NEUROMA-IN-CONTINUITY RESECTION - EARLY OUTCOME IN OBSTETRICAL BRACHIAL-PLEXUS PALSY

The short-term effect of neuroma-in-continuity resection in obstetrica l brachial plexus palsy was evaluated to test the hypothesis that the neuroma does not contribute to useful limb function. Twenty-six patien ts with obstetrical brachial plexus palsy underwent resection of the n euroma-in-continuity and interpositional nerve grafting, and 17 patien ts underwent neurolysis only. The preoperative and postoperative activ e movement scores were recorded using an eight-point scale for 15 join t motions in each patient. Data analysis examined the change in total limb motion scores over time within patients undergoing neuroma-in-con tinuity resection and a comparison with those patients undergoing neur olysis. Compared with preoperative assessment, limb motion scores afte r neuroma resection were significantly decreased at 6 weeks, not signi ficantly different by 3 months, and significantly improved at 12 month s postoperatively. In comparison to patients undergoing neurolysis onl y, limb motion scores after neuroma resection were not significantly d ifferent at 3, 6, and 12 months postoperatively. These findings are un likely to be accounted for by axonal regeneration across interposition al nerve grafts. Nerve regeneration or recovery in the nongrafted segm ent of the plexus must be sufficient to reproduce preoperative motion. Resection of the neuromas-in-continuity in obstetrical brachial plexu s palsy does not significantly diminish motor activity.