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Motor Recovery After Brachial Plexus Resection and Grafting
Christine Schaeffer BS, Darlene Sparkman MD, Ann Schwentker MD
Cincinnati Children's Hospital Medical Center
2015-03-15
Presenter: Christine Schaeffer
Affidavit:
The student was involved in the input, analysis and interpretation of data and drafting of the abstract.
Director Name: Dr. Ann Schwentker
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background:
This study assesses the impact of preoperative motor function on the outcome and rate of recovery following nerve grafting for neonatal brachial plexus palsy. With the advent of nerve transfer procedures, the suitability of exploration and grafting for patients who have begun to demonstrate motor recovery has been debated.
Methods:
From 2004 to 2009, 72 patients with neonatal brachial plexus injury underwent nerve grafting after neuroma resection. 56 had both preoperative and greater than 6 month postoperative data (median follow up of 25.5 months). For each movement assessed, patients were divided into two groups, those with preoperative movement (+), and those without (-). Changes in Active Movement Scale scores over time were analyzed using a Two Way Repeated Measures ANOVA..
Results:
Neuroma resection did result in temporary loss of motor function in all (+) patients. By six months postoperatively, patients with evidence of preoperative motor recovery (+) had significantly higher AMS scores for shoulder abduction (p<0.001), shoulder external rotation (p=0.021), and elbow flexion (p=0.002) compared to those with no preoperative motion (-). Motor recovery was also faster in these patients. (p<0.001)
Conclusions:
Although neuroma resection does result in temporary loss of function in those patients who have already begun to recovery motor function, patients with neonatal brachial plexus palsy and evidence of preoperative motor function (+) demonstrated faster postoperative motor recovery and increased postoperative motion compared to patients with preoperative paralysis (-). We believe that resection and grafting should remain the first line procedure for these patients.
