A meeting on brachial plexus injury
A meeting with Michael Wagels on the management of patients with severe brachial plexus injuries, attended by managers from WorkCover Queensland and NIIS Queensland.
What the brachial plexus is
The brachial plexus is the network of nerves that runs from the spinal cord in the neck, through the shoulder region, and on into the arm. Every movement and every sensation in the shoulder, arm and hand depends on it. A severe injury can tear these nerves, or pull them out of the spinal cord itself, and the result is weakness or complete paralysis of part or all of the limb, often with loss of sensation and with severe pain. Individual results vary.
Why the insurers were there
Severe brachial plexus injuries typically follow high-energy trauma, often motorcycle accidents, and they frequently arise in a workers' compensation or motor accident context. Treatment can involve complex nerve reconstruction and years of rehabilitation, so the people administering those schemes need to understand what the treatment pathway involves and over what timeframe. It was useful to be able to discuss these issues together.
With thanks to WorkCover and NIIS for arranging the meeting.
Why these injuries need a coordinated approach
Brachial plexus reconstruction is among the more involved areas of upper limb surgery. Assessment takes time, because which nerves have been injured and at what level is not always clear immediately, and nerve recovery has to be monitored rather than assumed. Surgery may involve nerve grafting, nerve transfer, or later tendon and muscle transfers to restore movement, and it is often staged. Rehabilitation runs alongside all of it.
Because these patients are frequently young and were previously working, and because the treatment is long, the surgical, rehabilitation and funding arrangements have to fit together. A discussion of that kind is more useful held in advance than negotiated case by case.
Related information
See our shoulder injuries, brachial plexus exploration and rehabilitation pages, and our post on the Cairns brachial plexus teaching session.