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Germany BPI Specialists/Clinics
Professor Dr. H.-E. Schaller
Dr. M. Haerle
Response to UBPN questionnaire:
NOTE: Only questions answered are included here
Identify what specialties related to brachial plexus injuries are represented by practitioners working in your clinic including
physical/occupational therapists, if any.
Plastic Surgeon/Hand Surgeon, Orthopaedic Surgeons and Traumatologists, Pain Treatment Clinic (Anaesthesiologist), Neurologist, Physiotherapist, Occupational Therapist (Ergotherapy).
What do you/your clinic specialize in treating?
- adult brachial plexus injuries
- obstetrical brachial plexus injuries
- trauma or other brachial plexus injuries
Indicate the total number of brachial plexus patients you/your clinic has evaluated since your establishment:
Number of children (Obstetrical brachial plexus injuries):
90
Number of children (Trauma or other brachial plexus injuries):
0
Number of adults (Obstetrical brachial plexus injuries):
10
Number of adults (Trauma or other brachial plexus injuries):
150
State your philosophy regarding evaluation, referral and treatment of obstetrical brachial plexus injuries in children.
Evaluation (see publications) is necessary as soon as possible in order to establish regeneration velocity. If at three months the regeneration process is slow or inexistent surgery is performed as soon as possible. Indicator for slow regeneration is biceps function at three month. Electrophysiological studies are performed with superficial electrodes, MRI is not done routinely.
Operative strategy is in all cases to restore hand function primarily. Neuroma resection and sural nerve grafting follows plexus neurolysis. If extraplexual axon donors are needed, intercostal, accessory and phrenic nerve are first choice. In a few cases we are practicing contralateral C7-transfer.
Postoperative casting is performed for 14 days in a special trunk/upper extremity cast. Physiotherapy is associated to neurofacilitating procedures as much as possible until adolescence. Children are seen first every 3 month and 6 months, after year 2 every year. Secondary operations are performed to restore function and relieve joint contractures. Shoulder operations such as subscapular release is performed starting at 1 ½ year of age, in a second step latissimus dorsi transposition may be necessary. Close contact with physiotherapist is elementary.
State your philosophy regarding evaluation, referral and treatment of trauma or other brachial plexus injuries in adults.
Evaluation of traumatic brachial plexus injuries in adults is performed as soon as possible clinically by balancing muscle-force and evaluation range of motion of each joint of the upper extremity. This data is summarized on specific charts which allow an easy over-view. Furthermore, precise documentation of the areas of sensibility and their quality is marked on specific charts.
Electrophysiological examinations are done routinely such as MRI-studies in order to complete information about the brachial plexus damage and on root-avulsions.
In complete paralysis, surgical exploration of the brachial plexus is done as soon as concomitant injuries permits.
In partial paralysis clinical examination is repeated every month, if the regeneration process is slow, brachial plexus exploration is done between 3 and 6 months after injury. If intraoperative findings show a neuroma in continuity, neuroma resection and histological evaluation and nerve grafting is standard. In the case of root-avulsions, extra plexual axon-donners are represented by the intercostals, accessory-nerve, phrenic nerve and intact-roots. In the case of complete avulsion of brachial plexus, the extra plexual neurotisation is performed by help of intercostal nerves as primary suture and if necessary with interposition of sural nerve grafts.
The primary goal of restoration is elbow-flexion, hand sensibility and shoulder function. Patients are followed postoperatively closely in the following years. Secondary operations are performed in our centre.
State your philosophy regarding pain management and brachial plexus injuries.
Patients with pain-syndromes of any kind regarding the injured limb are converted as soon as possible in our pain-ambulatory which is guided by specialized anaesthesists.
This offers the opportunity to treat these pain-syndromes already in the beginning of its appearance or by oral drugs, or by ganglion blocades and sympatico-leases. Contemporarily, psychological support is given by the Institute of Medical Psychology (Prof. Dr. Birbaumer, Tübingen) and eventually cortical reorganisation processes are monitored by magneto-encephalography and treated consequently. Parallel to pain-relief and psychological support, we strongly believe that continuous passive mobilization and if possible, active mobilization of all joints of the entire limb is helpful not only to prevent contractures but also to stimulate nerve regeneration and improve cortical representation of the limb. Therefore, our occupational therapists add to the continous physiotherapy also continuous sensibility training.
Indicate research efforts (include dates please) conducted by you specific to brachial plexus injuries.
Since 1998 cortical reorganisation processes are monitored by magneto-encephalography in collaboration with the Department of Medical Psychology in Tübingen.
Research program for the development of resorbable bio-artifical nerve-grafts (Start December 2001).
Do you accept any national/governmental payment for services or are you enrolled in any state medicaid plans? Please provide information on these plans and include
which states you are enrolled in for medicaid services.
Governmental payment, funds, research and bio-artifical nerve-grafts.
Our center is a specialized center for nerve injuries which occur during work accidents.
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