Brachial Plexus Injury

Chapter 17 of Volume 1, Hand & Upper Limb. Revision notes and examiner-style viva questions with model answers for the FRCS (Plast).

27 viva questions in this chapter

1. A 26-year-old motorcyclist is in resus after a high-speed collision. His right arm is flail and insensate. Take me through it.
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2. What are you actually looking for on examination?
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3. What imaging do you want, and when?
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4. What does neurophysiology add?
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5. When would you operate on this man’s plexus?
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6. This is a complete C5–T1 injury at four months. What are you going to reconstruct?
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7. In a complete avulsion, where are your axons coming from?
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8. How would you use the spinal accessory nerve?
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9. How will you get his elbow to flex?
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10. Describe your supraclavicular exploration of the brachial plexus.
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11. And the infraclavicular exposure?
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12. Describe the spinal accessory to suprascapular transfer.
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13. Describe a free functioning gracilis for elbow flexion.
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14. Would you use a contralateral C7 transfer in this man?
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15. What about the phrenic nerve as a donor?
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16. What can you offer his hand?
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17. He is now two years out. The elbow flexes to M3 but the shoulder is unstable and painful. What do you do?
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18. Would you ever amputate?
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19. He describes constant burning pain with lightning shocks in a completely numb hand. Manage it.
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20. What else does this man need, beyond an operation?
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21. How do you reconstruct the shoulder in a C5–C6 injury?
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22. And elbow flexion?
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23. Anything else at the elbow?
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24. The same patient, but the triceps and wrist extensors are weak too. What changes?
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25. He presents at eighteen months with no elbow flexion. Now what?
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26. What can you actually transfer?
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27. What about his intrinsics?
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