Health-related quality of life and functional outcomes following nerve transfers for traumatic upper brachial plexus injuries

Abstract

We report the patient-scored Health-Related Quality of Life (HRQoL) and functional outcomes of a cohort of 21 consecutive patients undergoing nerve transfer surgery for traumatic upper brachial plexus injuries. Outcomes were assessed using the British Medical Research Council power grading system, Short-Form 36, Disability of Arm, Shoulder and Hand questionnaire, and Pain Visual Analogue Scale (PVAS). The mean age of our cohort was 29.8 years (range 18-53 years), with a mean follow-up period of 42.9 months. At follow-up, elbow flexion ≥ M3 strength was achieved in 17/21 patients. Shoulder abduction ≥ M3 was achieved in 14/19 patients. External rotation ≥ M3 strength was achieved in 11/15 patients. Delayed surgical repair correlated negatively with HRQoL outcomes. Higher injury severity scores and smoking were associated with higher PVAS scores. These findings provide key prognostic information for patients and peripheral nerve surgeons embarking upon this intensive pathway to potential recovery.

MRI for Detecting Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Systematic Review and Meta-Analysis of Diagnostic Accuracy

“…Currently there is no evidence nor consensus to suggest whether a more sensitive or specific test is preferable. A more sensitive test would enable clinicians to rule out root avulsions (potentially avoiding unnecessary exploratory surgery), although the fiscal and functional costs of false-negative findings are substantial-notably, lifelong disability (2-6), pain (6-8), mental illness (9,10), and impaired quality of life (2,4,11). A more specific test might rule in root avulsion, enabling clinicians to avoid exploration and proceed directly to nerve transfer while eliminating prolonged surveillance (36)(37)(38).…”

Advances in the repair of segmental nerve injuries and trends in reconstruction

“…It is estimated that 1‐3% of all upper extremity trauma patients are diagnosed with nerve injuries during the first few months after trauma . These injuries are often severely debilitating, resulting in lifestyle disruptions from loss of function, both at work and in leisure . Moreover, traumatic nerve injuries frequently affect relatively young individuals, resulting in lifelong reductions in quality of life and income …”

How to Measure Outcomes of Peripheral Nerve Surgery

“…54 It includes 8 domains: physical functioning, social functioning, role limitations due to physical functioning, role limitations due to emotional problems, energy and vitality, mental health, bodily pain, and general perception of health. 55 Although a general health assessment questionnaire and not sensitive enough to evaluate regional conditions, 13 SF-36 is used in combination with other region specific questionnaires to evaluate peripheral nerve injury.…”