Diagnostic performance of preoperative ultrasound for traumatic brachial plexus root injury: A comparison study with an electrophysiology study

Abstract

PurposeAccurate preoperative assessment for traumatic brachial plexus injury (BPI) is critical for clinicians to establish a treatment plan. The objective of this study was to investigate the diagnostic performance of preoperative ultrasound (US) through comparison with an electrophysiology study (EPS) in the assessment of traumatic brachial plexus (BP) root injury.Materials and methodsWe performed a retrospective study in patients with traumatic BPI who had preoperative US and EPS, excluding obstetric palsy and other nontraumatic neuropathies. US examination was performed on an EPIQ 5 color Doppler equipment. EPS was performed on a Keypoint 9033A07 Electromyograph/Evoked Potentials Equipment, testing electromyography (EMG), nerve conduction studies (NCS), and somatosensory evoked potentials (SEP). Each BP root of all patients was assessed by US and EPS as completely injured or incompletely injured, respectively. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated based on the correlation with intraoperative findings. The accuracy of US and EPS were compared using the McNemar test. The added benefit of US was evaluated by comparing the sensitivity and specificity between the combined tests with EPS using the McNemar test.ResultsThis study included 49 patients with traumatic BPI who underwent BP surgeries from October 2018 to September 2022. Surgical exploration confirmed 89 completely injured BP roots in 28 patients. US correctly detected 80 completely injured BP roots (sensitivity, 0.899; specificity, 0.981; PPV, 0.964; NPV, 0.944; accuracy, 0.951). EPS correctly detected 75 completely injured BP roots (sensitivity, 0.843; specificity, 0.929; PPV, 0.872; NPV, 0.912; accuracy, 0.898). US showed significantly higher accuracy than EPS (p = 0.03). When combining US and EPS for completely injured BP root detection, the sensitivity of the inclusive combination (0.966) was significantly higher than EPS alone (p = 0.000977), and the specificity of the exclusive combination (1.000) was significantly higher than EPS alone (p = 0.000977).ConclusionPreoperative US is an effective diagnostic tool in the assessment of traumatic BP root injury. US had higher accuracy than EPS in this study. Sensitivity and specificity were significantly higher than EPS when US was combined with EPS.

Functional Electrical Stimulation in Conjunction With Proprioceptive Neuromuscular Facilitation (PNF) Technique to Improve Upper Limb Function in Traumatic Brachial Plexus Injury: A Case Report

“…BrAT 45 55 UEFI 30 45 [6,9,10,15]. This study showed the effect of PNF techniques that aim to regain functionality through a neurofacilitation approach by remodeling the cortex through motor control and motor learning principles [16].…”

“…The timely intervention is guaranteed to minimize secondary complications [1,2]. Physiotherapy interventions after TBPI are identified as essential interventions that need to be initiated timely and demand extended periods of treatment [9,10]. Physiotherapy intervention mainly focuses on impairments on a structural and functional level, including components of activity limitations and participation restrictions in their environmental and personal conditions [11].…”

“…This therapeutic approach can be applied to different types of neurological and musculoskeletal conditions [6]. It is the basis of the neurophysiologic approach to motor control and learning [10]. It utilizes the body's proprioceptive system to facilitate as well as to inhibit muscle contraction.…”

Surgical treatment of a nonunion following clavicle osteotomy in a child with a history of Erb's palsy: A case report

“…The developmental consequences of Erb's palsy results in serious shoulder dysfunction [ 9 ]. There are different treatment modalities suggested for Erb's palsy including hydrotherapy, physiotherapy, occupational therapy, medical therapy, and surgery [ 10 ]. The most commonly surgical method in these cases is clavicle osteotomy which places the shoulder in a more functional position [ 11 ].…”

Contralateral C7 nerve transfer to three recipient nerves-an optional surgical method in total brachial plexus avulsion combined with accessory and phrenic nerve injury

“…Brachial plexus avulsion injury (BPAI) is very di cult to treat despite advances in technology, and treatment results are not always satisfactory. The modern-day management of BPAI involves a combination of various neurotization with intraplexus and extraplexus ipsilateral/contralateral nerve donors, which include the spinal accessory nerve, phrenic nerve, intercostal nerves, and contralateral C7 nerve (CC7) [1][2][3][4][5]. The spinal accessory nerve is mainly used for direct neurotization of the suprascapular [6][7].…”