Use of the Medical Research Council Muscle Strength Grading System in the Upper Extremity

James, Michelle A.

doi:10.1016/j.jhsa.2006.11.008

Cited by 165 publications

(126 citation statements)

References 14 publications

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“…Sensation recovery was assessed via twopoint discrimination and muscle function via the currently accepted muscle grading system (M value) by the British Medical Research Counsel. 3 There was no unanticipated donor site morbidity among the nerve graft donors. All nerve donors experienced paresthesias of the lateral ankle in the distribution of the sural nerve; however, there were no cases of symptomatic neuroma or wound infection.…”

Section: Resultsmentioning

confidence: 96%

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Nerve allograft transplantation for functional restoration of the upper extremity: case series

Elkwood

Holland

Arbes

et al. 2011

The Journal of Spinal Cord Medicine

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Background: Major trauma to the spinal cord or upper extremity often results in severe sensory and motor disturbances from injuries to the brachial plexus and its insertion into the spinal cord. Functional restoration with nerve grafting neurotization and tendon transfers is the mainstay of treatment. Results may be incomplete due to a limited supply of autologous material for nerve grafts. The factors deemed most integral for success are early surgical intervention, reconstruction of all levels of injury, and maximization of the number of axonal conduits per nerve repair. Objective: To report the second series of nerve allograft transplantation using cadaveric nerve graft and our experience with living-related nerve transplants. Participants: Eight patients, seven men and one woman, average age 23 years (range 18-34), with multi-level brachial plexus injuries were selected for transplantation using either cadaveric allografts or living-related donors. Methods: Grafts were harvested and preserved in the University of Wisconsin Cold Storage Solution at 5°C for up to 7 days. The immunosuppressive protocol was initiated at the time of surgery and was discontinued at approximately 1 year, or when signs of regeneration were evident. Parameters for assessment included mechanism of injury, interval between injury and treatment, level(s) of deficit, post-operative return of function, pain relief, need for revision surgery, complications, and improvement in quality of life. Results: Surgery was performed using living-related donor grafts in six patients, and cadaveric grafts in two patients. Immunosuppression was tolerated for the duration of treatment in all but one patient in whom early termination occurred due to non-compliance. There were no cases of graft rejection as of most recent followup. Seven patients showed signs of regeneration, demonstrated by return of sensory and motor function and/or a migrating Tinel's sign. One patient was non-compliant with the post-operative regimen and experienced minimal return of function despite a reduction in pain. Conclusions: Despite the small number of subjects, it appears that nerve allograft transplantation may be performed safely, permitting non-prioritized repair of long-segment peripheral nerve defects and maximizing the number of axonal conduits per nerve repair. For patients with long, multi-level brachial plexus injuries or combined upper and lower extremity nerve deficits, the use of nerve allograft allows a more complete repair that may translate into greater functional restoration than autografting alone.

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Section: Resultsmentioning

confidence: 96%

“…Muscle strength was graded on a standard scale: 0 -no contraction; 1 -slight contraction, no movement; 2 -full range of motion gravity neutral; 3 -active movement against gravity; 4 -active movement against gravity and resistance; and 5 -normal. 3 …”

Section: Methodsmentioning

confidence: 99%

Nerve allograft transplantation for functional restoration of the upper extremity: case series

Elkwood

Holland

Arbes

et al. 2011

The Journal of Spinal Cord Medicine

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“…13 Supination was evaluated with the elbow flexed and extended. In those patients who ultimately underwent distal radio-ulnar fusion, this was conducted immediately before fusion surgery.…”

Section: Postoperative Evaluationmentioning

confidence: 99%

Nerve transfers for elbow and finger extension reconstruction in midcervical spinal cord injuries

Bertelli¹,

Ghizoni²

2015

JNS

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OBJECT The objective of this study was to report the results of elbow, thumb, and finger extension reconstruction via nerve transfer in midcervical spinal cord injuries. METHODS Thirteen upper limbs from 7 patients with tetraplegia, with an average age of 26 years, were operated on an average of 7 months after a spinal cord injury. The posterior division of the axillary nerve was used to reinnervate the triceps long and upper medial head motor branches in 9 upper limbs. Both the posterior division and the branch to the middle deltoid were used in 2 upper limbs, and the anterior division of the axillary nerve in the final 2 limbs. For thumb and finger extension reconstruction, the nerve to the supinator was transferred to the posterior interosseous nerve. RESULTS In 22 of the 27 recipient nerves, a peripheral type of palsy with muscle denervation was identified. At an average of 19 months follow-up, elbow strength scored M4 in 11 upper limbs and M3 in 2, according to the British Medical Research Council scale. Thumb extension scored M4 in 8 upper limbs and scored M3 in 4. Finger extension scored M4 in 12 hands. No donor-site deficits were reported or observed. CONCLUSIONS Nerve transfers are effective at restoring elbow, thumb, and finger extension in patients with a midcervical spinal cord injury, which occurs in the majority of patients with a peripheral type of palsy with muscle denervation in their upper limbs. Efforts should be made to perform operations in these patients within 12 months of injury.

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“…At each follow-up, clinical outcomes were assessed for sensory disturbances such as hypoaesthesia, paraesthesia or neuropathic pain, and muscle power/weakness was tested according to the Medical Research Council (MRC) muscle strength grading system [10] by an independent investigator (JHL). Also, these values were converted into sensory and motor evaluation scales which were expressed as scores with a reference value of 100 points for normal contralateral lower limb function.…”

Section: Evaluation Of Clinical Outcomementioning

confidence: 99%

Surgical outcome of Schwannomas arising from major peripheral nerves in the lower limb

Kim

Seo

Lee

et al. 2012

International Orthopaedics (SICOT)

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Purpose The treatment of symptomatic Schwannoma is surgical excision. However, in the case of major peripheral nerves with motor function, there are concerns including neurological complications following surgery. This study was designed to evaluate the surgical outcome of Schwannomas originating from major peripheral nerves of the lower limb. Additionally, we sought to find out the predictable factors for permanent neurological deficits. Methods Between 2004 and 2008, 30 consecutive Schwannomas underwent simple excision or enucleation. Surgical outcomes after excision were evaluated with an emphasis on neurological deficits and recurrence. Neurological complications were classified as major or minor neurological deficits and evaluated immediately after surgery and at final follow-up. Risk factors for development of neurological deficits were identified. Results Twenty-three patients (23/30, 76.7 %) developed neurological deficits immediately after surgery. After a mean of 58.8 months (32-79 months), 19 patients (19/30, 63.3 %) showed no residual neurological deficits. Among the remaining 11 (11/30, 36.7 %), nine patients had tolerable symptoms and two patients had major neurological deficits including significant motor weakness and sensory impairments. Larger tumours tended to be at greater risk of neurological deficit after surgery. One recurrence of the tumour was seen two years after surgery. There were no cases of reoperation or malignant transformation Conclusions In the majority of cases, Schwannomas in the lower limb can be excised with acceptable risk for neurological deficits. However, meticulous dissection is required in large-sized Schwannomas because these tumours seem to have a higher frequency of fascicular injury during dissection.

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Use of the Medical Research Council Muscle Strength Grading System in the Upper Extremity

Cited by 165 publications

References 14 publications

Nerve allograft transplantation for functional restoration of the upper extremity: case series

Nerve allograft transplantation for functional restoration of the upper extremity: case series

Nerve transfers for elbow and finger extension reconstruction in midcervical spinal cord injuries

Surgical outcome of Schwannomas arising from major peripheral nerves in the lower limb

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