Recovery of Hand Function Following Nerve Grafting and Transfer in Obstetric Brachial Plexus Lesions

2006 ◽  
Vol 22 (06) ◽  
Author(s):  
Willem Pondaag ◽  
Martijn Malessy
Keyword(s):  
Brachial Plexus ◽  
Hand Function ◽  
Nerve Grafting ◽  
Obstetric Brachial Plexus

scholarly journals Management of Brachial Plexus Injury in Adults

2008 ◽  
Vol 97 (4) ◽  
pp. 317-323 ◽  
Author(s):  
P. Songcharoen
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Nerve Repair ◽  
Hand Function ◽  
Nerve Transfer ◽  
Nerve Grafting ◽  
Muscle Transfer ◽  
Nerve Roots ◽  
Elbow Function ◽  
Motorcycle Accidents

Brachial plexus injury in adults is commonly caused by motorcycle accidents. Surgical management consists of nerve repair and nerve grafting for extraforaminal nerve root or trunk injury, and of neurotization or nerve transfer for nerve roots avulsion. In general, the results regarding restoration of shoulder and elbow function are good but reinnervation of the forearm muscles is less than safisfactory in respect to restoration of hand function. Functioning free muscle transfer in combination with selective nerve transfer is a reasonable alternative surgical procedure.

Brachialis Muscle Transfer to the Forearm Muscles in Obstetric Brachial Plexus Palsy

2006 ◽  
Vol 31 (3) ◽  
pp. 261-265 ◽  
Author(s):  
J. A. BERTELLI
Keyword(s):  
Brachial Plexus ◽  
Hand Function ◽  
Brachial Plexus Palsy ◽  
Muscle Transfer ◽  
Wrist Extension ◽  
Active Motion ◽  
Obstetric Brachial Plexus Palsy ◽  
Brachialis Muscle ◽  
Obstetric Brachial Plexus ◽  
Extensor Carpi Radialis

Tendon transfers are frequently needed to improve hand function in obstetric brachial plexus injuries. The reconstruction cannot always be achieved using local donor transfers in the forearm as these are not always available. In such cases, we propose the use of the brachialis muscle as a useful donor for transfer. Five adolescents with obstetric brachial plexus palsy were operated on to reconstruct wrist extension and/or pronation using the brachialis muscle transfer to the pronator teres ( n = 1) extensor carpi radialis brevis ( n = 1) and extensor carpi radialis longus ( n = 3). Twelve months after surgery, average active motion recovery was 20° for wrist extension and 14° for pronation. Active and passive range of motion was similar.

External Rotation as a Result of Suprascapular Nerve Neurotization in Obstetric Brachial Plexus Lesions

Neurosurgery ◽  
2005 ◽  
Vol 57 (3) ◽  
pp. 530-537 ◽  
Author(s):  
Willem Pondaag ◽  
Ralph de Boer ◽  
Marie S. van Wijlen-Hempel ◽  
Sonja M. Hofstede-Buitenhuis ◽  
Martijn J.A. Malessy
Keyword(s):  
Brachial Plexus ◽  
External Rotation ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Accessory Nerve ◽  
Nerve Grafting ◽  
Infraspinatus Muscle ◽  
Significant Difference ◽  
Obstetric Brachial Plexus ◽  
Grafting From

ABSTRACT OBJECTIVE: Obstetric brachial plexus lesions may cause lifelong limitations of upper limb function. Nerve repair is widely advocated in infants who do not show spontaneous recovery. Typically, the suprascapular nerve (SSN) is involved in the lesion. Neurotization of the SSN routinely is performed, aiming at reinnervation of the infraspinatus muscle to restore external rotation. The results after SSN neurotization have not, as yet, been studied in detail; therefore, this study was undertaken. Of special interest was the comparison of two commonly applied SSN neurotization procedures: nerve grafting from C5 versus nerve transfer of the accessory nerve. METHODS: Infants with obstetric brachial plexus lesions after nerve grafting of C5 to the SSN (n = 65) or nerve transfer of the accessory nerve to the SSN (n = 21) were selected for retrospective analysis after a mean follow-up period of 3 years. Outcome was expressed in degrees of true glenohumeral external rotation. This was defined as the angle between the position of the 90 degrees (actively or passively) flexed elbow resting against the abdomen and the position of the flexed elbow after external rotation with the upper arm held in adduction by the investigator. This movement can be executed only by infraspinatus muscle contraction. In addition, functional external rotation was evaluated by testing the ability to reach the mouth and the back of the head. RESULTS: Only 17 (20%) of the 86 patients reached more than 20 degrees of external rotation, whereas 35 (41%) were unable to perform true external rotation. There was no statistically significant difference between nerve grafting from C5 and extraplexal nerve transfer using the accessory nerve. Functional scores showed that 88% can reach the mouth and that 75% can reach the head. CONCLUSION: The restoration of a fair range of true glenohumeral external rotation after neurotization of the SSN in infants with obstetric brachial plexus lesions, whether by grafting from C5 or by nerve transfer of the accessory nerve, is disappointingly low. However, it seems that compensatory techniques contribute to effectuate a considerable range of movement.

scholarly journals Case Report: Bionic Reconstruction in an Adult With Obstetric Brachial Plexus Injury

2022 ◽  
Vol 2 ◽  
Author(s):  
Anna Boesendorfer ◽  
Agnes Sturma ◽  
Clemens Gstoettner ◽  
Anna Pittermann ◽  
Gregor Laengle ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Daily Living ◽  
Brachial Plexus Injury ◽  
Hand Function ◽  
Functional Improvement ◽  
Prosthetic Fitting ◽  
Obstetric Brachial Plexus ◽  
Bionic Reconstruction ◽  
Obstetric Brachial Plexus Injury

Introduction: Many adults who had a severe Narakas IV obstetric brachial plexus injury (OBPI) suffer from extensive impairments in daily living due to limited hand-arm function. The dramatic loss of axonal support at this very early age of development often render the entire extremity a biologic wasteland and reconstructive methods and therapies often fail to recover any functional hand use. In this scenario bionic reconstruction, including an elective amputation and a subsequent prosthetic fitting, may enable functional improvement in adults suffering from the consequences of such severe brachial plexus injuries. We here describe our experience in treating such patients and lay out the surgical rational and rehabilitation protocol exemplified in one patient.Case Presentation/Methods: A 27-year-old adult with a unilateral OBPI contacted our center. He presented with globally diminished function of the affected upper extremity with minimal hand activity, resulting in an inability to perform various tasks of daily living. No biological reconstructive efforts were available to restore meaningful hand function. An interdisciplinary evaluation, including a psychosocial assessment, was used to assess eligibility for bionic reconstruction. Before the amputation and after the prosthetic fitting functional assessments and self-reported questionnaires were performed.Results: One month after the amputation and de-rotation osteotomy of the humerus the patient was fitted with a myoelectric prosthesis. At the 1.5 year-follow-up assessment, the patient presented with a distinct improvement of function: the ARAT improved from 12 to 20 points, SHAP score improved from 8 to 29, and the DASH value improved from 50 to 11.7. The average wearing times of the prosthesis were 5 to 6 h per day (on 4–5 days a week).Discussion: The options for adults suffering from the consequences of severe OBPIs to improve function are limited. In selected patients in whom the neurological deficit is so severe that biologic hand function is unsatisfactory, an elective amputation and subsequent restoration of the hand with mechatronic means may be an option. The follow-up results indicate that this concept can indeed lead to solid hand function and independence in daily activities after amputation, subsequent prosthetic fitting, and rehabilitation.

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