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Journal Review: Role of electrodiagnosis in nerve transfers for focal neuropathies and brachial plexopathies
Journal Review: Role of electrodiagnosis in nerve transfers for focal neuropathies and brachial plexopathies

Over the past 2 decades, the surgical treatment of brachial plexus and peripheral nerve injuries has advanced considerably. Nerve transfers have become an important surgical tool in addition to nerve repair and grafting. Electrodiagnosis has traditionally played a role in the diagnosis and localization of peripheral nervous system injuries, but a different approach is needed for surgical decision-making and monitoring recovery. When patients have complete or severe injuries they should be referred to surgical colleagues early after injury, as outcomes are best when nerve transfers are performed within the first 3 to 6 mo after onset. Patients with minimal recovery of voluntary activity are particularly challenging, and the presence of a few motor unit action potentials in these individuals should be interpreted on the basis of timing and evidence of ongoing reinnervation. Evaluation of potential recipient and donor mus-cles, as well as redundant muscles, for nerve transfers requires an individualized approach to optimize the chances of a successful surgical intervention. Anomalous innervation takes on new importance in these patients. Communication between sur-geons and electrodiagnostic medicine specialists (EMSs) is best facilitated by a joint collaborative clinic. Ongoing monitoring of recovery post-operatively is critical to allow for decision making for continued surgical and rehabilitation treatments. Differ-ent electrodiagnostic findings are expected with resolution of neurapraxia, distal axon sprouting, and axonal regrowth. As new surgical techniques become available, EMSs will play an important role in the assessment and treatment of these patients with severe nerve injuries.

1)Understand and be able to use electrodiagnostic studies for diagnosis and prognosis in patients with focal neuropathies and plexopathies;
2)Be able to determine when and if a patient might be suitable for nerve transfer surgery;
3) Use electrodiagnostic studies for the evaluation of nerve transfer recipient muscles.  

The AANEM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The AANEM designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits TM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit expires 02/15/2025.

No one involved in the planning of this CME activity had any relevant financial relationships to disclose. 

Franco Gemignani, MD; Maria F. Bellanova, BSc; Elena Saccani, MD; Giovanni Pavesi, MD
Availability: On-Demand
Expires on Feb 15, 2025
Cost: Member: $0.00
Non-Member: $25.00
Credit Offered:
1 CME Credit
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