Rehabilitation of patients following traction lesions of the brachial plexus.

The management of patients with brachial plexus lesions requires a multidisciplinary approach. We insist on admission to our rehabilitation ward for a full assessment by the physiotherapist, occupational therapist, rehabilitation officer, and social worker when necessary. We confirm the diagnosis by clinical, electrophysiologic, and radiologic techniques and set out a plan of action, either involving definitive surgery or a conservative program involving functional splintage, relief of pain when possible, and return to work. We insist on regular follow-ups to check that the pain is still being relieved. At subsequent reviews it may become clear that spontaneous recovery is not going to occur, and a program of reconstructive surgery can be instituted. In general terms, three years or more should have elapsed before accepting that elbow flexion is not going to return. In patients with C5-C6 lesions, where elbow flexion is permanently paralyzed, the simple elbow lock splint may be perfectly satisfactory, but in some patients it may be wise to advise reconstructive procedure. In our experience the most satisfactory means of restoring elbow flexion is the Steindler flexor plasty, advancing the origins of the extensors and flexors of the forearm up the humerus. If present, latissimus dorsi can be transferred to replace the biceps. The pectoralis major transfer is useful but almost always requires an external rotation osteotomy, as there is too much adduction when the patient flexes the elbow. Finally, triceps can be transferred to biceps, but this is an operation that we do not like, as elbow extension is so useful.(ABSTRACT TRUNCATED AT 250 WORDS)