Comparing the Efficacy of Triple Nerve Transfers with Nerve Graft Reconstruction in Upper Trunk Obstetric Brachial Plexus Injury

The treatment of obstetric brachial plexus palsy (OBPP) with neuroma-in-continuity is controversial. The recent literature advocates excision of neuroma-in-continuity in OBPP and repair with nerve graft irrespective of its neurophysiological conductivity. This approach risks sacrificing the regenerating axons, and the result has not yet been proven to be superior to neurolysis alone. In this case report, the authors aim to outline their strategy of using the combination of preoperative and intraoperative clinical and neurophysiological findings to aid their decision making. The lack of upper trunk recovery and the unfavorable preoperative neurophysiological findings in a child with Narakas Group 4 OBPP at 5 months of age prompted an urgent exploration with the intention of performing neurotization. This procedure was abandoned and neurolysis was performed due to the favorable intraoperative neurophysiological findings. At 4 years of age, the child scored 12 of 15 on Mallet classification and has an excellent range of movement. No secondary operation was needed. The authors hope to highlight the idea that the surgical option for neurolysis alone should be kept open and that intraoperative electromyography can be a valuable tool to add to the surgeon's armamentarium.

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51. Early electrophysiologic findings in neonatal obstetric brachial plexus injury

Clinical Neurophysiology ◽

10.1016/j.clinph.2008.10.069 ◽

2009 ◽

Vol 120 (2) ◽

pp. e103

Author(s):

D. Chkhartishvili ◽

G. Natriashvili

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Injury ◽

Obstetric Brachial Plexus ◽

Obstetric Brachial Plexus Injury

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The Effects of Virtual Reality on Upper Extremity in Patients with Obstetric Brachial Plexus Injury

Journal of Pediatric Neurology ◽

10.1055/s-0041-1724100 ◽

2021 ◽

Author(s):

Havva Ezgi Karas ◽

Emine Atıcı ◽

Gamze Aydın ◽

Mert Demirsöz

Keyword(s):

Virtual Reality ◽

Brachial Plexus ◽

Upper Extremity ◽

Brachial Plexus Injury ◽

Control Group ◽

Nintendo Wii ◽

Significant Difference ◽

Obstetric Brachial Plexus ◽

Conventional Physiotherapy ◽

Obstetric Brachial Plexus Injury

AbstractThe present study aimed to examine the effects of playing Nintendo Wii games on upper extremity functions compared with conventional physiotherapy, in children with obstetric brachial plexus injury (OBPI). Twenty-two patients with brachial plexus injuries were enrolled. The patients were divided into two groups by simple randomization. The control group (conventional physiotherapy group [CTG]: n = 11) received conventional physiotherapy for 6 weeks (40 minutes per day, for 4 days per week). The study group, called Nintendo Wii group (NWG; n = 11), received conventional physiotherapy as well as tennis, baseball, and boxing games with Nintendo Wii on days when there was no physical therapy. The upper extremity range of motion (ROM) was evaluated using a digital goniometer, motor function was assessed using the Active Movement Scale (AMS), and shoulder functions were assessed with the Mallet Scoring System (MSS). Virtual reality treatment had a positive effect on shoulder flexion, forearm pronation, wrist flexion, ROM, and functionality (p < 0.05). There was a significant improvement in shoulder abduction and shoulder external rotation in the CTG (p < 0.05). There was no significant difference in the MSS values of either groups (p > 0.05). As per the AMS, in the NWG, the shoulder internal rotation increased significantly (p < 0.05). Nintendo Wii treatment used in addition to conventional physiotherapy may be effective in increasing upper extremity functions in children with OBPI. Clinical Trials Number NCT04605601.

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