Demographics and Etiologies of Patients Evaluated in a Multidisciplinary Brachial Plexus Clinic: A Ten-Year Experience.

Abstract

The epidemiological distribution of patients with brachial plexus injury (BPI) has not been well described. We categorized new consultations at our specialty clinic, aiming to offer insights into demographics and presentations to guide those considering establishing brachial plexus clinics in understanding the types of patients they may encounter. All new consultations seen at a single quaternary center's brachial plexus clinic were reviewed over a 10-year period. Patients were categorized into groups of BPI. A total of 1415 new patients were evaluated including 1009 (71.3%) males and 406 (28.7%) females with a mean age of 43.7 (standard deviation 21.1). Eight hundred and sisty-one (60.8%) cases were traumatic. One hundred and fifty-nine (11.2%) cases were iatrogenic, often due to orthopedic shoulder surgery (n = 87). Obstetric BPI comprised 150 (10.6%) cases. Parsonage-Turner syndrome was encountered in 111 (7.8%). Ninety-nine (7.0%) were believed to be a nonbrachial plexus condition. Five hundred and seventy-seven (40.8%) patients underwent surgery by our team, with common procedures being nerve transfer, tendon transfer, neurorrhaphy, arthrodesis, and free functioning muscle transfer. Types of surgery varied based on time to presentation in traumatic BPI. Underinsured status was associated with delayed presentation, and it was an independent predictor of not undergoing surgery. Our experience suggests that trauma is the most common cause of BPI. Patients often present delayed, affecting type of surgical intervention rendered. A considerable number did not have a brachial plexus lesion, and the surgeon must be cognizant of alternative diagnoses. Future studies should further evaluate how demographics and socioeconomic deprivation may affect care and outcomes of BPI.