ABSTRACT
OBJECTIVE: To investigate whether a sensorimotor deficit of the upper limb following a brachial plexus injury (BPI) affects the upright balance. DESIGN: Eleven patients with a unilateral BPI and 11 healthy subjects were recruited. The balance assessment included the Berg Balance Scale (BBS), the number of feet touches on the ground while performing a 60 s single-leg stance and posturographic assessment (eyes open and feet placed hip-width apart during a single 60 s trial). The body weight distribution (BWD) between the legs was estimated from the center of pressure (COP) lateral position. The COP variability was quantified in the anterior-posterior and lateral directions. RESULTS: BPI patients presented lower BBS scores (p = 0.048) and a higher frequency of feet touches during the single-leg stance (p = 0.042) compared with those of the healthy subjects. An asymmetric BWD toward the side opposite the affected arm was shown by 73% of BPI patients. Finally, higher COP variability was observed in BPI patients compared with healthy subjects for anterior-posterior (p = 0.020), but not for lateral direction (p = 0.818). CONCLUSIONS: This study demonstrates that upper limb sensorimotor deficits following BPI affect body balance, serving as a warning for the clinical community about the need to prevent and treat the secondary outcomes of this condition.
ABSTRACT
Objetivo: presentar un caso de mononeuropatía hipertrófica localizada. Descripción: paciente de 39 años de edad, que presenta una historia de dolor intenso y progresivo, hipoestesia en la región tenar y déficit motor en la mano izquierda. El examen físico mostró atrofia hipotener, mano en garra cubital y signo de Tinel en el antebrazo (8cm distal a la epitróclea). Intervención: la IRM mostró una masa a lo largo del recorrido del nervio cubital en el antebrazo. Se sugirió entonces tratamiento quirúrgico. No se obtuvo registro de conducción nerviosa durante la estimulación intraoperatoria, por lo cual se resecó la zona de fascículos afectados y se reemplazó la lesión por injertos autólogos extraídos de nervio sural. El diagnóstico histopatológico fue dificultoso y después de varias revisiones se concluyó que se trataba de de una mononeuropatía hipertrófica localizada. Conclusión: la paciente se encuentra actualmente bajo seguimiento y está mostrando signos de mejoría de la anestesía junto a remisión completa del dolor.
The authors report the case of a 39 year-old female, who presented with 10 years history of intense progressive pain, hypoesthesia in hypotenar region and motor deficit in the left hand. The physical exam showed hypotenar muscles atrophy, "claw hand", and Tinels sign in the forearm (8 cm distal from the medial epicondyle). Magnetic resonance imaging showed a mass lesion along ulnar nerve path in the forearm. Surgical treatment was, then, suggested. Nerve conduction could not be registered during intra-operative stimulation. Microsurgical resection of the damaged nerve fascicles and sural nerve grafting were performed. Histopathological diagnosis was difficult and could only be confirmed as localized hypertrophic mononeuropathy after revision of the biopsied material. The patient is being followed up and she is showing signs of hypoesthesia improvement in addition to complete remission of the pain.
