Single Versus Double Tendon Transfer to Improve Shoulder External Rotation During the Treatment of Brachial Plexus Birth Palsy

Hand ◽  
2020 ◽  
pp. 155894472091121
Author(s):  
Joshua M. Abzug ◽  
Elie Miller ◽  
Alexandria L. Case ◽  
Danielle A. Hogarth ◽  
Dan A. Zlotolow ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Internal Rotation ◽  
Tendon Transfer ◽  
External Rotation ◽  
Significant Loss ◽  
Tendon Transfers ◽  
Brachial Plexus Birth Palsy ◽  
Shoulder External Rotation ◽  
Birth Palsy ◽  
Single Versus

Background: Tendon transfers are commonly performed in patients with brachial plexus birth palsy (BPBP) to improve function. Transferring 2 tendons in patients with C5-7 injury has the potential complication of loss of midline function. The purpose of this study was to investigate whether a single tendon transfer (1TT) as opposed to the traditional double tendon transfer (2TT) resulted in any differences in functional outcomes in patients with C5-7 BPBP. Methods: A retrospective review of all patients with C5-7 BPBP who underwent tendon transfers to improve shoulder external rotation over a 5-year period was performed at 2 institutions. Outcomes were assessed using the modified Mallet (MM) classification scores. Results: Twenty-two C5-7 patients had complete records of preoperative and postoperative MM scores, including 11 sex-matched patients in both the 1TT and 2TT groups. When comparing preoperative and postoperative MM categories, there were significant improvements in both the 1TT and 2TT groups for global abduction ( P < .05 and P < .01, respectively) and external rotation ( P < .00001 for both). Modified Mallet (MM) hand to neck scores were significantly improved in the 2TT group ( P < .05) but not in the 1TT group ( P = .053). Internal rotation scores significantly decreased in both groups ( P < .001). Both groups demonstrated significant increases in total scores from the preoperative MM scores ( P < .01). Conclusion: The 1TT and 2TT procedures result in substantial gains in upper extremity functions for patients with C5-7 BPBP as measured by the MM score, specifically within the global abduction and external rotation subcategories. However, a significant loss occurs in internal rotation for both groups.

Functional outcomes of tendon transfer for brachial plexus birth palsy using the Hoffer technique

2020 ◽  
Vol 102-B (2) ◽  
pp. 246-253 ◽  
Author(s):  
Ram K. Alluri ◽  
Nina Lightdale-Miric ◽  
Erin Meisel ◽  
Gina Kim ◽  
Jesse Kaplan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Brachial Plexus ◽  
Functional Outcomes ◽  
External Rotation ◽  
Shoulder Abduction ◽  
Active Movement ◽  
Brachial Plexus Birth Palsy ◽  
Derotational Osteotomy ◽  
Birth Palsy

Aims To describe and analyze the mid-term functional outcomes of a large series of patients who underwent the Hoffer procedure for brachial plexus birth palsy (BPBP). Methods All patients who underwent the Hoffer procedure with minimum two-year follow-up were retrospectively reviewed. Active shoulder range of movement (ROM), aggregate modified Mallet classification scores, Hospital for Sick Children Active Movement Scale (AMS) scores, and/or Toronto Test Scores were used to assess functional outcomes. Subgroup analysis based on age and level of injury was performed. Risk factors for subsequent humeral derotational osteotomy and other complications were also assessed. A total of 107 patients, average age 3.9 years (1.6 to 13) and 59% female, were included in the study with mean 68 months (24 to 194) follow-up. Results All patients demonstrated statistically significant improvement in all functional outcomes and active shoulder abduction and external rotation ROM (p < 0.001). Patients < 2.5 years of age had higher postoperative AMS, abduction ROM and strength scores, and aggregate postoperative Toronto scores (p ≤ 0.035) compared to patients ≥ 2.5 years old. There were 17 patients (16%) who required a subsequent humeral derotational osteotomy; lower preoperative AMS external rotation scores and external rotation ROM were predictive risk factors (p ≤ 0.016). Conclusion Patients with BPBP who underwent the Hoffer procedure demonstrated significant improvement in postoperative ROM, strength, and functional outcome scores at mid-term follow-up. Patients younger than 2.5 years at the time of surgery generally had better functional outcomes. Limited preoperative external rotation strength and ROM were significantly associated with requirement for subsequent humeral derotational osteotomy. In our chort significant improvements in shoulder function were obtained after the Hoffer procedure for BPBP. Cite this article: Bone Joint J 2020;102-B(2):246–253.

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