scholarly journals Robotic rehabilitation training with a newly developed upper limb single-joint Hybrid Assistive Limb (HAL-SJ) for elbow flexor reconstruction after brachial plexus injury: A report of two cases

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901877788 ◽  
Author(s):  
Shigeki Kubota ◽  
Hideki Kadone ◽  
Yukiyo Shimizu ◽  
Yuki Hara ◽  
Tadashi Kubo ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Medical Research Council ◽  
Brachial Plexus Injury ◽  
Elbow Flexion ◽  
Intercostal Nerve ◽  
Elbow Flexor ◽  
Robotic Rehabilitation ◽  
Grade 3 ◽  
Hybrid Assistive Limb

This study aimed to evaluate the effectiveness and safety of using the upper limb single-joint Hybrid Assistive Limb (upper limb HAL-SJ) during elbow flexion training following elbow flexor reconstruction for brachial plexus injury (BPI). We present the cases of two patients in whom the upper limb HAL-SJ was implemented 5 and 7 months postoperatively following elbow flexor reconstruction for BPI. They underwent elbow flexor reconstruction with intercostal nerve crossing-to-musculocutaneous nerve (ICN-MCN crossing) after BPI. Postoperative training using the upper limb HAL-SJ was started from the Medical Research Council (MRC) grade 1 elbow flexion power to MRC grade 3 once every week or every 2 weeks. Both patients could implement elbow training using the upper limb HAL-SJ even in MRC grade 1 of their elbow flexion power. Training with the upper limb HAL-SJ was performed safely and effectively in two patients with elbow flexor reconstruction with ICN crossing after BPI.

scholarly journals Triceps to biceps transfer for restoration of elbow flexion following upper brachial plexus injury

2017 ◽  
Vol 50 (01) ◽  
pp. 035-042
Author(s):  
Pothula Durga Prasada Rao ◽  
Rayidi Venkata Koteswara Rao ◽  
R. Srikanth
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Biceps Tendon ◽  
Elbow Flexion ◽  
Triceps Muscle ◽  
Grade 5 ◽  
Muscle Transfers ◽  
Flexion Extension ◽  
Grade 3 ◽  
Nerve Surgery

ABSTRACT Introduction: Upper brachial plexus injury in adults causes loss of elbow fl exion; when the primary nerve surgery has failed or the patient seeks treatment after 12 months of injury and pedicled muscle transfers are required. Most commonly, the latissimus dorsi or the Steindler flexorplasty is used. Material and Methods: We have transferred one of the heads of triceps muscle to restore the elbow flexion in such cases. In addition to return of elbow flexion, extension of elbow following surgery is retained. Ten patients suffering from upper brachial plexus injuries underwent transfer of one head of triceps to biceps tendon between December 2011 and August 2015. Results: The recovery of elbow flexion was Grade 5 in 1, Grade 4 in 4 and Grade 3 in 2; only three of the ten patients had no functionally useful elbow flexion. Seven of the ten patients had an adequate elbow extension following the procedure.

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.

scholarly journals FUNCTIONAL OUTCOME OF OBERLIN PROCEDURE

2019 ◽  
Vol 27 (6) ◽  
pp. 294-297
Author(s):  
Fernando Antonio Silva de Azevedo Filho ◽  
Yussef Ali Abdouni ◽  
Guilherme Ogawa ◽  
Cloud Kennedy Couto de Sá ◽  
Antonio Carlos da Costa ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Range Of Motion ◽  
Functional Outcome ◽  
Brachial Plexus Injury ◽  
Elbow Flexion ◽  
Level Of Evidence ◽  
Hand Grip ◽  
Strength Recovery ◽  
Active Range Of Motion ◽  
Grade 3

ABSTRACT Objective: To evaluate the functional outcome of patients with traumatic brachial plexus injury undergoing the Oberlin procedure. Methods: Eighteen patients were assessed, comprising 17 men (94.4%) and 1 woman (5.6%), mean age 29.5 years (range 17-46 years), with upper traumatic brachial plexus injury (C5-C6 and C5-C7). We assessed active range of motion of the elbow, elbow flexion muscle strength and hand-grip strength, and applied the DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire. Results: Four patients (22.2%) did not achieve effective elbow flexion strength (BMRC Grade 3). Mean active range of motion was 100.2° (±45.6°), and we observed a mean percentage of strength recovery relative to the contralateral limb of 35.5% (0-66.3%). Elbow flexion (p = 0.0001) and hand-grip (p = 0.0001) strength levels were lower on the affected side. Conclusion: The surgical technique described by Oberlin for brachial plexus injuries proved effective for restoring elbow flexion and produced no functional sequelae in the hand. Bicep strength outcomes were better when surgery was performed within 12 months of injury. Level of evidence II, retrospective study.

scholarly journals A newly developed upper limb single-joint HAL in a patient with elbow flexion reconstruction after traumatic brachial plexus injury: A case report

2017 ◽  
Vol 10 ◽  
pp. 66-68 ◽  
Author(s):  
Shigeki Kubota ◽  
Yuki Hara ◽  
Yukiyo Shimizu ◽  
Hideki Kadone ◽  
Tadashi Kubo ◽  
...  
Keyword(s):  
Case Report ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Injury ◽  
Elbow Flexion

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.

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.

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