Department of Orthopaedic Surgery
Wake Forest Brachial Plexus and Peripheral Nerve Center
Clinical Concerns in Brachial Plexus Injury
The Wake Forest Brachial Plexus and Peripheral Nerve Center integrates clinical care, research, and education to advance the treatment of all types of obstetric and adult brachial plexus injuries and peripheral nerve pathologies, such as carpal tunnel syndrome, cubital tunnel syndrome, thoracic outlet syndrome. The development of an integrated multidisciplinary team approach to fulfill our mission ensures that individual patient care is always the primary objective.
The brachial plexus is a nerve network derived from the spinal cord that controls the movement and sensation of the hand and arm. Brachial plexus palsy occurs secondary to birth-related injury (Erb's Palsy, Obstetric Palsy), high speed trauma or results from tumor, radiation and compression. It is imperative that a patient with brachial plexus injury is evalulated by experienced medical specialists who can monitor and treat the patient early.
The goal of the Brachial Plexus and Peripheral Nerve Center is to provide a state-of-art diagnostic facility, surgical techniques and therapeutic approaches to maximize a patient's functional recovery. This is accomplished by an experienced multi-specialty team including reconstructive hand surgeons, neurologists, neurophysiologists, neuroradiologists, physical and occupational therapists.
What is the Brachial Plexus?
The brachial plexus is a network of nerves. It conducts signals from the spine to the arm and hand. These signals cause the arm and hand muscles to move. It also provides feeling for the hand and arm.
What Causes Brachial Plexus Injuries?
Adult brachial plexus injuries are often the result of high impact trauma such as a motorcyle injury, motor vehicle accident or sporting injury. Tumors, compression or irradiation therapy can also damage the brachial plexus.
Most pediatric (obstetric) brachial plexus injuries happen during birth. Many babies with birth palsy are larger than average at birth, had a prolonged labor, or breech delivery. About 45% are associated with shoulder dystonia. About two or three babies in 1,000 suffer brachial plexus injuries at birth.
How Do We Diagnose Birth Palsy at Wake Forest?
Patients with brachial plexus injuries are affected in different ways. Brachial plexus injuries are usually discovered, at birth or shortly after injury, by an inequality of upper arm movement or suspicion because of the type of delivery or trauma. Erb's Palsy is the most common type of obstetric palsy and involves C5 and C6 nerve roots. There is an inability to abduct the shoulder, externally rotate the arm, and to turn the forearm outward. The hand and wrist are spared. In contrast, Klumpke's Palsy is much less common. It involves C8 - T1 nerve roots and will have an inability to flex the wrist or grasp. Some patients have no muscle control and no feeling in the entire arm or hand due to the entire plexus involvement.
The initial evaluation should occur as early as possible following injury. When evaluation is delayed beyond six to nine months, treatment options are limited, although will still be valuable in maximizing the recovery. The diagnosis is based on a thorough medical history and physical examination. Studies including x-ray, MRI, CT, EMG will also be utilized to assist the physician to locate the injury and to identify the severity of the nerve damage.
How Do We Treat Brachial Plexus Injuries at Wake Forest?
The treatment for each child or adult is highly individualized based on the age, the type and severity of the injury. Immediately after injury, therapy and exercises should be emphasized to keep the muscles and joints flexible. Some patients show improvement or recover within three to six months of the injury. These patients are typically treated with exercises and physical therapy to improve range of motion, muscle strength and to prevent joint stiffness and deformity.
Surgery may be indicated if spontaneous recovery has not occurred within several months. The purpose of surgery is to improve the arm function. Nerve surgery, if required, is most effective when it is done early and should ideally occur within six months and typically not later than one year. By using microsurgical techniques, surgeons can repair the individual nerves of the brachial plexus to improve nerve regeneration and to restore some hand and arm functions. This may include nerve repair, release of the nerve from scar tissue (neurolysis), placing nerve grafts across the damaged nerves, or "nerve transfer" (neurotization) to sew an adjacent, functioning nerve into an irreparably injured nerve in an attempt to restore function in a paralyzed muscle. Late surgery may be done to release the contracted muscles, to reduce a dislocated shoulder, to correct a bony deformity (osteotomy) and to transfer muscles or tendons to rebuild the hand functions.
Neurolysis with Intraoperative Monitoring
Nerve Graft, Nerve Transfer (Neurotization)
Nerve Conduit to Bridge the Gap
Botulinum Toxin Injection for Muscle Contracture
Tendon Transfer to Rebuild Shoulder Function
Professor, Orthopaedics and Pediatrics
Vice Chairman, Orthopaedics
Director, Hand Fellowship ProgramSpecial Interests
- Brachial Plexus
- Cerebral Palsy
- Congenital Hand Deformity
- Pediatric Rehabilitation
- Spasticity Management
- Hand & Reconstructive Surgery
Assistant Professor, Orthopaedic Surgery
Special Interests
- Sports Medicine of the Upper Extremity
- Arthroscopy of the Shoulder/Elbow/Wrist
- Peripheral Nerve Surgery
- Hand and Upper Extremity Trauma
Zhongyu John Li, M.D., Ph.D.
Assistant Professor, Orthopaedic Surgery
Special Interests
- Brachial Plexus and Peripheral Nerve Surgery
- Hand and Microvascular Surgery
- Upper Extremity and Hand Trauma
- Arthroscopy
Professor and Interim Chairman, Neurology
Special Interests
- Neuromuscular Disorders (Amyotrophic Lateral Sclerosis, Motor Neuron Disease, Peripheral Neuropathy, Myasthenia Gravis, and Myopathies)
Professor, Neurology
Medical Director, EMG Laboratory
Special Interests
- Muscle Sonography
- Magnetic Stimulation
- EMG/Clinical Neurophysiology
Associate Professor, Neurology
Chief, Pediatric Neurology
Special Interests
- Pediatric Neurology Clinical Trials
- Neonatal Neurology
Associate Professor, OrthopaedicsSpecial Interests
- Skeletal Muscle Microcirculation
- Physiology of Peripheral Nerve Injury and Regneration
- Clinical Application of Botulinum A Toxin
Instructor, OrthopaedicsSpecial Interests
- Neuromuscular Junction Physiology
- Molecular Biology
- Brachial Plexus and Peripheral Nerve Injury and Regeneration
Patient Appointments:
- (336) 716-8092 or
- (336) 716-4015
Academic Office:
- (336) 716-2878, Dr. Koman
- (336) 716-9351, Dr. Li
- (336) 716-9347, Dr. Wiesler
Facsimile:
- (336) 716-6286
How do you get to the Medical Center and how do you find your way around once you get here? Please click the link below for visitor information.
Please click the link below for more information regarding the Department of Orthopaedic Surgery Research.
Department of Orthopaedic Surgery - Research
Traumatic Brachial Plexus Group
American Association for Surgery of the Hand - Brachial Plexus Injury
National Institutes of Health
