The patient came to the clinic 07-March-2006 with flail right upper
limb. The patient is an Iraqi citizen got RTA 02-August-2004 with
avulsion injury to the right upper limb and fracture of the right
humerus mid-third. The patient underwent several operations for the
fracture and neurolysis.
On examination, the deltoid , supra-infraspinatus , biceps
brachii muscles are completely paralyzed. The median and ulnar
nerves are completely not functioning. The triceps is weak 4/5 and
the brachioradialis muscle is 2/5.
MRI performed 07-March-2006 showing avulsion of right C7 root and
ECS confirmed extensive injury of the right brachial plexus with
absent response from right C6-7 and T1 roots.
The patient underwent exploration of the
through the most ugly incision undertaken before. The pectoralis
major was bisected for 3 cm to have more superior access to the
brachial plexus. The median nerve was identified from the most
distal part and followed up to end with vigorous scan without neural
The brachial artery and vein were dissected and preserved, trying
during that to preserve the integrity of the lymphatic nodes and
The ulnar nerve was identified distally and followed proximally.
It was penetrating the bone with useless neural elements at the
lower third of the arm.