Traumatic brachial plexopathies – Analysis of postsurgical functional and psychosocial outcome

Abstract

Introduction

Brachial plexus injuries (BPI) not only affect motor but also psychosocial aspects of patients' lives.

Aims and objectives

To evaluate results of surgery in terms of motor, functional and psychosocial recovery; and to evaluate the surgical outcome in relation to location of injury, time since injury and type of surgical procedure.

Methods

A total of 36 patients with traumatic BPI operated between Jan and Sept 2011 were prospectively analysed. Parameters analysed included demographic profile and complete injury details. Patients were evaluated in pre-op and post op (6, 9 months and then 6 monthly). Primary outcome measure was motor outcome. Secondary outcome measures included functional outcome as assessed by SF-36 score, DASH questionnaire, PVAS and psychosocial outcome assessment performed by DAQ and LH score.

Results

Mean interval between injury and surgery was 8 months (range 3–20 months). There were 15 partial and 21 panplexal injuries. Mean follow up was 13.5 months (range 9–18 months). Good motor recovery rate was 71% in partial and 23% in pan BPI. Neurotisation yielded the best motor outcome (53% patients). There was no statistical difference between motor recovery, timing of surgery and type of neurotisation. There was statistically significant improvement in all the functional outcome scores and mean PVAS score after surgery (p < 0.05).

Conclusions

Surgery offers a significant relief of neuropathic pain and improves the emotional well-being of the patient and should be offered to all, irrespective of delay in presentation.

Keywords

Traumatic - Brachial plexus injuries - Pain - Psychosocial - Functional outcome

Abbreviations

BPI, brachial plexus injuries - SF-36, short form 36 - DASH, disability of arm, shoulder and hand - PVAS, pain visual analogue scale - DAQ, dysfunction analysis questionnaire - LH, learned helplessness

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