Brachial plexus injury: long-term functional outcome is determined by associated scapulothoracic dissociation.
BACKGROUND
Trauma to the brachial plexus may result in devastating neurologic dysfunction associated with musculoskeletal and vascular injuries.


METHODS
Twenty-nine patients with unilateral brachial plexus injury caused by blunt trauma treated at a single institution were identified and divided into two subgroups: those with isolated brachial plexus injury (ISOL) (n = 18, 62%); and those with associated scapulothoracic dissociation (SD) (n = 11, 38%). Hospital and outpatient records for each patient were retrospectively reviewed, and long-term outcome was determined by use of an 18-question telephone survey.


RESULTS
Mean injury severity score for the ISOL group was 8, versus 22 for the SD group (p = 0.002). Mean length of hospital stay for the ISOL group was 1.9 days, versus 19.8 days in the SD group (p = 0.002). At 9-month follow-up, 11 ISOL patients (61%) had complete neurologic recovery, versus no SD patients (p = 0.001). Nineteen patients (68%) completed telephone surveys, including 12 (67%) ISOL patients and 7 (64%) SD patients. When contacted by phone (median = 60 months), all 12 ISOL patients reported that they could carry 5 pounds of weight with the affected extremity, versus only 4 (57%) SD patients reported the same (p = 0.036). Mean muscle strength at the shoulder was rated 4.1 in ISOL patients, versus 2.3 in SD patients (p = 0.009).


CONCLUSIONS
Most patients with ISOL experienced excellent long-term functional outcome. However, those with associated SD had significant short- and long-term disability.
Riess
Kevin P
KP
Department of Surgery, Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin, USA.
Cogbill
Thomas H
TH
Patel
Nirav Y
NY
Lambert
Pamela J
PJ
Mathiason
Michelle A
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D001917:Brachial Plexus / Q000293:injuries*; D002648:Child; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D004204:Joint Dislocations / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D020127:Recovery of Function; D012189:Retrospective Studies; D012540:Scapula / Q000293:injuries*; D013898:Thoracic Injuries / Q000453:epidemiology*; D014922:Wisconsin / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000453:epidemiology*