Motor Nerve-Conduction Studies in Obstetric Brachial Plexopathy for a Selection of Patients with a Poor Outcome

BackgroundThe criteria and timing for nerve surgery in infants with obstetric brachial plexopathy remain controversial. Our aim was to develop a new method for early prognostic assessment to assist this decision process.MethodsFifty-four patients with unilateral obstetric brachial plexopathy who wer...

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Bibliographic Details
Published in:Journal of bone and joint surgery. American volume 2009-07, Vol.91 (7), p.1729-1737
Main Authors: Heise, Carlos O, Siqueira, Mario G, Martins, Roberto S, Gherpelli, José Luiz D
Format: Article
Language:English
Subjects:
Action Potentials
Biological and medical sciences
Birth Injuries - diagnosis
Birth Injuries - surgery
Brachial Plexus - physiopathology
Brachial Plexus Neuropathies - diagnosis
Brachial Plexus Neuropathies - surgery
Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction
Diseases of the osteoarticular system
Female
Humans
Infant
Infant, Newborn
Male
Medical sciences
Muscle Strength
Nervous system (semeiology, syndromes)
Neural Conduction
Neurology
Orthopedic surgery
Patient Selection
Prognosis
ROC Curve
Sensitivity and Specificity
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Upper Extremity - innervation
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Summary:BackgroundThe criteria and timing for nerve surgery in infants with obstetric brachial plexopathy remain controversial. Our aim was to develop a new method for early prognostic assessment to assist this decision process.MethodsFifty-four patients with unilateral obstetric brachial plexopathy who were ten to sixty days old underwent bilateral motor-nerve-conduction studies of the axillary, musculocutaneous, proximal radial, distal radial, median, and ulnar nerves. The ratio between the amplitude of the compound muscle action potential of the affected limb and that of the healthy side was called the axonal viability index. The patients were followed and classified in three groups according to the clinical outcome. We analyzed the receiver operating characteristic curve of each index to define the best cutoff point to detect patients with a poor recovery.ResultsThe best cutoff points on the axonal viability index for each nerve (and its sensitivity and specificity) were
ISSN:0021-9355
1535-1386
DOI:10.2106/JBJS.H.00542