The importance of neurophysiological evaluation of plexus brachialis injury caused by open heart surgery.

The risk of brachial plexus injury as a complication of coronary bypass operation should be emphasized since the number of coronary operations is rapidly increasing. We describe six patients who developed symptoms consistent with brachial plexus injury after coronary bypass surgery. Four out of six patients had definitive electroneuromyography (ENMG) abnormalities consistent with an acute injury in the brachial plexus. Abnormal somatosensory evoked potential (SEP) was seen in two patients studied. Two of our patients suffered from diabetic polyneuropathy, which even seems a predisposing factor for plexus brachialis injury and to prolong the duration of disability. Based on literature and our own experience we strongly recommend the use of ENMG and SEP to all patients who have any postoperative neurogenic symptoms in the upper extremities. These methods confirm the site of the nerve damage, e.g., differentiate brachial plexus injury from peripheral ulnar nerve lesion, and help to predict the outcome.