Surgical Management And Outcomes Of Lower Trunk Brachial Plexus Injury Reconstruction
Year: 2026
Type: conference-paper
Study design: Observational Study
Abstract: Purpose: The functional reconstruction of lower trunk brachial plexus injuries (LTBPI) poses considerable challenges, primarily due to the concomitant loss of hand function, the significant distance from the injury site to the target musculature, and the limited availability of suitable nerve and tendon transfer options. Additionally, there is a notable gap in the current literature regarding the most effective treatment strategies for this patient population. This study hypothesizes that surgical intervention can improve functional outcomes and aims to analyze patient data to identify potential treatment protocols and prognostic factors associated with successful recovery. Methods: A retrospective cohort study was conducted on adults treated for LTBPI at a tertiary multidisciplinary brachial plexus clinic from 2001-2024. LTBPI was defined as C8-T1 functional deficits, variable C7 function, and intact C5-6 function with at least 12 months follow-up. Patients were categorized as early or late presenters based on a 6-month post-injury time point. Statistical comparisons were made using t-tests and chi-square analyses. Results: A total of 46 patients with LTBPI met the inclusion criteria. The mean duration from injury to presentation was 11.3 months with a mean postoperative follow-up of 21.0 months. Two distinct patient subgroups were identified: 18 patients with isolated (C8-T1) lower trunk (ILT) injuries and 26 patients with residual lower trunk (RLT) injuries following spontaneous proximal recovery from initial pan-plexus (C5-T1) injuries. ILT patients retained better proximal function (p0.002), underwent fewer surgeries (1.3 vs 2.2, p0.001), and reported less dissatisfaction (17% vs 33%, p=0.033) than RLT patients. Those who presented early (6 months) were more likely to undergo nerve transfers (p=0.018) and reported superior Disabilities of the Arm, Shoulder, and Hand (DASH) functional outcomes scores by over 10 points (p=0.026). Functional grasp was restored in 67% of patients, but 63% developed moderate/severe intrinsic clawing. Intrinsic clawing was significantly associated with poor patient satisfaction (p=0.008) with 79% of these patients declining further treatment despite the availability of anti-claw procedures. Conclusion: Restoration of distal function in lower trunk brachial plexus injury (LTBPI) remains a complex challenge. Serial and comprehensive patient history and examination is essential for differentiating isolated from residual lower trunk injury since RLT is associated with greater injury severity and poorer clinical outcomes. Early intervention is correlated with improved prognosis. Intrinsic clawing has been identified as a predictive factor for patient dissatisfaction, particularly when unaddressed. Although staged anti-claw procedures are often planned, they are frequently deferred, possibly due to patient surgical fatigue. Incorporating anti-claw techniques during initial reconstruction has shown efficacy in reducing claw development and enhancing patient satisfaction, suggesting its utility as a primary reconstructive strategy. *Source: https://ps-rc.org/meeting/Program/2026/CS24.cgi*
Institutions: Brown University, Mayo Clinic
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7160610481