Evaluation of Protective Sensation after Hemi-contralateral C7 Nerve Root Transfer to Median Nerve in Total Root Avulsion Brachial Plexus Injury: Level 4 Evidence

Abstract

There is no financial information to disclose. Hemi-contralateral C7 nerve root (hemi-CC7) transfer to median nerve has been done in total root avulsion brachial plexus injury to restore protective sensation of the hand and finger flexion. The hypothesis of this study is that hemi-CC7 transfer to median nerve can provide useful protective sensation of the hand in the brachial plexus injury patients. Brachial plexus injury patients who underwent hemi-CC7 transfer to median nerve from 2000 to 2012 at a single institution were evaluated with multimodality of sensory evaluation, including simple light touch, the Semmes-Weinstein monofilament testing, 2-point discrimination and vibration perception threshold. The measurements performed at least 4 years after the operation. Fifty patients underwent hemi-CC7 transfer to median nerve using a vascularized ulnar nerve graft were evaluated. The mean age at the time of injury was 25 years. The average time from injury to surgery was 9 months (range, 2-25 mo.). The average postoperative follow-up time was 89 months (range, 48 – 191 mo.). Nine patients (18%) showed response with the simple light touch. Sixteen patients (32%) could sense the Semmes-Weinstein monofilament test. Five patients recognized the 4.56 filament and 11 patients recognized the 6.65 filament. No patients developed 2-point discrimination sense less than 15mm. No patient responded to vibration testing with 256 Hz tuning fork. Nine patients (18%) had S3 recovery, according to British Medical Research Council grading system. •According to monofilament testing and 2-point discrimination interpretation, no patient had the sensory recovery at the level of protective sensation.•Previous studies reported recovery of the sensation more than 80% of the patients, however, most of them had difficulty to localize the stimulus.•Our study used multimodality sensory testing to evaluate the quality of neural recovery.