Adult brachial plexus injuries: mechanism, patterns of injury, and physical diagnosis.

Most brachial plexus injuries involve the entire plexus. An injury to major cords or branches often contains a mixed injury pattern, with portions of the nerve being avulsed, ruptured, or stretched. An advancing Tinel's sign implies the possibility of neurologic recovery; however, the surgeon should combine this physical finding with that of electrodiagnostic studies to assess the extent of nerve injury to allow for expedient surgical intervention when necessary.