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Papers by José Luiz D. Gherpelli

Research paper thumbnail of Twin-twin transfusion syndrome: what really matters concerning developmental outcome of survivals?

Arquivos de neuro-psiquiatria, 2015

Twin-twin transfusion syndrome: what really matters concerning developmental outcome of survivals... more Twin-twin transfusion syndrome: what really matters concerning developmental outcome of survivals? Síndrome da transfusão feto-fetal: o que realmente importa relacionado ao prognóstico do desenvolvimento nos sobreviventes?

Research paper thumbnail of Propedêutica neurológica do recém-nascido e sua evolução Neurological evaluation and follow-up of the newborn infant

RESUMO: O autor descreve a propedêutica neurológica do recém-nascido a termo e pré-termo, tecendo... more RESUMO: O autor descreve a propedêutica neurológica do recém-nascido a termo e pré-termo, tecendo considerações sobre as técnicas de exame mais freqüentemente empregadas na prática clínica e as síndromes neurológicas observadas no período neonatal. Posteriormente, descreve os padrões de desenvolvimento observados em crianças normais nos primeiros anos de vida, nas áreas motora, de linguagem, coordenação motora e adaptativa, descrevendo os testes mais comuns utilizados na avaliação das crianças pré-escolares. DESCRITORES: Desempenho psicomotor. Desenvolvimento infantil. Exame neurológico/métodos. Recém-nascido. Prematuro.

Research paper thumbnail of Uncommon findings in cerebral ultrasound in the neonatal period: clinical relevance

Jornal de Pediatria, 2002

Research paper thumbnail of Tratamento das cefaléias

Jornal de Pediatria, 2002

Research paper thumbnail of Diagnóstico e tratamento em neurologia infantil

Jornal de Pediatria, 2002

Research paper thumbnail of Motor conduction studies for prognostic assessment of obstetrical plexopathy

Muscle & Nerve, 2004

Early prognostic assessment of obstetrical brachial plexopathies (OBP) would facilitate rational ... more Early prognostic assessment of obstetrical brachial plexopathies (OBP) would facilitate rational selection of infants for brachial plexus surgery. We performed bilateral motor nerve conduction studies (MNCS) of axillary, musculocutaneous, radial, median, and ulnar nerves in 33 babies (age 10-60 days) with OBP in order to compare the amplitude of compound muscle action potentials (CMAPs). All babies were followed up until 6 months of age and the outcome was classified according to muscle strength and arm function. A CMAP amplitude reduction of more than 90%, compared to the unaffected side, predicted severe weakness of the corresponding root level (p < 0.01). Our results indicate that MNCS are a useful tool for very early prognostic assessment of OBP.

Research paper thumbnail of Motor Nerve-Conduction Studies in Obstetric Brachial Plexopathy for a Selection of Patients with a Poor Outcome

The Journal of Bone and Joint Surgery (American), 2009

Background: The criteria and timing for nerve surgery in infants with obstetric brachial plexopat... more Background: The criteria and timing for nerve surgery in infants with obstetric brachial plexopathy remain controversial. Our aim was to develop a new method for early prognostic assessment to assist this decision process. Methods: Fifty-four patients with unilateral obstetric brachial plexopathy who were ten to sixty days old underwent bilateral motor-nerve-conduction studies of the axillary, musculocutaneous, proximal radial, distal radial, median, and ulnar nerves. The ratio between the amplitude of the compound muscle action potential of the affected limb and that of the healthy side was called the axonal viability index. The patients were followed and classified in three groups according to the clinical outcome. We analyzed the receiver operating characteristic curve of each index to define the best cutoff point to detect patients with a poor recovery. Results: The best cutoff points on the axonal viability index for each nerve (and its sensitivity and specificity) were <10% (88% and 89%, respectively) for the axillary nerve, 0% (88% and 73%) for the musculocutaneous nerve, <20% (82% and 97%) for the proximal radial nerve, <50% (82% and 97%) for the distal radial nerve, and <50% (59% and 97%) for the ulnar nerve. The indices from the proximal radial, distal radial, and ulnar nerves had better specificities compared with the most frequently used clinical criterion: absence of biceps function at three months of age. Conclusions: The axonal viability index yields an earlier and more specific prognostic estimation of obstetric brachial plexopathy than does the clinical criterion of biceps function, and we believe it may be useful in determining surgical indications in these patients.

Research paper thumbnail of Treatment of febrile seizures with intermittent clobazam

Arquivos de Neuro-Psiquiatria, 1997

Fifty children, 24 female and 26 male, with ages varying from 6 to 72 months (mean=23.7 m.) that ... more Fifty children, 24 female and 26 male, with ages varying from 6 to 72 months (mean=23.7 m.) that experienced at least one febrile seizure (FS) entered a prospective study of intermittent therapy with clobazam. Cases with severe neurological abnormalities, progressive neurological disease, afebrile seizures, symptomatic seizures of other nature, or seizures during a central nervous system infection were excluded. Seizures were of the simple type in 25 patients, complex in 20 and unclassified in 5. The mean follow-up period was 7.9 months (range=l to 23 m.), and the age at the first seizure varied from 5 to 42 months (mean=16.8 m.). Clobazam was administered orally during the febrile episode according to the child's weight: up to 5 kg, 5 mg/day; from 5 to 10 kg, 10 mg/day; from 11 to 15 kg, 15 mg/day, and over 15 kg, 20 mg/day. There were 219 febrile episodes, with temperature above 37.8 °C, in 40 children during the study period. Twelve children never received clobazam and 28 rec...

Research paper thumbnail of Prognostic relevance of risk factors for obstetrical brachial plexopathy

Arquivos de Neuro-Psiquiatria, 2006

We did a case-control study to verify if the birthweight, forceps delivery or perinatal asphyxia ... more We did a case-control study to verify if the birthweight, forceps delivery or perinatal asphyxia have any significant effect on the prognosis of obstetrical brachial plexopathy. Group A was composed of 25 infants who completely recovered at the age of 6 months. Group B was composed of 21 infants who were still not able to remove a blindfold from the face with the affected limb in the sitting position at the age of 12 months. There was no statistical difference of the median birthweight or median first minute Apgar score between the groups. There was also no relation between birthweight higher than 4000g, first minute Apgar score lower than 6 or forceps delivery with a poor prognosis.

Research paper thumbnail of Neurological follow-up of small-for-gestational age newborn infants: a study of risk factors related to prognosis at one year of age

Arquivos de Neuro-Psiquiatria, 1993

To examine the relative importance of some risk factors and neurological prognosis in the first y... more To examine the relative importance of some risk factors and neurological prognosis in the first year of life, 37 small-for-gestational age newborns were followed prospectively to 1 year of conceptional age. An abnormal neurological examination was found in 51.3% of the newborns and, at 12 months, 32.5% were still considered abnormal. Only 8.1% of the group had severe neurological sequelae at 1 year of corrected age. The developmental tests showed little changes during the first year, with abnormality rates varying from 16.1 to 25%. The following risk factors were analyzed concerning their relation to neurological and developmental abnormalities: high-risk pregnancy, maternal hypertension, social class, pre-term birth, neonatal asphyxia and weight and height less than 2.5 percentile at the age of 1 year. The statistical analysis showed a high correlation between subnormal weight gain and neurological (p=0.000l) and developmental (p=0.001) abnormalities at 1 year. None of the other ri...

Research paper thumbnail of Differences in walking attainment ages between low-risk preterm and healthy full-term infants

Arquivos de Neuro-Psiquiatria, 2012

OBJECTIVE: To compare gross motor development of preterm infants (PT) without cerebral palsy with... more OBJECTIVE: To compare gross motor development of preterm infants (PT) without cerebral palsy with healthy full-term (FT) infants, according to Alberta Infant Motor Scale (AIMS); to compare the age of walking between PT and FT; and whether the age of walking in PT is affected by neonatal variables. METHODS: Prospective study compared monthly 101 PT and 52 FT, from the first visit, until all AIMS items had been observed. Results: Mean scores were similarity in their progression, except from the eighth to tenth months. FT infants were faster in walking attainment than PT. Birth weight and length and duration of neonatal nursery stay were related to walking delay. CONCLUSION: Gross motor development between PT and FT were similar, except from the eighth to tenth months of age. PT walked later than FT infants and predictive variables were birth weight and length, and duration of neonatal intensive unit stay.

Research paper thumbnail of Discontinuing Medication In Epileptic Children: a Study of Risk Factors Related to Recurrence

Epilepsia, 1992

Page 1. Epilepsia, 33(4):681486, 1992 Raven Press, Ltd., New York 0 International League Against ... more Page 1. Epilepsia, 33(4):681486, 1992 Raven Press, Ltd., New York 0 International League Against Epilepsy Discontinuing Medication in Epileptic Children: A Study of Risk Factors Related to Recurrence Jose Luiz D. Gherpelli ...

Research paper thumbnail of Choreoathetosis after cardiac surgery with hypothermia and extracorporeal circulation

Pediatric Neurology, 1998

Eleven children, 4-48 months old, with congenital cyanotic heart defects developed choreoathetoid... more Eleven children, 4-48 months old, with congenital cyanotic heart defects developed choreoathetoid movements 2-12 days after cardiac surgery with hypothermia and extracorporeal circulation (ECC). The abnormal movements mainly involved the limbs, facial musculature, and tongue, leading to a severe dysphagia. The symptoms had an acute onset, after a period of apparent neurologic normality, and had a variable outcome. Of the nine children that survive, three had abnormal movements when last seen (41 days to 12 months of follow-up). The other six children had a complete regression of the choreoathetoid movements 1-4 weeks after onset. No specific finding was observed in the CT scans, cerebrospinal fluid examination, or EEG that could be related to the abnormal movements. Symptomatic therapy with haloperidol, with or without benzodiazepines led to symptomatic improvement in six children, although there was no evidence that this treatment modified the evolution of the disease. The authors conclude that the choreoathetoid syndrome after cardiac surgery with deep hypothermia and ECC is an ill-defined entity requiring additional study to better understand its pathogenesis so that preventive measures can be taken to avoid a condition that can lead to permanent and incapacitating neurologic sequelae.

Research paper thumbnail of The role of spontaneous general movement assessment in the neurological outcome of cerebral lesions in preterm infants

Jornal de Pediatria, 2004

Apesar dos avanços na assistência pré-natal e na terapia intensiva neonatal terem gerado uma redu... more Apesar dos avanços na assistência pré-natal e na terapia intensiva neonatal terem gerado uma redução significante na mortalidade neonatal, os recém-nascidos pré-termo (RNPT) ainda correm risco de disfunções do sistema nervoso relacionadas a lesões cerebrais ocorridas durante os períodos pré-natal e perinatal 1. Os principais distúrbios neurológicos comumente relacionados à lesão cerebral perinatal no RNPT incluem as formas diplégica e hemiplégica de paralisia cerebral, geralmente acompanhadas de distúrbios cognitivos. As neuropatologias usualmente relacionadas a esses distúrbios motores são o infarto hemorrágico periventricular considerado uma das complicações da hemorragia periventricular e a leucomalácia periventricuar 2 .

Research paper thumbnail of Importância da avaliação dos movimentos generalizados espontâneos no prognóstico neurológico de recém-nascidos pré-termo

Jornal de Pediatria, 2004

Objetivo: Estudar a relação entre a qualidade, tipos e trajetória dos movimentos generalizados es... more Objetivo: Estudar a relação entre a qualidade, tipos e trajetória dos movimentos generalizados espontâneos em recém-nascidos prétermo com os achados da ultra-sonografia de crânio neonatal e com a evolução neurológica.

Research paper thumbnail of Clinical-Electromyography Correlation in Infants With Obstetric Brachial Plexopathy

The Journal of Hand Surgery, 2007

The real utility of needle electromyography (EMG) for evaluation of infants with obstetric brachi... more The real utility of needle electromyography (EMG) for evaluation of infants with obstetric brachial plexopathy remains controversial. The objective of this paper is to evaluate how EMG correlates with clinical evaluation of these patients. Methods: We performed EMG in 41 infants (42 arms) with severe obstetric brachial plexopathy who were from 3 to 12 months of age. We correlated the EMG interference pattern with the clinical assessment of infraspinatus, deltoid, biceps, triceps, and extensor digitorum communis muscles. Results: Motor unit potentials were always present, and abnormal spontaneous activity was not common in proximal muscles. The correlation between EMG interference pattern and clinical assessment was not good, except for extensor digitorum communis. EMG showed higher scores than clinical evaluation for infraspinatus, deltoid, and biceps muscles. Respiratory synkinesis was present in 19 patients, or 45% of the affected arms, and it could involve any muscle innervated from C5 to T1. Conclusions: Needle EMG fails to estimate or overestimates clinical recovery in proximal muscles in this age group. (J Hand Surg 2007;32A:999 -1004.

Research paper thumbnail of Twin-twin transfusion syndrome: what really matters concerning developmental outcome of survivals?

Arquivos de neuro-psiquiatria, 2015

Twin-twin transfusion syndrome: what really matters concerning developmental outcome of survivals... more Twin-twin transfusion syndrome: what really matters concerning developmental outcome of survivals? Síndrome da transfusão feto-fetal: o que realmente importa relacionado ao prognóstico do desenvolvimento nos sobreviventes?

Research paper thumbnail of Propedêutica neurológica do recém-nascido e sua evolução Neurological evaluation and follow-up of the newborn infant

RESUMO: O autor descreve a propedêutica neurológica do recém-nascido a termo e pré-termo, tecendo... more RESUMO: O autor descreve a propedêutica neurológica do recém-nascido a termo e pré-termo, tecendo considerações sobre as técnicas de exame mais freqüentemente empregadas na prática clínica e as síndromes neurológicas observadas no período neonatal. Posteriormente, descreve os padrões de desenvolvimento observados em crianças normais nos primeiros anos de vida, nas áreas motora, de linguagem, coordenação motora e adaptativa, descrevendo os testes mais comuns utilizados na avaliação das crianças pré-escolares. DESCRITORES: Desempenho psicomotor. Desenvolvimento infantil. Exame neurológico/métodos. Recém-nascido. Prematuro.

Research paper thumbnail of Uncommon findings in cerebral ultrasound in the neonatal period: clinical relevance

Jornal de Pediatria, 2002

Research paper thumbnail of Tratamento das cefaléias

Jornal de Pediatria, 2002

Research paper thumbnail of Diagnóstico e tratamento em neurologia infantil

Jornal de Pediatria, 2002

Research paper thumbnail of Motor conduction studies for prognostic assessment of obstetrical plexopathy

Muscle & Nerve, 2004

Early prognostic assessment of obstetrical brachial plexopathies (OBP) would facilitate rational ... more Early prognostic assessment of obstetrical brachial plexopathies (OBP) would facilitate rational selection of infants for brachial plexus surgery. We performed bilateral motor nerve conduction studies (MNCS) of axillary, musculocutaneous, radial, median, and ulnar nerves in 33 babies (age 10-60 days) with OBP in order to compare the amplitude of compound muscle action potentials (CMAPs). All babies were followed up until 6 months of age and the outcome was classified according to muscle strength and arm function. A CMAP amplitude reduction of more than 90%, compared to the unaffected side, predicted severe weakness of the corresponding root level (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Our results indicate that MNCS are a useful tool for very early prognostic assessment of OBP.

Research paper thumbnail of Motor Nerve-Conduction Studies in Obstetric Brachial Plexopathy for a Selection of Patients with a Poor Outcome

The Journal of Bone and Joint Surgery (American), 2009

Background: The criteria and timing for nerve surgery in infants with obstetric brachial plexopat... more Background: The criteria and timing for nerve surgery in infants with obstetric brachial plexopathy remain controversial. Our aim was to develop a new method for early prognostic assessment to assist this decision process. Methods: Fifty-four patients with unilateral obstetric brachial plexopathy who were ten to sixty days old underwent bilateral motor-nerve-conduction studies of the axillary, musculocutaneous, proximal radial, distal radial, median, and ulnar nerves. The ratio between the amplitude of the compound muscle action potential of the affected limb and that of the healthy side was called the axonal viability index. The patients were followed and classified in three groups according to the clinical outcome. We analyzed the receiver operating characteristic curve of each index to define the best cutoff point to detect patients with a poor recovery. Results: The best cutoff points on the axonal viability index for each nerve (and its sensitivity and specificity) were <10% (88% and 89%, respectively) for the axillary nerve, 0% (88% and 73%) for the musculocutaneous nerve, <20% (82% and 97%) for the proximal radial nerve, <50% (82% and 97%) for the distal radial nerve, and <50% (59% and 97%) for the ulnar nerve. The indices from the proximal radial, distal radial, and ulnar nerves had better specificities compared with the most frequently used clinical criterion: absence of biceps function at three months of age. Conclusions: The axonal viability index yields an earlier and more specific prognostic estimation of obstetric brachial plexopathy than does the clinical criterion of biceps function, and we believe it may be useful in determining surgical indications in these patients.

Research paper thumbnail of Treatment of febrile seizures with intermittent clobazam

Arquivos de Neuro-Psiquiatria, 1997

Fifty children, 24 female and 26 male, with ages varying from 6 to 72 months (mean=23.7 m.) that ... more Fifty children, 24 female and 26 male, with ages varying from 6 to 72 months (mean=23.7 m.) that experienced at least one febrile seizure (FS) entered a prospective study of intermittent therapy with clobazam. Cases with severe neurological abnormalities, progressive neurological disease, afebrile seizures, symptomatic seizures of other nature, or seizures during a central nervous system infection were excluded. Seizures were of the simple type in 25 patients, complex in 20 and unclassified in 5. The mean follow-up period was 7.9 months (range=l to 23 m.), and the age at the first seizure varied from 5 to 42 months (mean=16.8 m.). Clobazam was administered orally during the febrile episode according to the child's weight: up to 5 kg, 5 mg/day; from 5 to 10 kg, 10 mg/day; from 11 to 15 kg, 15 mg/day, and over 15 kg, 20 mg/day. There were 219 febrile episodes, with temperature above 37.8 °C, in 40 children during the study period. Twelve children never received clobazam and 28 rec...

Research paper thumbnail of Prognostic relevance of risk factors for obstetrical brachial plexopathy

Arquivos de Neuro-Psiquiatria, 2006

We did a case-control study to verify if the birthweight, forceps delivery or perinatal asphyxia ... more We did a case-control study to verify if the birthweight, forceps delivery or perinatal asphyxia have any significant effect on the prognosis of obstetrical brachial plexopathy. Group A was composed of 25 infants who completely recovered at the age of 6 months. Group B was composed of 21 infants who were still not able to remove a blindfold from the face with the affected limb in the sitting position at the age of 12 months. There was no statistical difference of the median birthweight or median first minute Apgar score between the groups. There was also no relation between birthweight higher than 4000g, first minute Apgar score lower than 6 or forceps delivery with a poor prognosis.

Research paper thumbnail of Neurological follow-up of small-for-gestational age newborn infants: a study of risk factors related to prognosis at one year of age

Arquivos de Neuro-Psiquiatria, 1993

To examine the relative importance of some risk factors and neurological prognosis in the first y... more To examine the relative importance of some risk factors and neurological prognosis in the first year of life, 37 small-for-gestational age newborns were followed prospectively to 1 year of conceptional age. An abnormal neurological examination was found in 51.3% of the newborns and, at 12 months, 32.5% were still considered abnormal. Only 8.1% of the group had severe neurological sequelae at 1 year of corrected age. The developmental tests showed little changes during the first year, with abnormality rates varying from 16.1 to 25%. The following risk factors were analyzed concerning their relation to neurological and developmental abnormalities: high-risk pregnancy, maternal hypertension, social class, pre-term birth, neonatal asphyxia and weight and height less than 2.5 percentile at the age of 1 year. The statistical analysis showed a high correlation between subnormal weight gain and neurological (p=0.000l) and developmental (p=0.001) abnormalities at 1 year. None of the other ri...

Research paper thumbnail of Differences in walking attainment ages between low-risk preterm and healthy full-term infants

Arquivos de Neuro-Psiquiatria, 2012

OBJECTIVE: To compare gross motor development of preterm infants (PT) without cerebral palsy with... more OBJECTIVE: To compare gross motor development of preterm infants (PT) without cerebral palsy with healthy full-term (FT) infants, according to Alberta Infant Motor Scale (AIMS); to compare the age of walking between PT and FT; and whether the age of walking in PT is affected by neonatal variables. METHODS: Prospective study compared monthly 101 PT and 52 FT, from the first visit, until all AIMS items had been observed. Results: Mean scores were similarity in their progression, except from the eighth to tenth months. FT infants were faster in walking attainment than PT. Birth weight and length and duration of neonatal nursery stay were related to walking delay. CONCLUSION: Gross motor development between PT and FT were similar, except from the eighth to tenth months of age. PT walked later than FT infants and predictive variables were birth weight and length, and duration of neonatal intensive unit stay.

Research paper thumbnail of Discontinuing Medication In Epileptic Children: a Study of Risk Factors Related to Recurrence

Epilepsia, 1992

Page 1. Epilepsia, 33(4):681486, 1992 Raven Press, Ltd., New York 0 International League Against ... more Page 1. Epilepsia, 33(4):681486, 1992 Raven Press, Ltd., New York 0 International League Against Epilepsy Discontinuing Medication in Epileptic Children: A Study of Risk Factors Related to Recurrence Jose Luiz D. Gherpelli ...

Research paper thumbnail of Choreoathetosis after cardiac surgery with hypothermia and extracorporeal circulation

Pediatric Neurology, 1998

Eleven children, 4-48 months old, with congenital cyanotic heart defects developed choreoathetoid... more Eleven children, 4-48 months old, with congenital cyanotic heart defects developed choreoathetoid movements 2-12 days after cardiac surgery with hypothermia and extracorporeal circulation (ECC). The abnormal movements mainly involved the limbs, facial musculature, and tongue, leading to a severe dysphagia. The symptoms had an acute onset, after a period of apparent neurologic normality, and had a variable outcome. Of the nine children that survive, three had abnormal movements when last seen (41 days to 12 months of follow-up). The other six children had a complete regression of the choreoathetoid movements 1-4 weeks after onset. No specific finding was observed in the CT scans, cerebrospinal fluid examination, or EEG that could be related to the abnormal movements. Symptomatic therapy with haloperidol, with or without benzodiazepines led to symptomatic improvement in six children, although there was no evidence that this treatment modified the evolution of the disease. The authors conclude that the choreoathetoid syndrome after cardiac surgery with deep hypothermia and ECC is an ill-defined entity requiring additional study to better understand its pathogenesis so that preventive measures can be taken to avoid a condition that can lead to permanent and incapacitating neurologic sequelae.

Research paper thumbnail of The role of spontaneous general movement assessment in the neurological outcome of cerebral lesions in preterm infants

Jornal de Pediatria, 2004

Apesar dos avanços na assistência pré-natal e na terapia intensiva neonatal terem gerado uma redu... more Apesar dos avanços na assistência pré-natal e na terapia intensiva neonatal terem gerado uma redução significante na mortalidade neonatal, os recém-nascidos pré-termo (RNPT) ainda correm risco de disfunções do sistema nervoso relacionadas a lesões cerebrais ocorridas durante os períodos pré-natal e perinatal 1. Os principais distúrbios neurológicos comumente relacionados à lesão cerebral perinatal no RNPT incluem as formas diplégica e hemiplégica de paralisia cerebral, geralmente acompanhadas de distúrbios cognitivos. As neuropatologias usualmente relacionadas a esses distúrbios motores são o infarto hemorrágico periventricular considerado uma das complicações da hemorragia periventricular e a leucomalácia periventricuar 2 .

Research paper thumbnail of Importância da avaliação dos movimentos generalizados espontâneos no prognóstico neurológico de recém-nascidos pré-termo

Jornal de Pediatria, 2004

Objetivo: Estudar a relação entre a qualidade, tipos e trajetória dos movimentos generalizados es... more Objetivo: Estudar a relação entre a qualidade, tipos e trajetória dos movimentos generalizados espontâneos em recém-nascidos prétermo com os achados da ultra-sonografia de crânio neonatal e com a evolução neurológica.

Research paper thumbnail of Clinical-Electromyography Correlation in Infants With Obstetric Brachial Plexopathy

The Journal of Hand Surgery, 2007

The real utility of needle electromyography (EMG) for evaluation of infants with obstetric brachi... more The real utility of needle electromyography (EMG) for evaluation of infants with obstetric brachial plexopathy remains controversial. The objective of this paper is to evaluate how EMG correlates with clinical evaluation of these patients. Methods: We performed EMG in 41 infants (42 arms) with severe obstetric brachial plexopathy who were from 3 to 12 months of age. We correlated the EMG interference pattern with the clinical assessment of infraspinatus, deltoid, biceps, triceps, and extensor digitorum communis muscles. Results: Motor unit potentials were always present, and abnormal spontaneous activity was not common in proximal muscles. The correlation between EMG interference pattern and clinical assessment was not good, except for extensor digitorum communis. EMG showed higher scores than clinical evaluation for infraspinatus, deltoid, and biceps muscles. Respiratory synkinesis was present in 19 patients, or 45% of the affected arms, and it could involve any muscle innervated from C5 to T1. Conclusions: Needle EMG fails to estimate or overestimates clinical recovery in proximal muscles in this age group. (J Hand Surg 2007;32A:999 -1004.