Compensation by the Uninjured Arm After Brachial Plexus Injury

Background: The goals of this study were to assess how preoperative and postoperative patients use their uninjured arm to compensate for adult brachial plexus injury (BPI) and to determine whether the Disabilities of Arm, Shoulder, and Hand (DASH) Questionnaire measures this compensation. Methods: Ten preoperative and 13 postoperative patients were enrolled in this qualitative-quantitative study. During the qualitative phase, patients were asked how they compensated because of BPI; responses were analyzed with grounded theory. During the quantitative phase, patients completed a standard-DASH reflecting the ability to do activities in any way using both arms as necessary, and a qualified-DASH reflecting their estimated ability to do activities using the uninjured arm the way they otherwise usually would. Two DASH scores were calculated (range, 0-100, higher = worse) and were compared with paired t tests. Results: There were 3 categories of compensation: using the uninjured arm more, exclusively, or to position the injured arm so that the hand (if functional) could be used. The mean standard-DASH and qualified-DASH scores, respectively, were 52 and 74 for preoperative patients (difference 22, P < .0001), and 41 and 64 for postoperative patients (difference 23, P = .0008). Conclusions: Patients with BPI report different types of compensation by the uninjured arm which can be discerned by the DASH.