A quantitative assessment of the functional recovery of flexion of the elbow after nerve transfer in patients with a brachial plexus injury.
OBJECTIVE
Improvements in the evaluation of outcome after nerve transfers are required. The assessment of force using the Medical Research Council (MRC) grades (0 to 5) is not suitable for this purpose. A ceiling effect is encountered within MRC grade 4/5 rendering this tool insensitive. Our aim was to show how the strength of flexion of the elbow could be assessed in patients who have undergone a re-innervation procedure using a continuous measurement scale.


METHODS
A total of 26 patients, 23 men and three women, with a mean age of 37.3 years (16 to 66), at the time of presentation, attended for review from a cohort of 52 patients who had undergone surgery to restore flexion of the elbow after a brachial plexus injury and were included in this retrospective study. The mean follow-up after nerve transfer was 56 months (28 to 101, standard deviation (sd) 20.79). The strength of flexion of the elbow was measured in a standard outpatient environment with a static dynamometer.


RESULTS
In total, 21 patients (81%) gained MRC grade 4 strength of flexion of the elbow. The mean force of flexion was 7.2 kgf (3 to 15.5, sd 3.3).


CONCLUSIONS
This study establishes that the dynamometer may be used for assessing the strength of flexion of the elbow in the outpatient department after nerve reconstructive surgery. Cite this article: Bone Joint J 2016;98-B:1517-20.
Royal National Orthopaedic Hospital, Stanmore, HA7 4AP, UK.
T J
TJ
Quick
Royal National Orthopaedic Hospital, Stanmore, HA7 4AP, UK.
A K
AK
Singh
Royal National Orthopaedic Hospital, Stanmore, HA7 4AP, UK.
M
M
Fox
Royal National Orthopaedic Hospital, Stanmore, HA7 4AP, UK.
M
M
Sinisi
Royal National Orthopaedic Hospital, Stanmore, HA7 4AP, UK.
A
A
MacQuillan
D000293:Adolescent; D000328:Adult; D000368:Aged; D001917:Brachial Plexus / Q000293:injuries* / Q000601:surgery; D020516:Brachial Plexus Neuropathies / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D004551:Elbow Joint / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D053581:Muscle Strength Dynamometer; D016067:Nerve Transfer / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
Brachial plexus injury; Dynamometer; Nerve injury; Nerve transfer; Oberlin; Outcome