الفهرس 
ANATOMYOnly 14 pages are availabe for public view
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Abstract
Prior to evaluating a patient with a brachial plexus injury the surgeon must have a firm grasp of the relevant anatomy, toassess the locus and extent of the injury, the plexus is formed ofthe anterior primary rami of the lower 4 cervical nerves and the first thoracic nerve, five stages of the plexus could be identified, roots, trunks, divisions, cords and terminal branches.
Microanatomy of the brachial plexus is that of peripheral nervous system, nerve trunks forming the brachial plexus consist of axons or neurons whose cell bodies located either in thespinal cord anterior horn cells or in the dorsal root ganglia. The axons withina nerve trunk are arranged in fascicles by means of connective tissue.
The mechanism and types of the brachial plexus injury is the same as that encountered in any peripheral nerve. The effect of the trauma on peripheral nerve is the same through-out the body but specific anatomic relationships contribute to the characteristic patterns of injury in case of the brachial plexusinjuries can be classified according to their severity intoneurapraxia, neurotemesis and axonotemesis.
Diagnosis can be made on the basis of patient’s medical history and neurological examination. Imaging studies such as plain X-ray, computed tomography and magnetic resonance imaging together with electrodiagnostic studies as nerve conduction, electromyography, nerve action potential and somatosensory evoked potential are essentially useful.
Management of the plexus injury is influenced by many factors including the patient’s age, the exact anatomical element of the plexus disrupted and the type as well as the severity of injury in general,if there is an open injury with clean sharp never transaction, immediate repair can be done. If we have an open injury with blunt nerve transection then repair of these elements should be delayed for 3 months, at which nerve conduction studies and inspection will help discern the extent of the injury. Management of closed plexus injury depends upon weather the injury is pre or post ganglionic. If the injury is postganglionic then follow up is continued for 4to5 months, exploration of the nerve at the area of injury should be considered if no recovery is seen during this period. The decision to explore a patient with preganglionic injury depends on the level of injury, the degree and type of injury sustained at other levels and the presence or absence of central stumps at the affected levels, but in general it is better not to wait for a long time before surgical intervention.
The type of surgery ranges fromneurolysis if the nerve is incontinuity and not damaged, however if the nerve is severelydamaged and no action potential could be elicited across the site of injury, resection of the affected part is done together with anastomosing the two nerve stumps directly or through nerve graft.In proximal injuries the patient may need nerve transfer procedures or more extensive tendons and muscles transfer. Motor and sensory rehabilitation play an important role before and after surgery.