Clinical and Elektroneuromyographycal Analysis of Dynamics of Reinnervation Processes in Patients with Traumatic Brachial Plexopathy at Therapeutic Electric Impulse Stimulation
Е.T. Afina, M.V. Nadezhdina
DOI: 10.22138/2500-0918-2017-14-4-325-331
Ural State Medical University, Yekaterinburg, Russian Federation
Abstract. The assessment of this work was to identify clinical and electromyographic (EMG) changes in patients with different variants of traumatic brachial plexopathy (TBP) on the background of therapeutic electroni-pulse stimulation (LEIS) at different times of the recovery period. There are the dynamic study of 74 patients with TBP: upper Erbs palsy (30), lower Klumpcs palsy (25) and whole palsy (19 observations) variants. The method of LEIS performed on the unit fluctuation of electrotherapy «Adapton-EMIT» a series of courses (3 course for 15 days with an interval of 10 days) after 1, 3, 6, and 12 months after injury with stimulation of denervated and intact muscles of the upper limb. The dynamics was determined by the indices of stimulatory EMG and the regress of the motor deficit with an evaluation of the strength of the denervated muscles according to the international 5-point scale. The control group consisted of 30 healthy volunteers. There are 3 groups of patients: I — with full recovery of neuromuscular conduction in the period up to 3 months, II — partial recovery and the reduction of the paresis to moderate in the period of 6 months and group III patients with persistent motor deficit (over 1 year). Dynamics of strength gain denervated muscles was consistent with the improvement in indices of neuromuscular сonductivity. The best EMG indicators of motor conduction was the stimulation of muscles innervated by the musculo-cutaneus, radial, median nerves due to common segments of innervation, intersegmentary, anastomotic connections between them. Patients II and to a greater extent of III group showed low M-response rates from the muscles innervated by peripheral nerves with common innervation segments, which reduced the recovery potential with TEIS.In patients with different TBP variants, the duration and degree of recovery of neuromuscular conduction and motor function depends on the degree of damage to the nerve trunks and innervated muscles. TEIS of relatively intact muscles promotes the activation of general and intersegmental connections with the improvement of neuromuscular conduction, a reduction in motor deficit and a reduction in the recovery time. Depending on the initial EMG data, it is possible to predict the recovery potential and justify the conduct of repeated LEIS courses.
Keywords: traumatic shoulder plexopathy, brachial plexus, electroneuromyography
Received 20.11.2017
For citation:
Afina E.T., Nadezhdina M.V. Clinical and elektroneuromyographycal analysis of dynamics of reinnervation processes in patients with traumatic brachial plexopathy at therapeutic electric impulse stimulation. Vestn. Ural. Med. Akad. Nauki. Journal of Ural Medical Academic Science. 2017, Vol. 14, no. 4, pp. 325–331. DOI: 10.22138/2500-0918-2017-14-4-325-331 (In Russ)
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Authors
Elmira T. Afina
Applicant of the Department of Nervous Diseases, Neurosurgery and Medical Genetics
Margarita V. Nadezhdina
Dr.Sci. (Med.), Professor, Professor of the Department of Nervous Diseases, Neurosurgery and Medical Genetics
Ural State Medical University
Russian Federation, Yekaterinburg, ul. Repin, 3
margaritaviktorovna123@mail.ru