Paralysis of the brachial plexus branches, which are commonly known as peripheral nerves or nerves, is called truncular nerve palsy as opposed to paralysis of the nerve roots or Erb’s palsy, and to paralysis of the nerve’s origin, called brachial plexus paralysis. Erb’s palsy is treated by neurosurgeons. Brachial plexus palsy and truncular nerve palsy are handled by hand surgeons with specific microsurgery training.
The therapeutic approach depends on the cause of the paralysis:
Spontaneous palsy with no traumatic background often necessitates surgical exploration including nerve release (neurolysis).
Paralysis subsequent to a wound (knife wound, bullet wound) requires emergency explorative and repair surgery.
Paralysis subsequent to a closed injury (dislocation, fracture), requires immediate bone stabilizationas well as close monitoring associated with rehabilitation.If recovery does not begin within 5 months of the injury, surgery must be proposed.
The treatment depends on time from injury:
In recent types of paralysis, within a year of the injury, direct nerve surgery can be carried out, release, suture, nerve graft or nerve transfer (neurotisation) depending on the situation.
In older types of paralysis exceeding a year, palliative tendinomuscular or arthrodesis (joint fusion) surgery can be carried out, exceptions may occur for children.
Recovery depends on a number of factors:
It depends on the patient’s age, time from injury, type of nervous lesion (contusion, stretching, partial or total severance).
Recovery often spreads over an 18-month period.
The younger the patient, the better the recovery, so the treatment of plexic injuries is not the same for children and teenagers and for adults. Likewise, beyond the age of 60, palliative musculotendinous transfer and joint fusion surgery can be chosen instead of nerve repair surgery.
The older the injury, the longer and harder post-operative recovery will be.