NEUROPHYSIOLOGICAL RECOVERY AFTER BRACHIAL PLEXUS LESION WITH MULTIMODAL PHYSICAL THERAPY – A CASE REPORT

Abstract

Brachial plexus lesions can cause significant impairment of upper-limb motor function. Electromyoneurography (EMNG) enables objective assessment of the functional status of peripheral nerves and muscles and monitoring of neurophysiological changes during recovery. The aim of this case report was to present changes in EMNG findings in a patient with a predominantly axonal partial brachial plexus lesion during a period of multimodal physiotherapy rehabilitation. Methodology: We present the case of a patient with a right brachial plexus lesion and previous osteosynthesis along the humerus. Two EMNG examinations were analyzed: the initial examination performed on February 5, 2026, and the follow-up examination performed on September 10, 2026. Between the two examinations, five cycles of targeted physical therapy were conducted, including electrical stimulation of the axillary and radial nerves, interferential currents applied to the right upper arm, and kinesiotherapy. The patient participated intermittently in the morning exercise program from January 12, 2026, and became a regular, active daily participant from March 16, 2026. Due to the osteosynthesis along the humerus, stimulation of the radial nerve was applied to the distal course of the nerve, from the elbow region along the forearm toward the hand. Results: The initial EMNG examination demonstrated a predominantly axonal partial lesion of the upper and middle trunks of the brachial plexus, involving the axillary nerve and, particularly, the radial nerve, with signs of extensive reinnervation. At follow-up, there were no signs of active denervation in the examined muscles, while improved M-wave amplitudes and more favorable voluntary muscle activity were observed. The M-wave amplitude of the axillary nerve, recorded from the deltoid muscle, increased from 143 μV to 363 μV. Compared with the initial examination, improvement was observed in the findings of the deltoid, triceps, and abductor pollicis brevis muscles. The neurophysiologist assessed the overall follow-up finding as significantly improved compared with the previous examination.
Conclusions: Significant neurophysiological improvement was observed in the presented patient during an approximately seven-month follow-up period. The improvement occurred during a period in which cycles of targeted physical therapy and continuous active exercise were implemented. Although a causal relationship between the applied physiotherapy interventions and neurophysiological recovery cannot be established based on a single case report, the comparative EMNG findings indicate a favorable course of neurological recovery.