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Sensory Outcome in Children with Total Brachial Plexus Palsy Following Microsurgical Reconstruction
Emily S. Ho, BSc OT Reg (Ont), MEd; Christine G. Curtis, BSc, PT; Howard M. Clarke, MD; PhD
The Hospital for Sick Children, Toronto, ON, Canada
Introduction: Children with total brachial plexus palsy (C5-T1) have long-term sequelae that include sensory impairment in the affected limb. Early microsurgical intervention is indicated for these children. The sensory outcome of children with total plexus palsy following microsurgical reconstruction that prioritizes reconstruction of the lower trunk (C8, T1) with nerve grafting or neurotisation has not been well studied.
Purpose: The purpose of this study was to first describe the sensory thresholds of children with total brachial plexus palsy who had reconstruction of the entire plexus including the lower trunk. Second, to determine the benefit of microsurgical reconstruction of the lower trunk on sensory outcome by comparing the outcomes between those with upper versus total plexus palsy.
Materials and Methods: A prospective case series of children between 6 to 18 years with a diagnosis of obstetrical brachial plexus palsy who had microsurgery at less than 12 months of age with nerve grafting or neurotisation was conducted. The sensory thresholds of children with upper and total plexus palsy were evaluated with the Weinstein Enhanced Sensory Test (WEST). Five sites on the affected and unaffected hands were tested. Results: Sixty children were evaluated. Deficits in the sensory threshold at the C6 (thenar eminence) distribution and the superficial branch of the radial nerve were statistically significant in the affected hands of children with total plexus palsy (n=34) compared to the unaffected hands. The sensory thresholds in the other 3 areas tested were not statistically different. Twelve of the children with upper plexus (46.2%) and 12 (35.3%) of the children with total plexus palsy had abnormal sensory thresholds. The proportion of children with and without sensory impairment was not statistically different between children with upper versus total plexus palsy.
Conclusions: Children with total plexus palsy had excellent recovery in their sensory thresholds in their hand following microsurgical reconstruction of the lower trunk of the brachial plexus.
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