scholarly journals Restoration of Elbow Flexion With a Free Functional Gracilis Muscle Transfer in an Arthrogrypotic Patient Using a Motor Nerve to Pectoralis Major

Hand ◽  
2020 ◽  
Vol 15 (5) ◽  
pp. NP80-NP84
Author(s):  
Kristen M. Sochol ◽  
George Edwards ◽  
Milan Stevanovic
Keyword(s):  
Medical Research ◽  
Research Council ◽  
Medical Research Council ◽  
Motor Nerve ◽  
Elbow Flexion ◽  
Gracilis Muscle ◽  
Pectoralis Major ◽  
Muscle Transfer ◽  
Motor Branch

Background: Patients with arthrogryposis may exhibit inability to flex the elbow. A free functional gracilis muscle transfer (FFGMT) can be used to restore elbow flexion. In our search of the available literature, we have not seen any descriptions of using a motor branch to the pectoralis major as a donor nerve to establish elbow flexion. Methods: We performed an FFGMT for restoration of elbow flexion in an arthrogrypotic patient with no active elbow flexion, who had a Medical Research Council (MRC) muscle grade of 0. Results: We report our 4.5-year outcomes. After undergoing an FFGMT for elbow flexion, our patient was able to gain an MRC grade 4 and achieve an arc of motion of 25° to 140°. Conclusion: An FFGMT for elbow flexion may be performed successfully using a motor branch to the pectoralis major.

scholarly journals Clinical Results of Transferring a Motor Branch of the Tibial Nerve to the Deep Peroneal Nerve for Treatment of Foot Drop

Neurosurgery ◽  
2013 ◽  
Vol 73 (4) ◽  
pp. 609-616 ◽  
Author(s):  
Leandro Pretto Flores ◽  
Roberto Sérgio Martins ◽  
Mario Gilberto Siqueira
Keyword(s):  
Medical Research ◽  
Soleus Muscle ◽  
Peroneal Nerve ◽  
Research Council ◽  
Medical Research Council ◽  
Tibial Nerve ◽  
Foot Drop ◽  
Deep Peroneal Nerve ◽  
Motor Branch ◽  
Patient Reported

Abstract BACKGROUND: Foot drop is a very debilitating condition affecting patients' daily activities, and its treatment has been a challenge for neurosurgeons. Grafting the peroneal or sciatic nerve usually results in poor outcomes. Our previous anatomic study demonstrated the feasibility of transferring a motor branch of the tibial nerve to the deep peroneal nerve at the level of the popliteal fossa. OBJECTIVE: To demonstrate the outcomes obtained after the transfer of a branch of the tibial nerve to the peroneal nerve for recovery of foot drop. METHODS: A retrospective review of 13 patients with foot drop caused by injuries to a lumbar root or the sciatic or peroneal nerve, who underwent a transfer of the nerve of the soleus muscle to the deep peroneal nerve. The results were evaluated using the British Medical Research Council grading system. RESULTS: Three patients were lost to follow-up. Of the remaining 10 patients, the outcomes were considered good (Medical Research Council grade M3 or M4) in 2 patients (20%) concerning ankle dorsiflexion and in 2 patients concerning toe extension (20%). One patient reported a reduced calf circumference. CONCLUSION: The transfer of the nerve of the soleus muscle to the deep peroneal nerve demonstrated poor results in most of the patients, although favorable outcomes were observed in a few subjects. Due to the inconsistency of the results, we do not favor the routine use of this technique for the treatment of foot drop.

Quantitative assessment of elbow flexion by handheld dynamometry in brachial plexus palsy

2018 ◽  
Vol 44 (3) ◽  
pp. 256-262 ◽  
Author(s):  
Abdelhakim Marei ◽  
Kazuteru Doi ◽  
Yasunori Hattori ◽  
Soutetsu Sakamot
Keyword(s):  
Medical Research ◽  
Brachial Plexus ◽  
Measurement Errors ◽  
Quantitative Assessment ◽  
Research Council ◽  
Medical Research Council ◽  
Intraclass Correlation ◽  
Elbow Flexion ◽  
Brachial Plexus Palsy ◽  
Level Of Evidence

The purpose of this study was to assess the relative and absolute reliability of a handheld dynamometer when used for examining elbow flexion power in patients with brachial plexus palsy. The assessment of the intra-rater and inter-rater reliability coefficients for the handheld dynamometer was done using the stationary Kin-Com® dynamometer as the reference standard. We determined the measurement errors and checked the systematic biases of the handheld dynamometer. The inter-rater and intra-rater reliabilities of the handheld dynamometer had a very high intraclass correlation coefficient. The values of handheld dynamometer readings had a high correlation to Kin-Com® readings. The Medical Research Council grading was a comparatively inaccurate method for quantitative assessment of motor power. We conclude that a handheld dynamometer measurement is more precise and reliable than the Medical Research Council grading for measuring recovery of elbow flexion in patients with brachial plexus palsy. Level of evidence: III

scholarly journals Ulnar and Median Fascicular Transfers for Elbow Flexion-Predicting Outcomes in a Heterogeneous Patient Group and Implications for Surgical Planning

2020 ◽  
Vol 7 ◽  
Author(s):  
Scott Ferris ◽  
William Alexander
Keyword(s):  
Medical Research ◽  
Brachial Plexus ◽  
Patient Outcomes ◽  
Patient Group ◽  
Surgical Planning ◽  
Research Council ◽  
Medical Research Council ◽  
Treatment Options ◽  
Elbow Flexion ◽  
Nerve Transfers

Purpose: To measure the outcomes in patients undergoing nerve transfers for elbow flexion restoration, and compare patient outcomes based on the pre-operative fascicular transfer plan.Methods: Single surgeon series of 48 consecutive patients who underwent median and/or ulnar fascicular nerve transfers for elbow flexion restoration to treat palsies of the brachial plexus or musculocutaneous nerve. Outcomes measured were Medical Research Council (MRC) power grade, strength in kilograms, and time taken to recover function.Results: Overall, 96% of patients achieved MRC M4 or greater power. The subgroup who were planned for, and particularly those who then underwent, double as opposed to single fascicular transfer, had significantly better results.Conclusions: Overall results were excellent. Double fascicular transfers were superior, with no failures in this group. If pre-operatively a single fascicle transfer alone is planned due to a paucity of expendable donors, the predicted outcomes are worse and other treatment options should be considered.

Depression and Anxiety in Traumatic Brachial Plexus Injury Patients Are Associated With Reduced Motor Outcome After Surgical Intervention for Restoration of Elbow Flexion

Neurosurgery ◽  
2016 ◽  
Vol 78 (6) ◽  
pp. 844-850 ◽  
Author(s):  
Thomas J. Wilson ◽  
Kate W.C. Chang ◽  
Lynda J.-S. Yang
Keyword(s):  
Patient Satisfaction ◽  
Medical Research ◽  
Brachial Plexus ◽  
Research Council ◽  
Medical Research Council ◽  
Brachial Plexus Injury ◽  
Elbow Flexion ◽  
Psychiatric Diagnoses ◽  
Medical Research Council Scale

Abstract BACKGROUND: Depression has been associated with poor outcomes in neurosurgical patients, including increased pain, poorer functional recovery, delayed return to work, and decreased patient satisfaction. No reports exist regarding an association of psychiatric diagnoses with outcomes after brachial plexus reconstruction. As outcomes and patient satisfaction become increasingly important to payers and physician reimbursement, assessing modifiable preoperative risk factors for their association with poor outcome and patient satisfaction is imperative. OBJECTIVE: To analyze patients undergoing brachial plexus reconstruction to assess the relationship of depression/anxiety with functional outcome. METHODS: Data were collected retrospectively on all patients who underwent brachial plexus reconstruction to restore elbow flexion between 2005 and 2013. Elbow flexion, graded via the Medical Research Council scale, was assessed at latest follow-up. Multiple variables, including the presence of Axis I psychiatric diagnoses, were assessed for their association with the dichotomous outcome of Medical Research Council scale score ≥3 (antigravity) vs <3 elbow flexion. Standard statistical methods were used. RESULTS: Thirty-seven patients met inclusion criteria. The median postsurgical follow-up time was 21 months. Operations included neurolysis (n = 3), nerve graft repair (n = 6), and nerve transfer (n = 28). Depression was present in 10 of 37 patients (27%). Of variables tested, only depression was associated with poor elbow flexion outcome (odds ratio: 6.038; P = .04). CONCLUSION: Preoperative depression is common after brachial plexus injury. The presence of depression is associated with reduced elbow flexion recovery after reconstruction. Our data suggest assessment and treatment of preoperative mental health is important in designing a comprehensive postoperative management plan to optimize outcomes and patient satisfaction.

Correlação entre a frequência respiratória e escalas de avaliação de dispneia

2016 ◽  
Vol 13 (6) ◽  
Author(s):  
Ivete Alonso Bredda Saad ◽  
Mariana De Moraes ◽  
Vinicius Minatel ◽  
Bruna Alonso Saad
Keyword(s):  
Medical Research ◽  
Research Council ◽  
Medical Research Council

A avaliação da dispneia tem sido feita por meio de instrumentos como escala de Borg modificada, a escala de cores e a escala do Medical Research Council modificada (mMRC). O objetivo deste estudo foi correlacionar a frequência respiratória com a sensação de dispneia, através das escalas citadas, correlacioná-las entre si e verificar se o grau de alfabetização influenciou na resposta do paciente sobre a sensação de dispneia. Para avaliar o esforço físico utilizou-se o teste de caminhada de seis minutos. Este foi um estudo prospectivo, transversal e analítico-descritivo composto por 124 voluntários com diagnóstico de doença pulmonar. Para comparar as variáveis categóricas entre os grupos foram utilizados os testes Qui-Quadrado e exato de Fisher. Para comparar as variáveis contínuas foi utilizado o teste Kruskal-Wallis e para análise de correlação foi utilizado o coeficiente de correlação de Spearman. A idade média foi de 55,9 (± 13,08 anos), 14% eram analfabetos. Nos tempos de análise houve correlação positiva entre as escalas mMRC e Borg, r = 0,43, r = 0,61 e r = 0,55. Entre as escalas mMRC e Cores, observou-se correlação negativa. Concluiu-se que a frequência respiratória correlacionou-se com as três escalas. O grau de alfabetização não modificou a resposta do paciente em relação à sensação de dispneia.Palavras-chave: dispneia, fisioterapia, avaliação.

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