title: Preoperative donor nerve electromyography as a predictor of nerve transfer outcomes.
abstract: OBJECTIVE
  We hypothesized that health of the donor nerve and corresponding muscle, as assessed by electromyography (EMG), could predict the outcome of nerve transfer surgery.
  
  
  METHODS
  A retrospective review was performed to investigate outcomes of nerve transfers for elbow flexion and shoulder abduction. Motor strength was graded preoperatively and after a minimum 1-year follow-up. Preoperative EMG results were classified as functionally normal or affected based on motor unit recruitment pattern and correlated with follow-up motor strength and range of motion.
  
  
  RESULTS
  Forty nerve transfers were identified: 27 were performed for elbow flexion and 13 for shoulder abduction. Overall, the 29 transfers in the normal EMG cohort showed significantly greater postoperative improvement in motor strength (Medical Research Council grade 0.2-4.1) than the 11 transfers in the affected EMG cohort (grade 0.0-3.0). In the shoulder cohort, normal donor nerves resulted in greater strength (grade 4.0 vs. 2.4) and active motion (83° vs. 25°) compared with affected donor nerves. Double fascicular transfers with 2 normal donor nerves demonstrated improved strength compared with double nerve transfers when 1 donor nerve was affected (grade 4.5 vs. 3.2).
  
  
  CONCLUSIONS
  Our findings demonstrate that a simple EMG classification that describes the quality of donor nerves can predict outcome as measured by postoperative motor strength and range of motion. Preoperative EMG evaluation should be considered a valuable supplementary component of the donor nerve selection process when planning brachial plexus reconstruction.
  
  
  METHODS
  Prognostic II.
authors.affiliation: Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, New York.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Schreiber
authors.affiliation: Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, New York.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Feinberg
authors.affiliation: Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, New York.
authors.forename: David J
authors.initials: DJ
authors.lastname: Byun
authors.affiliation: Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, New York.
authors.forename: Steve K
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, New York. Electronic address: wolfes@hss.edu.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Wolfe
mesh_terms: D000328:Adult; D001917:Brachial Plexus / Q000293:injuries*; D015331:Cohort Studies; D004550:Elbow / Q000294:innervation*; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D053580:Muscle Strength / Q000502:physiology*; D016067:Nerve Transfer / Q000379:methods*; D011183:Postoperative Complications / Q000503:physiopathology*; D011300:Preoperative Care; D011379:Prognosis; D016059:Range of Motion, Articular / Q000502:physiology*; D011999:Recruitment, Neurophysiological / Q000502:physiology; D012189:Retrospective Studies; D000070599:Shoulder Injuries
keywords: Nerve transfer; brachial plexus; electromyography