A Novel Approach to Treating Complex Brachial Plexus Injuries

The institute’s brachial plexus clinic currently serves 15-20 patients monthly, with three to five requiring surgical repair to the complex network of nerves linking the hand, arm and shoulder.

Justin W. Zumsteg, MD, and Karan Desai, MD — both experts in operative and non-operative treatment of the hand and upper extremity — work jointly, following a patient together from initial consultation through post-surgical completion. Dr. Zumsteg is a board-certified orthopedic surgeon with extensive training in hand and microvascular surgery. Dr. Desai is a board-certified plastic surgeon trained in hand and microvascular surgery.

“Our brachial plexus clinic is unique in that all our surgeries are done with two surgeons who have different, complementary training backgrounds,” says Dr. Zumsteg. “Simply having two experienced surgeons with collective skills in complex reconstruction of the brachial plexus and peripheral nerves allows us to do a better job together than most surgeons could do alone.”

Patients and referring physicians benefit from the knowledge and experience of each specialist, as well as a comprehensive team that includes electrophysiologists, experienced physical and occupational therapists, and specialized radiologists who can perform MRI neurography protocols for visualizing and evaluating the brachial plexus. Procedural options for brachial plexus injury include nerve reconstructions and transfers, microvascular services for free functional muscle transfer, complex shoulder stabilization procedures, selective arthrodesis and tendon transfers.

“If patients demonstrate either upper extremity sensory abnormalities or difficulty moving a portion of the extremity that seems to be unrelated to a fracture, they need to see a brachial plexus specialist as soon as possible,” says Dr. Desai. “If we can see someone with a brachial plexus injury within the first six months, we have a variety of possible options to treat the simplest to the most severe cases of arm dysfunction.”

Orlando Health Jewett Orthopedic Institute specialists are involved in advanced upper extremity research as well as training through the first and only orthopedic residency in Central Florida.