Brachial plexopathy in gunshot wounds and motor vehicle accidents: Comparison of electrophysiologic findings

Abstract

Objective: To characterize the extent and degree of severity in subjects with gunshot wounds (GSWs) to the brachial plexus and to investigate the association between type of injuries and the predominant level involved. Design: A cross-sectional, retrospective review of electrophysiologic data. Setting: Electromyography laboratory of a county hospital. Patients: Thirty consecutive patients with GSWs and 14 patients with traction brachial plexopathies during a 5-year period (1992 through 1996). Main Outcome Measures: The injury was categorized according to the level predominantly involved, and each component of the four major levels of the plexus was analyzed. The association between type of injury and predominant level involved was assessed via two-tailed χ 2 test. The mean number of elements per subject to each level involved was compared between GSW and motor vehicle accident (MVA) patients using unpaired t test. Results: The type of injury (GSW vs MVA) is significantly associated with the level involved. GSWs were implicated in infraclavicular rather than supraclavicular injury. Compared with MVA, the GSW plexopathies had significant lower mean number of components involved at the root and cord levels, but higher at the terminal nerve branches of plexus. In GSWs, nearly two thirds of all components were severely injured and 60% were completely damaged. Conclusion: These findings demonstrate that gunshot plexopathies are characterized with multielement distribution and a mixture of lesions with or without continuity.