Adult Brachial Plexus Injuries: A Historical Perspective

Background: The history of brachial plexus injury (BPI) reconstruction has evolved over the nineteenth and twentieth centuries and shown a dramatic change in attitude from pessimism to optimism in the twenty-first century. Methods: The evolution of treatment changes for BPI was divided into four periods: period of recognizing of BPI (before 1900), period of pessimism for clinical BPI repair (before microscope assistance, before 1964), period of improvement (I) by microscopy application (1964–1999), and period of improvement (II) by nerve transfer and functioning free muscle transplantation application (2000–till now). Results: Different surgeons in different periods had different approaches. The prognosis of the BPI reconstruction showed its significant improvement through the advances in its diagnosis and microsurgical nerve repair techniques in nerve repair, nerve grafts, and nerve transfers and microneurovascular anastomosis technique in functioning free muscle transplantation. Conclusions: The authors made one proposal and answers for two major debates. The proposal is that the level of BPI is better expressed with numbers (Levels I–IV), rather than word description. The first choice for surgical treatment for total root avulsion is traditionally brachial plexus exploration and performing multiple nerve transfers, instead of functioning free muscle transplantation. For incomplete BPI, proximal nerve graft/transfer offers more accurate diagnosis and proper treatment to restore shoulder and elbow functions simultaneously, instead of distal nerve transfers. However, when there is no healthy or insufficient donor nerve available, combining both strategies is recommended.