COMPLEX RECOVERY OF THE UPPER LIMB AFTER NERVE TRANSFERS IN PATIENTS WITH ADULT BRACHIAL PLEXUS INJURIES

ABSTRACT Introduction. Adult brachial plexus injuries may lead to a permanent physical impairment in the affected upper extremity. One of the most successful operative methods of treating these injuries is nerve transfer. Depending on the extent of the injury, one or more nerve transfers are usually done for better functional recovery. That is why the aim of our study is to present the results of a two-year postoperative follow-up of the complex upper limb function in patients with different nerve transfers after adult brachial plexus injuries. Methods: All of our 14 patients (mean age of 35.0 years) had one or more nerves in the shoulder and the elbow. The average time between injury and the first surgery was 7.1 months, and the average time between surgeries was 3.4 months. All patients underwent a physiotherapy program with electrostimulation, donor nerve activation exercises, and training activities for daily living. Some patients had also individual hand splints. The complex function of the upper extremity was assessed on the 12th and 24th postoperative month (POM) by the Bulgarian version of the questionnaire Disabilities of Arm, Shoulder, and Hand (DASH). Results: On the 12th POM the average total score of DASH was 49.3 points, and on the 24th POM it decreased to 27.6 points (α≤0.000) which shows an improvement in the complex function of the upper extremity. By the end of the 24th POM almost all of the patients have returned to their job before the accident. Six of our patients have also been practicing sports without serious difficulties in the end of the second postoperative year. Conclusion: The studied patients showed good recovery of the complex function of the upper limb after the nerve transfers. This led to both returning to work after the injury and practicing sports. Although the sample is small, it gives us valuable information about what function of the upper extremity could be expected in these patients.