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Hand sensibility is diminished in children with a C5, C6 brachial plexus birth injury, and correlates with diminished hand function
Sonja Buitenhuis, MSc1; Martijn JA Malessy, MD PhD2; Willem Pondaag, MD PhD2
1Leiden University Medical Center, Leiden, Netherlands; 2Neurosurgery, Leiden University Medical Center, Leiden, Netherlands

Background The aim of this study was to assess the sensibility of the hand in children with a C5, C6 brachial plexus birth injury (BPBI) and assess related dexterity and gripforce. Sensibility is generally perceived as intact in these children.
Methods Fifty children with BPBI (30 after nerve surgery, 20 conservatively treated, mean age 9.8 years) and 25 healthy controls (mean age 9.6 years) were investigated. Two-point discrimination and touch-pressure with Semmes-Weinstein monofilaments were tested. Additionally, correct localization of a sensory stimulus on the radial and ulnar side of the fingertip was assessed. Dexterity was evaluated with a single item from the Movement Assessment Battery for Children-2. Gripforce of both hands was assessed using a Jamar dynamometer. We compared the affected side with the nondominant hand of the control group.
Results The sensibility in the thumb and index finger was significantly diminished in the BPBI group for both two-point discrimination (P = 0.005 and P = 0.014, respectively) and monofilament test (P < 0.001). Localisation per finger differed significantly for the thumb, index finger, middle finger and ring finger, but not for the little finger. Dexterity was significantly lower in the BPBI group than in control group, corrected for age (P = 0.023). Hand function was significantly less with decreasing touch-pressure testing of the thumb (P = 0.036). The mean gripforce of the affected non-dominant hand of children with BPBI was reduced compared with controls (95 N and 123 N, respectively, P = 0.001). There was no relationship between gripforce reduction and sensibility, bimanual use or shoulder external rotation.
Conclusions

  1. The sensibility of the thumb and index finger in children with an upper BPBI (either surgically or conservatively treated) is diminished - contrary to what is generally believed.
  2. Localization of sensory stimuli was diminished in the thumb, index finger, middle finger, and ring finger. This finding suggests additional, but subclinical sensory involvement of C7 in lesions routinely seen as of only C5 and C6.
  3. Dexterity and gripforce is diminished in children with an upper BPBI when tested in detail, but not in routine examination. Dexterity was correlated with a decreased sensibility.

Awareness of diminished sensibility and hand function in patients with upper BPBI is important to enabe optimization of treatment.


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