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Objectives: Brachial plexus injury (BPI) often results in devastating loss of upper limb function and debilitating neuropathic pain. The medial cord is often damaged following low-energy falls and glenohumeral dislocation. Medial cord injury (MCI) is associated with poor functional hand outcome due to paralysis of intrinsic muscles innervated by median and ulnar nerves, yet management options are limited. Nerve injury severity, demographic factors and concomitant injuries are poorly defined in this group. This study aims to understand patterns of infraclavicular BPI to guide management. Methods: All consecutive cases of infraclavicular BPI presenting to a regional peripheral nerve injury service over a 3-year period were retrospectively analysed. Medical records and neurophysiology reports were reviewed, and demographics and injury details were recorded on a database. Results: Ninety-nine infraclavicular BPI cases were identified. Of these, 34 (34%) were attributed to glenohumeral dislocations sustained in low-energy falls. There were 21 females and 13 males with mean age 62 years and mean body mass index 31. Five (13%) and 11 (29%) patients sustained vascular injuries and rotator cuff tears, respectively. Twelve (35%) patients sustained 13 fractures, of the proximal humerus or greater tuberosity. Review of injury patterns identified MCI in 24 cases (71%), 12 (50%) of which were amenable to nerve transfers. Conclusion: Low-energy falls are often accompanied by glenohumeral dislocation, whereby the medial cord is commonly damaged, resulting in an intrinsic minus hand. This injury subgroup has not been previously described, yet early recognition and referral for novel nerve transfer surgery can improve outcomes for these life-changing injuries. |
