Prognosis in flail upper limbs

Excerpt

These patients have suffered complete disconnection of the upper limb from the brain and spinal cord. Restoration of function involves reinnervation of muscles for control of the shoulder, the elbow and of the hand. The preponderance of root avulsions implies that there is a serious deficiency of donor nerves. Traditional nerve transfers using the spinal accessory nerve and the phrenic or the intercostal nerves provide consistent results for the supraspinatus and biceps muscles. However, this merely enables the patient to place the arm in space, which can be made more useful as a paperweight by secondary operations such as derotation osteotomy of the humerus and wrist fusion in pronation. Addition of thoraco-brachial grasp demands reinnervation of the pectoralis major using an intercostal. Systematic exploration of the brachial plexus is essential as ruptured root stumps in the neck are invaluable sources of growing axons. …