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Current management of severe brachial plexus injury has undergone recent modifications, and surgical options have expanded.The case of a man with a severe closed brachial plexus injury resulting from a motorcycle accident is presented. The patient is found to have upper root avulsions that deprive him of function in the proximal arm.Pre-, intra-, and postoperative decision making is reviewed by an expert in peripheral nerve surgery. Attention is paid to both diagnosis and management. A brief review of the literature pertaining to these points follows.The recent expansion of surgical options for the management of severe brachial plexus injury has introduced significant controversy into this field.