Recovery of upper extremity function following endoscopically assisted contralateral C7 transfer for obstetrical brachial plexus injury

2016 ◽  
Vol 41 (8) ◽  
pp. 863-874 ◽  
Author(s):  
G. Leblebicioglu ◽  
C. Ayhan ◽  
T. Firat ◽  
A. Uzumcugil ◽  
M. Yorubulut ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Hand Function ◽  
Grading System ◽  
Nerve Roots ◽  
Level Of Evidence ◽  
The Mean ◽  
Upper Extremity Function ◽  
Postoperative Shoulder

Transfer of the contralateral C7 nerve for reconstruction of the brachial plexus in infants with obstetrical brachial plexus injury has rarely been reported. We developed a new endoscopy-assisted technique via the prevertebral (retroesophageal) route for the transfer of the contralateral C7 nerve in reconstruction of the brachial plexus. The reconstruction was performed in 20 infants (14 boys and six girls). Motor recovery was assessed using the Gilbert and Raimondi scales. The Narakas Sensory Grading System was used to evaluate hand sensation. The mean follow-up period was 45 months (SD 18.2). Of the 20 children, nine had contralateral C7 transfer to lower nerve roots, two had transfer to upper nerve roots and nine had transfer to both upper and lower roots. The postoperative shoulder and elbow functions were good or satisfactory according to the Gilbert classification in all children whose preoperative scores were poor. All patients with lower roots reconstruction (9) had satisfactory hand function. A total of 15 children had a Narakas score of S3. Our technique enables safe contralateral C7 transfer to the avulsed roots in severe obstetrical brachial plexus injury infants with a satisfactory functional recovery. Level of evidence: Level IV

Minimum Ten-Year Outcomes of Partial Ulnar Nerve Transfer for Restoration of Elbow Flexion in Patients with Upper Brachial Plexus Injury

2019 ◽  
Vol 24 (03) ◽  
pp. 283-288
Author(s):  
Yusuke Nagano ◽  
Daisuke Kawamura ◽  
Alaa Terkawi ◽  
Atsushi Urita ◽  
Yuichiro Matsui ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Functional Outcomes ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
The Mean ◽  
Flexion Strength

Background: Partial ulnar nerve transfer to the biceps motor branch of the musculocutaneous nerve (Oberlin’s transfer) is a successful approach to restore elbow flexion in patients with upper brachial plexus injury (BPI). However, there is no report on more than 10 years subjective and objective outcomes. The purpose of this study was to clarify the long-term outcomes of Oberlin’s transfer based on the objective evaluation of elbow flexion strength and subjective functional evaluation of patients. Methods: Six patients with BPI who underwent Oberlin’s transfer were reviewed retrospectively by their medical records. The mean age at surgery was 29.5 years, and the mean follow-up duration was 13 years. The objective functional outcomes were evaluated by biceps muscle strength using the Medical Research Council (MRC) grade at preoperative, postoperative, and final follow-up. The patient-derived subjective functional outcomes were evaluated using the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at final follow-up. Results: All patients had MRC grade 0 (M0) or 1 (M1) elbow flexion strength before operation. Four patients gained M4 postoperatively and maintained or increased muscle strength at the final follow-up. One patient gained M3 postoperatively and at the final follow-up. Although one patient achieved M4 postoperatively, the strength was reduced to M2 due to additional disorder. The mean score of QuickDASH was 36.5 (range, 7–71). Patients were divided into two groups; three patients had lower scores and the other three patients had higher scores of QuickDASH. Conclusions: Oberlin’s transfer is effective in the restoration of elbow flexion and can maintain the strength for more than 10 years. Patients with upper BPI with restored elbow flexion strength and no complicated nerve disorders have over ten-year subjective satisfaction.

scholarly journals Management of Brachial Plexus Injury in Adults

2008 ◽  
Vol 97 (4) ◽  
pp. 317-323 ◽  
Author(s):  
P. Songcharoen
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Nerve Repair ◽  
Hand Function ◽  
Nerve Transfer ◽  
Nerve Grafting ◽  
Muscle Transfer ◽  
Nerve Roots ◽  
Elbow Function ◽  
Motorcycle Accidents

Brachial plexus injury in adults is commonly caused by motorcycle accidents. Surgical management consists of nerve repair and nerve grafting for extraforaminal nerve root or trunk injury, and of neurotization or nerve transfer for nerve roots avulsion. In general, the results regarding restoration of shoulder and elbow function are good but reinnervation of the forearm muscles is less than safisfactory in respect to restoration of hand function. Functioning free muscle transfer in combination with selective nerve transfer is a reasonable alternative surgical procedure.

Reconstruction of hook grip function of the fingers in patients with traumatic brachial plexus injury

2021 ◽  
pp. 175319342110549
Author(s):  
Yuki Hara ◽  
Yasumasa Nishiura ◽  
Yuichi Yoshii ◽  
Shunsuke Asakawa ◽  
Yukei Matsumoto ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Latissimus Dorsi ◽  
Brachial Plexus Injury ◽  
Hand Function ◽  
Latissimus Dorsi Muscle ◽  
Flexor Digitorum Profundus ◽  
Reconstruction Method ◽  
Level Of Evidence ◽  
Pedicle Flap ◽  
Dorsi Muscle

We described a reconstruction method for restoring hook grip function of the fingers in patients with total brachial plexus injury. The paralysed latissimus dorsi muscle was transferred to the upper limb as a pedicle flap and sutured to the flexor digitorum profundus tendons. The muscle was then reanimated with two intercostal donor nerves to the thoraco-dorsal nerve. Fourteen young adult patients (mean 23 years, range 17 to 32 years) with traumatic brachial plexus injury who underwent reconstruction using this technique from 2000 to 2019. After mean follow-up of 65 months (range 20 to 170), finger flexion of strength greater than or equal to M3 was achieved in 10 of the 14 patients. The mean weight that could be lifted using a hook grip was 2.6 kg, and that which could be lifted with both hands was 4.1 kg. The intercostal nerve-innervated latissimus dorsi muscle transfer can provide useful hook grip hand function without the need to sacrifice donor vessels or healthy muscles. Level of evidence: IV

Obstetrical brachial plexus injuries: Late functional results of the Steindler procedure

2014 ◽  
Vol 39 (8) ◽  
pp. 868-875 ◽  
Author(s):  
A. Gilbert ◽  
S. Valbuena ◽  
C. Posso
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Elbow Flexion ◽  
Functional Results ◽  
Obstetrical Brachial Plexus Palsy ◽  
Long Term Follow Up ◽  
The Mean ◽  
Extensor Lag

We reviewed late functional results of a modified Steindler procedure in patients with obstetrical brachial plexus palsy and poor active elbow flexion. From 1982 to 2005, we reviewed final functional results and complications of 27 cases with flexion weakness of the elbow secondary to obstetrical brachial plexus injury, treated with a modified Steindler procedure. At the end of the follow-up, the mean active elbow flexion was 97° and the mean extensor lag was 10°. In the long-term follow-up, the modified Steindler procedure maintained good results in 67% of the cases in our series, and this percentage raised by 82% when the wrist extensor was present or restored before the Steindler procedure. There were poor results in 19% of the patients, but no major complications.

scholarly journals Functional deficits as a result of brachial plexus injury in anterior shoulder dislocation

2021 ◽  
pp. 175319342199308
Author(s):  
Rupert Jordan ◽  
Ryckie G. Wade ◽  
Gordon McCauley ◽  
Suzanne Oxley ◽  
Robert Bains ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Shoulder Dislocation ◽  
Medical Research Council ◽  
Brachial Plexus Injury ◽  
Muscle Power ◽  
Anterior Shoulder Dislocation ◽  
Nerve Reconstruction ◽  
Level Of Evidence ◽  
Functional Deficits

The incidence of brachial plexus injuries in anterior shoulder dislocation remains relatively uncommon. A retrospective study was conducted to observe the natural neurological recovery of patients following these injuries over a 2-year period. Muscle power according to the Medical Research Council scale and sensation were measured from presentation to discharge. In 28 patients, the power grade of proximal muscles supplied by nine injured nerves failed to improve over a median follow-up of 5 months. There was no statistically significant improvement in sensation over a median follow-up of 6 months. Poorer recovery in muscle power score was related to advancing age, whereby every decade increased the risk by approximately 30%. Anterior shoulder dislocation with a plexus injury carries a risk of permanent nerve injury. Patients should be referred for specialist nerve assessment leading to rehabilitation and timely early nerve reconstruction, if indicated. Level of evidence: IV

Glenohumeral fusion in adults with sequelae of obstetrical brachial plexus injury: a report of eight cases

2018 ◽  
Vol 44 (3) ◽  
pp. 248-255
Author(s):  
Zoubir Belkheyar ◽  
Amar Belkacem Djeffel ◽  
Adeline Cambon-Binder
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
External Rotation ◽  
Shoulder Abduction ◽  
Level Of Evidence ◽  
Flexor Muscles ◽  
Obstetric Brachial Plexus ◽  
Brachial Plexus Paralysis ◽  
Shoulder Arthrodesis

The purpose of this study was to assess the outcomes of glenohumeral fusion performed in adulthood in patients with poor recovery after obstetric brachial plexus injury. We reviewed eight patients with obstetrical brachial plexus injury who had undergone shoulder arthrodesis. The mean age was 28 years (range 16 to 55). All of the patients had active periscapular and elbow flexor muscles. At an average follow-up of 20 months, the active range of abduction and external rotation of the affected shoulder was 67° (range 50° to 85°) and 21° (range 0° to 40°), respectively. All of the patients were satisfied with the outcome of the intervention. Fusion was obtained between 3 and 6 months, and none of the patients experienced residual pain. Shoulder fusion improved the active shoulder abduction and external rotation in adults with residual obstetrical brachial plexus paralysis. Level of evidence: IV

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

Functioning Free Muscle Transfer for Brachial Plexus Injury: A Systematic Review and Pooled Analysis Comparing Functional Outcomes of Intercostal Nerve and Spinal Accessory Nerve Grafts

2020 ◽  
Vol 36 (08) ◽  
pp. 567-571
Author(s):  
Jeremie D. Oliver ◽  
Chase Beal ◽  
Emily M. Graham ◽  
Katherine B. Santosa ◽  
Michael S. Hu
Keyword(s):  
Brachial Plexus ◽  
Functional Outcomes ◽  
Latissimus Dorsi ◽  
Brachial Plexus Injury ◽  
Rectus Femoris ◽  
Elbow Flexion ◽  
Intercostal Nerve ◽  
The Mean ◽  
Lost To Follow Up

Abstract Background The aim of this study was to compare postoperative elbow flexion outcomes in patients receiving functioning free muscle transplantation (FFMT) innervated by either intercostal nerve (ICN) or spinal accessory nerve (SAN) grafts. Methods A comprehensive systematic review on FFMT for brachial plexus reconstruction was conducted utilizing Medline/PubMed database. Analysis was designed to compare functional outcomes between (1) nerve graft type (ICN vs. SAN) and (2) different free muscle graft types to biceps tendon (gracilis vs. rectus femoris vs. latissimus dorsi). Results A total of 312 FFMTs innervated by ICNs (169) or the SAN (143) are featured in 10 case series. The mean patient age was 28 years. Patients had a mean injury to surgery time of 31.5 months and an average follow-up time of 39.1 months with 18 patients lost to follow-up. Muscles utilized included the gracilis (275), rectus femoris (28), and latissimus dorsi (8). After excluding those lost to follow-up or failures due to vascular compromise, the mean success rates of FFMTs innervated by ICNs and SAN were 64.1 and 65.4%, respectively. Conclusion This analysis did not identify any difference in outcomes between FFMTs via ICN grafts and those innervated by SAN grafts in restoring elbow flexion in traumatic brachial plexus injury patients.

The natural history of recovery of elbow flexion after obstetric brachial plexus injury managed without nerve repair

2017 ◽  
Vol 42 (7) ◽  
pp. 706-709 ◽  
Author(s):  
T. E. J. Hems ◽  
T. Savaridas ◽  
D. A. Sherlock
Keyword(s):  
Brachial Plexus ◽  
Spontaneous Recovery ◽  
Brachial Plexus Injury ◽  
Elbow Flexion ◽  
Nerve Reconstruction ◽  
Level Of Evidence ◽  
Severe Injuries ◽  
Obstetric Brachial Plexus ◽  
The Mean ◽  
Obstetric Brachial Plexus Injury

In this study, we report the outcome for spontaneous recovery of elbow flexion in obstetric brachial plexus injury managed without nerve reconstruction. Excluding those with transient paralysis, our records revealed 152 children with obstetric brachial plexus injury born before our unit routinely offered brachial plexus reconstruction. Five had had nerve repairs. Of the remainder, only one patient had insufficient flexion to reach their mouth. Elbow flexion started to recover clinically at a mean age of 4 months for Narakas Group 1, 6 months for Group 2, 8 months for Group 3 and 12 months for Group 4. The mean active range of elbow flexion, in 44 cases, was 138°. The mean isometric elbow flexion strength, in 39 patients, was 63% (range 23%–100%) of the normal side. It appears to be rare for elbow flexion not to recover spontaneously, although recovery occurs later in more severe injuries. It is doubtful if nerve reconstruction can improve elbow flexion above the likely spontaneous recovery in babies with obstetric brachial plexus injuries. Level of evidence: II

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