Lesiones del plexo braquial en adultos. Parte 1: Anatomía, examen físico y evaluación
DOI:
https://doi.org/10.25214/28056272.1177Keywords:
Brachial plexus, Brachial Plexus Neuropathies, Peripheral Nerve InjuriesAbstract
Introduction: The Brachial plexus is an intricated network of nerves that provide motor and sensory innervation of the shoulder girdle and the upper extremity. A variety of mechanisms may injure the nerves at different locations to a variable degree. Most severely the nerves are avulsed from spinal cord resulting in global loss of function and sensation of the upper extremity.
Purpose: This paper intends to review the anatomy of the Brachial Plexus, Mechanisms and Patterns of Injury, and to provide guidelines for a structured physical examination. Additionally, the role of diagnostic and supporting studies will be reviewed.
Results: Knowledge of the anatomy of BP assists in identifying location of injury as well as treatment options. Closed traction is the most common mechanism and most of BP injuries are pan plexal at presentation. Physical examination is key in ruling out life threatening situations, diagnostic test interpretation and treatment decision making. CT Myelogram remains the gold standard in diagnostic imaging. Nerve electrophysiologic studies (EMG, NCS, SSEP/MEP) are the most reliable way of identifying nerve injury and document the earliest signs of recovery. While a variety of treatment options are available to restore function, the options chosen depend on which nerves are injured and what the exam findings are.
Conclusion: Prognosis in Brachial plexus injury lies on correct and prompt diagnosis. The multifactorial diagnosis process intends to narrow the options helping the surgeon decide the best course of treatment.
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