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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Traumatic Brachial Plexus Palsy: How Accurate Is the Pre-operative Diagnosis?

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  • presenting/speaker Peter Murray - Mayo Clinic, Jacksonville, United States
  • Yan Chen - Affiliated Puai Hospital of Tongji Medical College, Wuhan, China
  • Michael Wood - Mayo Clinic, Jacksonville, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-184

doi: 10.3205/19ifssh0611, urn:nbn:de:0183-19ifssh06110

Published: February 6, 2020

© 2020 Murray et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Brachial plexus injuries are devastating injuries and the pre-operative diagnosis can be difficult despite current imaging techniques and other diagnostic modalities.Purpose of this study was to assess at the individual nerve root level the accuracy of pre-operative diagnosis following evaluation by physical examination, imaging (CT, MRI) and elecrophysiologic (EMG).

Methods: Consecutive patients with non-penetrating traumatic brachial plexus injury requiring surgery by the same surgical team between 2005 to 2016 were included in the study. Pre- operative assessments of nerve root injury were made at individual nerve root levels using physical examination, MRI, CT myelogram, and EMG. The results were compared to intraoperative findings. Patient demographics were also recorded (Table 1 [Tab. 1]).

Results: Sixty patients were included in the study. Fifty four patients had CT myelogram, MRI or both. Fifty-five patients had EMG. All patients had a physical examination. Overall, the accuracy of CT myelogram /MRI was 77.8%, physical examination was 76.7% and EMG was 73.1%. The greatest accuracy of each of the tests was for injury diagnosis at the T1 nerve root: CT/MRI 88.9%, Physical Examination 81.7% and EMG 76.4%. CT/MRI and EMG were least accurate at C5 (64.8% and 69.1) while physical examination was least accurate a C7 (60.7%). When considering combinations of tests, the greatest accuracy was again seen at T1. Injury status of the T1 nerve root was also the most accurately diagnosed level among patients with a BMI > 30. CT myelogram/MRI and physical examination were equally accurate in the pre-operative diagnosis among the >30 BMI subgroup.

Discussion and Conclusion: Based on the results of this study, CT myelogram/MRI is more reliable in the pre-operative assessment of patients with brachial plexus injuries than either physical examination or EMG. The pre-operative status of the C8 and T1 nerve roots were more accurately assessed in this study compared to other nerve roots regardless of the type of testing performed suggesting that lower trunk abnormalities were easier to diagnose.