Magnetic stimulation of biceps after intercostal cross-innervation for brachial plexus palsy. A study of motor evoked potentials in 25 patients

Abstract

We studied the motor evoked potentials (MEP) in the biceps of 25 patients with traumatic brachial plexus palsy from root avulsion after cross-innervation by intercostal nerves. We used transcranial, transcervical and transthoracic magnetic stimulation at 8 to 235 months (mean 51) after transfer of intercostal nerves to the musculocutaneous nerve. Biceps strength recovered to MRC grade 2 in eight patients, grade 3 in three and grade 4 in 14. The mean latency of the MEP in the normal biceps on transcranial stimulation was 12.5 ± 1.3 ms and on transcervical stimulation 6.3 ± 1.1 ms. After intercostal reinnervation the mean latency on transcranial stimulation was 21.7 ± 4.5 ms and on transthoracic stimulation 11.6 ± 3.8 ms. The latency of the biceps MEP after reinnervation by intercostal nerves on transcranial and transthoracic magnetic stimulation correlated well with the duration of follow-up and the latency of the MEP on transthoracic magnetic stimulation correlated significantly with muscle power.