Research Article| Volume 35, ISSUE 2, P308-316, April 2022

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Ventilation asymmetry, diaphragmatic mobility and exercise capacity in men with traumatic brachial plexus injury

Published:April 28, 2022DOI:


      • 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.



      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.


      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.


      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.


      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.


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      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 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
      • # 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
      • # 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
      • # 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)
      • # 5.
        All TBPl patients demonstrated reduced shortening velocity and ventilation asymmetry
        • a.
          not true
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.