FUNCTIONAL RECOVERY AFTER NERVE TRANSFERS IN THE SHOULDER AREA FOR ADULT BRACHIAL PLEXUS INJURIES

Abstract

Purpose: Presentation of а physiotherapeutic program after nerve transfers in the shoulder area and follow-up of the effect of its application. Material and methodology: The contingent is 15 men with a mean age of 37.1 years with adult brachial plexus injury and subsequent double nerve transfer in the shoulder area. The physiotherapeutic program before reinnervation, focuses on exercises with activation of the donor nerve. After the reinnervation active exercises are used, both with and without resistance, as well as exercises for distinguishing the old nerve function from the new one. Physiotherapeutic results were reported at the 6th and 12th postoperative months by goniometry and Medical Research Council Scale (MRCS). Results: At the 12th postoperative month average active flexion 97.9º, average abduction 86.4º and average external rotation 32.1º were reported. The results of the MRCS of 12th postoperative month showed an average score of 3.6 for the shoulder abductors, an average of 3.1 for the shoulder flexors and an average of 2.9 for the external rotators. Conclusion: An adequate physiotherapy program after nerve transfers provides the necessary reeducation of the donor’s nerve. For a period of 12 postoperative months it is possible to achieve a good active range of motion and satisfactory muscle function in the shoulder area. This creates preconditions for the improvement of the combined movements in the shoulder, which are necessary for several activities of daily living.