Motor grading of elbow flexion – is Medical Research Council grading good enough?

Recovery of elbow flexion is considered as top priority in reconstruction following brachial plexus injury, hence lot of procedures have been described to restore it [1-4]. Nerve transfer is the most preferred method unless the patient presents very late. To assess the recovery of elbow flexion Medical Research Council Grading has been most commonly used worldwide. Serious limitations of MRC grading system have been expressed by many authors [5,6] but it continues to be in use because of its simplicity. Many modifications have been used by various authors [5-9] but none are widely used. We believe that for any grading system to be widely acceptable it need to be a modification of the existing MRC grading system as this has been fed into at least three generations of residents and all are very used to and comfortable using this scale, may be at cost of accuracy. In addition, the grading system has to be comprehensive, easy to use and reproducible.We have been using a modified MRC grading scale to assess the recovery of elbow flexion following nerve transfer in our patients (Table 1). This is a very simple grading system which basically is an elaborated MRC scale. The grade 0 and 1 remains same. Division of Grade 2 & 3 is influenced by the active motion scale described by Curtis et al [9]. Grade 2 has been subdivided into three subdivisions; A, B & C based on the range of motion with gravity eliminated. Grade 3 has been similarly subdivided depending on the range of motion against gravity. The subdivision of Grade 4 is based on the patient's ability to lift the weight through full range of flexion on a biceps curl machine, with weights in 0.5 Kg increments, a commonly used machine in physiotherapy departments and gymnasiums to strengthen the biceps. Grade 4 has three subdivisions; A- if the patient is able to lift less than 30% weight of the normal side; B- if he is able to lift 30–60% weight of the normal side; and C- if he is able to lift more than 60% weight of the