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Sensory nerve action potential in traumatic brachial plexus injuries.

OBJECTIVE: To show the contribution of the sensory nerve action potential in the topographic diagnosis of traumatic brachial plexus injuries through an illustration of 7 clinical cases.

OBSERVATIONS: We report 7 clinical cases of patients with unilateral traumatic brachial plexus injuries, following public highway accident. We realized an electroneuromyographic test (ENMG) for each patient in our service. A radiculopathy C5C6C7 were found in 3 subjects. Other patients had a radiculopathy C5 T1, a radiculopathy C7C8 T1, a lesion of the upper trunk or a lesion of the posterior cord. In all patients, pre- and post-ganglionic lesion was defined by the sensory potential: a sensory potential is unaffected in pre-ganglionic lesions, however, in a post-ganglionic lesion it is attenuated or absent. This electromyographic topographical definition was confirmed by myelography in two cases, by surgery for a patient and by clinical recovery for other patients.

DISCUSSION-CONCLUSION: With the sensory nerve action potential, we could define the topography of the lesion in traumatic brachial plexus injury (pre or post-ganglionic lesion). This conclusion is concordant with the study of Ferrante. The myelography was the gold standard for radiological confirmation of a root avulsion. Currently, only the physical examination and the EMG exploration allows to have topographic definition of lesion in order to define surgical indication. A well-performed electrodiagnostic assessement and a correctly done sensory nerve action potential are helpful for the planning of a therapeutic strategy of traumatic brachial plexus injuries.

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