C5/C6 brachial plexus palsy reconstruction using nerve surgery: long-term functional outcomes - 04/08/20

Doi : 10.1016/j.otsr.2020.03.033

Laure Pages ^a, Malo Le Hanneur ^b,^{^{1
Twitter handle: @malo_lh.},}⁎ , Adeline Cambon-Binder ^c, Zoubir Belkheyar ^d
^a Department of Orthopedics and Traumatology – Service of Hand Surgery; Bichat-Claude Bernard Hospital, Assistance Publique–Hôpitaux de Paris (AP–HP), 46, rue Henry-Huchard, 75018 Paris, France
^b Department of Orthopedics and Traumatology – Service of Hand, Upper Limb and Peripheral Nerve Surgery; Georges-Pompidou European Hospital (HEGP), Assistance Publique–Hôpitaux de Paris (AP–HP), 20, rue Leblanc, 75015 Paris, France
^c Department of Orthopedics and Traumatology – Service of Hand Surgery; Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris (AP–HP), 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
^d Department of Orthopedics – Service of Hand Surgery, Clinique du Mont-Louis, 8-10, rue de la Folie-Regnault, 75011 Paris, France

^⁎Corresponding author at:Department of Orthopedics and Traumatology – Service of Hand, Upper Limb and Peripheral Nerve Surgery; Georges-Pompidou European Hospital (HEGP), Assistance Publique–Hôpitaux de Paris (AP–HP), 20, rue Leblanc, 75015 Paris, France.Department of Orthopedics and Traumatology – Service of Hand, Upper Limb and Peripheral Nerve Surgery; Georges-Pompidou European Hospital (HEGP), Assistance Publique–Hôpitaux de Paris (AP–HP)20, rue LeblancParis75015France

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Abstract

Introduction

In traumatic proximal brachial plexus lesions (i.e., C5/C6), reconstruction of the musculocutaneous, axillary and suprascapular nerves yields satisfactory short- and medium-term functional outcomes.

Hypothesis

Early functional outcomes after nerve surgery will be maintained in the long-term.

Methods

A retrospective analysis was done using the medical records of 29 patients with C5/C6 palsy treated by nerve surgery. Active range of motion and strength at the elbow (i.e., flexion) and shoulder (i.e., flexion, abduction, external rotation with the elbow at the side of the body and with the arm 90° abducted ) were evaluated clinically using a goniometre and the British Medical Research Council grading scale, respectively.

Results

At a mean follow-up of 46±15 months (25;76), the mean active elbow flexion was 126°±18° (90;150) and the mean strength was 3.8±0.5 (2;4). At the shoulder, mean active flexion, abduction, external rotation with the elbow at the side of the body and with the arm 90° abducted were 109°±39° (0;180), 99°±38° (0;180°), 12°±34° (−80;70) and 3°±21° (−40;50), while mean strength was 3.6±0.8 (0;4), 3.6±0.8 (0;4), 3.4±0.9 (0;4) and 2.5±1.2 (0;4), respectively.

Discussion

In cases of C5/C6 palsy, early nerve surgery yields satisfactory functional outcomes that are maintained over time for elbow flexion and shoulder elevation. However, when the teres minor is not reinnervated, it is difficult to restore satisfactory shoulder external rotation.