Brachial Plexus and Limb Paralysis Center

When someone talks about "brachial plexus and limb paralysis," they're referring to a situation where there's some injury or damage to the brachial plexus nerves, which results in a loss of movement and sensation in the affected arm or hand. This can happen due to various reasons such as trauma, stretching, or compression of the nerves during birth, accidents, or certain medical conditions.

As one of the only private practice plexus clinics in the United States and one of the most sought-after in the nation, we stand at the forefront of innovation in this specialized field.

At our clinic, we understand that brachial plexus injuries affect individuals across all walks of life and the very essence of our daily functioning, from the simplest tasks to the most complex movements. That's why our dedicated team is committed to providing comprehensive care that addresses your unique needs. 

In our clinic, we offer a range of treatment options tailored to your specific circumstances. Sometimes, observation and therapy are sufficient for recovery, while in other cases, surgical intervention may be necessary. We also offer a multi-surgeon approach where all doctors review and collaborate on the best methods for each patient. 

Our goal is not only to restore function but also to support you on your journey toward recovery and rehabilitation. With a commitment to excellence and a dedication to compassionate care, we are proud to be a beacon of hope for those facing brachial plexus injuries.

Reach out to bpc@orthocarolina.com with any questions or to schedule an appointment.

Procedures

• Nerve transfers
• Tendon transfers
• Nerve grafting
• Free tissue transfer
• Brachial plexus neurolysis
• Nerve monitoring

Make an Appointment

To make an appointment, email bpc@orthocarolina.com

Patient Education

What is a Brachial Plexus Injury?

Recognition

At the Hand Specialty Center, we lead the way in pioneering research focused on the brachial plexus, pushing the boundaries of understanding and treatment. Through our dedication to scientific inquiry and international presentations, we aim to advance knowledge and improve outcomes for patients worldwide.

PUBLICATIONS

• Serbin R, Waters PM, Lewis D, Gaston G, Loeffler B. Shoulder reconstruction for brachial plexus birth injury: An in-depth review and case-based update. J POSNA 2023;Nov 5(4):1-15.
• Dy CJ, Antes AL, Sisk BA et al. Which tests should be ordered prior to brachial plexus reconstruction? The Musculoskeletal Journal of Hospital for Special Surgery. 2023 ahead of press.
• Dy CJ, Brogan DM, Lee SK, Desai MJ, Loeffler BJ, Tuffaha SH; PLANeT Study Group. The influence of psychosocial factors on disability and expected improvement before surgery for adult traumatic brachial plexus injury. J Hand Surg Am. 2023 Jul 27:S0363-5023(23)00302-7.
• Marinello PG, Gaston RG, Loeffler BJ, Lewis DR. Steindler Flexorplasty: A Description of Current Technique and Case Series.Tech Hand Up Extrem Surg. 2019 Dec;23(4):165-169. doi: 10.1097/BTH.0000000000000248.
• Gaston RG. “An Update on Upper Extremity Tendon Transfers.” Hand Clinics 2016 Aug;32(3):xiii.
• Shores JT, Gaston RG, Reider L, Bosse MJ, METRC Investigators. “A Prospective Multicenter Registry of Peripheral Nerve Injuries Associated with Upper and Lower Extremity Orthopedic Trauma.” (Abstract) Journal of Hand Surgery September 2014;39(9):e53-e54

LECTURES

• ASSH Webinar on Management of Neuropathic Pain.  May 30, 2023. Gaston RG Course Chair
• ASPN Annual Meeting 2025.  Waikoloa HA.ICL 305:  What is the future for Pan-Plexus Injuries: Functional Reconstruction vs Myoelectric Prosthesis Gaston RG
• American Society for Surgery of the Hand 2024 Annual Meeting.  MIneapolis MN September 21 2024Precourse 3:  Brachial plexus injuries: Current role of glenohumeral fusion in pan plexus injuries Gaston RG

AWARDS

• 2021 ASSH 2^nd Place Best Video Theater: Pinch reconstruction via transfer of the motor branch of the opponens pollicis to the terminal division of the ulnar nerve. RG Gaston and B Loeffler

MANUSCRIPTS

• Bonvillain K, Saltzman EB, Mastracci JC, Drexelius KD, Herman AC, Gachigi KK, Loeffler BJ, Waters PM, Gaston RG.  A Comparison Study of Major and Minor Complications After Inpatient Versus Outpatient Pediatric Brachial Plexus Surgery: A Preliminary Report.  J Pediatr Orthop 2025 Sep 1;45(8)e733-737.  PMID 40689552
• Christy MN, Dy CJ, Gaston RG, Loeffler BJ, Desai MJ, Lee SK, Chim HL, Friedrich JB, Puri SK, Ko JH, Planet Study Group.  Variations in Recommended Treatment Strategies Among Eight American Surgeons for Actual Adult Traumatic Brachial Plexus Injury Cases. J Hand Surg Am 2024 Nov 18.  PMID 39570220
• Mastracci J, Gaston RG, Loeffler BJ.  Reverse Shoulder Arthroplasty Following End-to-End Triceps to Axillary Nerve Transfer: A Case Series.  JSES Rev Rep Tech 2024 Aug 5;4(4):805-811.  PMID: 39474171.
• Serbin R, Waters PM, Lewis D, Gaston G, Loeffler B.  Shoulder reconstruction for brachial plexus birth injury:  An in-depth review and case-based update.  J POSNA 2023;Nov 5(4):1-15. 

PAPERS

1. Dy CJ, Brogan DM, Lee SK, Desai MJ, Loeffler BJ, Tuffaha SH; PLANeT Study Group. The Influence of Psychosocial Factors on Disability and Expected Improvement Before Surgery for Adult Traumatic Brachial Plexus Injury. J Hand Surg Am. 2023 Jul 27:S0363-5023(23)00302-7. doi: 10.1016/j.jhsa.2023.05.023. Epub ahead of print. PMID: 37498270; PMCID: PMC10818022.
2. Dy CJ, Brogan DM, Lee SK, Desai MJ, Loeffler BJ, Tuffaha SH; PLANeT Study Group. The Influence of Psychosocial Factors on Disability and Expected Improvement Before Surgery for Adult Traumatic Brachial Plexus Injury. J Hand Surg Am. 2023 Jul 27:S0363-5023(23)00302-7. doi: 10.1016/j.jhsa.2023.05.023. Epub ahead of print. PMID: 37498270; PMCID: PMC10818022.
3. Christy M, Dy CJ, Friedrich J; PLANeT Study Group. Are Patients With Adult Traumatic Brachial Plexus Injuries Satisfied With Their Appearance? J Hand Surg Am. 2024 Jul 9:S0363-5023(24)00238-7. doi: 10.1016/j.jhsa.2024.05.011. Epub ahead of print. PMID: 38980234.
4. Dy CJ, Brogan DM, Loeffler BJ, Lee SK, Chim H, Desai MJ, Tuffaha SH, Liu Y; PLANeT Study Group. Pain Interference Prior to and 1 Year After Surgery for Adult Traumatic Brachial Plexus Injury. J Hand Surg Am. 2024 Sep 17:S0363-5023(24)00388-5. doi: 10.1016/j.jhsa.2024.08.001. Epub ahead of print. PMID: 39297827.
5. Drexelius K, Saltzman E, Bonvillain K, Mastracci J, Gachigi K, Lewis D, Waters P, Loeffler BJ, Gaston RG. Safety and efficacy of Outpatient versus Inpatient Adult Brachial Plexus Surgery. Journal of Hand and Microsurgery. 2024 Sep 28;17(1):100164. doi: 10.1016/j.jham.2024.100164. eCollection 2025 Jan.PMID: 39876945
6. Dy CJ, DeMartini SJ, Sane E, Brogan DM; PLANet Study Group. Accuracy and Reliability of Video-Based Range-of-Motion Assessments in Postreconstruction Brachial Plexus Patients. JB JS Open Access. 2025 Jun 24;10(2):e25.00012.
7. Gaston G, Reid R, Gart M, Lewis D, Alexander D, Loeffler B. The Prevalence of PTSD and Depression in Adults with Traumatic Brachial Plexus Palsy. J Surg Orthop Adv. 2025 Summer;34(1):15-19. PMID: 40327732.
8. Mosa A, Li NY, Chamessian A, Crock LW, Curtin CM, Belzberg A, Buday S, Loeffler BJ, Janney C, Mahan MA, Moore AM. Perioperative Treatment of Neuropathic Pain (Nerve SPACE 2025). J Hand Surg Glob Online. 2026 Jan 29;8(2):100936. doi: 10.1016/j.jhsg.2025.100936. PMID: 41657748; PMCID: PMC12874565.
9. Gerull KM, Brogan DM, Chim H, Loeffler BJ, Jack MM, Spinner RJ, Stonner MM. Ongoing Clinical Challenges in Nerve Surgery (Nerve SPACE 2025). J Hand Surg Glob Online. 2026 Jan 28;8(2):100938. doi: 10.1016/j.jhsg.2025.100938. PMID: 41657745; PMCID: PMC12874579.
10. Arendale CR, Dib AG, Hysong A, Owens V, Loeffler BJ, Gaston RG. Nerve Transfers for Cervical Spine Pathology: Restoring Shoulder and Elbow Function for C5 Nerve Root Palsy. Hand (N Y). 2026 Jan 25:15589447251409356. doi: 10.1177/15589447251409356. Epub ahead of print. PMID: 41582310; PMCID: PMC12834687.

PRESENTATIONS

Download the OrthoCarolina Brachial Plexus Center Presentations Listing