Brachial plexus and peripheral nerve injuries

We work with microsurgery techniques that allow us to repair the most sensitive nerves.

The technical knowledge and experience of the medical team are essential for brachial plexus and peripheral nerve surgery to achieve optimal results. At Centro Médico Teknon, these types of injuries are treated by specialists in Traumatology and Neurology, who provide personalised and comprehensive treatment to improve recovery. The Trauma Unit team, led by Dr Joaquim Casañas, has been treating peripheral nerve and brachial plexus injuries in a pioneering and unique way in our country for more than 10 years, with highly satisfactory results.

Teknon specialists also use microsurgical techniques to repair the most sensitive nerves, and intraoperative imaging-guided surgery techniques to locate the exact site of the injury.

What is the brachial plexus? And the peripheral nerve?
The brachial plexus is a network of nerves responsible for the mobility and sensitivity of the upper limb (shoulder, arm, hand); it originates in the spinal cord. Brachial plexus injuries are associated with high-energy accidents, in other words, strong impacts such as a car accident or a sports injury.

In contrast, the peripheral nerve is the part where all the nerves that run from the limb to the root originate, and it is responsible for the connection between the limb and the brain. There are many causes of this injury, such as an accident, an injury, or surgery.

An injury to the brachial plexus and/or peripheral nerve results in reduced mobility of the affected limb and, in most cases, is associated with a high level of pain.
How is the injury diagnosed?
After carrying out an assessment of the area of the injury and taking a complete medical history, the specialist will usually request an MRI scan and electromyography to accurately locate and assess the damaged area, as well as to check the activity of the affected muscle.

Likewise, in certain cases, the specialist may consider performing a controlled block to check the patient's pain level and assess whether the proposed treatment could be effective.
In which cases is surgery necessary?
Surgery is necessary in most brachial plexus injuries, although the extent of the injury varies depending on each case. Despite being a common treatment for this condition, surgery is not immediate and is rarely recommended within three months of the injury.

The reason for not performing surgery until three months after the injury is that in a small number of cases, recovery occurs spontaneously and surgery is not necessary to improve nerve function. Therefore, surgery is performed in cases where recovery is slow, or in patients who recover incompletely or do not recover at all; it is often performed between three and six months after the injury.

It is important to perform the surgery at the right time, since, after the accident, the muscle may begin to degenerate due to lack of movement and the results of the surgery will not be as expected.
What surgical technique is used in brachial plexus and peripheral nerve surgery?
Brachial plexus and peripheral nerve injuries vary from patient to patient, so it is important to select the appropriate surgical technique for reconstruction based on the type and severity of the injury:
- Neurolysis. The aim of this technique is to clean and decompress the scar tissue on the affected nerve that is limiting mobility.
- Nerve grafting. In order to reconstruct a flaw in one of the severed nerves, a graft is placed as a bridge between the two ends of the injured nerve to connect the damaged nerves. This nerve bridge is usually taken from one of the lower limbs.
- Nerve transfers. This technique involves using a healthy nerve adjacent to the injured nerve to reconstruct the nerve connection and limb function.
- Palliative surgery. When it is not possible to reconstruct the nerve, palliative surgery can be performed, which involves transferring tendons to restore the function of permanently denervated muscles. There are multiple tendon transfers that depend on each individual situation...
After surgery, patients usually need to undergo physiotherapy and rehabilitation treatment to help restore function. The duration of this treatment may vary depending on the injury, but it is estimated to last between six months and a year on average.
What is intraoperative registration-assisted surgery?
Centro Médico Teknon is one of the only European centres that uses intraoperative recording-assisted mapping in brachial plexus and peripheral nerve surgery. This technique is performed by a neurologist and allows the affected area to be mapped during surgery to locate which nerves are affected and check the exact functioning of those nerves.

This allows for better surgical outcomes by enabling the identification of healthy nerve tissue, recovering tissue, and damaged tissue.

It is also useful for treating cases of neuropathic pain that is clearly peripheral in origin.
What results can be expected from surgery?
Results may vary depending on the injury, the roots affected by the injury, and the timing of the surgery. In most cases, the outcome is optimal and patients can resume their normal activities in cases of peripheral nerve injuries, with significant improvement in cases of brachial plexus injuries.

It is important to emphasise that the main objective of the surgery is to restore function and reduce the patient's pain. Over 100 surgeries of this type are performed at Teknon every year.

Brachial plexus and peripheral nerve injuries

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