Clinical aspects of patients with traumatic lesions of the brachial plexus following surgical treatment

Abstract

ObjectiveTo evaluate sociodemographic and clinical aspects of patients undergoing operations due to traumatic lesions of the brachial plexus.MethodThis was a retrospective study in which the medical files of a convenience sample of 48 patients operated between 2000 and 2010 were reviewed. The following were evaluated: (1) range of motion (ROM) of the shoulder, elbow and wrist/hand, in degrees; (2) grade of strength of the shoulder, elbow and wrist/hand; (3) sensitivity; and (4) visual analogue scale (VAS) (from 0 to 10). The Student's t, chi-square, Friedman, Wilcoxon and Kruskal–Wallis tests were used (p < 0.05).ResultsThe patients’ mean age was 30.6 years; 60.4% of them had suffered motorcycle accidents and 52.1%, multiple trauma. The mean length of time until surgery was 8.7 months (range: 2–48). Thirty-one patients (64.6%) presented complete rupture of the plexus. The frequent operation was neurosurgery in 39 cases (81.3%). The ROM achieved was ≥30° in 20 patients (41.6%), with a range from 30° to 90° and mean of 73° (p = 0.001). Thirteen (27.1%) already had shoulder strength ≥M3 (p = 0.001). Twenty-seven patients (56.2%) had elbow flexion ≥80°, with a range from 30° to 160° and mean of 80.6° (p < 0.001). Twenty-two had strength ≥M3 (p < 0.001). Twenty-two patients (45.8%) had wrist extension ≥30° starting from flexion of 45°, with a range from 30° to 90° and mean of 70° (p = 0.003). Twenty-seven (56.3%) presented wrist/hand extension strength ≥M3 (p = 0.002). Forty-five (93.8%) had hypoesthesia and three (6.2%) had anesthesia (p = 0.006). The initial VAS was 4.5 (range: 1.0–9.0) and the final VAS was 3.0 (range: 1.0–7.0) (p < 0.001).ConclusionTraumatic lesions of the brachial plexus were more prevalent among young adults (21–40 years), men, people living in urban areas, manual workers and motorcycle accidents, with multiple trauma and total rupture of the plexus. Neurosurgery, with a second procedure consisting of muscle-tendon transfer, was the commonest operation. Surgery for traumatic lesions of the brachial plexus resulted in significant improvement in the ROM and strength of the shoulder, elbow and wrist/hand, improvement of the sensitivity of the limb affected and reduction of the final pain.

Manejo de heridas en plexo braquial por proyectil de arma de fuego: revisión sistemática

“…Observamos que en los estudios de Rasulić y Herrand-Perdomo, la neurolisis fue el tratamiento que más se utilizó para la restauración del plexo afectado por este tipo de lesión. Sin embargo, en los estudios de Baik Cho y Barra de Moraes, (7) los tratamientos quirúrgicos más utilizado fueron neurotizaciones de diferentes tipos.…”

Diagnosis and treatment of plexus brachial traumatic injury in adults

“…Se esta não for realizada ainda neste período, após um ano utilizam-se transferências musculares para restaurar funções de mobilidade do membro superior. 17…”

Brachial Plexus Injuries in Adults with Traumatic Brain Injury : A Retrospective Study

“…BPIs are PNIs that may lead to motor and sensory deficits, pain, functional limitation, and impaired quality of life 4) . They are most commonly caused by direct trauma, especially motor vehicle accidents.…”

“…They are most commonly caused by direct trauma, especially motor vehicle accidents. It has been known that BPIs also may accompany TBI 4) . However, in the literature, there are only a few studies to evaluate BPI in patients with TBI 14) .…”