When a patient is referred for surgical evaluation of a severe brachial plexus injury, once the imaging and EMG is completed, if there's potential for the patient to recover function, we will often follow him with serial evaluations. That is, sequential physical examinations and additional EMG studies to see whether recovery will ensue. If we do not see recovery by three or even six months, it is then time to go onto surgical reconstruction. If evidence on imaging demonstrates that nerves are severed or avulsed from the spinal cord, there is really no need to wait on the reconstructive intervention. Once we know the recovery will not take place on its own, it is time to get the patient to the operating room and perform the reconstructive procedures that will be required to restore movement to that arm.
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