The Staff

The service employs:

• A Lead Clinician (Hand and Orthopaedic Surgeon).
• A Plastic Surgeon.
• An Orthopaedic Consultant.
• A Clinical Nurse Specialist.
• A Specialist Physiotherapist.
• An Occupational Therapist.
• A Service Administrator.

The service has close ties with the University of Strathclyde's Department of Orthotics and Prosthetics.

Referrals

Referrals are accepted from all over Scotland, from Northern Ireland and occasionally from the north of England. Referrals usually come from orthopaedic consultants, specialist registrars or general practitioners. Occasionally referrals are accepted from extended scope practitioner (ESP) physiotherapists, but this is usually with prior consultation.

Clinical Assessment

Patients are assessed at the monthly brachial plexus clinics in Glasgow, the Aberdeen outreach clinics (spring and autumn), at a fracture or an orthopaedic clinic or, if necessary, on the ward as an emergency admission.

Surgery

Surgery for adult patients is performed primarily at the Queen Elizabeth University Hospital in Glasgow with some procedures performed at the Glasgow Royal Infirmary.

Mandatory

Radiographs - Chest/C-Spine

Optional

MRI of the C-spine or CT myelography. Both are useful in diagnosing root avulsions although neither is 100% accurate. MRI is easier to perform early after injury (see MRI Protocol at the bottom of this page).

CT of the cervical spine is useful in excluding cervical fractures and dislocations acutely. CT angiography is good when there is evidence of vascular injury.

Neurophysiology

Neurophysiology is not usually helpful in the acute situation.

Brachial Plexus MRI Protocol

The introduction of the National PACS means we can now access most imaging directly. It is therefore not usually necessary to send films or CDs with the patient. However we may not have access to radiology reports on PACS for investigations carried out in other hospitals. We would therefore be grateful if reports on MRI and CT scans could be sent with the referral.

Recommended Protocol for MRI in Cases of Injury to the Supraclavicular Brachial Plexus

MRI is most useful at defining nerve root avulsions (pre-ganglionic injury) or spinal cord damage. Imaging of damage to the post-ganglionic elements of the plexus is difficult to interpret. Therefore high resolution imaging of the C-spine from C3 to T2 is the priority.

Currently we use:

MR Cervical Spine

• Saggital T1, T2, Stir
• Axial C3 to T2

MR Brachial Plexus

• Coronal T1, T2, Stir
• Saggital T1, T2, Stir

Brachial Plexus Injuries associated with Dislocation or Fracture of the Shoulder

For brachial plexus injuries associated with dislocation of the shoulder, or other shoulder trauma, the nerve damage is usually below the level of the clavicle (infraclavicular). Therefore MRI of the C-spine is not necessary.

MRI of the shoulder is very useful particularly in diagnosing associated rotator cuff tears which may warrant early repair.