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Comparing Surgical and Nonsurgical Outcomes for Treatment of Brachial Neuritis
Allison K Baergen, MD1; Samantha Visva, BHSc1; Kirsty Usher Boyd, MD, FRCSC2
1University of Ottawa, Ottawa, ON, Canada; 2Department of Surgery, Division of Plastic Surgery, University of Ottawa, Ottawa, ON, Canada

Introduction: Brachial neuritis (BN) also known as neuralgic amyotrophy, is a disease of the peripheral nerves that typically presents with sudden onset upper extremity neuropathic pain with associated weakness and atrophy. Traditionally, treatment has consisted of options such as corticosteroid administration, IVIg, or oral analgesics as the disease was thought to be self-limited. However, recent literature suggests that up to two-thirds of patients are left with residual symptoms and deficits. At the authors’ centre, BN is now frequently managed surgically with techniques including supercharge end-to-side (SETS) nerve transfers. The objective of this study was to compare clinical outcomes of patients treated with SETS nerve transfer versus nonoperative management. Currently, there are no randomized-controlled or long-term studies comparing these populations.
Materials and Methods: A retrospective cohort of all patients presenting to our peripheral nerve clinic with a diagnosis of BN between 2010-2020 was identified. All patients who were managed nonoperatively and those who had a SETS nerve transfer for treatment of BN were included in this study. Patients were excluded if they had fewer than one follow-up Medical Research Council (MRC) strength grade assessment. Basic demographic information and clinical outcomes including MRC strength grades for various upper extremity muscles were extracted from patient charts. Statistical analysis was performed using descriptive statistics and unpaired t tests.
Results: Thirteen patients (92.3% male, mean age 44.5 ± 15.3 years) were treated nonoperatively and sixteen patients (75.0% male, mean age 50.5 ± 10.8 years) were treated with SETS nerve transfer for BN. Mean follow-up duration was 12.2 ± 5.5 months following surgery and mean follow-up duration for those treated non-operatively from initial consultation to last follow-up was 6.6 ± 4.6 months. The average MRC at first visit for nonoperative patients was 2.72 (range 0, 5) and at last visit was 3.54 (range 0, 4+). For patients treated operatively, the average preoperative MRC scores combined to 1.43 (range 0, 4+) and improved postoperatively to 3.84 (range 0, 5). The average DMRC in the nonoperative group was an improvement of 1.00 compared with 2.34 among operative patients (p=0.0291) (95% CI [0.1475, 2.539]).
Conclusion: Novel treatment options for BN include SETS nerve transfer such as ECRB to AIN, FCR to PIN or FCR to brachialis. Our preliminary data demonstrates greater recovery of MRC strength grades among patients treated with surgical intervention compared to patients managed conservatively


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