Highlight
- •We have shown for the first time that after the trauma, TBPI patients who had not been treated with nerve transfer surgery present a decrease in inspiratory muscle strength, and exercise capacity.
- •Besides diaphragmatic mobility, reduced volume variation and ventilation asymmetry of the upper ribcage compartment.
- •It can also be speculated that the use of incentive spirometry may decrease the level of ventilation asymmetry; however, this issue needs further investigation.
Abstract
Objective
To investigate the repercussions of traumatic brachial plexus injury (TBPI) on diaphragmatic
mobility and exercise capacity, compartmental volume changes, as well as volume contribution
of each hemithorax and ventilation asymmetry during different respiratory maneuvers,
and compare with healthy individuals. The velocity of shortening of the diaphragm,
inspiratory, and expiratory muscles were also assessed.
Participants
The cross-sectional study was conducted with 40 male individuals (20 with TBPI who
have not undergone nerve transfer surgery [mean age 30.1 ± 5.3] and 20 healthy paired
by age and body mass index). Only patients with C8-T1 root avulsion were studied.
Main outcome
Compartmental and hemithoracic volumes, as well as asymmetry between the affected
and unaffected sides were assessed using optoelectronic plethysmography. The 6 minute
walking test was performed to evaluate exercise capacity, while diaphragm mobility
was assessed during quiet breathing (QB) using an ultrasound device.
Results
TBPI patients with mean lesion time of 174 ± 45.24 days showed a decreased pulmonary
function, respiratory muscle strength, exercise capacity, and diaphragm mobility (all
p < .001) compared with healthy. The pulmonary ribcage compartment of the affected
side was the main contributor to the reduction in volume during inspiratory capacity,
vital capacity, and inspiratory load imposition (all p < .05). This compartment also
exhibited a higher ventilation asymmetry with reduced shortening velocity of the inspiratory
ribcage muscles.
Conclusion
Compared with healthy, TBPI patients who have not undergone nerve transfer surgery
present low exercise capacity and diaphragmatic mobility, as well as reduced volume
of the upper ribcage compartment on the affected side that leads to reduced shortening
velocity and ventilation asymmetry.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand TherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Epidemiology of brachial plexus injuries in a multitrauma population.Neurosurgery. 1997; 40: 1182-1188
- Current concepts of the treatment of adult brachial plexus injuries.J Hand Surg Am. 2010; 35: 678-688
- Improving shoulder and elbow function in children with Erb's palsy.Seminars in pediatric neurology. 2000; 7: 44-51
- Outcome after brachial plexus injury surgery and impact on quality of life.Acta neurochirurgica. 2017; 159: 1257-1264
- Ventilation and exercise performance after phrenic nerve and multiple intercostal nerve transfers for avulsed brachial plexus injury.Chest. 2005; 128: 3434-3439
- Brachial plexus neurotization with donor phrenic nerves and its effect on pulmonary function.J Neurosurg. 2002; 96: 523-526
- Phrenic nerve transfer for brachial plexus motor neurotization.Microsurgery. 1989; 10: 287-289
- Pulmonary and biceps function after intercostal and phrenic nerve transfer for brachial plexus injuries.J Hand Surg Br. 2004; 29: 8-11
- Chest wall kinematic determinants of diaphragm length by optoelectronic plethysmography and ultrasonography.J Appl Physiol. 2003; 94: 621-630
- Respiratory muscle dynamics and control during exercise with externally imposed expiratory flow limitation.J Appl Physiol. 2002; 92: 1953-1963
- Assessment of the acute effects of different PEP levels on respiratory pattern and operational volumes in patients with Parkinson's disease.Respiratory physiology & neurobiology. 2014; 198: 42-47
- ATS/ERS Statement on respiratory muscle testing.American journal of respiratory and critical care medicine. 2002; 166: 518-624
- Sociedade Brasileira de Pneumologia e Tisiologia – SBPT. Diretrizes para testes de função pulmonar.J Bras Pneumol. 2002; 29: 207-221
- Reference values for lung function tests: II. Maximal respiratory pressures and voluntary ventilation.Brazilian J Med and Biolog Res. 1999; 32: 719-727
- Ultrasound M-mode assessment of diaphragmatic kinetics by anterior transverse scanning in healthy subjects.Ultrasound Med Biol. 2011; 37: 44-52
- Thoracic ultrasound: Potential new tool for physiotherapists in respiratory management. A narrative review.J Crit Care. 2016; 31: 101-109
- Reference equations for the six-minute walk in healthy adults.American j respiratory and critical care med. 1998; 158: 1384-1387
- Reference equations for the six-minute walk distance based on a Brazilian multicenter study.Brazilian journal of physical therapy. 2013; 17: 556-563
- Opto-electronic plethysmography.Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace /Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio. 59. Universita di Napoli, 2003: 12-16 (Secondo ateneo)
- Chest wall and lung volume estimation by optical reflectance motion analysis.J applied physiol. 1996; 81: 2680-2689
- Compartmental chest wall volume changes during volitional normocapnic hyperpnoea.Respiratory physiology & neurobiology. 2011; 177: 294-300
- Acute effects of volume-oriented incentive spirometry on chest wall volumes in patients after a stroke.Respiratory care. 2014; 59: 1101-1107
- An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation.American j respiratory and critical care med. 2013; 188: e13-e64
- Inspiratory muscle training in chronic airflow limitation: comparison of two different training loads with a threshold device.The European respiratory j. 1994; 7: 1266-1274
- Optoelectronic plethysmography as an alternative method for the diagnosis of unilateral diaphragmatic weakness.Chest. 2013; 144: 887-895
- Statistical power analysis for the behavioral sciences.Lawrence Erbaum, Hillsdale, New Jersey1988 (2ª ed)
- Effect size estimates: current use, calculations, and interpretation.J experimental psychol General. 2012; 141: 2-18
- Pulmonary function after complete unilateral phrenic nerve transection.J neurosurgery. 2005; 103: 464-467
- Hemidiaphragmatic paresis during interscalene brachial plexus block: effects on pulmonary function and chest wall mechanics.Anesthesia and analgesia. 1992; 74: 352-357
- Effects of hemiplegy on pulmonary function and diaphragmatic dome displacement.Respiratory physiology & neurobiology. 2011; 178: 196-201
- . Ultrasonographic evaluation of diaphragmatic motion.J ultrasound in med: official j American Institute of Ultrasound in Med. 2001; 20: 597-604
- Exercise testing in patients with diaphragm paresis.Respiratory physiol & neurobiol. 2018; 248: 31-35
- Effect of severe isolated unilateral and bilateral diaphragm weakness on exercise performance.American journal of respiratory and critical care medicine. 2002; 165: 1265-1270
- Rib cage mechanics during quiet breathing and exercise in humans.J applied physiol. 1997; 83: 1242-1255
- Scalene and sternomastoid muscle function.J Appl Physiol. 1966; 21: 497-502
- Coordination between rib cage muscles and diaphragm during quiet breathing in humans.J applied physiol: respiratory, environmental and exercise physiol. 1984; 57: 899-906
- Activity of latissimus dorsi muscle during inspiratory threshold loads.The European respiratory j. 1995; 8: 441-445
- Chest wall and trunk muscle activity during inspiratory loading.J applied physiol. 1992; 73: 2373-2381
- Chest wall kinematics in patients with hemiplegia.American j respiratory and critical care med. 2003; 168: 109-113
- Mediastinal and chest wall limitations to asymmetry of lung inflation.J applied physiol. 2004; 96: 999-1004
- Function of the respiratory muscles in acute hemiplegia.The American review of respiratory disease. 1981; 123: 631-632
- Diaphragmatic paresis: pathophysiology, clinical features, and investigation.Thorax. 1989; 44: 960-970
- Treatment options for brachial plexus injuries.ISRN Orthop. 2014; 314137
- Long-term observation of respiratory function after unilateral phrenic nerve and multiple intercostal nerve transfer for avulsed brachial plexus injury.Neurosurgery. 2012; 70: 796-801
- Treatment of a brachial plexus injury using kinesiotape and exercise.Physiother Theory Pract. 2010; 26: 490-496
- Traumatic brachial plexus injury rehabilitation using neuromuscular electrical muscle stimulation in a polytrauma patient.BMJ case reports. 2019; 12e232107
- Reabilitação na paralisia parcial do plexo braquial.Revista Brasileira de Cirurgia Plástica. 2013; 28: 175-179
JHT Read for Credit
Quiz: # 859
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- # 1.The muscles of inspiration were
- a.not addressed in this study
- b.insignificantly weakened
- c.uniformly paralyzed
- d.uniformly weakened
- a.
- # 2.Every subject in the patient group had
- a.C8-T1 nerve root compression
- b.C5-C6 root avulsion
- c.C8-T1 root avulsion
- d.at least 3 cervical levels involved
- a.
- # 3.What was the main contributor to reduced volume during inspiration?
- a.the pulmonary ribcage on the affected side
- b.the left and right pulmonary ribcages
- c.the diaphragmatic excursion
- d.slowed NCV across the lower brachial plexus
- a.
- # 4.Exercise capacity was tested using the
- a.one hour light exercise assessment tool
- b.6 minute walking test
- c.standard treadmill 2 minute max exertion protocol
- d.WHO Exercise Capacity Battery of Tasks (WECBT)
- a.
- # 5.All TBPl patients demonstrated reduced shortening velocity and ventilation asymmetry
- a.not true
- b.true
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: April 28, 2022
Accepted:
March 27,
2022
Received in revised form:
January 12,
2022
Received:
May 20,
2021
Footnotes
Conflict of interest: All named authors hereby declare that they have no conflicts of interest to disclose.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
