The Prevention of Injuries of the Brachial Plexus Secondary to Malposition of the Patient During Surgery

Brachial plexus injuries that occur secondary to malposition of the patient during general anesthesia have been described in the medical literature for nearly a century. However, little can be found in the orthopedic literature. Of the peripheral nerve groups, the brachial plexus may be the most vulnerable to injury from malpositioning. This study presents three such cases of brachial plexus injury and reviews the literature concerning the subject. Pertinent anatomy, etiology, and pathogenesis of injury to the brachial plexus reveal that injury can occur from stretch or compression of nerves and is usually caused by a combination of the two. With awareness of risk factors and the positions which are likely to cause injury to the brachial plexus, careful positioning of the upper extremity can prevent injury and potential disability to the patient.