Management of Birth Brachial Plexus Injury Including Use of Distal Nerve Transfers

2020 ◽  
Vol 25 (03) ◽  
pp. 267-275
Author(s):  
Mukund R. Thatte ◽  
Nayana S. Nayak ◽  
Amita S. Hiremath
Keyword(s):  
Brachial Plexus ◽  
Spontaneous Recovery ◽  
Brachial Plexus Injury ◽  
Significant Proportion ◽  
Standard Of Care ◽  
Review Article ◽  
Nerve Transfers ◽  
Current Usage ◽  
Pros And Cons ◽  
Distal Nerve

Birth Brachial plexus injury continues to remain a problem despite significant care from obstetricians to prevent it. Many children show spontaneous recovery but a significant proportion do not have adequate recovery. This review article discusses, etiology, assessment, investigations and overall strategy to treat the condition. Surgical strategy consists of primary intraplexal repair as the standard of care but of late the distal nerve transfers used in adult plexus injuries are increasingly being used in infants too. We discuss the history, current usage and pros and cons of distal nerve transfers, the usage of Botulinum Toxin and finally given an overall algorithm for the management.

Trends in Brachial Plexus Surgery: Characterizing Contemporary Practices for Exploration of Supraclavicular Plexus

Hand ◽  
2021 ◽  
pp. 155894472110146
Author(s):  
J. Ryan Hill ◽  
Steven T. Lanier ◽  
Liz Rolf ◽  
Aimee S. James ◽  
David M. Brogan ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Treatment Strategies ◽  
Technical Difficulty ◽  
Nerve Grafting ◽  
Structured Interviews ◽  
Lower Trunk ◽  
Nerve Transfers ◽  
Case Vignettes ◽  
Distal Nerve

Background There is variability in treatment strategies for patients with brachial plexus injury (BPI). We used qualitative research methods to better understand surgeons’ rationale for treatment approaches. We hypothesized that distal nerve transfers would be preferred over exploration and nerve grafting of the brachial plexus. Methods We conducted semi-structured interviews with BPI surgeons to discuss 3 case vignettes: pan-plexus injury, upper trunk injury, and lower trunk injury. The interview guide included questions regarding overall treatment strategy, indications and utility of brachial plexus exploration, and the role of nerve grafting and/or nerve transfers. Interview transcripts were coded by 2 researchers. We performed inductive thematic analysis to collate these codes into themes, focusing on the role of brachial plexus exploration in the treatment of BPI. Results Most surgeons routinely explore the supraclavicular brachial plexus in situations of pan-plexus and upper trunk injuries. Reasons to explore included the importance of obtaining a definitive root level diagnosis, perceived availability of donor nerve roots, timing of anticipated recovery, plans for distal reconstruction, and the potential for neurolysis. Very few explore lower trunk injuries, citing concern with technical difficulty and unfavorable risk-benefit profile. Conclusions Our analysis suggests that supraclavicular exploration remains a foundational component of surgical management of BPI, despite increasing utilization of distal nerve transfers. Availability of abundant donor axons and establishing an accurate diagnosis were cited as primary reasons in support of exploration. This analysis of surgeon interviews characterizes contemporary practices regarding the role of brachial plexus exploration in the treatment of BPI.

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

2017 ◽  
Vol 140 (4) ◽  
pp. 747-756 ◽  
Author(s):  
Kathleen M. O’Grady ◽  
Hollie A. Power ◽  
Jaret L. Olson ◽  
Michael J. Morhart ◽  
A. Robertson Harrop ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Nerve Graft ◽  
Nerve Transfers ◽  
Obstetric Brachial Plexus ◽  
Graft Reconstruction ◽  
Obstetric Brachial Plexus Injury

Expression of c-Fos Protein in the Spinal Cord after Brachial Plexus Injury: Comparison of Root Avulsion and Distal Nerve Transection

Neurosurgery ◽  
1998 ◽  
Vol 42 (6) ◽  
pp. 1357-1362 ◽  
Author(s):  
Shurun Zhao ◽  
Ying Pang ◽  
Roger W. Beuerman ◽  
Hilary W. Thompson ◽  
David G. Kline
Keyword(s):  
Spinal Cord ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Nerve Transection ◽  
Root Avulsion ◽  
Fos Protein ◽  
Distal Nerve

Restoration of Elbow Flexion in Traumatic Upper Brachial Plexus Palsy in Adults: Outcome with Intraplexus Distal Nerve Transfers in 78 Patients

2018 ◽  
Vol 37 (04) ◽  
pp. 285-290
Author(s):  
Mario Siqueira ◽  
Roberto Martins ◽  
Wilson Faglioni Junior ◽  
Luciano Foroni ◽  
Carlos Heise
Keyword(s):  
Brachial Plexus ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Traumatic Injury ◽  
Surgical Techniques ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Nerve Transfers ◽  
Significant Difference ◽  
Distal Nerve

Objective To present the functional outcomes of distal nerve transfer techniques for restoration of elbow flexion after upper brachial plexus injury. Method The files of 78 adult patients with C5, C6, ± C7 lesions were reviewed. The attempt to restore elbow flexion was made by intraplexus distal nerve transfers using a fascicle of the ulnar nerve (group A, n = 43), or a fascicle of the median nerve (group B, n = 16) or a combination of both (group C, n = 19). The result of the treatment was defined based on the British Medical Research Council grading system: muscle strength < M3 was considered a poor result. Results The global incidence of good/excellent results with these nerve transfers was 80.7%, and for different surgical techniques (groups A, B, C), it was 86%, 56.2% and 100% respectively. Patients submitted to ulnar nerve transfer or double transfer (ulnar + median fascicles transfer) had a better outcome than those submitted to median nerve transfer alone (p < 0.05). There was no significant difference between the outcome of ulnar transfer and double transfer. Conclusion In cases of traumatic injury of the upper brachial plexus, good and excelent results in the restoration of elbow flexion can be obtained using distal nerve transfers.

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