POSTOPERATIVE EVALUATION OF QUALITY OF LIFE IN PATIENTS WITH PARTIAL AND TOTAL POST-TRAUMATIC BRACHIAL PLEXUS PALSY

Abstract

Purpose: Until recently, evaluation of surgical treatment for brachial plexus palsy has been purely analytic, not taking into account the patient’s overall functional capacity nor his/her quality of life. The unilateral nature of these palsies and the fact that the limb remains healthy requires a global assessment of outcome. We propose here to associate the classical analytical evaluation with a global quality of life evaluation to determine the beneficial effect of surgical treatment for partial or total brachial plexus palsy.

Material and methods: Forty-four patients, mean age 30 years (17–60) were reviewed with a mean follow-up of 34 months. These patients were divided into two groups: C5–C6 ± C7 palsy (n=18), C5-T1 palsy (n=26). In each group, we recorded a complete muscle analysis, a visual analogue scale test of pain, and results of three quality of life questionnaires (DASH, Abilhand, MOS SF-36). We studied for each group the influence of recovered elbow flexion (biceps ≥ M3+), recovered shoulder function (abduction ≥ M3+), and residual pain on quality of life.

Results: The overall analysis did not demonstrate any difference in quality of life between partial and complete palsy. The three questionnaires were correlated with each other (p< 0.03). Residual pain (visual analogue scale ≥ 4 in 59% of the patients) was correlated with quality of life (p< 0.05) while involvement of the dominant side did not have any influence. In the partial palsy group, recovery of shoulder function (61%, n=11) improved significantly all the quality of life scores (p< 0.01). Conversely, recovery of elbow flexion (72%, n=13) did not improve quality of life in patients with a functional shoulder (p< 0.02). In the group with total palsy, recovery of shoulder function (77%, n=20) appeared to be as least as important as elbow flexion on quality of life (p ≤ 0.05).

Discussion: Unlike generally accepted notions, postoperative assessment of quality of life in these brachial plexus palsy patients demonstrates the importance of shoulder function which appears to be as least as important as recovery of elbow flexion. Furthermore, persistent pain appeared as one of the main negative factors affecting quality of life. Appropriate management is necessary.