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

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.

scholarly journals The influence of shoulder arthrodesis on the function of the upper limb in adult patients after a brachial plexus injury: a systematic literature review with elements of meta-analysis

2021 ◽  
Vol 6 (9) ◽  
pp. 797-807
Author(s):  
Michał Górecki ◽  
Piotr Czarnecki
Keyword(s):  
Brachial Plexus ◽  
Shoulder Pain ◽  
Brachial Plexus Injury ◽  
Meta Analysis ◽  
Delayed Union ◽  
Adult Patients ◽  
The Mean ◽  
High Level ◽  
Shoulder Arthrodesis

Based on the literature, 294 shoulder arthrodeses after brachial plexus injury in adults were assessed, mostly male; the mean age of the patients was 33 years, and the mean follow-up time was 5.5 years. The most common cause of injury was a traffic accident, especially on a motorcycle. Arthrodesis position ranged from 15 to 40 degrees of flexion, 15 to 60 degrees of abduction, and 0 to 50 degrees of internal rotation with the predominance of position by the 30-30-30 rule. Plates, screws, and external fixation were used for stabilization. The complication rate was at the level of 28%, the most common complication being delayed union or nonunion. Active movements of flexion and abduction averaged 61 and 56 degrees, respectively, while reaching the hand to the mouth, front pocket, and buttock was feasible for 69%, 71%, and 38%, respectively, after surgery. Shoulder pain was present in 77% of patients, and 28% experienced no relevant pain reduction after surgery. The subjective satisfaction rate was 82% based on significant improvement and satisfaction reported by patients after arthrodesis. Arthrodesis of the shoulder, in adult patients after brachial plexus palsy, can reduce shoulder pain, increase stability, and result in a range of motion that increases the possibility of carrying out everyday activities. This affects the high level of subjective patient satisfaction after surgery. Cite this article: EFORT Open Rev 2021;6:797-807. DOI: 10.1302/2058-5241.6.200114

scholarly journals Pearls and Pitfalls of Phrenic Nerve Transfer for Shoulder Reconstruction in Brachial Plexus Injury

2021 ◽  
Vol 16 (01) ◽  
pp. e1-e9
Author(s):  
Kazuteru Doi ◽  
Sei Haw Sem ◽  
Bipin Ghanghurde ◽  
Yasunori Hattori ◽  
Sotetsu Sakamoto
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Functional Outcomes ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Pulmonary Complications ◽  
Predisposing Factors ◽  
Shoulder Range Of Motion ◽  
Shoulder Reconstruction

Abstract Objectives The purpose of this study was to report the functional outcomes of phrenic nerve transfer (PNT) to suprascapular nerve (SSN) for shoulder reconstruction in brachial plexus injury (BPI) patients with total and C5–8 palsies, and its pulmonary complications. Methods Forty-four out of 127 BPI patients with total and C5–8 palsies who underwent PNT to SSN for shoulder reconstruction were evaluated for functional outcomes in comparison with other types of nerve transfers. Their pulmonary function was analyzed using vital capacity in the percentage of predicted value and Hugh-Jones (HJ) breathless classification. The predisposing factors to develop pulmonary complications in those patients were examined as well. Results PNT to SSN provided a better shoulder range of motion significantly as compared with nerve transfer from C5 root and contralateral C7. The results between PNT and spinal accessory nerve transfer to SSN were comparable in all directions of shoulder motions. There were no significant respiratory symptoms in majority of the patients including six patients who were classified into grade 2 HJ breathlessness grading. Two predisposing factors for poorer pulmonary performance were identified, which were age and body mass index, with cut-off values of younger than 32 years old and less than 23, respectively. Conclusions PNT to SSN can be a reliable reconstructive procedure in restoration of shoulder function in BPI patients with total or C5–8 palsy. The postoperative pulmonary complications can be prevented with vigilant patient selection.

Effectiveness of arthroscopic management of idiopathic shoulder stiffness: A meta-analysis

2021 ◽  
pp. 1-8
Author(s):  
Ya-Dong Wang ◽  
Yu-Xiang Ming ◽  
Yong-Hua Pang ◽  
Wei-Nan Chen ◽  
Xu-Hua Zong ◽  
...  
Keyword(s):  
Range Of Motion ◽  
External Rotation ◽  
Meta Analysis ◽  
Eligibility Criteria ◽  
Shoulder Stiffness ◽  
Capsular Release ◽  
Shoulder Range Of Motion ◽  
Arthroscopic Capsular Release ◽  
Shoulder Range

BACKGROUND: Persisting shoulder stiffness adversely affects quality of life by causing pain and motion restrictions especially in patients with diabetes. OBJECTIVE: The aim of this study was to evaluate the outcomes of arthroscopic capsular release in patients with idiopathic shoulder stiffness. METHOD: A literature search was conducted in electronic databases and studies were selected by following precise eligibility criteria. Random-effects meta-analyses were performed to estimate the changes at latest follow-up in scores of the Constant, American Shoulder and Elbow Surgeons (ASES), and University of California at Los Angelis (UCLA) scales, Visual Analogue Scale (VAS), and shoulder range of motion. RESULTS: Nineteen studies were included. The follow-up duration was 42 months [95% confidence interval (CI): 32, 51]. Improvements in scores of the Constant, ASES, UCLA scales, and VAS were 48.3 [95% CI: 38.0, 58.6], 44.6 [95% CI: 24.6, 64.6], 19.3 [95% CI: 16.6, 22.0], and -6.1 [95% CI: -6.9, -5.4] respectively (P< 0.05 all). Improvements in the shoulder range of motion were: abduction 82.0 [95% CI: 65.0, 98.9]; forward flexion 75.9 [95% CI: 59.7, 92.1]; external rotation 43.2 [95% CI: 37.5, 49.0]; and internal rotation 25.4 [95% CI: 15.2, 35.5] degrees; P< 0.05 all). CONCLUSION: Arthroscopic capsular release effectively improves shoulder function in patients with idiopathic shoulder stiffness.

Does technical components of microanastomoses influence the functional outcome of free gracilis muscle transfer for elbow flexion in traumatic brachial plexus injury?

2021 ◽  
pp. 102827
Author(s):  
Francisco Vilmar Felix Martins-Filho ◽  
Fernanda do Carmo Iwase ◽  
Gustavo Bersani Silva ◽  
Alvaro Baik Cho ◽  
Teng Hsiang Wei ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Functional Outcome ◽  
Brachial Plexus Injury ◽  
Elbow Flexion ◽  
Gracilis Muscle ◽  
Muscle Transfer

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

2007 ◽  
Vol 63 (5) ◽  
pp. 1021-1025 ◽  
Author(s):  
Kevin P. Riess ◽  
Thomas H. Cogbill ◽  
Nirav Y. Patel ◽  
Pamela J. Lambert ◽  
Michelle A. Mathiason
Keyword(s):  
Brachial Plexus ◽  
Functional Outcome ◽  
Brachial Plexus Injury ◽  
Scapulothoracic Dissociation

Treatment of Supination Deformity for Obstetric Brachial Plexus Injury: A Systematic Review and Meta-Analysis

2014 ◽  
Vol 39 (10) ◽  
pp. 1948-1958.e2 ◽  
Author(s):  
W.P. Metsaars ◽  
J. Nagels ◽  
B.G. Pijls ◽  
J.M. Langenhoff ◽  
R.G.H.H. Nelissen
Keyword(s):  
Systematic Review ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Meta Analysis ◽  
Obstetric Brachial Plexus ◽  
Obstetric Brachial Plexus Injury

scholarly journals Comparison of spinal accessory nerve transfer to supra-scapular nerve vs. shoulder arthrodesis in adults with brachial plexus injury

2019 ◽  
Vol 105 (8) ◽  
pp. 1555-1561
Author(s):  
Benjamin Degeorge ◽  
Cyril Lazerges ◽  
Pierre Emmanuel Chammas ◽  
Bertrand Coulet ◽  
Fabien Lacombe ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Spinal Accessory ◽  
Shoulder Arthrodesis

Shoulder arthrodesis in adult brachial plexus injury: what is the optimal position?

2011 ◽  
Vol 36 (7) ◽  
pp. 541-547 ◽  
Author(s):  
R. Sousa ◽  
A. Pereira ◽  
M. Massada ◽  
M. Trigueiros ◽  
R. Lemos ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Internal Rotation ◽  
Brachial Plexus Injury ◽  
Glenohumeral Joint ◽  
Functional Results ◽  
Pelvic Reconstruction ◽  
Optimal Position ◽  
Forward Flexion ◽  
The Face ◽  
Shoulder Arthrodesis

Brachial plexus injuries are a major indication for shoulder arthrodesis. However, there is no consensus concerning the optimal position of the glenohumeral joint for fusion. Between 1997 and 2008, 19 shoulder arthrodeses were performed using pelvic reconstruction plates. The radiographic and functional characteristics of 13 patients of mean age 46 years were examined at a mean of 101 months after arthrodesis. Arthrodeses showed 30° mean angle of abduction, 32° forward flexion and 44° internal rotation of the humerus with respect to the scapula. Abduction >35° and forward flexion ≥30°seem to offer slightly better functional results. Internal rotation ≤45° significantly relates to better ability of the hand to reach the face ( p = 0.012). Neither abduction >35° nor forward flexion ≥30° showed a higher prevalence of periscapular pain. Abduction around 35° and forward flexion around 30° are needed for good functional results. Internal rotation should not exceed 45°.

scholarly journals Functional Outcome of Neurotization to The Musculocutaneous Nerve in Traumatic Brachial Plexus Injury

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Mohammad Azrul Bin Abdul Rashid ◽  
Kamarul Ariffin Khalid ◽  
Raffael Ismail
Keyword(s):  
Brachial Plexus ◽  
Functional Outcome ◽  
Brachial Plexus Injury ◽  
Cross Sectional Study ◽  
Elbow Flexor ◽  
Musculocutaneous Nerve ◽  
Dash Score ◽  
Elbow Flexors ◽  
Cross Sectional ◽  
The Mean

Introduction:  Neurotization procedures to the elbow flexors are commonly done in traumatic brachial plexus injury (BPI). The objective of this study was to evaluate the recovery of elbow flexors in patients who underwent neurotization procedure to musculocutaneous nerve in the panplexus and upper trunk BPI. Materials and Methods: This was a cross sectional study involving 70 patients who underwent neurotization to elbow flexor. A total of 31 patients (44%) had panplexus injury and 39 (56%) had upper trunk BPI. Elbow flexor motor power and post-operative Disabilities of the Arm, Shoulder and Hand (DASH) score were evaluated. Results:  The mean age of the patients was 22.7 years. Patients with panplexus BPI underwent neurotization to the elbow flexor using spinal accessory nerve as a donor and patients with upper trunk BPI used either ulnar or median nerve as a donor. The results of elbow flexors recovery in panplexus BPI were good (MRC grade 4 and 5) in 11 patients (35.5%) and poor in 20 patients (64.5%). Conversely, the recovery of elbow flexors in upper trunk BPI were better with 28 patients (71.8%). Good post-operative DASH score (score <50 points) were noted in 29 patients (74.4%) with upper trunk BPI. Only seven patients (22.6%) with panplexus BPI showed good post-operative DASH score. Majority of patients with panplexus BPI demonstrated poor recovery of elbow flexor and post-operative DASH score as compare to upper trunk BPI (p= 0.002). Conclusion:  Overall, this study showed significantly better functional outcome of neurotization procedure to elbow flexor in upper trunk BPI than in panplexus BPI.

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