Long-Term Outcome of Brachial Plexus Reimplantation After Complete Brachial Plexus Avulsion Injury

Abstract

Background: Complete brachial plexus avulsion injury is a severe disabling injury due to traction to the brachial plexus. Brachial plexus reimplantation is an emerging surgical technique for the management of complete brachial plexus avulsion injury.

Objective: We assessed the functional recovery in 15 patients who underwent brachial plexus reimplantation surgery after complete brachial plexus avulsion injury with clinical examination and electrophysiological testing.

Methods: We included all patients who underwent brachial plexus reimplantation in our institution between 1997 and 2010. Patients were assessed with detailed motor and sensory clinical examination and motor and sensory electrophysiological tests.

Results: We found that patients who had reimplantation surgery demonstrated an improvement in Medical Research Council power in the deltoid, pectoralis, and infraspinatous muscles and global Medical Research Council score. Eight patients achieved at least grade 3 MRC power in at least one muscle group of the arm. Improved reinnervation by electromyelography criteria was found in infraspinatous, biceps, and triceps muscles. There was evidence of ongoing innervation in 3 patients. Sensory testing in affected dermatomes also showed better recovery at C5, C6, and T1 dermatomes. The best recovery was seen in the C5 dermatome.

Conclusions: Our results demonstrate a definite but limited improvement in motor and sensory recovery after reimplantation surgery in patients with complete brachial plexus injury. We hypothesize that further improvement may be achieved by using regenerative cell technologies at the time of repair.

Keywords: Brachial plexus; Brachial plexus avulsion; Brachial plexus reimplantation surgery.

Figure 1

Schematic representation of referred sensation in 2 patients. 1) Sensation in the thumb and index finger on stimulating at the lateral aspect of the upper arm and sensation in T2 distribution on stimulating at the medial forearm. 2) Sensation in little finger when touching the thumb, sensation in little finger when inner aspect of forearm, sensation in the thumb on stimulating at C4 distribution, and sensation in the thumb on stimulating at C5 distribution.