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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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Physical therapy after nerve transfers in the shouder area

Meeting Abstract

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  • presenting/speaker Nadezhda Popova - National Sports Academy "Vassil Levski", Sofia, Bulgaria
  • Georgi Petrov - Sofiamed Hospital, Sofia, Bulgaria
  • Margarita Kateva - Sofiamed Hospital, Sofia, Bulgaria

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. DocIFSHT19-1064

doi: 10.3205/19ifssh1450, urn:nbn:de:0183-19ifssh14507

Published: February 6, 2020

© 2020 Popova 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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Clinical issue/s: Presentation of rehabilitation program after nerve transfers (NT) in the shoulder area for patients with late brachial plexus injuries (BPIs).

Clinical reasoning: Based on the available literature and our experience we have identified three periods in the recovery process after NT - protection period, pre-reinervation and post-reinervation period. The protection period usually lasts between 2 and 4 weeks. For the beginning of the post-reinervation period, we consider the moment when twitching in the recipient muscules of the NT is detected. Physical therapy (PT) was performed within 1 postop. year, and it was consistent with the recovery period and the treatment stage. We used various passive, specialized, active-assisted, isometric, isotonic and resistance exercises; exercises for "learning" of the NT and separation of the new function of the nerve from the old, exercises to build new movement models. Electrostimulation was used as well.

Innovative, analytical or new approach: In the period 2015-2018 we worked with 14 men (mean age 38.2 years). All of them had a late BPI as a result of crashes. The NT are as follows: 8 n. accessorius to n. Suprascapularis, 4 n. phrenicus to n. axillaris, 5 n. radialis to n. axillaris and 1 n. phrenicus to n. radialis. PT results were reported at 6 and 12 postop. month (POM) by goniometry and MRC scale.

Contribution to advancing HT practice: There was a statistically significant improvement in the active range of motion in the shoulder - flexion 52.9 degrees of 6th POM and 97.9 degrees of 12th POM, abduction 40.0 degrees of 6th POM and 86.4 degrees of 12th POM and external rotation of 18.9 degrees of 6th POM and 32.1 degrees of 12th POM. The muscle strength of the abductors (2.5 per 6th POM and 3.6 per 12th POM), flexors (2.4 per 6th POM and 3.1 per 12th) and external rotators (2.1 per 6th POM and 2.9 per 12th POM) also reported positive changes. These results are associated with the quality of the surgical technique, the proper periodization and the correctly selected exercises and procedures.