The Use of Electrodiagnosis in Operative Decision-Making for Early Plexus Reconstruction in Birth Brachial Plexus Palsy

Article Outline

• Disclosures
• Objective
• Design
• Setting
• Participants
• Interventions
• Main Outcome Measures
• Results
• Conclusions
• Copyright

Keywords: Rehabilitation, Electrodiagnosis, Brachial plexus, Obstetric paralysis

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Disclosures 

G. Bosques, None.

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Objective 

The aim of this study was to determine whether electrodiagnostic findings contribute unique information in the assessment of infants with birth brachial plexus palsy (BBPP) that is useful in decision making for operative versus non-operative management.

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Design 

Retrospective chart review of infants evaluated through an interdisciplinary clinic in a tertiary children's hospital from 2002 to the present. Descriptive and comparative statistical analyses were conducted to assess clinical and electrodiagnostic predictors of operative vs. non-operative management and of intra-operative findings.

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Setting 

Tertiary children's hospital interdisciplinary clinic.

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Participants 

Infants with a diagnosis of BBPP who underwent electrodiagnosis.

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Interventions 

Clinical and electrodiagnostic evaluations.

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Main Outcome Measures 

Operative vs. non-operative intervention and intra-operative findings.

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Results 

A total of 66 infants with BBPP were identified who underwent electrodiagnosis as part of their clinical evaluation. Of these, 28 were managed operatively (42.4%), and 38 non-operatively (57.6%). Among operatively managed infants, 26/28 had no clinical biceps function (Toronto score = 0; T-bic-0); 28/28 had intra-operative findings for which repair was indicated. Among the 38 non-operatively managed infants, 13 lacked biceps function (T-bic-0). The non-operatively managed infants lacking clinical biceps function had higher median and ulnar compound muscle action potential (CMAP) amplitudes when compared to the operative group (P = .0146). Among the 41 infants with T-bic-0, the biceps interference pattern was significantly lower in the operative vs. non-operative group (P = .0265).

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Conclusions 

Electrodiagnostic data, specifically biceps interference patterns and median and ulnar CMAP amplitudes, contributed information not available on physical examination that was useful in determining whether to proceed with operative management of BBPP. Approximately one-third of infants without clinical biceps function at age 3 months may not warrant surgical intervention if biceps interference pattern and CMAP amplitudes are taken into consideration, potentially decreasing overall costs and risks.