The Effectiveness of Different Nerve Transfers in the Restoration of Elbow Flexion in Adults Following Brachial Plexus Injury: A Systematic Review and Meta-Analysis

Lee, Chung Yan Vernon; Cochrane, Elliott; Chew, Misha; Bains, Robert; Bourke, Gráinne; Wade, Ryckie

doi:10.1016/j.jhsa.2022.11.013

Cited by 6 publications

(1 citation statement)

References 64 publications

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“…In brachial plexus injury, we now have evidence that early exploration and reconstruction yield better outcomes; however, even with this approach, we cannot always be certain of the extent of nerve injury, particularly if we do not have visibility proximal to the foramina (Bourke et al., 2021; Jivan et al., 2009; Wade et al., 2018a, 2018b, 2019). Specifically in adults with traumatic brachial plexus injuries, each month of delay from the time of injury to reconstruction reduces the probability of achieving ≥M4 elbow flexion by 7% (Vernon Lee et al., 2023) Given that early reconstruction is associated with more favourable outcomes, medical tests for diagnosing nerve injury should be accurate enough to differentiate those who need early intervention from those who may recover spontaneously.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Updates in diagnostic tools for diagnosing nerve injury and compressions

Bourke,

Wade,

van Alfen

2024

J Hand Surg Eur Vol

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Predicting prognosis after nerve injury and compression can be challenging, even for the experienced clinician. Although thorough clinical assessment can aid diagnosis, we cannot always be precise about long-term functional recovery of either motor or sensory nerves. To evaluate the severity of nerve injury, surgical exploration remains the gold standard, particularly after iatrogenic injury and major nerve injury from trauma, such as brachial plexus injury. Recently, advances in imaging techniques (ultrasound, magnetic resonance imaging [MRI] and MR neurography) along with multimodality assessment, including electrodiagnostic testing, have allowed us to have a better preoperative understanding of nerve continuity and prediction of nerve health and possible recovery. This article outlines the current and potential roles for clinical assessment, exploratory surgery, electrodiagnostic testing ultrasound and MRI in entrapment neuropathies, inflammatory neuritis and trauma. Emphasis is placed on those modalities that are improving in diagnostic accuracy of nerve assessment before any surgical intervention.

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