Brachial plexus injuries: regeneration timing and prognosis in patients without need for urgent operation. Preliminary results on truncus primarius superior

Summary

Background. In Italy, and more generally in the industrialized countries, traumatic nerve lesions have become more frequent. It is commonly accepted that it is necessary to wait 6 months after injury to suggest surgery if movement does not appear. In the scientific literature, there is no systematic clinical evidence of nerve regeneration timing after trauma., especially regarding brachial plexus.

Method. We have performed a follow-up study of 15 consecutive patients with traumatic brachial plexus injuries involving truncus primaries superior without need for urgent surgery. In each patient an extensive clinical and neurophysiological evaluation was performed to detect the kind of lesion, level of lesion, severity of lesion and the outcome.

Findings. In our sample, some cases improved within a few weeks. This rapid improvement may be attributed to resolution of neuro-apraxic block, in other cases slower improvement occurred due to rearrangement of motor units and axonal regeneration. In some cases voluntary activity clinically appeared after more than 6 months following injury.

Conclusions. The current study is preliminary, but it provides evidence that a period of 6 months may not be sufficient for the reappearance of clinical movement. Moreover, current results confirm that neurophysiological evaluation may be a highly prognostic tool in traumatic nerve lesions. We hope that our study together with other data may provide us a timetable for expected nerve regeneration.