Outcomes of shoulder abduction after nerve surgery in patients over 50 following traumatic brachial plexus injury

Publication date: Available online 20 September 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Joshua A. Gillis, Joseph S. Khouri, Michelle F. Faupel, Robert J. Spinner, Allen T. Bishop, Alexander Y. Shin

Abstract

Purpose

There is controversy regarding the effectiveness of brachial plexus reconstruction in older patients as it is felt that outcomes are poor. The aim of this study is to determine the outcomes of shoulder abduction obtained after nerve reconstruction in patients over the age of 50 and factors related to success.

Methods

Forty patients over the age of 50 underwent nerve surgery to improve shoulder function after a traumatic brachial plexus injury. Patients were evaluated pre- and post-operatively for shoulder abduction strength and range of motion (ROM), Disability of the Arm, Shoulder, and Hand (DASH) scores, pain, age bracket, gender, body mass index (BMI), delay from injury to operation, concomitant trauma, severity of trauma, and type of reconstruction.

Results

The average age was 58.2 years (range 50-77) with an average follow-up of 18.8 months. The average modified BMRC (British Medical Research Council) shoulder abduction grade improved significantly from 0.23 to 2.03 (p<0.005). Fourteen patients achieved functional shoulder abduction of ≥M3 post-operatively. There was no correlation between age or age range stratification and BMRC grade or those obtaining useful shoulder abduction ≥M3. Active shoulder abduction improved significantly from 18.25° to 40.64°, with no difference based on age or age stratification. There were improved modified BMRC grades with nerve transfers versus nerve grafts. Less patients achieved ≥M3 function if surgery was delayed >6 months. The mean DASH score decreased from 45.3 to 40.7 post-operatively and the average pain score decreased from 3.7 to 3.0. Patients with higher post-operative BMRC grade for shoulder abduction had improved post-operative DASH scores and VAS for pain (p=0.011 and 0.005, respectively).

Conclusion

Brachial plexus nerve reconstruction for shoulder abduction in patients over the age of 50 can yield useful BMRC scores and ROM and age should not be used to exclude nerve reconstruction in these patients.