Early external neurolysis surgery reduces the pain and improves the functional outcomes and quality of life among traumatic brachial plexus injury patients (original) (raw)
Related papers
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.
Outcome after brachial plexus injury surgery and impact on quality of life
Acta neurochirurgica, 2017
The aim of this study was to investigate outcomes after surgery for brachial plexus injury (BPI), not only motor outcomes but also the quality of life of the patients. We operated on 128 consecutive patients with BPI from 1992 to 2012. We documented the information on the injured nerve, level of injury, type of treatment used, timing of surgery, patient age, and preoperative and postoperative motor deficits. In 69 patients who agreed to participate in a quality of life study, additional assessments included functionality, pain, quality of life, patient satisfaction, and psychosocial health. Of patients who underwent only exploration and neurolysis, 35.3% showed a good quality of recovery. Patients who underwent nerve reconstruction using nerve grafting showed a better rate of good quality recovery (56.7%), and the results following nerve transfer depended on the type of transfer used. After surgery, 82.6% of patients showed significant improvement, 82.6% were satisfied, and 81.2% re...
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
Journal of Evidence Based Medicine and Healthcare, 2015
BACKGROUND: Epidemiological studies on traumatic brachial plexus injuries are few and these Studies help us to improve the treatment, rehabilitation of these patients and to allocate the resources required in their management. Epidemiological factors can vary in different countries. We wanted to know the situation in an eastern Indian Centre. MATERIALS AND METHODS: Data regarding age, sex, affected side, mode of injury, distribution of paralysis, associated injuries, and pain at the time of presentation and the index procedure they underwent were collected from 30 patients. RESULTS: Road traffic accidents accounted for 76.6% of patients and of the road traffic accidents 90% involved two wheelers. Brachial plexus injury formed a part of multitrauma in 54% of this study group and 46% had isolated brachial plexus injury. Associated injuries like fractures, vascular injuries and head injuries are much less probably due to the lower velocity of the vehicles compared to the western world. The average time interval from the date of injury to exploration of the brachial plexus was 3 to 6 month and 20 (66.7%) patients presented to us within this duration. Fifty-seven per cent had joined back to work by an average of12 month.
Traumatic Brachial Plexus Injury in Indonesia: An Experience from a Developing Country
Journal of Reconstructive Microsurgery
Background Brachial plexus injuries (BPI) cause severe physical disability and major psycho-socioeconomic burden. Although various countries have reported BPI incidence, the data from Indonesia as the fourth most populated country in the world remains unknown. We aim to assess the distribution of traumatic BPI, patients' characteristics, and treatment modalities in Indonesia. Methods A retrospective investigation was performed comprising 491 BPI patients at a tertiary referral hospital in Indonesia from January 2003 to October 2019. Demographic and outcomes data were retrieved from medical records. Results The average BPI patients' age was 27.3 ± 11.6 years old, with a male/female ratio of 4.6:1. Motorcycle accidents caused the majority (76.1%) of all BPI cases. Concomitant injuries were present in 62.3% of patients, dominated by fractures (57.1%) and brain injuries (25.4%). BPI lesion type was classified into complete (C5-T1, observed in 70% patients), upper (C5-C6, in 15% ...
Arquivos de Neuro-Psiquiatria, 2016
Objective To describe the pain profile of patients with traumatic brachial plexus injury. Methods We enrolled 65 patients with traumatic brachial plexus injury. The Douleur Neuropathique 4 questionnaire was used to classify pain and the SF-36 was used to evaluate quality of life. Results The patients with traumatic brachial plexus injury were predominantly young male victims of motorcycle accidents. Pain was present in 75.4% of the individuals and 79% presented with neuropathic pain, mostly located in the hands (30.41%). The use of auxiliary devices (p = 0.05) and marital status (p = 0.03) were both independent predictors of pain. Pain also impacted negatively on the quality of life (p = 0.001). Conclusions Pain is frequent in patients with traumatic brachial plexus injury. Despite the peripheral nervous system injury, nociceptive pain is not unusual. Pain evaluation, including validated instruments, is essential to guide optimal clinical management of patients with the condition.
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.
American Journal of Roentgenology
In the 1940s, Seddon [8, 9] popularized a three-tier classification of nerve injury. According to Seddon, neuropraxia occurs after disruption of the myelin sheath, but without distal Wallerian degeneration. Axonotmesis denotes complete axonal injury, resulting in distal Wallerian degeneration, but the continuity of the endoneurium or perineurium is maintained. Neurotmesis implies complete disruption of essential parts of a nerve with or without gross anatomic nerve discontinuity. Sunderland's classification [10] more precisely describes and predicts recovery, although there are varying opinions as to which is more important for surgical planning. Sunderland's first-degree injury [10] is equivalent to Seddon's neuropraxia [8, 9] and a complete and rapid recovery is expected. Axonotmesis (Sunderland's second-degree injury) involves axonal injury and resultant Wallerian degeneration, but the endoneurial tubes are intact. With a short gap, complete recovery is expected because the axons regenerate in the correct orientation as a result of endoneurial tube guidance [10]. Neurotmesis is further split into third-through fifthdegree injuries with increasing connective tissue injuries, beginning from the endoneurium and continuing peripherally to the epineurium. In third-degree injury, the endoneurial tubes are disrupted, allowing the chance of axonal mismatch and resulting in functional loss. Fourth-degree injuries are characterized by additional perineurium damage and
Cureus, 2020
Introduction: Brachial plexus injuries are common and result in significant disabilities. This study evaluated the outcome of triple neurotization as a single procedure for upper trunk brachial plexus injury. Patients and Methods: Some 25 adult consecutive patients with injured upper trunk brachial plexus who underwent microscopic reconstructive surgery using triple neurotization technique in the authors' institute were recruited in this study. Data on operative and functional outcomes were captured. Modified Narkas scale was used to evaluate the shoulder function in addition to Waikakul scale which was used to evaluate the elbow function. Data were analyzed with respect to short and long term with a median follow-up duration of two years. Results: Assessment of the recovered shoulder abduction was excellent in 48% (n=12), good in 24% (n=6), fair in 16% (n=4), and poor in 12% of cases (n=3). Shoulder external rotation recovery was excellent in 48% (n=12), good in 12% (n=3), fair in 12% (n=3), and poor in 28% of cases (n=7). Recovery of elbow flexion was excellent in 60% (n=15), good in 12% (n=3), fair in 12% (n=3), and poor in 16% of cases (n=4). The mean value of recovered shoulder abduction was 111.26 degrees (range: 70-150). The mean value of restored shoulder external rotation was 57.5 degrees (range: 45-70). The mean value of restored elbow flexion was 75 degrees (range: 55-120). Conclusion: Triple neurotization technique can be effective to restore elbow flexion, shoulder abduction, and external rotation in adult patients with upper trunk brachial plexus injury.
Management strategy in post traumatic brachial plexus injuries
The Indian Journal of Neurotrauma, 2012
Background: Traumatic brachial plexus injury is a devastating condition resulting mainly from motor cycle accidents and primarily affecting the young adults. In the past there was a pessimistic attitude in the management of these injuries. However in last two decades with the introduction of microsurgical techniques and advances in imaging modalities, these injuries are being explored and repaired early with satisfactory to good functional out comes. Methods: Neurolysis, nerve repair, nerve grafting, nerve transfer, pedicle muscle transfer and functioning free-muscle transfer are the main surgical procedures in the management of brachial plexus injury. In the management of these injuries an immediate intervention is considered in penetrating trauma. All other common high velocity traction injuries are initially observed for a spontaneous recovery. If there are no signs of recovery by three months, surgery is indicated, as further delay will affect the ultimate results. In global brachial plexus palsy with all root avulsions, intervention is even earlier, as chances of spontaneous recovery are practically nil. Results: Good results are expected with early intervention in upper plexal lesions. Results are favorable with short nerve grafts, distal nerve transfers, and intraplexal neurotization. The aim in global brachial plexus palsy is to restore the elbow flexion and provide a stable shoulder. Restoration of a fully functional and sensate hand is still far from being a reality. Conclusion: The management of brachial plexus injury remains a challenging problem. Functional results have considerably improved in the past two decades with the incorporation of microsurgical techniques in nerve surgery, and advancements in anesthesia. Following microsurgical reconstruction many of these patients are expected to return to their original work and amputation is no longer considered a treatment option.