The Spontaneous Reeovery in Brachial Plexus Injury

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Journal of the Korean Society for Surgery of the Hand 1997;2(1):79-89.
Published online January 1, 1997.

Moon Sang Chung,Deuk Soo Jun,Goo Hyun Baek

상완 신경총 손상에서 자연 회복

정문상,전득수,백구현

Abstract

The results of surgical treatment for brachial plexus injury (BPI) is usually poor in terms of postoperative integral function of the involved upper extremity, From our early experiences, we knew by chance that spontaneous recovery in BPI patients may begin even later than 8 months after injury. Authors' strategy, which was based on our early experiences, for the treatment of closed fresh injury was 'wait and see' until 8 months after injury. From 1985 to 1994, we observed 103 patients with BPI. All of them did not any operation until 8 months after injury. There were 95 men and 8 women with a mean age of 29 years. Motorcycle injury (37%) and vehicle accident (28%) were main causes of injury. Whole plexus types were observed in 56 patients (54%), upper plexus types in 29 (28%), lower plexus types in 3 (3%), and infraclavicular types in 15 (15%). Electromyography was performed in all patients. This was repeated every three months to detect the recovery. Results were evaluated by authors' criteria, in which AMA system of brachial plexus impairment was modified. Duration of follow-up was average 25 months. 47 patients (46 % ) showed spontaneous improvement which was assessed by electromyography. These improvements were detected at average 7.8 months (range, 3 months 16 months) after trauma. The average score of these 47 patients improved from 14.8 points to 39.8 points. Thirty one patients (30%) had nerve surgery such as nerve graft, neurotization or neurolysis. Average duration from injury to nerve surgery was 10 months. Among 31 patients who had nerve surgery, 16 patients improved from preoperative 21.5 points to postoperative 36.3 points in average. Because spontaneous recovery began in average 7.8 months after injury, we think that it would be better to 'wait and see' for at least one year in patients with closed BPI expecting spontaneous recovery.

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