Lesson 3

Brachial Plexus Injury

• Risk Factors: Stretch and compression injuries associated with anatomical constraints.
  • Stretch Injury: Caused by fixed points at cervical vertebrae and axillary fascia; risk highest when arms are abducted > 90° and head is contralateral.
  • Compression Injury: Occurs between clavicle and first rib or due to external forces.

Positioning Considerations for Surgical Safety

• General Principles:

  • Avoid contralateral neck rotation to minimize stretch injury risk.
  • Avoid shoulder compression to limit compression injury risk.
  • Limit arm abduction to <90°.

• Supine Position:

  • Arm abduction > 90° can stretch the brachial plexus.
  • Prevent excessive neck rotation and sternal retraction to avoid injury.

• Trendelenburg Position:

  • Avoid shoulder braces; use a non-sliding mattress instead.
  • If used, place braces at distal clavicle ends, not at neck or mid-clavicle.

• Prone Position:

  • Keep arms at or below 90°; assess for thoracic outlet syndrome preoperatively.

• Lateral Decubitus Position:

  • Place chest support (axillary roll) distal to axilla; avoid inner axilla placement to prevent compression.
  • Ensure neutral neck alignment and prevent circumduction of downside shoulder.
  • Use retaining straps positioned correctly across the hip, and ensure no pressure points with any padding used.