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A Prospective Study Comparing Single and Double Fascicular Transfer to Restore Elbow Flexion After Brachial Plexus Injury

Martins, Roberto Sergio MD, PhD*,‡; Siqueira, Mario Gilberto MD, PhD*; Heise, Carlos Otto MD, PhD*; Foroni, Luciano MD*,‡; Teixeira, Manoel Jacobsen MD, PhD*

Neurosurgery:
doi: 10.1227/NEU.0b013e318285c3f6
Research-Human-Clinical Studies: Editor's Choice
Editor's Choice
Abstract

BACKGROUND: The recovery of elbow flexion in upper brachial plexus injury can be achieved by the reinnervation of the biceps muscle (single reinnervation), but concomitant restoration of brachialis and biceps function (double reinnervation) has been recommended to improve elbow flexion strength.

OBJECTIVE: To prospectively compare morbidity and outcomes of single or double muscle reinnervation in restoring elbow flexion following incomplete injury to the brachial plexus.

METHODS: Forty consecutive patients were prospectively submitted to single or double muscle reinnervation. Elbow flexion strength was evaluated with a push-and-pull dynamometer 12 months after surgery. Hand morbidity related to the procedures was evaluated by the Semmes-Weinstein monofilaments test, quantification of static 2-point discrimination, and measurements of handgrip and lateral pinch strength in serial evaluations up to the final follow-up.

RESULTS: Similar results for the strength of elbow flexion were observed in both groups. A worsening of sensibility, measured by using Semmes-Weinstein monofilaments, was identified in 8 patients, all of whom showed recovery during follow-up. No worsening of 2-point discrimination was observed. A decrease in handgrip and lateral pinch strength was identified in 8 and 9 patients, respectively, which improved during follow-up. There was no difference between the groups in the incidence of hand motor morbidity parameters.

CONCLUSION: The strength of elbow flexion did not differ significantly between the groups treated with single or double muscle reinnervation. Deterioration of handgrip, lateral pinch strength, and sensibility measured by using Semmes-Weinstein monofilaments, was temporary, resulting in low morbidity for both techniques.

ABBREVIATIONS: FI, flexion index

SI, elbow flexion strength on the normal side

SN, elbow flexion strength on the injured side

Author Information

*Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil;

Hospital Santa Marcelina, São Paulo, Brazil

Correspondence: Roberto S. Martins, MD, PhD, Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo, Medical School Rua Sumaré 28, CEP 06343-240 Carapicuíba, São Paulo, Brazil. E-mail: robar@ig.com.br

Received September 05, 2012

Accepted December 11, 2012

Copyright © by the Congress of Neurological Surgeons