Brachial Plexus - bad prognosis?

[lehughes]

Laurie,

Today I saw my first brachial plexus injury patient for rehab. The initial injury was 11/22/17. Is it possible that I won't get muscle contraction when using the e-stim? I tried it on the triceps today and also tried using it on a muscle and the paw to see if I could get withdrawal of the leg. Even with it turned up all the way, I did not get any response. I have gotten responses using the same setting 5pps and 200usec in my IVDD dogs post hmmilaminectomy surgery. If it is possible to not get a response, is that a poor prognostic indicator.

Thanks,

LW

[lehughes]

Hi L,

Sorry for my tardy reply!

Okay… so yes, it is a bit of a poor prognostic indicator if you can’t get a muscle contraction with the e-stim.
I have tried using it by connecting the leads to alligator clips and acupuncture needles inserted into the triceps (hoping for a deeper stimulus).
On ONE dog I got a response this way before getting a response with just superficial pads.
Usually triceps would come back first, if it were to come back. I always test all muscles (acknowledging the different nerves supplying the different muscle groups), but I’ve found that when things come back, Triceps is usually first.

I usually give it 2 months to see ‘something’… but at this point, when you are almost 1 month from injury… no response isn’t good, I’m afraid.

You could try to set your machine to 300usec (if available), to get more bang for your buck when testing… or the acup needle thing.

Fingers crossed for the patient, but I’d start to prep the owner for worst case scenario.

Sorry!


Laurie

[lehughes]

Laurie,

Thanks for your response. Last week I tried it at 300usec, and I think I even turned it up to 40Hz.

I was afraid that this was bad. I have been prepping "mom" for amputation from the beginning.


Thanks,

L

[lehughes]

Aww…

But the 5 Hz is still good. I don’t know that there is a benefit to more Hz… that just creates a different kind of contraction.
But either way, seeing nothing isn’t good.

Sorry! But these things are a bit of a crap shoot!

Laurie

[lehughes]

Laurie,

So, this past Wed I saw the brachial plexus dog again. This time when I put the e-stim on his triceps I did not get a contraction, but he was bothered by the stem. I had to turn it down to 200usec and still was not able to turn the intensity up as hight as I had done in the past. I thought this is an encouraging sign? But I would have liked to see a contraction. I did not get any indication of sensation over the biceps. Thoughts?



Thanks,

L

[lehughes]

Hi L!

Okay… good sign for the Triceps (radial nerve).
Less good for the biceps (musculocutaneous nerve)
And you are getting closer to that 2 month mark!

But now, you have to worry about 1) sensation returning to radial nerve (which could mean mutilation in the future). If the owners see ANY signs of licking or chewing, then the dog needs to be coned for… I don’t know how long! Maybe months!
2) Will the biceps or any of the muscles distal to the elbow return? I’d not be optimistic at this point in time.
I’m not one to say chop off the leg… but maybe some kind of a splint that the dog could use for the limb as a prop could be constructed… Or maybe you let it / encourage it to contract up a bit so it’s out of the way for ambulation.

You sort of have a double edged sword right now…
It’s likely time to lay it out to the owners about the reality of the whole of the limb not coming back to ‘life’ again. A bit more recovery might happen, but it is not likely to be full.
You can still help them, but you might need to change the plan…

Laurie