Abstract
Global brachial plexopathies including multiple nerve root avulsions may result in complete upper limb paralysis despite surgical treatment. Bionic reconstruction, which includes the elective amputation of the functionless hand and its replacement with a mechatronic device, has been described for the transradial level. Here, we present for the first time that patients with global brachial plexus avulsion injuries and lack of biological shoulder and elbow function benefit from above-elbow amputation and prosthetic rehabilitation. Between 2012 and 2017, forty-five patients with global brachial plexus injuries approached our centre, of which nineteen (42.2%) were treated with bionic reconstruction. While fourteen patients were amputated at the transradial level, the entire upper limb was replaced with a prosthetic arm in a total of five patients. Global upper extremity function before and after bionic arm substitution was assessed using two objective hand function tests, the action research arm test (ARAT), and the Southampton hand assessment procedure (SHAP). Other outcome measures included the DASH questionnaire, VAS to assess deafferentation pain and the SF-36 health survey to evaluate changes in quality of life. Using a hybrid prosthetic arm mean ARAT scores improved from 0.6 ± 1.3 to 11.0 ± 6.7 (p = 0.042) and mean SHAP scores increased from 4.0 ± 3.7 to 13.8 ± 9.2 (p = 0.058). After prosthetic arm replacement mean DASH scores improved from 52.5 ± 9.4 to 31.2 ± 9.8 (p = 0.003). Deafferentation pain decreased from mean VAS 8.5 ± 1.0 to 6.7 ± 2.1 (p = 0.055), while the physical and mental component summary scale as part of the SF-36 health survey improved from 32.9 ± 6.4 to 40.4 ± 9.4 (p = 0.058) and 43.6 ± 8.9 to 57.3 ± 5.5 (p = 0.021), respectively. Bionic reconstruction can restore simple but robust arm and hand function in longstanding brachial plexus patients with lack of treatment alternatives.
Highlights
Deafferentation pain decreased from mean VAS 8.5 ± 1.0 to 6.7 ± 2.1 (p = 0.055), while the physical and mental component summary scale as part of the SF-36 health survey improved from 32.9 ± 6.4 to 40.4 ± 9.4 (p = 0.058) and 43.6 ± 8.9 to 57.3 ± 5.5 (p = 0.021), respectively
High-speed motor vehicle accidents account for the majority of adult traumatic brachial plexus injuries (BPIs), as severe traction on the brachial plexus may occur with violent arm motion when the motorcycle rider collides with a car or other obstacle [1,2,3]
We have shown that prosthetic rehabilitation after bionic substitution of the entire arm enables useful upper limb function in patients with global brachial plexus avulsion injuries, where biological treatment alternatives have failed to improve function
Summary
High-speed motor vehicle accidents account for the majority of adult traumatic brachial plexus injuries (BPIs), as severe traction on the brachial plexus may occur with violent arm motion when the motorcycle rider collides with a car or other obstacle [1,2,3]. Avulsions of multiple nerve roots, still have a very remote chance of recovery [10]. In some patients with global brachial plexopathy the extent of neurological injury results in complete paralysis of all upper limb muscles despite primary and secondary biological reconstructions. Patients who regain no arm and hand function emotionally detach from their insensate, functionless limb [11]. Besides marked functional disability [12] and greatly impaired quality of life [13], a chronic pain syndrome affects up to 90% of patients with nerve root avulsions, referred to as deafferentation pain [14]
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