The Procedure
Brachial Plexus Exploration (BPE) is a procedure that involves exploration and examination of the brachial plexus to locate and resolve nerve injuries. It can involve decompression of nerves or nerve repair. The brachial plexus is the group of nerves that controls hand and arm movement. The procedure may be performed as a primary surgery where conservative treatment is unsuccessful, or after another surgery where abnormal pain is occurring.
The procedure is performed arthroscopically (keyhole) and typically takes 1.5 hours.
Pre Op
Whilst you wait for your surgery date, there are a few things to do:
- Speak to your health fund to confirm if the hospital fee for your surgery is covered on your policy
- Speak to your anaesthetist to confirm their fees
- Register your details with the hospital
- Read through, complete and return your paperwork to our office
- Plan your transport to and from the hospital. You won’t be able to drive yourself home after the surgery, so make sure you have a travel plan in place
- If required, arrange any recommended pre op physio appointments
- If required, get any pre op pathology tests (e.g., blood tests)
- Use benzoyl peroxide 5% wash on your shoulder for 5 applications: twice a day for two days, and then again on the morning of the surgery. This will help reduce your risk of infection from Cutibacterium acnes.
- Pack a bag for your hospital stay including regular medications in the original packaging, a loose button-up shirt to wear after surgery, nightwear, personal items including toiletries. If you have sleep apnoea, you must bring your CPAP machine.
- If you are on any blood thinners ring my office and confirm when to stop taking them before the operation.
- If you are on any diabetic tablet medications ring your anaesthetist and confirm whether you need to stop taking them before the operation
- Confirm your admission details with my office one to two business days prior to surgery
Though this can seem overwhelming, you will be provided with detailed instructions on what needs to be done so your surgery journey can be as smooth as possible.
Complications
General risks of surgery include:
- Bruising & haematoma: this will vary for each patient. Bruising is a normal side effect of surgery and usually resolves in a short time. Haematoma may require a return to theatre for drainage.
- Infection: infection is a rare but possible risk and is usually treated with antibiotics.
- DVT and PE: deep vein thrombosis and pulmonary embolism are blood clots that form in either the lower limbs or lungs. If left untreated, DVT and PE can have serious effects, however if treated promptly, the risks are significantly lowered.
- Anaesthetic risks: general anaesthetic (GA) carries a number of risks, which will be discussed in detail with your anaesthetist prior to surgery. Fortunately, Australia is one of the safest places to undergo a GA. In Australia, the risk of mortality from GA is around 1 in 100,000. For context, the risk of death in a car accident in Queensland is around 1 in 10,000 per year.
- Wound issues: some superficial issues can develop in surgical wounds postoperatively, however most will require a small intervention to resolve the problem.
- Frozen shoulder: a small percentage (maybe 2%) of patients can develop frozen shoulder. It resolves with time. You will still get a good result from the surgery once the frozen shoulder has resolved however it can make the rehab prolonged and miserable if the frozen shoulder is severe.
Specific risks and complications of BPE include:
- Nerve damage
- Pneumothorax
- Persistent pain
- Vascular injury
Day of Surgery
Your admission details will be confirmed one to two business days prior to surgery. You will need to make note of your admission time and your fasting time. Your admission time may be as early as 6am. If you aren’t local to Brisbane, it is usually recommended that you stay the night before in case your admission is early.
When you arrive at the hospital, you will go through the admissions process and then be taken through to the surgical waiting area. Your anaesthetist will have a short consultation with you before you go into theatre and under general anaesthetic. I will say hi to you before the surgery in the anaesthetic bay of the operating theatre and mark your operation site with you.
Your hospital stay will usually be one night. You will be discharged usually after 10am. I will see you before your discharge. I will provide you with a folder containing a detailed postoperative pack including a letter telling you what I found at surgery and exactly what I did in your operation along with information about your rehabilitation and postoperative care. Remember to have someone available to take you home from the hospital.
Post Op Recovery & Healing
Recovery after the BPE can be lengthy, depending on the severity and type of injury, and will be determined according to individual needs. A sling may be needed to immobilise the shoulder, and appropriate rest will also be required, which may involve time off from work, physical activities, and driving.
Physiotherapy is an essential part of the recovery process following BPE.
Rehabilitation
Rehabilitation after BPE focuses on restoring shoulder function and improving pain or sensation. Physiotherapy protocols will depend
Physiotherapy Guidelines
Results After Surgery
The results of BPE surgery can vary, as it can be both adiagnostic procedure and a treatment. Individual circumstances willsignificantly affect the results, including the timing of the procedurefollowing an injury, as well as adhering to rehabilitation guidelines.