The course
Dr Cutbush attended a brachial plexus course in Bangkok in June 2015, held at Siriraj Hospital. The faculty included international brachial plexus surgeons from Japan, China and Brazil.
The lectures and workshops were of an impressive standard, and the course covered techniques for restoring function to an injured arm.
What the brachial plexus is
The brachial plexus is the network of nerves that carries every signal between the spinal cord and the arm. Nerve roots leave the spine in the neck, join and divide in a set pattern as they pass behind the collarbone, and emerge as the main nerves of the arm. All movement and all sensation in the shoulder, arm and hand depend on it. An injury may stretch the nerves, tear them across, or pull a root out of the spinal cord altogether, and the pattern of the injury determines what can be repaired. The usual causes are high energy trauma, motorcycle crashes in particular, and traction on the shoulder at birth.
What restoring function involves
Because the whole nerve supply of the limb can be affected, treatment is a reconstruction rather than a repair of one structure. A divided nerve may be joined directly, a gap may be bridged with a graft of nerve taken from elsewhere in the body, or a nerve transfer may be performed, in which a working nerve with a less important function is rerouted to drive a muscle that has lost its supply. Where nerve surgery cannot restore a movement, tendon and muscle transfers may be used later to recover part of it. Nerves regrow slowly, and the muscle they supply will not recover if it is left without a nerve supply for too long, so the timing of surgery matters as much as the technique. Individual results vary.
Why this is specialised work
Severe brachial plexus injuries damage the nerve supply to the whole arm, and restoring function requires nerve repair, grafting or transfer rather than treating a single structure. The surgeons who do this work are relatively few, which is why courses draw faculty from across several countries.