Shoulder and Elbow Recovery at 2 and 11 Years Following Brachial Plexus Reconstruction
| Autor: | Jung-Pan Wang, Schneider K. Rancy, Joseph H. Feinberg, Steve K. Lee, Scott W. Wolfe |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Elbow Cohort Studies 03 medical and health sciences Young Adult 0302 clinical medicine Elbow Joint medicine Paralysis Humans Orthopedics and Sports Medicine Brachial Plexus Muscle Strength Range of Motion Articular Brachial Plexus Neuropathies Nerve Transfer Aged Aged 80 and over 030222 orthopedics business.industry Electromyography Shoulder Joint Recovery of Function Collateral sprouting Middle Aged medicine.disease Surgery Motor unit medicine.anatomical_structure Treatment Outcome Brachial plexus injury Motor unit recruitment medicine.symptom business Range of motion Brachial plexus 030217 neurology & neurosurgery |
| Zdroj: | The Journal of hand surgery. 41(2) |
| ISSN: | 1531-6564 |
| Popis: | To report short-term and long-term outcomes on a single patient cohort observed longitudinally after nerve reconstruction for adult brachial plexus injury.Eleven male patients who underwent plexus reconstruction by the same surgeon at 2 institutions presented for clinical examination 7.5 or more years after surgery (average, 11.4 years; range, 7.5-22 years). Average age at the time of operation was 35 years (range, 17-73 years). Mean delay until surgery was 5 months (range, 2-11 months). Two patients had C5 paralysis, 2 had C5-C6 paralysis, 2 had C5-C7 paralysis, and 5 had complete 5-level injuries. Outcome parameters included active range of motion (ROM) in degrees, a modified British Medical Research Council (mBMRC) scale for muscle strength, and electromyographic motor unit configuration and recruitment pattern. Differences in ROM and mBMRC between 2-year and long-term follow-up were assessed with paired-sample t tests using an alpha value of .05.Average shoulder abduction and mBMRC at final follow-up were both significantly improved compared with the 2-year follow-up results (P.05). Average elbow flexion and mBMRC increased significantly between 2 years and final follow-up (P.05). Electromyographic results for 6 patients at final follow-up showed improved motor unit configuration in 10 of 15 muscles and improved recruitment in 3 of 15 muscles compared with 2-year electromyographic results.Patients continued to gain ROM and strength in the shoulder and elbow well after 2 to 3 years after surgery, contrary to previous reports. Although the precise mechanism is unknown, we speculate that a number of factors may be involved, including terminal collateral sprouting, maturation of motor units, improvements in motor unit recruitment, additional muscle fiber hypertrophy, or an as-yet undescribed mechanism. We recommend that patients be encouraged to continue strengthening exercises well after the initial recovery period and that more comparative long-term data be collected to expand on these observations. |
| Databáze: | OpenAIRE |
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