We read the recent article “Compensation by the UninjuredArm After Brachial Plexus Injury” published in Hand withgreat interest.5 Brachial plexus injury (BPI), like a numberof other devastating unilateral upper limb injuries, will resultin compensation with the unaffected limb based on the leveland severity of the initial injury. The authors of this articlehave 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 ofoverall physical function including compensation are important as in the real world people will use techniques that arethe quickest and easiest to perform. We know, for example,unilateral upper limb amputees report similarly low DASHdisability scores to people with Dupuytren contracture andfinger amputation, as presumably they become very skilledat using compensatory techniques.1,7 However, the results ofthis study seem to indicate that when completing the DASH,people can differentiate between tasks performed by theaffected or unaffected limb for both unilateral and bilateralactivities based purely on how the question is worded. Bymeasuring actual day-to-day use of the affected limb following BPI, rather than the degree of compensation, we may beable to investigate the true benefit of what are often longterm and expensive treatment modalities.
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