Long-term follow-up of children with obstetric brachial plexus palsy I: functional aspects

Seventeen children with Erb’s (C5/6 and C5/6/7 types) obstetric brachial plexus palsy who underwent low rotation humeral osteotomy to treat internal rotation contracture of the shoulder were recalled back to the clinic at a mean of 10 (range 8–14) years after surgery. Eight were male and nine female with mean age of 16 (range 13–20) years. The osteotomy procedure was done at a mean age of 6 (range 5–8) years. Preoperative, early postoperative, and late postoperative motor assessments were compared. There was no recurrence of the internal rotation posturing of the shoulder and there was maintenance of the improvements in elbow extension deficit and forearm rotation. The most surprising finding was a significant ( P = 0.003) decrease in shoulder abduction on long-term follow-up (the mean shoulder abduction was 135 °, 146° and 109° measured pre-, early post- and late postoperatively, respectively). There was no correlation between changes in shoulder abduction and the radiological score of the shoulder.

Download Full-text

Outcome of secondary shoulder surgery in children with neonatal brachial plexus palsy with and without nerve surgery treatment history: A long-term follow-up study

Journal of Rehabilitation Medicine ◽

10.2340/16501977-2193 ◽

2016 ◽

Vol 48 (7) ◽

pp. 609-617 ◽

Cited By ~ 4

Author(s):

M Holst ◽

C Wal ◽

R Wolterbeek ◽

W Pondaag ◽

T Vlieland ◽

...

Keyword(s):

Brachial Plexus ◽

Shoulder Surgery ◽

Brachial Plexus Palsy ◽

Treatment History ◽

Follow Up Study ◽

Neonatal Brachial Plexus Palsy ◽

Long Term Follow Up ◽

Nerve Surgery

Download Full-text

Functional Scoring System for Obstetric Brachial Plexus Palsy

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.1999.0281 ◽

2000 ◽

Vol 25 (1) ◽

pp. 41-45 ◽

Cited By ~ 24

Author(s):

H. BASHEER ◽

V. ZELIC ◽

F. RABIA

Keyword(s):

Brachial Plexus ◽

Scoring System ◽

Good Recovery ◽

Brachial Plexus Palsy ◽

Obstetric Brachial Plexus Palsy ◽

Upper Limb Function ◽

Obstetric Brachial Plexus ◽

Good Score ◽

New Scoring

We suggest a new scoring system that measures the upper limb function both as a unit and in separate parts. Our system was designed to study the recovery in patients with obstetric brachial plexus palsy (OBPP). It measures active limb movements and compares them with the normal side to obtain a ratio, which is then converted to a score. Fifty-two patients with OBPP were studied with a follow-up of 2 years. The progress of the patients was monitored using the system. Thirty-seven patients (71%) achieved very good recovery, eight patients (15%) achieved a good score, and five patients (10%) achieved a poor score. Most of the recovery occurred before the age of 6 months.

Download Full-text

Shoulder function and anatomy in complete obstetric brachial plexus palsy: long-term improvement after triangle tilt surgery

Child s Nervous System ◽

10.1007/s00381-010-1174-2 ◽

2010 ◽

Vol 26 (8) ◽

pp. 1009-1019 ◽

Cited By ~ 9

Author(s):

Rahul K. Nath ◽

Priyanka Karicherla ◽

Faiz Mahmooduddin

Keyword(s):

Brachial Plexus ◽

Shoulder Function ◽

Brachial Plexus Palsy ◽

Obstetric Brachial Plexus Palsy ◽

Obstetric Brachial Plexus

Download Full-text

Surgical Correction of Supination Deformity in Children with Obstetric Brachial Plexus Palsy

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2001.0647 ◽

2002 ◽

Vol 27 (1) ◽

pp. 20-23 ◽

Cited By ~ 34

Author(s):

J. BAHM ◽

A. GILBERT

Keyword(s):

Brachial Plexus ◽

Treatment Plan ◽

Final Position ◽

Brachial Plexus Palsy ◽

Forearm Rotation ◽

Obstetric Brachial Plexus Palsy ◽

Obstetric Brachial Plexus ◽

The Mean ◽

Surgical Corrections

We present a series of 40 children who were operated on for supination contracture following severe obstetric brachial plexus palsy. Surgery was done at an average age of 7 years and the mean postoperative follow-up was 4 years. In the 23 cases treated by an open or closed radial osteotomy, the mean intraoperative derotation was 78°, the immediate postoperative position was 29° pronation and it stabilized at follow-up at 17° pronation. Biceps rerouting was performed in 17 cases without any recurrence of supination deformity and the final position was 22° pronation. Some active forearm rotation was obtained in a few cases. These surgical corrections are part of an overall treatment plan and allow the “begging hand” to be corrected to a more functional and less noticeable position.

Download Full-text

Elbow Flexion Reconstruction by Steindler Flexorplasty in Obstetric Brachial Plexus Palsy

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2005.03.003 ◽

2005 ◽

Vol 30 (4) ◽

pp. 424-427 ◽

Cited By ~ 17

Author(s):

M. M. AL-QATTAN

Keyword(s):

Brachial Plexus ◽

Selection Criteria ◽

Elbow Flexion ◽

Drill Hole ◽

Flexion Contracture ◽

Brachial Plexus Palsy ◽

Older Children ◽

Obstetric Brachial Plexus Palsy ◽

Obstetric Brachial Plexus

The results of Steindler flexorplasty in nine patients with obstetric brachial plexus palsy are reported. There were 5 girls and 4 boys with a mean age of 6 (range 2–13) years. Selection criteria for the procedure included strong (at least M4) grip strength and wrist and elbow extension, as well as the presence of the “Steindler effect”. Pre-operatively, elbow flexion was rated as M0 or M1 in three patients and M2 in the remaining six patients. Intra-operatively, the detached common flexor origin was advanced 5 to 7 cm and fixation was done to the anterior humerus either with direct suture to the periosteum (in younger children) or suturing into a drill hole in the humerus (in older children). Postoperatively, the elbow was immobilized in flexion and supination for 6 weeks. At a mean follow-up of 5 years, the results in eight patients were good with mean active elbow flexion against resistance of 110° and a mean elbow flexion contracture of 35°. The result in the remaining patient was poor (unsuccessful transfer). It is concluded that the results of the Steindler flexorplasty in obstetric brachial plexus palsy patients are good and reliable, provided patient selection is careful.

Download Full-text

Results of Sever- L’ Episcopo procedure for obstetric brachial plexus palsy

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164628 ◽

2016 ◽

Vol 3 (1) ◽

pp. 50

Author(s):

Karthi Sundar V. ◽

Anil Kumar S.V.

Keyword(s):

Brachial Plexus ◽

External Rotation ◽

Social Stigma ◽

Functional Results ◽

Functional Improvement ◽

Brachial Plexus Palsy ◽

Obstetric Brachial Plexus Palsy ◽

Obstetric Brachial Plexus ◽

Teres Major

Background: The reported incidence of obstetric brachial plexus palsy (OBPP) varies from 0.3 to 2.5 per 1000 live birthsresulting in internal rotation deformity and weak abduction of the involved side shoulder.Methods: To retrospectively analyse the functional results of the Sever- L‘ Episcopo procedure for OBPP with a minimum follow-up of 2 years to a maximum of 13 years using modified Mallet scoring system for shoulder.Results: A significant improvement in the range of abduction and the restoration of external rotation of shoulder was achieved with Sever- L’Episcopo procedure. Conclusions: The results of secondary reconstruction of a dysfunctional shoulder by means of a Lattismus dorsi & Teres major transfer as described by Sever- L’Episcopo is definitely beneficial. However this procedure will improve, but will not normalize, function. Apart from functional improvement this procedure corrects a deformity thereby easing the psycho-social stigma associated with it.

Download Full-text

Evidence of the Effectiveness of Primary Brachial Plexus Surgery in Infants With Obstetric Brachial Plexus Palsy–Revisited

Child Neurology Open ◽

10.1177/2329048x17709395 ◽

2017 ◽

Vol 4 ◽

pp. 2329048X1770939 ◽

Cited By ~ 1

Author(s):

Amel A. F. El-Sayed

Keyword(s):

Brachial Plexus ◽

Elbow Flexion ◽

Motor Recovery ◽

Brachial Plexus Palsy ◽

Obstetric Brachial Plexus Palsy ◽

Primary Surgery ◽

Obstetric Brachial Plexus ◽

Brachial Plexus Surgery ◽

Surgical Group

A recent systematic review questioned the effectiveness of primary surgery in infants with obstetric brachial plexus palsy. At our center, the indication for primary surgery in infants with upper Erb’s obstetric palsy is the lack of active elbow flexion at age 4 months. The current study compares the outcome of motor recovery in 2 groups of infants with upper Erb’s palsy: one group (n = 9) treated surgically between age 4 and 5 months, and another group (n = 9) treated conservatively despite the lack of active elbow flexion at age 4 months. The only reason for not doing the surgery in the latter group was refusal by the parents. The scores of motor recovery were collected at the 2-year follow-up visit, and they were significantly better in the surgical group. The study demonstrates the effectiveness of primary surgery in infants with upper Erb’s obstetric palsy compared to conservative management.

Download Full-text