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Monitoring Reinnervation and Neuroplasticity After Neurotization Using Needle Electromyography.

Štěpánka Brušáková1, Ivan Humhej2, Jan Lodin2

  • 1Department of Neurology, Masaryk Hospital Krajská Zdravotní a.s., Ústí nad Labem, Czech Republic.

Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society
|February 12, 2026
PubMed
Summary
This summary is machine-generated.

Needle electromyography (EMG) can track nerve recovery after brachial plexus injury surgery. Early reinnervation and synkinesis resolution on EMG correlate with better functional outcomes, suggesting neuroplasticity.

Keywords:
Brachial plexus injuryNeedle electromyographyNerve transferNeuroplasticityReinnervationSynkineses

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Area of Science:

  • Neurosurgery
  • Neurology
  • Rehabilitation Medicine

Background:

  • Brachial plexus injuries significantly impact shoulder and elbow function.
  • Recovery involves axonal regeneration and central nervous system (CNS) neuroplasticity.
  • Current neuroimaging methods for assessing neuroplasticity have limited clinical utility.

Purpose of the Study:

  • To evaluate needle electromyography (EMG) as a reproducible, low-cost method for assessing neuroplasticity markers after nerve transfer surgery.
  • To correlate EMG findings of reinnervation and synkinesis with functional recovery.
  • To explore the clinical utility of EMG in tracking recovery from traumatic brachial plexus injuries.

Main Methods:

  • Longitudinal observational study of 21 patients undergoing 34 proximal nerve transfers for brachial plexus injury.
  • Serial EMG performed over ≥36 months to assess spontaneous activity, motor unit potentials, and synkineses.
  • Functional outcomes assessed using MRC scale, goniometry, Mallet scale, and DASH questionnaire.

Main Results:

  • Functional success (MRC ≥3/5) achieved in 58.8% of nerve transfers.
  • Early reinnervation (<6 months) observed in 53% and correlated with increased muscle strength (Rs = 0.53, p < 0.01).
  • Synkinesis resolution occurred in 29% and negatively correlated with time to surgery (Rs = -0.50, p = 0.005); absence of synkinesis associated with better outcomes.

Conclusions:

  • Needle EMG provides systematic and accessible monitoring of reinnervation and synkinesis.
  • Resolution of synkinesis may signify functional cortical reorganization and improved patient recovery.
  • This EMG-based approach warrants further prospective validation for clinical application.