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.

NERVE TRANSFER SURGERY FOR ADULT BRACHIAL PLEXUS INJURY

Neurosurgery ◽  
2009 ◽  
Vol 65 (suppl_4) ◽  
pp. A55-A62 ◽  
Author(s):  
Olawale A.R. Sulaiman ◽  
Daniel D. Kim ◽  
Clint Burkett ◽  
David G. Kline
Keyword(s):  
Brachial Plexus ◽  
Research Council ◽  
Medical Research Council ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Nerve Transfers ◽  
Direct Repair ◽  
Grade 3

Abstract OBJECTIVE To review the clinical outcomes in our patients who have undergone nerve transfer operations for brachial plexus reconstruction at the Louisiana State University (LSU) over a 10-year period. A secondary objective is to compare clinical outcomes in patients who had only nerve transfer operations as compared with patients whose nerve transfers were supplemented with direct repair of brachial plexus elements. METHODS Retrospective review of the medical records, imaging, and electrodiagnostic studies (electromyographic and nerve conduction studies) of patients with brachial plexus injuries who underwent nerve transfer operations at LSU over a period of 10 years. RESULTS A total of 81 patients were treated between 1995 to 2005 at the LSU Health Sciences Center; 7 of these patients were lost to follow-up, leaving 74 patients, with an average follow-up of 3.5 years, for review. We evaluated recovery of elbow flexion and shoulder abduction. Ninety percent of patients with medial pectoral to musculocutaneous nerve transfers recovered to LSU grade 2 (Medical Research Council grade 3), and 60% of those patients with intercostal to musculocutaneous nerve transfer regained similar strength in elbow flexion. Shoulder abduction recovery to LSU grade 2 (Medical Research Council grade 3) after spinal accessory to suprascapular and/or thoracodorsal to axillary nerve transfer, was 95% and 36%, respectively. There was a tendency for better motor recovery when nerve transfer operations were combined with direct repair of plexus elements. CONCLUSION Nerve transfers for repair of brachial plexus injuries result in excellent recovery of elbow and shoulder functions. Patients who had direct repair of brachial plexus elements in addition to nerve transfers tended to do better than those who had only nerve transfer operations.

Free functioning gracilis transfer for reanimation of elbow and hand in total traumatic brachial plexopathy in children

2018 ◽  
Vol 43 (6) ◽  
pp. 596-608 ◽  
Author(s):  
Tomas Madura ◽  
Kazuteru Doi ◽  
Yasunori Hattori ◽  
Sotetsu Sakamoto ◽  
Takashi Shimoe
Keyword(s):  
Brachial Plexus ◽  
Elbow Flexion ◽  
Limb Length Discrepancy ◽  
Flexion Contracture ◽  
Brachial Plexopathy ◽  
Brachial Plexus Palsy ◽  
Level Of Evidence ◽  
Old Patients ◽  
Useful Power

The purpose of this study was to evaluate long-term outcomes of the free functioning gracilis transfer in children with traumatic total brachial plexus palsy. We used the free functioning gracilis transfer to reconstruct elbow flexion and prehension in 17 children with a mean age of 13.4 years (range 3–17) who were followed-up over a mean period of 6 years (range 2–16). The transferred gracilis delivered a stable elbow flexion with a useful power, as well as reconstructed active finger motion. In 3–11-year-old patients we noted a tendency towards developing a progressive flexion contracture of the elbow. The limb length discrepancy observed in our patients was not different from the brachial plexus palsy patients treated without the free functioning gracilis transfer. In conclusion, the free functioning gracilis transfer is a reliable reconstructive technique for reanimating upper extremity in children of all ages capable of delivering stable function over a long period of time. Level of evidence: IV

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.

A novel strategy for repairing preganglionic cervical root avulsion in brachial plexus injury by sural nerve grafting

2009 ◽  
Vol 110 (4) ◽  
pp. 775-785 ◽  
Author(s):  
Jau-Ching Wu ◽  
Wen-Cheng Huang ◽  
Ming-Chao Huang ◽  
Yun-An Tsai ◽  
Yu-Chun Chen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Muscle Strength ◽  
Medical Research ◽  
Brachial Plexus ◽  
Sural Nerve ◽  
Research Council ◽  
Medical Research Council ◽  
Brachial Plexus Injury ◽  
Cervical Spinal Cord ◽  
Nerve Grafting

Object In this study, the authors evaluated the efficacy of a new surgical strategy for reconnecting the injured brachial plexus with the spinal cord using fibrin glue containing acidic fibroblast growth factor as an adhesive and neurotrophic agent. Methods Eighteen patients with preganglionic brachial plexus injuries, each with varying degrees of upper limb dysfunction, underwent cervical laminectomy with or without sural nerve grafting. The treatment of each avulsed root varied according to the severity of the injury. Some patients also underwent a second-stage operation involving supraclavicular brachial plexus exploration for reconnection with the corresponding segment of cervical spinal cord at the trunk level. Muscle strength was graded both pre- and postoperatively with the British Medical Research Council scale, and the results were analyzed with the Friedman and Wilcoxon signed-rank tests. Results Muscle strength improvements were observed in 16 of the 18 patients after 24 months of follow-up. Significant improvements in mean muscle strength were observed in patients from all repair method groups at 12 and 24 months postoperatively (p < 0.05). Statistical significance was not reached in the groups with insufficient numbers of cases. Conclusions The authors' new surgical strategy yielded clinical improvement in muscle strength after preganglionic brachial plexus injury, such that nerve regeneration may have taken place. Reconnection of the brachial plexus to the cervical spinal cord is possible. Functional motor recovery, observed through increases in Medical Research Council–rated muscle strength in the affected arm, is likewise possible.

C5-8 neonatal brachial plexus palsy. Operative findings, reconstructive strategy and outcome

2020 ◽  
Vol 45 (8) ◽  
pp. 798-804
Author(s):  
Aude Lombard ◽  
Manon Bachy ◽  
Frank Fitoussi
Keyword(s):  
Brachial Plexus ◽  
External Rotation ◽  
Elbow Flexion ◽  
Active Movement ◽  
Brachial Plexus Palsy ◽  
Level Of Evidence ◽  
Neonatal Brachial Plexus Palsy ◽  
Brachial Plexus Repair ◽  
Operative Findings

From 1998 to 2014, we performed primary brachial plexus repair in 260 children with neonatal brachial plexus palsy. Thirty-three presented with a C5-8 palsy and 24 were reviewed for this study. The surgical strategy was to focus on repairing the upper trunk. Secondary surgical procedures were performed in 21 patients, mainly for shoulder external rotation deficit or weak wrist extension. After a mean follow-up of 9.7 years (range 3 to 19), the median Mallet score for the shoulder was 9.5 and the mean Raimondi score for the hand was 3.3. Median active movement scale was 5, 7 and 5.5 for the deltoid, biceps and triceps, respectively. We conclude that primary C5-8 brachial plexus reconstruction provides restoration of elbow flexion and most patients have a sensitive and functional hand. We also found that secondary surgery to improve shoulder and wrist function is often necessary, which should initially be explained to the family. Level of evidence: IV

Sign in / Sign up

Export Citation Format

Share Document