title: Modified Quad surgery significantly improves the median nerve conduction and functional outcomes in obstetric brachial plexus nerve injury.
abstract: BACKGROUND
  Nerve conduction studies or somatosensory evoked potentials (SSEPs) have become an important tool in the investigation of peripheral nerve lesions, and is sensitive in detecting brachial plexus nerve injury, and other nerve injuries. To investigate whether the modified Quad surgical procedure improves nerve conductivity and functional outcomes in obstetric brachial plexus nerve injury (OBPI) patients.
  
  
  METHODS
  All nerves were tested with direct functional electrical stimulation. A Prass probe was used to stimulate the nerves, and recording the response, the compound motor action potential (CMAP) in the muscle. SSEP monitoring was performed pre- and post modified Quad surgery, stimulating the median and ulnar nerves at the wrist, the radial nerve over the dorsum of the hand, recording the peripheral, cervical and cortical responses. All patients have had the modified Quad surgery (n = 19). The modified Quad surgery is a muscle release and transfer surgery with nerve decompressions. All patients were assessed preoperatively and postoperatively by evaluating video recordings of standardized movements, the modified Mallet scale to index active shoulder movements.
  
  
  RESULTS
  The cervical responses were significantly lower in amplitude in the affected arm than the un-affected arm. The median nerve conduction was significantly improved from 8.04 to 9.26 (P < 0.022) post-operatively. The shoulder abduction was also significantly improved (pre-op 30° ± 23.3 to 143° ± 33.7, p < 0.0001), with a mean follow-up of 43 months after the modified Quad surgery in these patients.
  
  
  CONCLUSIONS
  Median nerve conduction, and shoulder abduction were significantly improved in OBPI children, who have undergone the modified Quad procedure with neuroplasty, internal microneurolysis and tetanic stimulation of the median nerve.
authors.affiliation: Texas Nerve and Paralysis Institute, 6400 Fannin st, Houston, TX 77030, USA.
authors.forename: Rahul K
authors.initials: RK
authors.lastname: Nath
authors.affiliation: Texas Nerve and Paralysis Institute, 6400 Fannin st, Houston, TX 77030, USA.
authors.forename: Nirupuma
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Texas Nerve and Paralysis Institute, 6400 Fannin st, Houston, TX 77030, USA.
authors.forename: Chandra
authors.initials: C
authors.lastname: Somasundaram
keywords: Electromyography; Modified Quad surgery; Nerve conduction study; Obstetric brachial plexus nerve injury; Shoulder abduction; Somatosensory evoked potentials