[Critical evaluation of diagnostics and therapeutic strategies in brachial plexus injuries in Austria: a retrospective study on incidence, diagnostics, treatment results and algorithm]

Abstract

Background: Brachial plexus injury is a rare entity, often resulting in lifelong motor and sensory dysfunctions. Sometimes neuropathic pain is predominant. The aim of this retrospective cohort study was to analyse current algorithms of diagnostics and treatment in brachial plexus injuries. The results have been compared to literature.

Patients and methods: A retrospective analysis of 214 patients suffering from a brachial plexus injury was conducted. Our results were compared to those in the literature.

Results: A sufficient algorithm for the diagnosis of and therapy for brachial plexus injuries was not apparent. Only a few studies have been published concerning this problem. The incidence for Austria is 1.29 cases per 100 000 inhabitants; this represents the middle range compared to international data. The main causes of brachial plexus injury were falls (45 %) and traffic accidents (26.6 %). 20.1 % of patients were multitraumatised, 29.9 % had a closed head injury. In 3.7 % the brachial plexus lesion was associated with spinal cord trauma. In contrast to the literature data (9-13 %), we did not find any stab or gun shot wounds. 5.6 % sustained a vascular injury at the arm or shoulder level; two patients had to undergo an emergency surgical procedure because of this injury. Clinical assessment was generally insufficient. Electrophysiological assessment was performed in 34.6 % of the patients, MRI in 13.6 %. In 38.3 % of the patients no clinical improvement was observed after three months. An operative procedure was performed in 8.4 % of these patients. 61.1 % of these operated patients were not satisfied with the clinical results. Practically no reconstructive procedures had been performed.

Conclusion: An algorithm for diagnosis and treatment needs to be established. Awareness for the sophisticated treatment of this type of injury has to be stimulated. Precise clinical assessment and knowledge of differentiated treatment options have to be available in order to improve the results.