Brachial Plexus Injury: Long-Term Functional Outcome is Determined by Associated Scapulothoracic Dissociation

We are presenting a paper on the effectiveness of spinal cord stimulation (SCS) in 2 patients suffering pain from brachial plexus injury (BPI). After a traumatic brachial plexus lesion about 80% of patients develop pain in the deafferentated arm. This pain is considered very resistant to many forms of therapy. In the early 1970s, SCS was introduced in the treatment of BPI pain with disappointing results. There are only about 20 published cases of BPI pain treated with SCS. Many injuries are due to motorcycle accidents, so that patients are often young and require long-term pain relief. During the SCS trial the pain relief was more than 50% with an absolute improvement in the quality of life and significant drug reduction. The results of the SCS were excellent in these 2 patients, defined as more than 50% pain relief at 6 and 18 months. Key words: Spinal cord stimulation, brachial plexus injury, neurophatic pain.

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Results of Operative Treatment of Brachial Plexus Injury Resulting from Shoulder Dislocation: A Study with A Long-Term Follow-Up

World Neurosurgery ◽

10.1016/j.wneu.2017.06.059 ◽

2017 ◽

Vol 105 ◽

pp. 623-631 ◽

Cited By ~ 4

Author(s):

Olga Gutkowska ◽

Jacek Martynkiewicz ◽

Sylwia Mizia ◽

Michał Bąk ◽

Jerzy Gosk

Keyword(s):

Brachial Plexus ◽

Operative Treatment ◽

Shoulder Dislocation ◽

Brachial Plexus Injury ◽

Long Term Follow Up

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Extrapleural Apical Fluid Collection: An Important Sign on Plain X-ray Suggesting a Pre-ganglionic Brachial Plexus Injury

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193408090100 ◽

2008 ◽

Vol 33 (4) ◽

pp. 501-506 ◽

Cited By ~ 1

Author(s):

J. MCCAUL ◽

H. SHARMA ◽

T. E. HEMS

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Injury ◽

Fluid Collection ◽

X Rays ◽

X Ray ◽

First Rib ◽

Chest X Ray ◽

Important Sign ◽

The Difference

Forty of 136 consecutive patients referred for management of brachial plexus injuries had closed supraclavicular injuries. The results of the initial chest X-rays were available for 29 patients. Nine had avulsion of the C8 and T1 nerve roots from the spinal cord. Eight cases had MR confirmation of lower root avulsion, six of these cases were confirmed surgically and none had any long-term clinical recovery. Twenty had partial brachial plexus injuries without avulsion of these roots. Seven of nine patients with avulsion of C8 and T1 had an extrapleural apical fluid collection. One of these had a fractured first rib. Two of 20 without avulsion had an extrapleural apical fluid collection. Both had fractured the first rib. The difference in incidence of extrapleural apical fluid collection between the two groups, excluding those cases with first rib fractures, was statistically significant. Without a first rib fracture, an ipsilateral extrapleural apical haematoma on a plain chest X-ray of patients with brachial plexus injury strongly suggests pre-ganglionic injury to the lower roots.

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Obstetrical brachial plexus injuries: Late functional results of the Steindler procedure

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193414537203 ◽

2014 ◽

Vol 39 (8) ◽

pp. 868-875 ◽

Cited By ~ 7

Author(s):

A. Gilbert ◽

S. Valbuena ◽

C. Posso

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Injury ◽

Elbow Flexion ◽

Functional Results ◽

Obstetrical Brachial Plexus Palsy ◽

Long Term Follow Up ◽

The Mean ◽

Extensor Lag

We reviewed late functional results of a modified Steindler procedure in patients with obstetrical brachial plexus palsy and poor active elbow flexion. From 1982 to 2005, we reviewed final functional results and complications of 27 cases with flexion weakness of the elbow secondary to obstetrical brachial plexus injury, treated with a modified Steindler procedure. At the end of the follow-up, the mean active elbow flexion was 97° and the mean extensor lag was 10°. In the long-term follow-up, the modified Steindler procedure maintained good results in 67% of the cases in our series, and this percentage raised by 82% when the wrist extensor was present or restored before the Steindler procedure. There were poor results in 19% of the patients, but no major complications.

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Constrained Induced Movement Therapy for Children with Brachial Plexus Injury: Upper and Lower Extremity Immediate and Long Term Changes

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2016.08.023 ◽

2016 ◽

Vol 97 (10) ◽

pp. e8-e9 ◽

Cited By ~ 1

Author(s):

Tasos Karakostas ◽

Erik King ◽

Simon Hsiang

Keyword(s):

Lower Extremity ◽

Brachial Plexus ◽

Brachial Plexus Injury ◽

Movement Therapy ◽

Long Term Changes

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Extended Long-Term (5 Years) Outcomes of Triangle Tilt Surgery in Obstetric Brachial Plexus Injury

The Open Orthopaedics Journal ◽

10.2174/1874325001307010094 ◽

2013 ◽

Vol 7 (1) ◽

pp. 94-98 ◽

Cited By ~ 2

Author(s):

Rahul K Nath ◽

Chandra Somasundaram

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Injury ◽

External Rotation ◽

Functional Score ◽

Age At Surgery ◽

Medial Rotation ◽

Obstetric Brachial Plexus ◽

Functional Movements ◽

Obstetric Brachial Plexus Injury

Objective: We evaluated the "extended" long-term (5 years) functional outcomes in obstetric brachial plexus injury (OBPI) patients, who underwent triangle tilt surgery between February 2005 and January 2008. Methods: Twenty two children (9 girls and 13 boys, mean age at surgery was 5.8 years; ranging 2.1-11.8 years old), who initially presented with medial rotation contracture and scapula deformity secondary to obstetric brachial plexus injury were included in this study. Functional movements were evaluated pre-operatively, and 5 years following triangle tilt surgery by modified Mallet scale. Results: Here, we report long-term (5 years) follow-up of triangle tilt surgery for 22 OBPI patients. Upper extremity functional movements such as, external rotation (2.5±0.6 to 4.1±0.8, p<0.0001), hand-to-spine (2.6±0.6 to 3.4±1.1, p<0.005), hand-to-neck (2.7±0.7 to 4.3±0.7, p<0.0001), hand-to-mouth (2.3±0.9 (92º±33) to 4.2±0.5 (21º±16), p<0.0001), and supination (2.6±1.1 (-8.2º ±51) to 4.1±0.7 (61±32)) were significantly improved (p<0.0001), and maintained over the extended long-term (5 years). Total modified Mallet functional score was also shown to improve from 14.1±2.7 to 20.3±2.5. Conclusions: The triangle tilt surgery improved all shoulder functions significantly, and maintained over the extended long-term (5 years) in these patients.

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Shoulder Arthrodesis versus Upper Trapezius Transfer for Traumatic Brachial Plexus Injury: A Proportional Meta-Analysis

Advances in Orthopedics ◽

10.1155/2021/4445498 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Dafang Zhang ◽

Rohit Garg ◽

Brandon E. Earp ◽

Philip Blazar ◽

George S. M. Dyer

Keyword(s):

Brachial Plexus ◽

Functional Outcome ◽

Brachial Plexus Injury ◽

Meta Analysis ◽

Upper Trapezius ◽

Shoulder Range Of Motion ◽

Outcome Scores ◽

Shoulder Arthrodesis ◽

Shoulder Range ◽

Shoulder Reconstruction

Shoulder arthrodesis and upper trapezius transfer are two surgical options for secondary shoulder reconstruction for traumatic brachial plexus injury (BPI). There is a lack of comparative evidence to guide the choice for one procedure over the other. The objectives of this study were to compare (1) rates of complications and reoperation and (2) shoulder range of motion and functional outcome scores following shoulder arthrodesis versus upper trapezius transfer for traumatic BPI. A systematic review and meta-analysis were conducted by a search of four databases of studies assessing shoulder arthrodesis and/or upper trapezius transfer for shoulder reconstruction following adult traumatic BPI. A proportional meta-analysis was performed using a random effects model in anticipation of unobserved heterogeneity. The final meta-analysis included 374 patients from 17 studies, including 232 patients from 11 studies on shoulder arthrodesis and 142 patients from 6 studies on upper trapezius transfer. Shoulder arthrodesis had higher rates of complications and reoperations than upper trapezius transfer for traumatic BPI, but these differences did not reach a statistical significance. Due to the limited sample size, variations in reporting, and study heterogeneity in the published literature, we were not able to draw conclusions regarding shoulder range of motion and functional outcome scores between these two procedures. Shoulder arthrodesis and upper trapezius transfer are both viable options for secondary shoulder reconstruction for traumatic BPI, but with different complications and reoperation profiles. Patients should be counseled on the risk of nonunion and humerus fracture following shoulder arthrodesis.

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