Adult brachial plexus injury: evaluation and management.

Adult traumatic brachial plexus injury involves injury of the C5-T1 spinal nerves. Common patterns of injury include "upper arm" and "total arm" types. The specific signs of preganglionic avulsion injury infer a poor prognosis for spontaneous recovery and surgery may be needed. Detailed preoperative evaluation is recommended for localization of the lesions. The treatment of upper arm type injury comprises restoration of elbow flexion and shoulder control. Good functional results may be achieved after multiple nerve transfers. The treatment of total arm type includes hand function reconstruction, in addition to shoulder and elbow treatment. Current options for hand function reconstruction include functioning free muscle transfers and nerve transfers.