ABSTRACT
Ruptures of the cords and of the terminal branches of the brachial plexus are usually caused by violent injury. They are often complicated by fractures or fracture/dislocations of the shoulder girdle. The incidence of injury to the axial vessels is high. Penetrating missile injuries cause extensive damage to skin and muscle. Closed traction lesions result in extensive longitudinal injury to the nerve trunks which retract widely if ruptured. Nerves are particularly vulnerable to the activities of surgeons working on the shoulder joint or humerus. The prognosis for restoration of hand function after repair of the long nerves, the radial, median and ulnar, is compromised by the level of injury. Diagnosis and treatment is urgent and in the presence of an arterial injury, it is an emergency. The operating surgeon needs to be able to treat the vascular and the skeletal injuries as well as the neurological injury. The prognosis for the lesion in continuity of the nerve trunk, commonly seen after penetrating missile injuries or after stretching injury, is particularly perplexing.
