J Reconstr Microsurg 2020; 36(06): 445-449
DOI: 10.1055/s-0040-1702177
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Reliability of Various Predictors for Preoperative Diagnosis of Infraclavicular Brachial Plexus Lesions with Shoulder and/or Elbow Paresis

Shan Shan Qiu
1  Department of Plastic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
2  Department of Plastic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
,
Tommy Nai-Jen Chang
1  Department of Plastic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
,
Johnny Chuieng-Yi Lu
1  Department of Plastic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
,
David Chwei-Chin Chuang
1  Department of Plastic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
› Author Affiliations
Funding None.
Further Information

Publication History

19 July 2019

05 January 2020

Publication Date:
23 March 2020 (online)

Abstract

Background The distinction between supraclavicular and infraclavicular acute brachial plexus injuries (BPIs) could be challenging in cases of combined shoulder and elbow paresis. The reliability of several preoperative predictors was investigated to avoid unnecessary dissection, prolonged operation time, increased postoperative morbidity, and long scars.

Methods Between 2004 and 2013, 75 patients, who sustained acute BPI and presented with motor paresis of shoulder and elbow with preservation of hand function, were included and studied retrospectively. Various predictors including muscles function, sensation, fractures, Tinel's sign and nerve conduction velocity (NCV) studies were reviewed.

Results The highest odds ratio (OR) values for infraclavicular BPI were healthy clavicular head of pectoralis major and biceps, presenting with OR = 36.5 and 31.76, respectively, which were identified the most important predictors.

Conclusion A combination of functioning pectoralis major or biceps, scapular fracture, an infraclavicular Tinel's sign, and normal NCV in the musculocutaneous nerve was highly predictive of an infraclavicular level.

Note

This study was presented at the 26th EURAPS Congress, Edinburgh, May 28–30, 2015.