Trauma to the brachial plexus may result in devastating neurologic dysfunction associated with musculoskeletal and vascular injuries.

Twenty-nine patients with unilateral brachial plexus injury caused by blunt trauma treated at a single institution were identified and divided into two subgroups: those with isolated brachial plexus injury (ISOL) (n = 18, 62%); and those with associated scapulothoracic dissociation (SD) (n = 11, 38%). Hospital and outpatient records for each patient were retrospectively reviewed, and long-term outcome was determined by use of an 18-question telephone survey.

Mean injury severity score for the ISOL group was 8, versus 22 for the SD group (p = 0.002). Mean length of hospital stay for the ISOL group was 1.9 days, versus 19.8 days in the SD group (p = 0.002). At 9-month follow-up, 11 ISOL patients (61%) had complete neurologic recovery, versus no SD patients (p = 0.001). Nineteen patients (68%) completed telephone surveys, including 12 (67%) ISOL patients and 7 (64%) SD patients. When contacted by phone (median = 60 months), all 12 ISOL patients reported that they could carry 5 pounds of weight with the affected extremity, versus only 4 (57%) SD patients reported the same (p = 0.036). Mean muscle strength at the shoulder was rated 4.1 in ISOL patients, versus 2.3 in SD patients (p = 0.009).

Most patients with ISOL experienced excellent long-term functional outcome. However, those with associated SD had significant short- and long-term disability.