Supraclavicular palsy

This is by far the most frequent clinical form.
It can be complete, with the 5 roots damaged, or partial, with only upper roots of C5, C6 +/_ C7 damaged.

For complete forms, there is complete sensory loss up to the elbow, affecting the motricity of the whole limb.
In C5 C6 partial forms only shoulder movement and elbow flexion are paralyzed, the hand retains sensation even though the thumb is less sensitive.

Recent palsy

Within a year of the injury, nerve surgery is possible.

In recent partial types, the purpose of this surgery is to restore shoulder and elbow mobility.For the shoulder, neurotisation (nerve transfer) of the spinal nerve into the suprascapular nerve is possible as well as nerve grafting of C5 into the axillary nerve. For the elbow, neurotisation of the ulnar nerve into the biceps nerve and of the median nerve into the nerve of the brachial muscle is performed to restore elbow flexibility.

Neurotisation du netf musculocutané (Oberlin)

In recent complete types, surgery aims at restoring the shoulder’s function partially and elbow flexibility, but the hand remains insensitive and its mobility can rarely be improved.For the shoulder, neurotisation of the suprascapular by the spinal nerve as well as nerve grafting of C5 into the axillary nerve is also possible. For the elbow, flexion can be revived by the neurotisation (nerve transfer) of intercostal nerves into the biceps nerve. In some cases, when elbow flexion recovery is very good, tendon can be grafted between the biceps and the finger flexors so as to restore finger flexion partially, but the hand remains insensitive unfortunately.

Older palsy

When plexus paralysis is diagnosed late, more than a year after the injury, nerve surgery is no longer possible and palliative surgery is then discussed.

In partial older types, shoulder mobility can be improved through glenohumeral arthrodesis (joint fusion). For the elbow, restoring shoulder flexion leads to two alternatives, which are transferring free gracilis muscle to the arm reinnervated by the intercostal nerves or transferring forearm muscle to the arm (Steindler procedure).

Lambeau libre du droit interne réanimation de la flexion du coude

In complete older types, shoulder mobility can be improved through glenohumeral arthrodesis (joint fusion).For the elbow, only flexion can be restored through free gracilis muscle transfer to the arm; the benefit of this surgery must be discussed on an individual basis. In some cases, when elbow flexion recovery is very good, tendon can be grafted between the biceps and the finger flexors so as to restore finger flexion partially, but the hand remains insensitive unfortunately.