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Brachial plexus injury repair - microsurgery, timed properly.

Nerve grafting, nerve transfers and - where indicated - free-functioning muscle transfer for adult and obstetric brachial plexus injuries. Delivered in UK peripheral nerve centres with structured hand-therapy from the outset.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private brachial plexus injury repair costs in the UK.

Indicative ranges from our peripheral nerve centres.

In short

Nerve transfer package (Oberlin + spinal accessory): £18,000–£30,000, home 1–2 nights.

ProcedureIndicative range
Brachial plexus exploration and neurolysis £14,000–£22,000
Nerve grafting (sural graft to one or more elements) £20,000–£32,000
Nerve transfer (Oberlin, spinal accessory to suprascapular, triple transfer) £18,000–£30,000
Free-functioning gracilis muscle transfer £30,000–£45,000
Obstetric brachial plexus repair (infant) £22,000–£35,000
Structured hand-therapy programme (first 12 months) £3,500–£6,500
Peripheral nerve MDT consultation £350–£600

Prices vary by surgeon, by the number of grafts or transfers, and by whether free-tissue transfer is needed. Hand therapy is priced separately because it runs across the first year, not the first week.

The problem

The right operation, done in the right month.

Brachial plexus outcomes hinge on three things: honest timing, an MDT that plans a personalised combination of transfers, and hand therapy booked in from day one.

  • Miss the window, lose the muscle

    Motor end-plates start degenerating around 12–18 months. Late surgery for late referral is a real problem - we move fast.

  • Transfers, not grafts alone

    For root avulsions, nerve transfers from intact donors outperform grafts. A modern plexus MDT plans a combination.

  • Therapy is the operation

    Retraining the brain to use a transferred nerve is what turns a good repair into a good result.

The journey

From injury to hand therapy - what happens, in order.

One MDT sees you from imaging and electrophysiology through microsurgery and the long reinnervation road.

  1. 01

    Before

    Mechanism of injury (motorbike, birth, gunshot, iatrogenic), date, current sensation and movement, imaging and EMG so far.

  2. 02

    Before

  3. 03

    Before

    Imaging and electrophysiology

    MRI or MR neurography of the plexus, nerve conduction studies and EMG at 4–6 weeks post-injury and again at 3 months to detect early reinnervation.

  4. 04

    Before

    MDT and consent

    A peripheral nerve MDT (surgeon, neurophysiologist, hand therapist, pain specialist) confirms the plan. Consent covers realistic recovery timescales and the possibility of secondary tendon transfer years later.

  5. 05

    On the day

    Microsurgical repair

    General anaesthetic. Exploration of the plexus, direct repair, sural nerve grafts, nerve transfers (Oberlin, spinal accessory to suprascapular) or - occasionally - free-functioning gracilis muscle transfer. Four to eight hours.

  6. 06

    On the day

    Ward recovery

    One to three nights on the ward. Arm in a sling. Splints fitted by the hand therapist before discharge.

  7. 07

    After

    Long recovery, close support

    Hand therapy weekly for the first six months, then tapering. Reinnervation is measurable from six months and continues to 18–24 months. Secondary reconstruction planned only when the primary result is judged.

Typical end-to-end: 6–12 weeks from injury to surgery. Reinnervation is judged from 6 months onwards.

When it helps

When brachial plexus surgery is the right step.

Injury patterns we see most, plus the red flag that means vascular surgery today.

  • Adult closed traction plexus injury

    The classic motorbike injury - closed traction on the upper limb. Timing matters: exploration and reconstruction within 3–6 months of injury.

  • Sharp or open plexus injury

    Gunshot, stab, iatrogenic injury during clavicle or shoulder surgery. Early exploration for direct repair or grafting is often correct.

  • Obstetric brachial plexus injury

    Newborn with a flail arm after shoulder dystocia. Most improve spontaneously; those without biceps recovery by three months are referred for surgery.

  • Pan-plexal injury with root avulsions

    Multiple roots torn from the spinal cord. Reconstruction relies on nerve transfers from intact donors and, sometimes, free-muscle transfer.

  • Late presentation (over 12 months)

    Beyond the reinnervation window for primary nerve surgery. Secondary options - tendon transfers, free-muscle transfer, fusion - remain.

  • Radiation-induced plexopathy

    Late fibrosis after chest wall or axillary radiotherapy. Surgery is rarely helpful; pain and rehabilitation programmes are the mainstay.

  • Thoracic outlet syndrome (neurogenic)

    A distinct entity. Confirmed by nerve conduction studies and specialist imaging; decompression may involve first rib resection.

  • Red flag: acute plexus injury with vascular compromise

    A cold, pulseless arm after a high-energy accident is a vascular emergency - A&E, angiography and vascular surgery today, not a routine plexus referral.

Procedure options

Every option - from neurolysis to free-muscle transfer.

The full menu, matched to injury pattern, elapsed time and available donor nerves.

  • Neurolysis

    Freeing a nerve in continuity from scar tissue. Chosen when nerve conduction studies show conducting nerve trapped in fibrosis.

  • Direct nerve repair

    For a clean-cut nerve where the two ends can be brought together without tension - typically after a sharp injury.

  • Sural nerve grafting

    For a gap between healthy nerve ends. The sural nerve from the leg is harvested and used to bridge the defect.

  • Nerve transfer - Oberlin

    Fascicles of the ulnar nerve are transferred to the biceps branch of the musculocutaneous nerve to restore elbow flexion. Powerful and reliable.

  • Nerve transfer - spinal accessory to suprascapular

    To restore shoulder external rotation and abduction. Frequently done with an Oberlin transfer in upper-plexus injuries.

  • Free-functioning muscle transfer

    A gracilis muscle from the thigh is transferred to the arm with microvascular anastomosis and reinnervated from a nearby motor nerve. For late presentations or pan-plexal cases.

  • Tendon transfers

    Later reconstruction for cases where nerve regeneration has not produced enough power. Rerouting working tendons to replace paralysed ones.

  • Pain and rehabilitation only

    For radiation plexopathy or very late complete avulsions, pain medicine, mirror therapy and prosthetic options may be more helpful than more surgery.

Safety and recovery

What to expect afterwards - honestly.

Brachial plexus surgery is a long game. The honest expectation is partial, gradual recovery, well-supported by hand therapy and pain medicine.

  • GA with a peripheral nerve theatre team

    A consultant anaesthetist with peripheral nerve experience, careful positioning to protect uninvolved nerves, and neuromonitoring where indicated.

  • Recovery takes 12–24 months

    Nerves regenerate at roughly 1 mm/day. Meaningful recovery is judged at six months and continues to 18–24. Setting expectations honestly is half the job.

  • Donor-site morbidity

    Sural nerve harvest leaves a small area of numbness on the lateral foot. Gracilis harvest leaves a well-hidden thigh scar with no functional loss.

  • Neuropathic pain

    Common after avulsion injuries and often the most difficult symptom. Managed by a specialist pain team from the outset - not left until later.

  • Infection and wound problems

    Rare in a clean planned exploration (under 3%). Free-flap wounds carry the usual free-flap risks and need close monitoring for 48 hours.

  • Incomplete recovery is common

    Even after excellent surgery, complete return of pre-injury function is unusual. Secondary tendon transfers or fusions may still add function years later.

  • Depression and adjustment

    A profound life-event injury. Psychology and vocational support are part of a proper plexus service, not an afterthought.

  • Driving, work and daily life

    Driving returns when arm control allows an emergency manoeuvre. Return to manual work is often prolonged; office roles may be possible within 6–12 weeks.

  • Red flags after surgery

    Spreading redness or fever, sudden loss of a recovered movement, new severe pain, or in free-flap cases a cool or pale flap - same-day call to the on-call plastic surgery team.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whether the operation was neurolysis, grafting, transfer or free-muscle, the note the peripheral nerve surgeon sends you keeps to the same shape.

A UK peripheral nerve surgeon reviewing MR neurography of the brachial plexus

A quiet reminder

Medical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the imaging and the electrophysiology before your review, just ask.

  1. 01Header

    Injury type, level and interventions

    Which roots and cords, level of the lesion (pre- or post-ganglionic), and every graft, transfer or muscle used.

  2. 02Technique

    Operative findings and donor tissue

    What was seen at exploration - root continuity, neuromas in continuity, scar. Length and source of grafts. State of donor nerves for transfers.

  3. 03Findings

    Neurophysiology and imaging correlate

    How the operative findings matched the pre-operative MRI, EMG and nerve conduction studies - the map for later interpretation of recovery.

  4. 04Impression

    Recovery timeline and next-step plan

    Read this first: the expected first movement, the review schedule and when secondary reconstruction will be considered if progress stalls.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Brachial plexus surgery is usually covered when clinically indicated.

Frequently asked

Everything we get asked about brachial plexus repair.

Quick answers on timing, grafts versus transfers, expected recovery, cost and hand therapy.

  • When should brachial plexus surgery be done after an injury?

    For closed traction injuries with no evidence of recovery on serial examination and neurophysiology, surgery is usually offered between 3 and 6 months post-injury - early enough for reinnervation to occur before muscle end-plates degenerate, late enough to give spontaneous recovery a chance. Sharp injuries are usually explored much earlier. Obstetric injuries without biceps recovery by three months are referred for surgery around six to nine months of age.

  • What is the difference between a nerve graft and a nerve transfer?

    A nerve graft bridges a gap in the injured nerve using a piece of donor nerve (usually sural). A nerve transfer takes a working, ‘expendable’ motor fascicle from a nearby nerve and reroutes it to power a paralysed muscle - Oberlin transfer for elbow flexion is the classic example. Nerve transfers often work better and faster because reinnervation distance is shorter.

  • How much recovery can I expect after brachial plexus repair?

    Very individual. For upper-plexus injuries with good donor nerves and early surgery, useful elbow flexion returns in the majority. Shoulder function is harder. Complete recovery of hand intrinsic muscles after pan-plexal injury with root avulsions is uncommon; secondary tendon transfers or free-muscle transfer may add function later.

  • How much does private brachial plexus surgery cost in the UK?

    Roughly £14,000–£22,000 for exploration and neurolysis, £20,000–£32,000 for nerve grafting, £18,000–£30,000 for nerve transfer(s) and £30,000–£45,000 for free-functioning muscle transfer. A structured 12-month hand-therapy programme is £3,500–£6,500 and MDT consultation is £350–£600.

  • Is hand therapy really that important?

    Yes - arguably as important as the surgery. Splinting, joint mobilisation, motor re-education and, once reinnervation begins, retraining the brain to use a transferred nerve are what turn a good operation into a good outcome.

  • Can this be done on the NHS?

    Yes - there are dedicated NHS peripheral nerve centres (Leeds, Stanmore, Great Ormond Street, others) with excellent outcomes. Referral pathways can be slow, and the reinnervation window is short. Many families and patients go private to shorten the wait to the same MDT.

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