Percutaneous humeral derotational osteotomy in obstetrical brachial plexus palsy: a new technique

Thirty three per cent of children with obstetrical brachial plexus palsy with incomplete neurological recovery develop shoulder internal contracture associated with osseous deformity. Some of the older children are treated by humeral derotational osteotomy. The classical technique of open approach to the humeral diaphysis and plate fixation imposes a longitudinal scar and carries significant risks (nonunion, nerve palsy); a secondary procedure for plate removal is necessary in a significant proportion of patients. The authors report a new technique of percutaneous humeral osteotomy with osteosynthesis by Hoffmann external fixator. In six cases bone healing was obtained at an average of 45 days, without adverse complication. The postoperative results showed improved shoulder function. This new technique is simple and safe; it represents a new option for the treatment of sequelae of obstetrical brachial plexus palsy.

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Contralateral Spinal Accessory Nerve Transfer: A New Technique in Panavulsive Brachial Plexus Palsy

Indian Journal of Surgery ◽

10.1007/s12262-013-1020-3 ◽

2013 ◽

Vol 77 (3) ◽

pp. 247-250 ◽

Cited By ~ 1

Author(s):

Jaime Zermeño-Rivera ◽

Bianca Ethel Gutiérrez-Amavizca

Keyword(s):

Brachial Plexus ◽

Nerve Transfer ◽

Spinal Accessory Nerve ◽

Accessory Nerve ◽

New Technique ◽

Brachial Plexus Palsy ◽

Spinal Accessory ◽

A New Technique

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Extending the Indications for Primary Nerve Surgery in Obstetrical Brachial Plexus Palsy

BioMed Research International ◽

10.1155/2014/627067 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 11

Author(s):

Stuart A. Bade ◽

Jenny C. Lin ◽

Christine G. Curtis ◽

Howard M. Clarke

Keyword(s):

Brachial Plexus ◽

Surgical Intervention ◽

External Rotation ◽

Shoulder Function ◽

Small Subset ◽

Brachial Plexus Palsy ◽

Surgical Indications ◽

Obstetrical Brachial Plexus Palsy ◽

Spontaneous Improvement ◽

Nerve Surgery

Purpose.This study identifies a small subset of patients with obstetrical brachial plexus palsy who, while they do not meet common surgical indications, may still benefit from primary nerve surgery.Methods.Between April 2004 and April 2009, 17 patients were offered primary nerve surgery despite not meeting the standard surgical indications of the authors. The authors performed a retrospective analysis of these 17 patients using prospectively collected data.Results.This group of 17 patients were identified as having poor shoulder function at about 9 months of age despite passing the Cookie Test. Fourteen patients underwent surgical intervention and three families declined surgery. All patients in the operative group regained some active external rotation after surgery. Five patients in this group have required further interventions. Two of the three patients for whom surgery was declined have had no subsequent spontaneous improvement in active external rotation.Discussion.The commonly used indications for primary nerve surgery in obstetrical brachial plexus palsy may not adequately identify all patients who may benefit from surgical intervention. Patients who pass the Cookie Test but have poor spontaneous recovery of active shoulder movements, particularly external rotation, may still benefit from primary nerve surgery.

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Shoulder Subluxation Pain as a Secondary Indication for Trapezius to Deltoid Transfer

Journal of Brachial Plexus and Peripheral Nerve Injury ◽

10.1055/s-0038-1676786 ◽

2018 ◽

Vol 13 (01) ◽

pp. e20-e23

Author(s):

Andrew Elkwood ◽

Michael Rose ◽

Matthew Kaufman ◽

Tushar Patel ◽

Russell Ashinoff ◽

...

Keyword(s):

Pain Relief ◽

Brachial Plexus ◽

Medication Use ◽

Deltoid Muscle ◽

Shoulder Girdle ◽

Shoulder Function ◽

Pain Medication ◽

New Technique ◽

Muscle Transfer ◽

A New Technique

AbstractBrachial plexus injuries can be debilitating. We have observed that manual reduction of the patients' shoulder subluxation improves their pain and have used this as a second reason to perform the trapezius to deltoid muscle transfer beyond motion. The authors report a series of nine patients who all had significant improvement of pain in the shoulder girdle and a decrease in pain medication use after a trapezius to deltoid muscle transfer. All patients were satisfied with the outcomes and stated that they would undergo the procedure again if offered the option. The rate of major complications was low. The aim is not to describe a new technique, but to elevate a secondary indication to a primary for the trapezius to deltoid transfer beyond improving shoulder function: pain relief from chronic shoulder subluxation.

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The “Mini-Bier’s Block”: A New Technique for Prevention of Tourniquet Pain During Axillary Brachial Plexus Anaesthesia

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(94)90087-6 ◽

1994 ◽

Vol 19 (3) ◽

pp. 347-349 ◽

Cited By ~ 3

Author(s):

N. K. JAMES ◽

C. T. K. KHOO ◽

R. H. FELL

Keyword(s):

Brachial Plexus ◽

Regional Anaesthesia ◽

Low Dose ◽

New Technique ◽

Controlled Study ◽

Axillary Block ◽

Pneumatic Tourniquet ◽

Axillary Approach ◽

A New Technique ◽

Local Block

Tourniquet cuff pain is a significant cause of morbidity following regional anaesthesia of the upper limb. We describe a simple new technique for effectively anaesthetizing the area under a pneumatic tourniquet (the “mini-Bier’s block”), which permits comfortable surgery under axillary block anaesthesia even if the local block is incomplete. We report a controlled study of 40 patients in whom statistically significant tourniquet cuff pain relief was obtained in patients receiving an additional low-dose intravenous injection of local anaesthetic localized beneath the cuff. This technique ensures that the safe axillary approach to the brachial plexus can always be used with avoidance of pain from the pressure of the tourniquet cuff.

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