Electrophysiologic findings and muscle strength grading in brachioplexopathies

The electrophysiological evaluations and the British Medical Research Council (MRC) scale (0-5) findings of target muscles in brachioplexopathies before surgery and 1 year postsurgery were conducted. Each component of the brachial plexus was analyzed in 15 patients with injuries, among them, to 5 roots, 19 trunks, 7 cords, and 13 terminal nerves. In each of these cases, neurolysis and/or nerve transfer and/or neurotization were performed, within 3 weeks to 6 months after the injury was incurred, to ameliorate the resulting severe disabilities. The degrees of impairment were graded using a modified version of Dumitru's and Wilbourn's scale (mild: normal to slight decrease of SNAP amplitude and CMAP amplitude, and occasional denervation; moderate: profound decrease of SNAP amplitude and CMAP amplitude, constant denervation, and normal to slight decrease in motor unit recruitment; severe: absent SNAP amplitude, absent CMAP amplitude, marked denervation, and profound decrease or no volitional motor unit recruitment. mild = 1; moderate = 2; severe = 3). The motor power of the target muscles was graded through MRC scores. The presurgical versus postsurgical differences in the severity of the injury to each brachial plexus component, and differences in the grading of target muscle power, were calculated through the Wilcoxon signed-rank test. The presurgical degrees of the severity of injury, as measured by the electromyography (EMG) were 3.00 +/- 0.00 (mean +/- SD) in root, 2.84 +/- 0.50 in trunk, 3.00 +/- 0.00 in cord, and 2.85 +/- 0.38 in terminal nerves. The postsurgical results were 2.60 +/- 0.55 in root, 2.53 +/- 0.70 in trunk, 2.43 +/- 0.53 in cord, and 1.77 +/- 0.73 in terminal nerves. There was significant improvement at the trunk, cord, and terminal nerve levels after repair, but not at the root levels. Moreover, although the MRC grading showed significant motor recovery in the infraspinatus, deltoid, biceps, and triceps muscles, there was little apparent improvement in the pectoralis major, EDC, APB, and ADM muscles. Nerve repair was notably successful in all plexuses except at the root level. However, our cases demonstrated only poor motor power gains in the forearm and the hand muscles. Consequently, future surgical techniques for brachioplexopathy repairs need further improvement.