[The plexal hand (involvement of the hand in traumatic lesions of the brachial plexus in adults)].
After spontaneous recovery following brachial plexus injuries, or after nerve regeneration following nervous surgery on traumatic brachial plexus, there usually is a variable residual distal deficit involving the hand and wrist. This deficit is defined by both a functional approach, and its anatomical nervous correspondence, in order to predict which motor muscles will be available for palliative surgery, and to establish the most reasonable therapeutic plan. Total palsy of the hand will only be mentioned, whereas three main presentations of the "plexic hand" are of a greater surgical interest and will be detailed: the "wrist drop", due to C5 C6 +/- C7 supra-clavicular lesions, the hand presenting with a deficit of digit flexion, pinch and intrinsic functions, due to C8 T1 +/- C7 supra-clavicular lesions, non-standardized deficits due to infra- and retro-clavicular lesions, whose therapeutic indications and prognosis are closer to more classical trunk palsies. The review of 44 "plexic hands" after distal palliative surgery indicates the need to modify the fundamental rules of tendinous transfer surgery, and suggests new principles properly adapted to the surgery of plexic hand palsies.
Alnot
J Y
JY
Département de Chirurgie du Membre Supérieur, Hôpital Bichat, Paris.
Salon
A
A
D000328:Adult; D001174:Arthrodesis; D001917:Brachial Plexus / Q000293:injuries* / Q000503:physiopathology* / Q000601:surgery; D005385:Fingers / Q000294:innervation / Q000503:physiopathology; D005500:Follow-Up Studies; D006225:Hand / Q000294:innervation* / Q000503:physiopathology*; D006801:Humans; D009068:Movement; D009119:Muscle Contraction / Q000502:physiology; D016067:Nerve Transfer; D010166:Palliative Care; D010243:Paralysis / Q000209:etiology / Q000503:physiopathology; D013126:Spinal Nerve Roots / Q000293:injuries / Q000503:physiopathology / Q000601:surgery; D013709:Tendon Transfer; D013933:Thumb / Q000294:innervation / Q000503:physiopathology; D014953:Wrist / Q000294:innervation / Q000503:physiopathology