Stroke and brachial plexus injury: a difficult problem.

Five patients are presented, all of whom had middle cerebral artery syndrome with hemiplegia on the contralateral side. All five had electromyographic evidence consistent with neuropathy involving the upper trunk of the brachial plexus on the side affected by the stroke. All patients were exposed to intensive rehabilitation team effort involving range of motion, strengthening exercises, positioning, splinting, coordination exercises and exercises designed to increase ability at arm placement. Three patients regained EMG evidence of innervation of the shoulder girdle muscles after more than eight months, during which time a rehabilitative effort was made. The other two patients have not yet regained control over the muscles of the shoulder girdle by EMG or clinical criteria. The EMG evidence of brachial plexus injury in those patients who eventually showed reinnervation took 8 to 12 months to resolve. The rehabilitation of the patients with stroke involving the upper extremity may have been set back significantly as a result of the neuropathy. It is suggested that patients with stroke and brachial plexus injury probably will have a more arduous and prolonged course in rehabilitation of the upper extremity as a result.