The Journal of Bone and Joint Surgery (American). 2009;91:1729-1737.
doi:10.2106/JBJS.H.00542
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Motor Nerve-Conduction Studies in Obstetric Brachial Plexopathy for a Selection of Patients with a Poor Outcome

Carlos O. Heise, MD1, Mario G. Siqueira, MD2, Roberto S. Martins, MD2 and José Luiz D. Gherpelli, MD2

1 Fleury Institute, Avenue Lacerda Franco, 220, São Paulo, CEP: 01536-000, Brazil. E-mail address: carlos.heise{at}fleury.com.br
2 Departments of Neurosurgery (M.G.S. and R.S.M.) and Neurology (J.L.D.G.), University of São Paulo Medical School, Hospital das Clínicas, Departmento de Neurologia Av. Dr. Enéas de Carvalho Aguiar, 255 05403-000 São Paulo – SP, Brazil. E-mail address for M.G. Siqueira: mgsiqueira{at}uol.com.br. E-mail address for R.S. Martins: robar{at}ig.com.br. E-mail address for J.L.D. Gherpelli: jldg{at}osite.com.br

Investigation performed at the University of São Paulo Medical School Clinics Hospital, São Paulo, Brazil

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: The criteria and timing for nerve surgery in infants with obstetric brachial plexopathy remain controversial. Our aim was to develop a new method for early prognostic assessment to assist this decision process.

Methods: Fifty-four patients with unilateral obstetric brachial plexopathy who were ten to sixty days old underwent bilateral motor-nerve-conduction studies of the axillary, musculocutaneous, proximal radial, distal radial, median, and ulnar nerves. The ratio between the amplitude of the compound muscle action potential of the affected limb and that of the healthy side was called the axonal viability index. The patients were followed and classified in three groups according to the clinical outcome. We analyzed the receiver operating characteristic curve of each index to define the best cutoff point to detect patients with a poor recovery.

Results: The best cutoff points on the axonal viability index for each nerve (and its sensitivity and specificity) were <10% (88% and 89%, respectively) for the axillary nerve, 0% (88% and 73%) for the musculocutaneous nerve, <20% (82% and 97%) for the proximal radial nerve, <50% (82% and 97%) for the distal radial nerve, and <50% (59% and 97%) for the ulnar nerve. The indices from the proximal radial, distal radial, and ulnar nerves had better specificities compared with the most frequently used clinical criterion: absence of biceps function at three months of age.

Conclusions: The axonal viability index yields an earlier and more specific prognostic estimation of obstetric brachial plexopathy than does the clinical criterion of biceps function, and we believe it may be useful in determining surgical indications in these patients.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.


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