LAUSR

We read the recent article “Compensation by the Uninjured Arm After Brachial Plexus Injury” published in Hand with great interest.5 Brachial plexus injury (BPI), like a number of other devastating unilateral upper limb injuries, will result in compensation with the unaffected limb based on the level and severity of the initial injury. The authors of this article have clearly demonstrated that the Disability of the Shoulder, Arm and Hand (DASH)3 summed score reflects both disability of the injured limb and compensation with the uninjured limb following BPI. We concur that measures of overall physical function including compensation are important as in the real world people will use techniques that are the quickest and easiest to perform. We know, for example, unilateral upper limb amputees report similarly low DASH disability scores to people with Dupuytren contracture and finger amputation, as presumably they become very skilled at using compensatory techniques.1,7 However, the results of this study seem to indicate that when completing the DASH, people can differentiate between tasks performed by the affected or unaffected limb for both unilateral and bilateral activities based purely on how the question is worded. By measuring actual day-to-day use of the affected limb following BPI, rather than the degree of compensation, we may be able to investigate the true benefit of what are often long-term and expensive treatment modalities.