Electrophysiological studies of brachial plexus traumatic traction injuries in comparison to mri and surgical exploration outcome

Abstract EN

Objective : To evaluate and emphasize the role of electrophysiological studies in traumatic traction injuries of the brachial plexus in: localizing the level of the injury, diagnosing the type and severity of the lesion and to identify the patient with poor prognosis who warrants neurosurgical intervention.

This is to be compared with the results of MRI and documenting this with the findings after exploration.

Methodology : Sixteen patients with traumatic traction injury of the brachial plexus were included in this study.

The following was performed for all them: i Clinical Motor & sensory examination including muscle examination according to the British Medical Research Council Scale (0-5) with stress on the supraspinatus, infraspinatus, pectorals major, deltoid, biceps, triceps, pronator teres, extensor digitorum, abductor pollicis brevis and abductor digiti minimi.

ii) Motor nerve conduction study to median, ulnar, radial, axillary & musculocutaneous nerves.

iii) Sensory nerve conduction study to median, ulnar and radial nerves.

iv Needle electromyography to rhomboid major, serratus anterior, supraspinatus, biceps, deltoid, triceps, abductor polices brevis and abductor digiti minimi.

v) Magnetic resonance imaging (MRI) to the cervical and supraclavicular parts of the plexus.

All the data were collected, evaluated and compared with the results after surgical exploration.

Results : One of the sixteen patients included in the study was excluded.

Motor vehicle accident was the main cause of injury.

Most of patients were males.

80% of patient had supraclavicular and 20% had infraclavicular lesions.

66.6% EMG & MRI for Traumatic Brachial Plexus Injuries Nihal Al-Shishtawy 486 had total brachial plexus injury.

Thirty-four roots were found to be injured with electrophysiological studies and 29 roots with exploration.

The difference of those 4 was discussed.

21 roots were avulsed.

Electrophysiological studies showed that all were complete axonal loss with poor outcome.

MRI showed 16 (64 %) roots to be affected and 11 (44 %) were avulsed.

Electrophysiological studies showed that 8 trunks were affected 3 with complete axonal loss (poor outcome).

They appeared to be ruptured by exploration: 9 cords were affected, 4 were with complete axonal loss with poor outcome they appeared ruptured by exploration.

MRI was not able to diagnose any trunk or cord affection.

Conclusion : Electrophysiological tests are reliable in diagnosing the type, severity and locality of the lesion in traumatic traction injuries of the brachial plexus and predicting patients with poor outcome.

MRI under-estimated the number of the roots affected and / or avulsed.