Brachial plexus surgery

Benefit from the best possible results due to our innovative treatment concept

WHAT IS THE BRACHIAL PLEXUS

The brachial plexus is a network of peripheral nerves in the area of the neck, from which all the nerve trunks for the shoulder and arm region are formed. It provides the arms with feeling and muscle strength.

It controls all the muscles in the arms including the shoulder girdle. Furthermore, sensitive nerves run from the respective receptors in the skin and the muscles to the central nervous system.

Depending which area is injured (one or more spinal roots) and in what way (avulsion, tearing or strain), it can cause paralysis, sensory disturbances and pain. The treatment depends on the degree of severity of the injury and can comprise surgical or non-surgical methods.

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We are specialised in the diagnosis and treatment of nerve injuries. Our aim is to provide you with the best possible treatment, to achieve the maximum possible restoration of function and thereby help you to overcome or minimise your complaints.

THE FOLLOWING AWAITS YOU WITH US

A specialised surgical team

A specialised surgical team

A specialised surgical team

A specialised surgical team with many years of experience.

A comprehensive treatment concept

A comprehensive treatment concept

A comprehensive treatment concept

A comprehensive treatment concept based on the knowledge and decades of experience of Prof. Hanno Millesi, which we are continuously developing further on the basis of the latest scientific research findings.

A part of the Wiener Privatklinik hospital

A part of the Wiener Privatklinik hospital

A part of the Wiener Privatklinik hospital

As part of the Wiener Privatklinik hospital, we boast the latest equipment.

experienced interpreters

experienced interpreters

experienced interpreters

On request, we can arrange experienced interpreters.

all-round care

all-round care

all-round care

You are provided with all-round care – from your enquiry until you leave the hospital after your treatment. All the necessary examinations, treatment and care take place at the hospital.

Support you after the treatment

Support you after the treatment

Support you after the treatment

We continue to support you after the treatment and carry out corrective therapies if necessary.

surroundings where you feel competently taken care of

surroundings where you feel competently taken care of

surroundings where you feel competently taken care of

It is important to us to offer you surroundings where you feel competently taken care of and at ease.

This is how we make the diagnosis

The diagnosis of a brachial plexus injury is generally made by means of a clinical examination. In addition, electrophysiological examinations, high-resolution ultrasounds and neurologicalmagneticresonance tomography provide important information.

Our treatment concept

For all brachial plexus injuries, we apply a comprehensive treatment concept that has been proven to help patients achieve the best possible treatment outcome. It is very individual, in accordance with the injury pattern and the achieved function, with either conservative measures or an operation on the neuroplexus.

In addition, we make every effort to develop new treatment options that take into account all the compromised functional structures (nerves, the organs they supply and the central nervous system). Apart from the possible peripheral nerve fibre transfer, we pay particular attention to also remedying the lesion (= injury or functional disorder) on the brachial plexus. Our aim is to achieve maximum functionality and the best possible reduction of pain for patients.
The treatment of injuries to the brachial plexus and the resulting paralysis of the arm is very individual for every child and every adult and depends on the age of the patient, the start of treatment after the trauma and the type and severity of the injury.

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Treatment in three phases

  1. The first phase of neurosurgical treatment must take place in the first year after the nerve trauma.
  2. The second phase of physical therapy lasts around one to two years.
  3. After the nerve regeneration, the third phase of reconstructive operations to improve the result starts.

In total, treatment for adults lasts between two and five years. 

Conservative and operative treatment

Due to our decades of experience in the treatment of brachial plexus injuries and the continuous further development of treatment strategies, we have been able to achieve enormous progress.

Not all brachial plexus injuries require an operation, but our own results have shown that among 20% of patients there is no or only a partial regeneration of the arm nerve network. For some patients, there can also be an interruption to the already started regeneration. In these cases, an operation becomes necessary.

Through the method of interfascicular nerve transplants developed by Prof. Hanno Millesi, a safe method of remedying ongoing nerve injuries was introduced. Even among patients with an avulsion of all nerve roots of the brachial plexus, useful functions can be restored. Nerve fibres from other regions of the body are used for this.

These operations on the brachial plexus are carried out by us

Our operative treatments range from the decompression of individual nerves and the technique of neurolysis (exposure of the nerve structures) to highly complex, protracted microsurgical reconstructions of the brachial plexus. We employ all the available nerve resources (= reconstruction of the brachial plexus plus peripheral nerve fibre transfer) if necessary to achieve an optimal result for you.

Interfascicular nerve transplants
In interfascicular nerve transplants, part of the brachial plexus is removed and replaced by a transplant with a nerve from another part of the body. We generally carry out this operation on patients with severe lesions of the brachial plexus that do not respond to conservative treatment methods. We can thus ideally reconstruct your brachial plexus and restore the motor and sensory functions of your arm.

Peripheral nerve fibre transfers
Peripheral nerve fibre transfers are used in isolation for avulsion injuries, as well as in connection with the reconstruction of the brachial plexus, in order to guide as many nerve fibres as possible into the periphery.

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Good prospect of success


Recovery from a brachial plexus injury is a complex and protracted process. However, we know from our own experience that the treatment is very successful in most cases. Complete recovery is rare, but most patients can become fully or largely mobile again after the operation with physiotherapeutic help and other rehabilitation methods.

The most common cause of a brachial plexus injury among children is a birth trauma. During a natural birth, a strain, rupture (= tear) or avulsion injury of the brachial plexus can occur if the baby’ shoulder gets caught in the mother’s birth canal (shoulder dystocia).

Brachial plexus injuries can also occur during Caesarean sections, as the trend of imitating a natural birth has become increasingly widespread. The consequences of such an injury are paralysis and sensory disorders, but contrary to adults never neuropathic pain.

The diagnosis and treatment of a brachial plexus injury among adults and infants are identical. However, the type and duration of the reconstructive procedures used later for children are different, as children grow, develop and learn.

 

PRELIMINARY ANAMNESIS QUESTIONNAIRE

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questionnaire

If you already have a long history of illness behind you regarding your physical complains, we kindly request that you fill in our free questionnaire. Your answers provide us with information about your complaints and your prior medical history. This helps us to prepare your first consultation, to make a diagnosis and to choose the suitable treatment.

FAQ

THE MOST FREQUENTLY ASKED QUESTIONS OF OUR PATIENTS SUMMARIZED.

Brachial plexus injuries often occur during motorcycle accidents, other traffic accidents or sports accidents. Tumours, compression (pressure) or radiation treatments can also damage the brachial plexus.

The possible outcome of the treatment depends on the extent of the injury and on the commencement of treatment and so this question cannot be answered in general terms.

The brachial plexus is examined and, depending on the extent of the injury, decompression or reconstruction by means of nerve fibre transfers is carried out.

The arm is immobilised with a sling for five to seven days. Stitches are removed after two weeks. Then passive kinesitherapy starts up to a horizontal position. The extent of movement may increase until the sixth postoperative week. Then muscle stimulation of the muscles subject to denervation (= interrupted nerve paths) is started. This stimulation should also be carried out before the operation, as this allows the contractile elements (those areas that can draw together) of the muscle to be kept alive for longer.

It has been proven that paralysed muscles that are passively moved offer better functional results after innervation has been restored. The tendon and joint mobility must be preserved through physical therapy.

Yes, it is useful and necessary. It contributes to a good functional result. As a rule, adults go through a long phase of physical therapy: one to two years.