Correlation between functional and electrophysiological recovery following repair of complete median and ulnar nerve lacerations at the wrist in adults

الملخص EN

Objective : to perform a comparative study between functional and electrophysiological recovery following repair of complete median and ulnar nerve injuries at the wrist in adults, and to assess to what extent they can provide a prognosis for recovery and in decision making in further treatment interventions during the regeneration stage.

Methodology : this prospective follow-up study was conducted on 40 patients with complete median and ulnar nerve injuries.

The functional assessment and electro diagnostic evaluation tests were performed every three months for 18 months follow-up period post-operatively, with the first baseline test was performed within four weeks of the injury.

Assessment was performed according to standardized tests procedures and numerical scoring for documentation of outcome after nerve repair.

Results : our study results revealed better acceptable motor functional recovery in 85 % of all study population when compared with only 65 % of cases who achieved acceptable recovery of sensibility.

The ulnar nerve tended to achieve clinically poorer sensory and motor function outcome.

In 70% of cases, the functional motor score was equivalent to the functional sensory recovery score with a moderate strength of agreement with each other.

On comparing the functional and electrophysiological outcome data, we found that there was 52.5 % of cases showed identical scores for all three outcome measures with a fair strength of agreement between these variables.

Poor agreement between functional sensory and sensory electrophysiological recovery scores were demonstrated in most (57.5 %) of our patients, and this could be expected from the poor obtained sensory electrophysiological findings demonstrated in 23 cases of patient population.

On assessing the enervation of the small intrinsic muscles, we found a substantial agreement and statistically significant difference between electrophysiological and motor functional recovery scores.

We also discovered that for the ‘good’ and ‘moderate’ functional motor recovery cases, improvement was detected first with electro diagnosis.

Conclusion: From the study, we can report that sensory electrophysiological scores are inadequate predictors of functional sensory recovery.

Our study also demonstrated a substantial agreement between the functional motor and electrophysiological recovery scores, and the regeneration of the intrinsic muscles was detected earlier by electrophysiological testing than by functional clinical assessment methods.

So, electrophysiological evaluation tests may add valuable information and considered an adjunct to the clinical assessment methods to evaluate the regeneration process earlier and in case of doubt, and help to decide on the correct treatment strategy if secondary surgical re-exploration is required.