ARM PARALYSIS SEEN IN ADULTS

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(TRAUMATIC BRACHIAL PLEXUS INJURIES)

Branches of five nerve roots which exits from neck vertebras control movement and sense of all upper extremity by forming a web (Figure 1).

Nerves give the electrical stimulus to our muscles that provide our movements. When nerves are out of function, movement is impossible in muscles that they give electric.

Arm paralysis of adults arise after motorcycle accidents, other traffic accidents, falling from high and forearm wounding. In closed injuries the patient is followed up for three months and some tests are run. In cases that nerve structural integrity is not damaged but regression arises, transmission losses are expected to regress at most within three months. Accompanying tissue injuries such as bone fractures, vessel injuries that may occur in the trauma area are examined and treated. Advanced radiological tests (MRI, Myelo CT) that will help to show whether the nerve is damaged and if it is, the level of injury; and tests that shows nerve transmission and if the muscles take stimulus or not lighten the differential diagnosis.

As in all nerve injuries, operations that will be performed immediately after the diagnosis provides more successful results. Nerves grow by extending 1 mm rate daily from the repair area to downwards. While waiting function from shoulder and elbow muscles is possible, muscles that provide detailed hand movements are the farthest aims.  Reason for this is muscles that nerves will give electric turns into the connective tissue slowly and looses their contraction features irreversible.   If requirement for nerve operations is considered, it should applied before one year. In this term, how many nerve roots are damaged and their damage levels are important. For nerve roots that are damaged on spine level, transplantation from nerves that we use less may be required. In lower level injuries that nerve roots are visualized, nerves taken from legs are used by making bridge between the deficient region. Nerves taken from the leg are sensory nerves that do not cause any movement failure. Scars of the area that they are taken should be ignored for arm functions.

One of the most important points that the patient and patient relatives should remember related with either brachial plexus or other nerve operations is operations results will be taken after a long time. The purpose after this difficult treatment protocol that may last for years is to form a helper extremity that helps to the stable extremity by providing the maximum function in the arm and the hand (one hundred percent recovery and providing all functions should never be waited). But even this is possible with surgeries that will be performed in a long term, with a complying follow-up between the patient and the doctor and physiotherapy process and a big patience.

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