. Vanaclocha and Nieves Vanaclocha

Preface

the muscles that move and support it.

nerve plexus at the root of the limb.

brachial plexus injuries.

if the quality of obstetric attention is suboptimal.

The human shoulder requires a wide range of motion to allow a great variety of movements, among them, throwing objects. This capability is precisely what afforded our ancestors in the distant past the skills of hunting and self-defense. In fact, the oldest known defensive objects are common cobblestones found in a cave in Ukraine. These round stones, which came from a nearby river, were supposedly used by the region's primitive inhabitants to defend themselves from potential predators. Pitching a projectile is a significant task for the delicate configuration of a humerus that barely articulates with the shoulder blade, which in turn only articulates at a very small joint with the clavicle, which itself articulates with the sternum, again by way of a very small joint. The entire stability of the shoulder depends on

The shoulder's wide range of movements is a great evolutionary advance, but it is also a source of problems. At times, the joint can move excessively, inducing luxation of the hu‐ merus head or damage to the soft tissues, among them, the brachial plexus. In fact, both upper and lower extremities are made by extension and fusion of the given somites. As muscles are made from more than one somite, nerves have to anastomose between them to allow a proper innervation of each muscle. This creates the necessity for a well-formed

The combination of a nerve plexus with a wide range of movement in a highly mobile joint at the shoulder creates the perfect scenario for a brachial plexus injury. In normal childbirth, there is already stretching of the brachial plexus as the infant's head and shoulder (usually the right one) are moved in opposite directions. Such injuries are always a possibility when the newborn is large and the mother's pelvis outlet is perhaps small; this is particularly true

As we grow, we start to move in multiple ways. Motorbikes and bicycles are economical transportation, particularly in big cities. They are relatively inexpensive, can adapt to small roads or to heavy traffic conditions and can be parked almost anywhere. But unfortunately, accidents are common. The head is perhaps protected with a helmet, but the shoulder re‐ mains exposed and can be separated violently from the head, inducing a great variety of

Once a brachial plexus injury is established, there exists a large array of treatment strategies. Conservative measures can help in some cases, but many injuries may need some sort of surgical repair. In these cases, nerve transfers opened a door allowing the repair of lesions once considered irrecoverable. In fact, even when a successful nerve suture, with or without intervening grafts was achieved, regenerating axons reached the distal muscles that were fibrotic and functionally dead. There is still much room for improvement: this is the arena of

#### **Section 6 Challenges in Peripheral Nerve Surgery 123**

Chapter 7 **Starting A Peripheral Nerve Surgery Unit in an Area of Limited Resources - Our Experience 125** Chiazor U. Onyia, Ravi Sankaran and Ashok Pillai
