What are the key clinical features to assess in a patient with suspected traumatic brachial plexus injury?

In a patient with suspected traumatic brachial plexus injury, the key clinical features to assess include:

• Peripheral nerve function: Assess the specific peripheral nerves of the affected limb to identify which nerves are involved and the extent of functional deficit, including both motor and sensory loss.
• Motor function: Evaluate muscle strength and motor control in the affected upper limb to detect any paralysis or weakness.
• Sensory function: Check for sensory loss or changes such as numbness or altered sensation in the distribution of the brachial plexus nerves.
• Range of movement: Assess the range of movement of each joint in the affected limb to identify stiffness or contractures.
• Tissue viability: Monitor for risks to tissue viability due to sensory or motor loss, which may predispose to injury or ulceration.
• Signs of nerve recovery: Regularly reassess for any signs of nerve regeneration or functional improvement over time.
• Associated injuries and complicating factors: Consider the presence of multiple injuries, cognitive impairment, head injury, or complex fractures that may mask or complicate the nerve injury assessment.

Early identification of the involved nerves and functional deficits is essential to guide management, including the need for early surgical intervention or specialist referral.

Psychological impact and the need for multidisciplinary rehabilitation assessment should also be considered as part of comprehensive care.

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