Invited Review: Role of electrodiagnosis in nerve transfers for focal neuropathies and brachial plexopathies-Article

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Nerve transfer surgery has become an important tool in the treatment of brachial plexus and peripheral nerve injuries. In this article, the authors discuss the role of electrodiagnosis in the management of these types of injuries and how electrodiagnostic studies can guide surgical decision-making and post-operative monitoring. They emphasize the importance of early surgical referral for patients with complete or severe injuries, as outcomes are better when nerve transfers are performed within the first 3 to 6 months after onset. They also provide recommendations for evaluating potential recipient and donor muscles for nerve transfers, taking into account the timing of potential nerve recovery and the presence of anomalous innervation. The authors suggest a collaborative approach between surgeons and electrodiagnostic medicine specialists (EMSs), with joint clinics and regular meetings to discuss patient management and results of electrodiagnostic studies. Electrodiagnostic monitoring after nerve transfers is crucial to assess the success of the surgery and guide further treatment. The authors highlight the need for repeated electrodiagnostic assessments to detect reinnervation of muscles and to evaluate patterns of muscle use and co-activation. They also provide specific recommendations for stimulation and recording sites during post-operative monitoring. Ultimately, electrodiagnosis plays a vital role in the assessment and treatment of patients with severe nerve injuries, and ongoing collaboration between surgeons and EMSs is essential for optimal patient care.

Keywords

nerve transfer surgery

brachial plexus injuries

peripheral nerve injuries

electrodiagnosis

surgical decision-making

post-operative monitoring

early surgical referral

nerve recovery

anomalous innervation

electrodiagnostic assessments