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

Restoration of elbow flexion is top priority in reconstruction following brachial plexus injury. Medical Research Council (MRC) Grading is the most commonly used scale to grade muscle power. Though simple to use, it has several limitations. Each grade represents a very wide range and hence precludes accurate assessment of function and outcome following a given procedure. Wide range of Grade 4 is most worrisome. Definitely all grade 4 labeled can not equate to good functional results. With most of the nerve transfer procedures described now claiming grade 4 recoveries in more than 80% of the reported cases a need for more detailed and accurate assessment of this grade is greatly felt. A modified MRC grading system is described which is comprehensive and easy to use.