Brachial Plexus Surgery by Anthony MacQuillan
As one of only four dedicated consultant peripheral nerve surgeons in the UK, Anthony MacQuillan provides world-class nerve and tumour surgery.
Brachial Plexus Surgery stands as a significant intervention in the field of nerve repair and reconstruction.
It’s tailored to address the intricate issues associated with the brachial plexus, which, due to its complexity, requires a nuanced understanding and approach. This surgery is not just a medical procedure; it’s a journey towards regaining control and functionality of one’s arm and hand, profoundly impacting an individual’s daily life and activities.
When you’re facing challenges with movement or enduring persistent pain in your arm, shoulder, or hand, it’s possible that the brachial plexus nerves have been compromised. These nerves are like the electrical wiring of your limb, sending signals from your spine to your shoulder, arm, and hand. Damage to these nerves can result from various causes, including traumatic injuries, such as those from vehicular accidents or severe falls, or could be due to medical conditions that affect nerve health.
The goal is to restore as much function as possible and alleviate pain, which in turn can have a transformative effect on your ability to engage in everyday tasks and enjoy a more active lifestyle.
2 to 4 hours
General
1 to 7 nights depending on complexity.
4 to 6 weeks
Brachial Plexus Surgery is just the first step in your journey towards recovery. The surgery is followed by a period of rehabilitation, which is critical for regaining strength and function in the affected limb.
Brachial Plexus surgery is a highly specialised field within nerve repair, involving intricate procedures designed to mend or rebuild the damaged nerves of the brachial plexus. This network of nerves, crucial for the movement and sensation in your arm and hand, can be impaired due to various reasons, including traumatic injuries or medical conditions. The primary goal of this surgery is to bring back as much function as possible to your affected limb and to alleviate the discomfort that often accompanies such nerve damage.
Brachial Plexus Surgery demands a high level of skill and experience from the surgical team, as well as commitment from you, both in preparing for the surgery and in the following rehabilitation. The journey toward recovery can be challenging, but the potential benefits of improved function and reduced pain are substantial.
Who Needs Brachial Plexus Surgery?
Brachial Plexus surgery is a targeted intervention for those who have experienced significant nerve damage in the neck and shoulder area. This type of surgery isn’t a universal solution but is considered for specific cases where the damage to the brachial plexus nerves is such that other treatments are unlikely to provide adequate relief or restoration of function.
The typical candidates for Brachial Plexus Surgery are patients who have sustained traumatic injuries leading to nerve damage. These injuries can arise from a variety of incidents, including:
- Motor vehicle accidents: High-impact crashes can cause severe damage to the nerves in the neck and shoulder region.
- Sports injuries: Certain sports, especially contact sports, can result in injuries that affect the brachial plexus.
- Severe falls: Falls from a significant height or with substantial force can damage these delicate nerves.
In addition to traumatic injuries, there are other circumstances where Brachial Plexus Surgery might be necessary:
- Congenital conditions: Some individuals are born with brachial plexus injuries, which can affect the development and function of the arm and hand.
- Tumours: Growths in or near the brachial plexus can compress or damage the nerves.
- Inflammation: Certain inflammatory conditions can lead to nerve damage in the brachial plexus area.
The suitability of the surgery for you will depend on various factors, including the nature of the nerve damage, your overall health, and your specific circumstances. The goal is always to achieve the best possible outcome, which means restoring as much function as possible and reducing discomfort.
Benefits of Brachial Plexus Surgery
The benefits of Brachial Plexus Surgery extend beyond the physical repair of nerves; they touch on various aspects of your life, making everyday tasks more manageable and enjoyable.
The primary benefits of Brachial Plexus Surgery include:
- Improved arm and hand function: The surgery aims to restore movement and strength in the affected arm and hand. For those who have experienced paralysis or severe weakness, this can mean a significant improvement in performing daily tasks such as dressing, eating, and typing.
- Reduced pain: Nerve injuries often come with considerable discomfort or pain. Brachial Plexus Surgery can alleviate, leading to a more comfortable and manageable daily life.
- Enhanced quality of life: With improved functionality and reduced pain, your overall quality of life can see a marked improvement. This encompasses a range of activities and experiences, from personal care to professional tasks and leisure activities.
- Increased independence: Regaining arm and hand function can significantly boost your independence. Tasks that were once challenging or required assistance can become manageable again.
- Better ability to work: For many, the improved function following surgery means a return to work or an enhanced capacity to perform job-related tasks. This can have a positive impact on your professional life and financial stability.
- Enjoyment of recreational activities: With improved movement and reduced discomfort, engaging in hobbies and sports becomes more feasible and enjoyable.
- Psychological benefits: The restoration of function and reduction in pain can also have a positive impact on your mental state. The ability to engage more fully in life can boost your overall outlook and satisfaction.
It’s important to remember that while Brachial Plexus Surgery offers these potential benefits, the outcomes can vary based on the individual case. The extent of nerve damage, the type of surgery performed, and your commitment to post-operative rehabilitation all play crucial roles in determining the success of the surgery.
Types of Brachial Plexus Procedures
Nerve grafting
This involves replacing damaged sections of the brachial plexus nerves with nerve grafts, which are typically taken from another part of your body. This procedure is often used when there are gaps in the nerves that cannot be directly reconnected.
Nerve Transfer
In cases where the original nerve can’t be repaired, a nerve transfer may be performed. This involves rerouting a less important nerve or a part of a nearby working nerve to the damaged area.
Muscle Transfer
This procedure is used to restore function or strengthen the affected limb. It involves transferring a muscle or tendon from another part of your body to the area affected by the brachial plexus injury.
Neurolysis
During neurolysis, the affected nerve is carefully accessed, and any scar tissue, adhesions, or other obstructions that may be impeding its function are removed or disrupted.
Direct Nerve Repair
When the damage to the nerve is minimal, direct nerve repair might be possible. This involves surgically reconnecting the ends of the severed nerve.
Free Muscle Transfer
This advanced procedure is used in cases of more severe damage. It involves transplanting a muscle with its nerve supply from one part of the body to the affected area to restore function.
How is the Brachial Plexus Surgery Performed?
Brachial Plexus Surgery encompasses a range of procedures, each designed to address specific types of nerve injuries. The nature of your injury will dictate the most appropriate surgical approach. These procedures are complex and require a high level of expertise from your surgical team. The main types of Brachial Plexus procedures include Nerve Grafting, Nerve Transfer, Muscle Transfer, Neurolysis, Direct Nerve Repair, and Free Muscle Transfer.
Each of these Brachial Plexus Surgery procedures has its specific indications and is chosen based on your condition. The decision on which type of surgery to undergo will be made after a thorough assessment of your nerve injury, including the location, type, and extent of the damage.
The surgery is conducted under general anaesthesia, ensuring you’re completely unconscious and free from pain during the Brachial Plexus Surgery. The steps involved in the surgery vary depending on the type and extent of your nerve injury, as well as the specific surgical technique being used. Here’s a general overview of what happens during the surgery:
- Preparation: Before the surgery begins, you’ll be prepared for the operation. This includes administering general anaesthesia and positioning you in a way that gives the surgeon the best access to the affected area.
- Incision: Anthony makes an incision in the neck or shoulder region. The location and size of the incision depend on where the damaged nerves are located.
- Accessing the nerves: Anthony carefully exposes the brachial plexus nerves. This step requires meticulous dissection to avoid damaging surrounding tissues.
- Assessing the damage: Once the nerves are exposed, Anthony assesses the extent of the nerve damage. This assessment guides the choice of surgical technique.
- Repairing the nerves: Depending on the nature of your nerve injury, Anthony may perform one of several procedures mentioned before (Nerve Grafting, Nerve Transfer, Muscle Transfer or Neurolysis).
- Closing the incision: Once the nerve repair is complete, Anthony closes the incision with sutures.
- Post-operative care: After the surgery, you’ll be taken to a recovery area where your vital signs are monitored as you wake up from the anaesthesia.
The duration of Brachial Plexus Surgery can vary significantly, from a few hours to much longer, depending on the complexity of the injury and the type of repair being performed.
For most operations, you will only need to stay in hospital one or two nights. But for more complex reconstructions involving muscles being moved from one part of the body to another, or if the nerves from the chest are needed to provide a new source of electricity to the muscles in the arm, then this may be increased to up to a week.
Recovery after Brachial Plexus Surgery
Recovery following Brachial Plexus Surgery is a critical phase, requiring time, patience, and dedication. It’s a period marked by gradual healing and rehabilitation, with the aim of regaining as much function and comfort in your arm and hand as possible. The length and nature of the recovery process vary depending on the extent of the nerve injury and the type of surgery performed. Here’s what you can typically expect during the recovery period:
- Initial Healing: In the first few weeks after surgery, the focus is on allowing your body to heal. This involves managing post-operative pain and taking care to protect the surgical site. You’ll likely have follow-up appointments with Anthony to monitor your progress and address any concerns.
- Physical Therapy: Physical therapy is a cornerstone of your recovery. Starting a regimen of physical therapy early in the recovery process is essential. This therapy will be tailored to your specific needs and will evolve as you progress. It typically includes exercises to improve strength and flexibility in the arm and hand, techniques to enhance fine motor skills and activities to improve range of motion.
- Pain Management: Managing pain is an important aspect of your recovery. Your medical team will work with you to find the most effective pain management strategies, which may include medications to control pain and inflammation, techniques for nerve pain relief and alternative therapies, such as acupuncture or massage, if appropriate.
- Home Care: Your involvement in your recovery at home is vital. This includes adhering to your physical therapy exercises, attending all follow-up appointments, and taking prescribed medications as directed.
- Lifestyle Adjustments: Depending on the extent of your recovery, you may need to make temporary adjustments to your daily activities. This might involve modifying how you perform certain tasks or using assistive devices.
- Emotional Support: Recovery can be challenging not just physically, but also emotionally. Seeking support from family, friends, or support groups can be beneficial.
- Long-Term Rehabilitation: Recovery doesn’t end when the initial healing is complete. Long-term rehabilitation may be necessary to continue improving strength and function in the affected limb.
Videos
How Much is Brachial Plexus Surgery in the UK?
The cost of Brachial Plexus surgery in the UK, can vary widely based on several factors. These include the complexity of the procedure, the specific techniques used, the duration of the surgery, the setting in which the surgery is performed (hospital or private clinic), and the surgeon’s experience and expertise. Additionally, the overall cost may include pre-surgical consultations, anaesthesia fees, hospital or facility charges, and post-operative care and follow-ups.
This is a highly specialised and complex procedure, with costs that can reflect its intricacy. Prices may range significantly depending on the specifics of the case. Patients might expect the cost to be in the tens of thousands of pounds, considering the surgery’s complexity and the extensive rehabilitation often required.
It’s important for patients to consult with Anthony’s team for a detailed estimate that includes all aspects of the surgical journey.
Insurance coverage can also play a significant role in the financial planning for reconstructive surgery, as some procedures may be partially or fully covered if deemed medically necessary.
FAQs
Find out more about your surgical journey
What are typical symptoms of Brachial Plexus injury?
The brachial plexus is a group of five nerves that emerge from the neck and join together to form a network that supplies the arm.
There are many conditions that can affect these including compression, tumour formation and injury.
Such problems with the nerves are often referred to as lesions and a lesion of the plexus can result in pain, altered sensation, loss of sensation, weakness or paralysis of some or all of the muscles of the arm. Many of these conditions are treatable provided they are seen early enough.
Possible treatments can include:
- Thoracic outlet syndrome (compression of the nerves of the brachial plexus)
- Nerve transfers (usually done after traumatic injury to the plexus)
- Nerve grafting (usually done after traumatic injury to the plexus)
- Free functional muscle transfer (usually done after traumatic injury to the plexus)
If you have been diagnosed with a brachial plexus injury, a tumour of the plexus or have thoracic outlet symptoms (compression) then early intervention is recommended.
What are the success rates of Brachial Plexus Surgery in restoring function or reducing pain?
The success rates of Brachial Plexus Surgery can vary significantly based on factors such as the type and severity of the injury, the specific surgical technique used, and the timing of the surgery.
Generally, success rates are higher when surgery is performed soon after the injury. Studies have shown that patients often experience improved function and pain reduction post-surgery, but complete restoration of function is not always possible. Success rates can range from 70% to 90% for certain types of nerve injuries and surgical procedures.
It’s important for patients to have realistic expectations and understand that success also depends on postoperative rehabilitation and the body’s natural healing process.
Can Brachial Plexus Surgery help in cases of chronic brachial plexopathy, and what are the expectations?
Brachial Plexus Surgery can be beneficial in cases of Chronic Brachial Plexopathy, especially when conservative treatments have not yielded significant improvement. However, the expectations need to be adjusted as the outcomes can be less predictable than in acute cases. The extent of nerve damage over time can impact the effectiveness of the surgery. While complete restoration of function might not be possible, the surgery can often provide improvements in pain, sensation, and partial motor function. The success in chronic cases also heavily relies on the patient’s commitment to postoperative rehabilitation.
How are brachial plexus lesions diagnosed?
Damage is diagnosed by taking the history of the complaint (telling Anthony during your consultation what the problems are you’re currently experiencing with your arm), clinical examination and then specialist investigations as directed by the examination findings.
The specialist tests most frequently requested include MRI scans, ultrasound scans and nerve conduction studies (looking how well the nerves are conducting electrical impulses and how healthy the muscles are).
If the concern is that you have developed a growth in your brachial plexus, a tissue sample (biopsy) may need to be obtained in order to make a definitive diagnosis prior to any surgery.
Is Brachial Plexus surgery always necessary?
Often surgery is not necessary. Many injuries recover by themselves, and compression syndromes frequently respond to physiotherapy. The decision to operate or not is a joint one based on your wishes and the treatments that you have had or not had previously. Anthony will give you all treatment options and the pros and cons of each. All of the potential risks of surgery will be discussed and you will have the opportunity to ask as many questions as you wish.
When is the best time to have Brachial Plexus Surgery after an Injury?
Within THREE MONTHS!
There has been a lot of debate over when surgery should be performed. In some cases, the condition can spontaneously go away by itself which means surgeons often prefer to delay an operation to see whether it is actually required.
However, if surgery is delayed for too long, it is known to result in a poor functional outcome.
After new research, surgeons have a much better idea of when surgery should be performed to get the best outcome.
The study involved first carrying out a systematic search to find related studies into the timings of Brachial Plexus surgery.
Patients in these studies were divided into five different delay groups, ranging from 0 to 3 months to over 12 months before surgery was performed.
There were 43 studies included, and most showed surgery performed within THREE months had the best chance of success.
The shorter the delay, the better patients scored in terms of quality of life and pain.
Giving the three-month delay allows plenty of time to see whether the injury is likely to correct itself. Longer delays showed a poorer result outcome, while patients also struggled with increased pain and lack of mobility.
Where are the Incisions made for Brachial Plexus Surgery?
Depending on where the lesion is located, the severity of the problem and the timing of the surgery (is it soon after the initial problem occurred or is it now many months later?) the surgery can involve one or more incisions.
The initial incision is usually either at the base of the neck or just in front of the shoulder. Depending on what the problem is further incisions may be necessary.
Anthony will go through all the possibilities with you regarding potential incisions during your consultation.
Watch the brief video describing the incisions commonly used and the video will show you how the brachial plexus is exposed during surgery (if you are not keen on the sight of blood, however, don’t worry it is an animated video with no real blood in it).
What should I expect during the pre-operative evaluation for Brachial Plexus Surgery?
During the pre-operative evaluation for Brachial Plexus Surgery, patients can expect a thorough assessment that includes a detailed medical history, physical examination, and various diagnostic tests. This evaluation aims to determine the extent of the nerve injury and the best surgical approach. Diagnostic tests may include MRI scans, CT myelography, and electrophysiological studies like EMG and nerve conduction studies. These tests help in mapping out the damaged nerves and planning the surgical procedure. Patients may also consult with a team of specialists, including neurologists, neurosurgeons, and physical therapists. This comprehensive evaluation is crucial for tailoring the surgery to the patient’s specific needs and optimising the chances of a successful outcome.
What are the risks of Brachial Plexus Surgery?
While this surgery offers the possibility of improved function and reduced discomfort, like any surgical intervention, it comes with its own set of risks. Being informed about these risks will help you make a well-considered decision and prepare for the surgery with a clear understanding of what to expect.
The general risks associated with any surgery, include:
- Infection: As with any surgical procedure, there is a risk of infection at the incision site or within the operated area.
- Bleeding: There is a possibility of bleeding during or after the surgery, which can lead to complications.
- Adverse reactions to anaesthesia: Some individuals may experience negative reactions to the anaesthesia used during the procedure.
Specific risks associated with Brachial Plexus Surgery include:
- Incomplete recovery of nerve function: Despite the best efforts of your surgical team, there is a chance that the surgery may not fully restore nerve function.
- Nerve damage: The surgery itself carries a risk of causing additional nerve damage, either directly or through complications during the healing process.
- Muscle weakness: The affected arm or hand may experience ongoing weakness, even after the surgery.
- Scar tissue formation: Scar tissue can develop around the surgical site, potentially affecting nerve function and mobility.
- Loss of sensation: There is a risk of losing sensation in the area affected by the surgery.
- Pain: Some individuals may experience ongoing pain or discomfort in the affected limb after surgery.
It’s important to have a thorough discussion with Anthony about these risks. He will provide you with detailed information based on your specific condition and the type of Brachial Plexus Surgery you are undergoing.
Anthony will also discuss how these risks are managed and mitigated. This includes pre-operative preparations, careful surgical techniques, and post-operative care and monitoring. The goal is to minimise the likelihood of these risks occurring and to manage them effectively if they do arise.
Medical References about Brachial Plexus Surgery
- Brachial plexus injury – Diagnosis and treatment – Mayo Clinic
- Brachial Plexus Surgery – Yale Medicine
- Treatment Options for Brachial Plexus Injuries – PMC – NCBI
- Brachial Plexus Treatment – PubMed
- Surgical options to treat brachial plexus injuries – Mayo Clinic News Network
Reviews
Patient satisfaction is the top priority for Anthony. You can find how patients feel about his work below.
Free Muscle and Nerve Transfer into Biceps – March 2016.
Following a motorcycle accident which left me with a left arm Brachial Plexus Injury, suspected C5,6,7 avulsed, but likely C8,T1 also avulsed, I was introduced to Anthony after 9 months of rehab on the NHS at RNOH Stanmore under Mr M Fox and locally at Salisbury and Southampton Rehab units.
I was keen to explore all avenues of regaining some bicep function but moreover I was eager to find a permanent solution to preventing my shoulder from subluxing. It was causing me intense neck and back ache and the strapping I had to wear to support my shoulder was very intrusive, uncomfortable and being bespoke for me meant that I only had one sling and it wasn’t very hygenic.
I met Anthony in Bristol Spire shortly before Christmas ’15 to discuss if my situation was suitable for a Muscle and Nerve Transfer operation. First impressions last…and my first impressions put me completely at ease. Anthony ensured I left knowing exactly the realistic outcomes achievbable to me. I was also shown videos and pictures of previous operations and was put under no illusion that if I were to go ahead with the operation the immediate 6-12 months would be extremely tough both physically but more so mentally.
Anthony’s confidence and passion was infectious and as I departed from the meeting I remember feeling 100% sure that I would be safe under his guidance and the knife!
Fast forward 3 months and I was at Bristol Spire again ready for the operation. Again every part of the operation was discussed in detail, alongwith what to expect immediately after in recovery and then when returning to my room.
Upon waking up Anthony was present to confirm all had gone well. I was transferred into the safe hands of the staff in recovery. For the next 24 hours Anthony visited regularly when he could to check on my drains and the blood flow through thr gracilis muscle now in my bicep.
Shortly after this I was transferred back to my room and recall Anthony visiting me daily, sometimes twice a day to ensure everything was going to plan. This was very reassuring both on a personal level but also for the Nurses and team looking after me too.
I was up out of bed after 24 hours, walking after 48 hours and discharged after 5 days, Good Friday. The human body is amazing when pushed and Anthony certainly doesn’t let one rest on one’s morals. I was up for the challenge and I think Anthony could see this in me.
The 6 week check up was the time for me to take my arm out of the sling and see if everything had worked. My shoulder immediately stayed in place and did not sublux and the head of the joint was perfectly stable too, if a little weak. This was incredible.
I now had up to 12 months of constant self-rehab to encourage my intercostal nerves now firing my gracilis as a new bicep. Mental fatigue and remaining upbeat was the hardest challenge here; but after just 7 months my arm flickered as I yawned one night. The connection had been made and the recovery accelerated or snowballed at an astonishing pace up to Christmas. I have now (July 17) regained a lot of shoulder control and movement and can also ennovate my bicep so that my left hand goes from my waist to above my right nipple/chest.
This has allowed me to re-engage in the activities I love doing most. The pictures I’ve attached show a couple of pictures of me in Bristol during the recovery phase, riding my 900cc Kawasaki for 3 days in Portimao, Portugal in May 2017 in the safe knowledge that I can control my arm (with the assistance of some velcro) and I am also now in serious training and competition in athletics, primarily Long, Triple, High Jump and 400m with Paralympics GB. I am currently #1 in the UK for Long Jump in my para classification T/F46 and #2 in the UK for 400m.
All of this would not have been possible without Anthony’s most excellent work, his vision and determination to help me achieve the goals I have now set following the motorcycle accident that could have ruined my life – it most certainly has not. Thank you so much Anthony.
Re brachial plexus injury
I have been a patient of Mr MacQuillan’s since 2011 over which time I have had four operations. They were a gracilis transfer to my arm, shoulder surgery to give external rotation, wrist tendon transfer to enable grip function and surgery on my hand. Each operation has been a great success. Before surgery each procedure and the outcome I could expect was explained in great detail. Mr MacQuillan is an exceptional surgeon, he is enthusiastic and will work with you to obtain the best possible outcome. If you are lucky enough to be referred to Mr MacQuillan grab the opportunity!
Why Choose Anthony for Your Procedure
Choosing the right surgeon for your surgery is essential, and Anthony stands out for several reasons:
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- Expertise and Experience: Anthony is a Consultant Plastic Surgeon with extensive training and experience in reconstructive surgery, particularly in the delicate and complex fields of brachial plexus and nerve surgery. His proficiency ensures that patients receive care that is both advanced and tailored to their specific needs.
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- Personalised Care Approach: Anthony is committed to understanding each patient’s unique situation, goals, and concerns. He offers personalised consultations to devise a surgical plan that aligns with the patient’s expectations and desired outcomes, ensuring a collaborative approach to care.
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- Comprehensive Support: From the initial consultation through to recovery and beyond, Anthony and his team provide comprehensive support. Patients receive detailed information on what to expect, guidance on preparing for surgery, and robust post-operative care, including follow-ups and rehabilitation support.
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- State-of-the-Art Techniques: Utilising the latest surgical techniques and technologies, Anthony is able to achieve optimal outcomes for his patients. His commitment to ongoing education and incorporation of innovative methods means patients benefit from the most advanced care available
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- Empathetic and Compassionate Service: Recognising the often-challenging circumstances that lead patients to seek reconstructive surgery, Anthony offers a service that is not only professional but also empathetic and compassionate. He understands the physical and emotional aspects of recovery and is dedicated to providing a comforting and reassuring environment.
Choosing Anthony for your procedure means entrusting your care to a surgeon who not only has the technical skill and knowledge to achieve the best possible outcomes but also values the importance of patient-centred care.
