Root avulsion injury can be further divided based on the location of the lesion: pre- and postganglionic lesions. In a preganglionic lesion, the sensory fibre remain attached to the cell body of the sensory ganglion, thus there is no wallerian degeneration of the sensory fibre, thus sensory action potential can still be detected at the distal end of the spinal nerve. However, those who get this type of lesion have sensory loss over the affected nerve roots. In this case, surgical repair of the lesion is not possible because the proximal nerve tissue is too short for stitching to be possible. For postganglionic lesions, the cell body of the sensory ganglion is detached from the spinal nerve, leading to wallerian degeneration of the sensory fibre. Thus, no action potential detected at the distal end of spinal nerve. However, surgical repair is possible because proximal nerve tissue has enough length for stitching. Impact
Heavy impact to the shoulder is the second common mechanism to causing injury to the brachial plexus. Depending on the severity of the impact, lesions can occur at all nerves in the brachial plexus. The location of impact also affects the severity of the injury and depending on the location the nerves of the brachial plexus may be ruptured or avulsed. When passing through between the clavicle and first rib, the brachial plexus may be crushed in the costoclavicular space. This is usually due to direct trauma to the shoulder or neck region as a result of motorvehicular accidents, occupational injuries or sports injuries.
People who have accidents with riding motorcycles and snowmobiles have higher risks of getting a BPI and with ihg-injury injuries such as motorcycle accidents, root avulsion from the spinal cord is the most common pattern of injury (~72% prevalence of at least 1 root avulsion) which requires surgery to reanimate the arm. Prognosis
The site and type of brachial plexus injury determine the prognosis. Avulsion and rupture injuries require timely surgical intervention for any chance of recovery. For milder injuries involving buildup of scar tissue and for neurapraxia, the potential for improvement varies, but there is a fair prognosis for spontaneous recovery, with a 90–100% return of function. References


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