title: Shoulder and Elbow Recovery at 2 and 11 Years Following Brachial Plexus Reconstruction.
abstract: OBJECTIVE
  To report short-term and long-term outcomes on a single patient cohort observed longitudinally after nerve reconstruction for adult brachial plexus injury.
  
  
  METHODS
  Eleven male patients who underwent plexus reconstruction by the same surgeon at 2 institutions presented for clinical examination 7.5 or more years after surgery (average, 11.4 years; range, 7.5-22 years). Average age at the time of operation was 35 years (range, 17-73 years). Mean delay until surgery was 5 months (range, 2-11 months). Two patients had C5 paralysis, 2 had C5-C6 paralysis, 2 had C5-C7 paralysis, and 5 had complete 5-level injuries. Outcome parameters included active range of motion (ROM) in degrees, a modified British Medical Research Council (mBMRC) scale for muscle strength, and electromyographic motor unit configuration and recruitment pattern. Differences in ROM and mBMRC between 2-year and long-term follow-up were assessed with paired-sample t tests using an alpha value of .05.
  
  
  RESULTS
  Average shoulder abduction and mBMRC at final follow-up were both significantly improved compared with the 2-year follow-up results (P < .05). Average elbow flexion and mBMRC increased significantly between 2 years and final follow-up (P < .05). Electromyographic results for 6 patients at final follow-up showed improved motor unit configuration in 10 of 15 muscles and improved recruitment in 3 of 15 muscles compared with 2-year electromyographic results.
  
  
  CONCLUSIONS
  Patients continued to gain ROM and strength in the shoulder and elbow well after 2 to 3 years after surgery, contrary to previous reports. Although the precise mechanism is unknown, we speculate that a number of factors may be involved, including terminal collateral sprouting, maturation of motor units, improvements in motor unit recruitment, additional muscle fiber hypertrophy, or an as-yet undescribed mechanism. We recommend that patients be encouraged to continue strengthening exercises well after the initial recovery period and that more comparative long-term data be collected to expand on these observations.
authors.affiliation: Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY; Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Jung-Pan
authors.initials: JP
authors.lastname: Wang
authors.affiliation: Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY.
authors.forename: Schneider K
authors.initials: SK
authors.lastname: Rancy
authors.affiliation: Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY; Weill Medical College of Cornell University, New York, NY.
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, NY; Weill Medical College of Cornell University, New York, NY.
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, NY; Weill Medical College of Cornell University, New York, NY. Electronic address: wolfes@hss.edu.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Wolfe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001917:Brachial Plexus / Q000293:injuries*; D020516:Brachial Plexus Neuropathies / Q000503:physiopathology / Q000601:surgery*; D015331:Cohort Studies; D004551:Elbow Joint / Q000502:physiology*; D004576:Electromyography; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D016067:Nerve Transfer; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012785:Shoulder Joint / Q000502:physiology*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Brachial plexus; EMG; long-term; nerve graft; nerve transfer