Daily Life Impact of Brachial Plexus Reconstruction in Adults: 10 Years Follow-Up

Ruben Dukan; Thibault Gerosa; Emmanuel Henri Masmejean

doi:10.1016/j.jhsa.2022.03.022

Daily Life Impact of Brachial Plexus Reconstruction in Adults: 10 Years Follow-Up

J Hand Surg Am. 2023 Nov;48(11):1167.e1-1167.e7. doi: 10.1016/j.jhsa.2022.03.022. Epub 2022 May 28.

Authors

Ruben Dukan¹, Thibault Gerosa², Emmanuel Henri Masmejean³

Affiliations

¹ Hand, Upper Limb, and Peripheral Nerve Surgery Service, Georges-Pompidou European Hospital (HEGP), Paris, France. Electronic address: ruben.dukan@aphp.fr.
² Hand, Upper Limb, and Peripheral Nerve Surgery Service, Georges-Pompidou European Hospital (HEGP), Paris, France.
³ Hand, Upper Limb, and Peripheral Nerve Surgery Service, Georges-Pompidou European Hospital (HEGP), Paris, France; University of Paris-Medical School, Paris, France; Clinique Blomet (Research Unit), Paris, France.

PMID: 35641388
DOI: 10.1016/j.jhsa.2022.03.022

Abstract

Purpose: Reconstructive surgery of brachial plexus injury in adults remains a challenge. Short- and midterm follow-up results have been described in terms of impairments, such as muscle strength grading. However, psychologic management has been shown to be a major contributor in long-term results. A new, specific brachial plexus injury scale, including functional and psychologic components, was described. Objectives of this study were: (1) to assess functional long-term brachial plexus reconstruction outcomes; and (2) to validate the Mancuso scale at 10 years of follow-up.

Methods: Twenty patients with at least 10 years of follow-up were included in the study. Four patients had C5-C6 palsy and 16 had a C5-T1 injury. Shoulder abduction and elbow flexion were assessed with Medical Research Council grades. Shoulder function was evaluated with a Constant score. The 36-item short-form survey (SF36) was used to assess quality of life, and the quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) was used for patient reports of disability. The Mancuso scale was assessed and correlated to the different scores used.

Results: At the last follow-up, the Medical Research Council grade was at least grade 3 in 10 cases (50%) of shoulder abduction and in 12 cases (60%) of elbow flexion. The Constant score was 31.4 (SD, 15.1). The SF36 score was 67.5 (SD, 4.25) and the QuickDASH was 50 (SD, 15.9). We found a correlation between the symptom score (Mancuso score) and the different quality-of-life scores (QuickDASH: coefficient, 0.491; SF36: coefficient, -0.565; limitations score: coefficient, 0.445).

Conclusions: This study reported results from the Mancuso scale at a minimum of 10 years of follow-up of reconstructive surgery for brachial plexus injury in adults. Correlations between this composite scale and the SF36 and QuickDASH scores suggest construct validity.

Type of study/level of evidence: Therapeutic IV.

Keywords: Adult; brachial plexus injury; nerve reconstruction; quality of life.

MeSH terms

Adult
Brachial Plexus Neuropathies*
Brachial Plexus* / injuries
Elbow Joint*
Follow-Up Studies
Humans
Nerve Transfer* / methods
Quality of Life
Range of Motion, Articular / physiology
Treatment Outcome