Outcome after brachial plexus injury surgery and impact on quality of life (original) (raw)
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Improvement in motor function after brachial plexus surgery
The Journal of Hand Surgery, 1990
Motor functional recovery of 52 patients with brachial plexus surgery followed up for more than 2 years was evaluated. Fifty-eight surgical procedures were done, including autologous nerve grafting (38 cases), neurolysis (14 cases), and neurotization (6 cases). Overall results, evaluated according to the 0 to 5 formula of the Medical Research Council, were as follows: good, 58%; fair, 15%; and poor, 27%. Good results were evident in 58% of patients with nerve grafts and in 64% of those with neurolysis. In patients with neurotization, no good recovery and only one fair recovery were seen. Patients with open Injuries showed good recovery, whereas the group with closed injury showed good recovery in only 48%. Patients with closed injuries caused by traffic accidents showed a worse recovery than those caused by other means. Patients with closed injuries and nerve grafting done within 3 months of injury or neurolysis within 6 months showed better recovery. (J HAND 8URG 1990;15A:30-6.)
Arquivos de Neuro-Psiquiatria, 2011
OBJECTIVE: The study aims to demonstrate the techniques employed in surgery of the brachial plexus that are associated to evidence-based improvement of the functional outcome of these patients. METHOD: A retrospective study of one hundred cases of traumatic brachial plexus injuries. Comparison between the postoperative outcomes associated to some different surgical techniques was demonstrated. RESULTS: The technique of proximal nerve roots grafting was associated to good results in about 70% of the cases. Significantly better outcomes were associated to the Oberlin's procedure and the Sansak's procedure, while the improvement of outcomes associated to phrenic to musculocutaneous nerve and the accessory to suprascapular nerve transfer did not reach statistical significance. Reinnervation of the hand was observed in less than 30% of the cases. CONCLUSION: Brachial plexus surgery renders satisfactory results for reinnervation of the proximal musculature of the upper limb, howev...
Surgical outcomes following nerve transfers in upper brachial plexus injuries
Indian Journal of Plastic Surgery, 2009
Background: Brachial plexus injuries represent devastating injuries with a poor prognosis. Neurolysis, nerve repair, nerve grafts, nerve transfer, functioning free-muscle transfer and pedicle muscle transfer are the main surgical procedures for treating these injuries. Among these, nerve transfer or neurotization is mainly indicated in root avulsion injury. Materials and Methods: We analysed the results of various neurotization techniques in 20 patients (age group 20-41 years, mean 25.7 years) in terms of denervation time, recovery time and functional results. The inclusion criteria for the study included irreparable injuries to the upper roots of brachial plexus (C5, C6 and C7 roots in various combinations), surgery within 10 months of injury and a minimum follow-up period of 18 months. The average denervation period was 4.2 months. Shoulder functions were restored by transfer of spinal accessory nerve to suprascapular nerve (19 patients), and phrenic nerve to suprascapular nerve (1 patient). In 11 patients, axillary nerve was also neurotized using different donors-radial nerve branch to the long head triceps (7 patients), intercostal nerves (2 patients), and phrenic nerve with nerve graft (2 patients). Elbow flexion was restored by transfer of ulnar nerve motor fascicle to the motor branch of biceps (4 patients), both ulnar and median nerve motor fascicles to the biceps and brachialis motor nerves (10 patients), spinal accessory nerve to musculocutaneous nerve with an intervening sural nerve graft (1 patient), intercostal nerves (3rd, 4th and 5th) to musculocutaneous nerve (4 patients) and phrenic nerve to musculocutaneous nerve with an intervening graft (1 patient). Results: Motor and sensory recovery was assessed according to Medical Research Council (MRC) Scoring system. In shoulder abduction, five patients scored M4 and three patients M3+. Fair results were obtained in remaining 12 patients. The achieved abduction averaged 95 degrees (range, 50-170 degrees). Eight patients scored M4 power in elbow flexion and assessed as excellent results. Good results (M3+) were obtained in seven patients. Five patients had fair results (M2+ to M3).
Clinics in Orthopedic Surgery
Brachial plexus injury (BPI) is one of the most disabling peripheral nerve diseases. If left untreated, it will cause impairment on the upper extremity. 1) Moreover, BPI commonly occurs in productive ages, which may lead to a colossal socioeconomic burden on the patient. 2,3) In the United States, it is estimated that 0.6-3.9 per 100,000 person-years is affected by BPI. In our center, there are approximately 35 cases of BPI per year, which is commonly caused by motor vehicle accidents in patients aged 21-30 years. 2) Treatment for BPI keeps evolving alongside peripheral nerve reconstruction techniques. Some of the established modalities for surgeons are neurolysis, nerve repair, nerve grafting, and nerve transfer. The goal of the therapy is to regain clinical function and improve the quality of life. Despite advancements in the treatment of
Functional Outcomes after Treatment of Traumatic Brachial Plexus Injuries: Clinical Study
Turkish journal of trauma & emergency surgery, 2013
BACKGROUND: The aim of this study is to evaluate functional outcome and quality of life using statistically validated tools. METHODS: Participating patients were called and asked questions from the Short Form 36 (SF-36), the Disability of the Arm, Shoulder and Hand (DASH) questionnaire, a pain scale and an additional question on their satisfaction with surgery. RESULTS: A total of 33 patients were operated by a single surgeon (MI) between 1997 and 2010 at the Neurosurgery Department of Istanbul School of Medicine. Three of these patients refused to participate and three other patients were excluded, leaving 27 patients, with an average follow-up of 79,6 months, for review. The most common cause of traumatic brachial plexus injuries (TBPI) was motor vehicle accidents. Fourteen patients had isolated supraclavicular injuries and three patients had infraclavicular injuries. The remaining 10 patients' injuries were both supra-and infraclavicular. Avulsion was encountered in three patients. The patients who were operated within the first six months after trauma represented significantly better scores in DASH, SF-36 and pain scale. CONCLUSION: Statistically validated tests like DASH and SF-36 questionnaires are valuable tools for evaluating TBPI patients. Centers specialized in treating TBPI with surgery may use these tests pre-and postoperatively which lead to objective personalized evaluation of patients' subjective symptoms.
Acta Neurochirurgica, 2011
Background Peripheral nerve lesions usually are associated with neuropathic pain. In the present paper, we describe a simple scale to quantify pain after brachial plexus injuries and apply this scale to a series of patients to determine initial outcomes after reconstructive surgery. Methods Fifty-one patients with traumatic brachial plexus avulsion injuries were treated over the period of one calendar year at one center by the same surgical team. Of these, 28 patients who were available for follow-up reported some degree of neuropathic pain radiating towards the hand or forearm and underwent reconstructive microsurgery and direct pain management, including trunk and nerve neurolysis and repair. A special pain severity rating scale was developed and used to assess patients' pain before and after surgery, over a minimum follow-up of 6 months. An independent researcher, not part of the surgical team, performed all pre- and postoperative evaluations. Findings Of the 28 patients with brachial plexus traction injuries who met eligibility criteria, 93% were male, and most were young (mean age, 27.6 years). The mean preoperative severity of pain using our scale was 30.9 out of a maximum of 37 (±0.76 SD), which fell to a mean of 6.9 (±0.68 SD) 6 months post-procedure. On average, pain declined by 78% across the whole series, a decline that was statistically significant (p Conclusions We have designed and tested a simple and reliable method by which to quantify neuropathic pain after traumatic brachial plexus injuries. Initial surgical treatment of the paralysis—including nerve, trunk and root reconstruction, and neurolysis—comprises an effective means by which to initially treat neuropathic pain. Ablative or neuromodulative procedures, like dorsal root entry zone, should be reserved for refractory cases.
Concepts of nerve regeneration and repair applied to brachial plexus reconstruction
Microsurgery, 2006
Brachial plexus injury is a serious condition that usually affects young adults. Progress in brachial plexus repair is intimately related to peripheral nerve surgery, and depends on clinical and experimental studies. We review the rat brachial plexus as an experimental model, together with its behavioral evaluation. Techniques to repair nerves, such as neurolysis, nerve coaptation, nerve grafting, nerve transfer, fascicular transfer, direct muscle neurotization, and end-to-side neurorraphy, are discussed in light of the authors' experimental studies. Intradural repair of the brachial plexus by graft implants into the spinal cord and motor rootlet transfer offer new possibilities in brachial plexus reconstruction. The clinical experience of intradural repair is presented. Surgical planning in root rupture or avulsion is proposed. In total avulsion, the authors are in favor of the reconstruction of thoraco-brachial and abdomino-antebrachial grasping, and on the transfer of the brachialis muscle to the wrist extensors if it is reinnervated. Surgical treatment of painful conditions and new drugs are also discussed. V V C 2006 Wiley-Liss, Inc. Microsurgery 26:230-244, 2006.
Nerve Transfers in Adult Brachial Plexus Injuries
Advances in Spine Surgery [Working Title]
Brachial plexus injuries are semi-emergency conditions that require early intervention. Nerve transfers in adult brachial plexus injuries have become the standard treatment that gives reasonably good results if performed before the degeneration of muscle end plates. A clinical diagnosis based on clinical examinations supported by radiological and electrophysiological investigations is required that guides the specific procedures to be chosen. The surgeons must prioritize the objectives of reconstruction and keeping the different lifeboats for the use in future before choosing a specific nerve transfer. Also, it is important to be familiar with different nerve transfers so that one can select and perform a specific one based on pre-operative examinations and intraoperative findings of nerve stimulations. The author aims to describe the approach for exploring and dissecting the brachial plexus and different surgical techniques of nerve transfers used for different muscle reinnervation...
Bali Medical Journal, 2022
Introduction: Traumatic brachial plexus injury (TBPI) is a debilitating and devastating injury that significantly impacts individuals' quality of life. This study aimed to evaluate the functional outcomes, pain improvement and quality of life after external neurolysis surgery in TBPI patients. Methods: A retrospective study was conducted at Dr Soetomo Hospital in Surabaya, Indonesia. Data of TBPI patients who were operated with external neurolysis surgery from 2003 to 2020 were collected. The functional outcome was measured using disabilities of the arm, shoulder, and hand (DASH) score, the pain assessment with pain visual analog score (VAS) and the quality of life with 36-item short-form (SF-36). The outcomes were also compared between those who had the surgery less or more than 6 months after the injury. Results: A total of 493 TBPI patients were diagnosed between 2003 to 2020. Out of total, 37 patients had external neurolysis surgery, mean age of 31±12.5 years, were included in the analysis. External neurolysis surgery in TBPI patients improved all DASH, VAS and SF-36 scores and these improvements were likely influenced by sex, age, occupation, affected side and the level of the injury. In addition, our data also suggested that the patients who had external neurolysis surgery before 6 months had better outcomes than those after 6 months after the injury in term of DASH, VAS and SF-36 scores. Conclusion: In TBPI cases, earlier external neurolysis surgery could result in better pain reduction, functional outcome and quality of life outcomes.