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Brachial Plexus Exploration

A keyhole operation to examine the nerves of the brachial plexus, so that an injured or compressed nerve can be identified and treated.

The brachial plexus is the network of nerves that leaves the neck, passes beneath the collarbone and supplies the shoulder, arm and hand. Injury to these nerves can cause weakness, altered sensation and pain that does not settle.

Brachial plexus exploration is an operation to examine the nerves directly so that an injury can be identified and treated, either by releasing pressure on a nerve or by repairing it. It may be carried out as the primary operation when non-surgical treatment has not helped, or it may follow earlier surgery where unexplained pain is occurring.

The procedure

The exploration is performed arthroscopically, through keyhole incisions, and typically takes about an hour and a half. Because the operation is both diagnostic and therapeutic, what is done depends on what is found: a nerve under pressure can be decompressed, and a damaged nerve can be repaired.

Risks and complications

All surgery carries risk. The risks that are relevant to you are discussed with you in consultation before any decision about surgery is made.

General surgical risks

  • Bruising and haematoma. The amount of bruising varies from patient to patient and usually settles quickly. A haematoma, which is a collection of blood under the wound, may need to be drained in theatre.
  • Infection. Infection is rare but possible, and is usually treated with antibiotics.
  • Deep vein thrombosis (DVT) and pulmonary embolism (PE). Blood clots can form in the veins of the leg and can travel to the lungs. These are serious conditions, but the risk of lasting harm is significantly reduced when they are recognised and treated promptly.
  • Anaesthetic risks. These are discussed with your anaesthetist before surgery. In Australia the risk of death from a general anaesthetic is around 1 in 100,000.
  • Wound problems. Superficial wound problems can occur. Most settle with a small intervention.
  • Frozen shoulder. This affects approximately 2% of patients. It resolves with time and the result of the surgery itself is generally unaffected, but if it is severe, rehabilitation can be prolonged and difficult.

Risks specific to this procedure

  • Nerve damage. The operation is performed on and around the nerves themselves, so injury to a nerve is a recognised risk.
  • Pneumothorax. Air entering the space around the lung, causing it to partially collapse.
  • Persistent pain. Pain may continue after surgery.
  • Vascular injury. Injury to a blood vessel, as major vessels run alongside the brachial plexus.

Before surgery

There are a number of things to work through while you are waiting for your surgery date. You will be given detailed written instructions covering all of this.

  • Confirm with your health fund that the hospital fee is covered.
  • Confirm your anaesthetist’s fees.
  • Register your details with the hospital.
  • Read, complete and return your paperwork to the rooms.
  • Plan your transport to and from hospital. You cannot drive yourself home.
  • Attend any pre-operative physiotherapy that has been recommended.
  • Complete any pre-operative pathology, such as blood tests, if it has been requested.
  • Wash the shoulder with benzoyl peroxide 5% wash twice daily for two days, and then once more on the morning of surgery, five applications in total. This reduces the risk of infection with Cutibacterium acnes, a bacterium that lives in the skin.
  • Pack your hospital bag: your regular medications in their original packaging, a loose button-up shirt, nightwear and toiletries. Bring your CPAP machine if you have sleep apnoea.
  • If you take blood thinners, phone the rooms to confirm when to stop them.
  • If you take tablets for diabetes, phone your anaesthetist to confirm whether to stop them.
  • Confirm your admission details with the rooms one to two business days before surgery.

The day of surgery

  • Your admission details are confirmed one to two business days beforehand. Make a note of your admission time, which may be as early as 6am, and the time from which you must fast.
  • If you do not live in Brisbane, staying in the city the night before is usually recommended.
  • After the admissions process you wait in the surgical waiting area. Your anaesthetist will see you for a brief consultation before you go through to theatre.
  • Dr Cutbush will greet you in the anaesthetic bay and mark the operation site. You are then given the general anaesthetic.
  • The usual stay is one night. Discharge is generally after 10am, and Dr Cutbush will review you beforehand.
  • You will be given a folder containing your post-operative pack: a letter describing what was found and what was done, together with your rehabilitation and aftercare information.
  • Arrange for someone to take you home.

Recovery and healing

Recovery after brachial plexus exploration can be lengthy, and how long it takes depends on the severity and the type of nerve injury that is found and treated. Nerve tissue recovers slowly.

A sling may be needed to immobilise the shoulder for a period. Rest is an important part of recovery, which generally means time away from work, from physical activity and from driving. Physiotherapy is an essential part of getting function back.

Rehabilitation

Rehabilitation after brachial plexus exploration works towards restoring shoulder function and improving pain and sensation in the arm.

Because the findings at surgery differ so much from one patient to the next, the physiotherapy programme is set individually. Your specific guidelines, including any sling period and any restrictions on movement, are provided in your post-operative pack and are explained to you by the hospital physiotherapist before you are discharged. Follow those instructions rather than a general protocol, and raise any questions with the rooms or with your physiotherapist.

Results after surgery

Results vary, because brachial plexus exploration is both a diagnostic and a therapeutic operation and the outcome depends on what is found. How soon after the original injury the surgery is carried out makes a difference, as does how closely the rehabilitation guidelines are followed. Individual results vary.

Next steps

This page is general information about a surgical procedure and is not a recommendation that you have it. Whether surgery is appropriate for you can only be determined after assessment. All surgery carries risk; the risks relevant to you are discussed in consultation before any decision is made.

General information about a surgical procedure. It is not a recommendation that you have this operation, and it does not replace the advice Dr Cutbush gives you about your own shoulder. All surgery carries risk, and individual results vary. Read about the risks and what recovery involves.