Efficacy and Safety of Oberlin's Procedure in the Treatment of Brachial Plexus Birth Palsy

Neurosurgery ◽  
2012 ◽  
Vol 71 (6) ◽  
pp. 1156-1161 ◽  
Author(s):  
Mario G. Siqueira ◽  
Mariano Socolovsky ◽  
Carlos Otto Heise ◽  
Roberto S. Martins ◽  
Gilda Di Masi
Keyword(s):  
Surgical Treatment ◽  
Brachial Plexus ◽  
Elbow Flexion ◽  
High Rate ◽  
X Rays ◽  
Efficacy And Safety ◽  
Motor Branch ◽  
Brachial Plexus Birth Palsy ◽  
Birth Palsy

ABSTRACT BACKGROUND: In brachial plexus injuries, when there are no available roots to use as a source for graft reconstruction, nerve transfers emerge as an elective technique. For this purpose, transfer of an ulnar nerve fascicle to the biceps motor branch (Oberlin's procedure) is often used. Despite the high rate of good to excellent results in adults, this technique is seldom used in children. OBJECTIVE: To evaluate the efficacy and safety of Oberlin's procedure in the surgical treatment of brachial plexus birth palsy. METHODS: Striving to restore elbow flexion, we performed Oberlin's procedure in 17 infants with brachial plexus birth palsy. After follow-up of at least 19 months, primary outcomes were the strength of elbow flexion (modified British Medical Research Council Scale), hand function measured using Al-Qattan's Scale, and comparative x-rays of both hands to detect altered growth. RESULTS: Good to excellent results related to biceps contraction were obtained in 14 patients (82.3%) (3/MRC3, 11/MRC4). The preoperative Al-Qattan Scale score for the hand was maintained at final follow-up. Comparing the treated and normal limb, no difference was observed in hand development by x-ray. CONCLUSION: Oberlin's procedure is an effective and safe option for the surgical treatment of upper brachial plexus birth palsy.

scholarly journals Biceps Brachii Long Head Overactivity Associated with Elbow Flexion Contracture in Brachial Plexus Birth Palsy

2012 ◽  
Vol 94 (4) ◽  
pp. 289-297 ◽  
Author(s):  
Lindsey C Sheffler ◽  
Lisa Lattanza ◽  
Mitell Sison-Williamson ◽  
Michelle A James
Keyword(s):  
Brachial Plexus ◽  
Biceps Brachii ◽  
Elbow Flexion ◽  
Flexion Contracture ◽  
Brachial Plexus Birth Palsy ◽  
Birth Palsy ◽  
Long Head

Functional outcomes of tendon transfer for brachial plexus birth palsy using the Hoffer technique

2020 ◽  
Vol 102-B (2) ◽  
pp. 246-253 ◽  
Author(s):  
Ram K. Alluri ◽  
Nina Lightdale-Miric ◽  
Erin Meisel ◽  
Gina Kim ◽  
Jesse Kaplan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Brachial Plexus ◽  
Functional Outcomes ◽  
External Rotation ◽  
Shoulder Abduction ◽  
Active Movement ◽  
Brachial Plexus Birth Palsy ◽  
Derotational Osteotomy ◽  
Birth Palsy

Aims To describe and analyze the mid-term functional outcomes of a large series of patients who underwent the Hoffer procedure for brachial plexus birth palsy (BPBP). Methods All patients who underwent the Hoffer procedure with minimum two-year follow-up were retrospectively reviewed. Active shoulder range of movement (ROM), aggregate modified Mallet classification scores, Hospital for Sick Children Active Movement Scale (AMS) scores, and/or Toronto Test Scores were used to assess functional outcomes. Subgroup analysis based on age and level of injury was performed. Risk factors for subsequent humeral derotational osteotomy and other complications were also assessed. A total of 107 patients, average age 3.9 years (1.6 to 13) and 59% female, were included in the study with mean 68 months (24 to 194) follow-up. Results All patients demonstrated statistically significant improvement in all functional outcomes and active shoulder abduction and external rotation ROM (p < 0.001). Patients < 2.5 years of age had higher postoperative AMS, abduction ROM and strength scores, and aggregate postoperative Toronto scores (p ≤ 0.035) compared to patients ≥ 2.5 years old. There were 17 patients (16%) who required a subsequent humeral derotational osteotomy; lower preoperative AMS external rotation scores and external rotation ROM were predictive risk factors (p ≤ 0.016). Conclusion Patients with BPBP who underwent the Hoffer procedure demonstrated significant improvement in postoperative ROM, strength, and functional outcome scores at mid-term follow-up. Patients younger than 2.5 years at the time of surgery generally had better functional outcomes. Limited preoperative external rotation strength and ROM were significantly associated with requirement for subsequent humeral derotational osteotomy. In our chort significant improvements in shoulder function were obtained after the Hoffer procedure for BPBP. Cite this article: Bone Joint J 2020;102-B(2):246–253.

scholarly journals Pronator Quadratus to Extensor Carpi Radialis Brevis Nerve Transfer in C5–C7 or C5–C8 Brachial Plexus Injuries for Independent Wrist Extension

2020 ◽  
Vol 53 (01) ◽  
pp. 036-041
Author(s):  
Anil Bhatia ◽  
Mahmoud Salama
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Wrist Extension ◽  
Pronator Quadratus ◽  
Motor Branch ◽  
Nerve Surgery ◽  
Extensor Carpi Radialis

Abstract Background Patients with lesions affecting C7 and C8 roots (in addition to C56) demonstrate loss of independent wrist dorsiflexion in addition to loss of shoulder abduction and elbow flexion. Traditionally, this deficit has been addressed using tendon transfers after useful function at the shoulder and elbow has been restored by primary nerve surgery. Confidence with nerve transfer techniques has prompted attempts to replace this method by incorporating procedures for wrist dorsiflexion in the primary operation itself. Aim The objective of this study was to report the results of pronator quadratus motor branch transfers to the extensor carpi radialis brevis motor branch to reconstruct wrist extension in C5–C8 root lesions of the brachial plexus. Patients and Methods Twenty-three patients, average age 30 years, with C5–8 root injuries underwent operations an average of 4.7 months after their accident. Extrinsic extension of the fingers and thumb was weak or absent in two cases while the remaining 18 patients could open their hand actively. The patients lacked independent wrist extension when they were examined with the fingers flexed as the compensatory action of the extrinsic finger extensors was removed. The average follow-up was 21 months postoperative with the minimal follow-up period was at least 12 months. Results Successful reinnervations of the extensor carpi radialis brevis (ECRB) were demonstrated in all patients. In 17 patients, wrist extension scored M4, and in 3 patients it scored M3. Conclusions The pronator quadratus (PQ) to ECRB nerve transfer in C5–C7 or C5–C8 brachial plexus injuries for independent wrist extension reconstruction gives consistently good results with minimal donor morbidity.

scholarly journals Onabotulinum toxin type A injection into the triceps unmasks elbow flexion in infant brachial plexus birth palsy

Medicine ◽  
2020 ◽  
Vol 99 (34) ◽  
pp. e21830
Author(s):  
Melanie A. Morscher ◽  
Matthew D. Thomas ◽  
Suneet Sahgal ◽  
Mark J. Adamczyk
Keyword(s):  
Brachial Plexus ◽  
Elbow Flexion ◽  
Type A ◽  
Brachial Plexus Birth Palsy ◽  
Birth Palsy

Surgical Treatment of Brachial Plexus Birth Palsy

1991 ◽  
Vol &NA; (264) ◽  
pp. 39???47 ◽  
Author(s):  
ALAIN GILBERT ◽  
ROBERTA BROCKMAN ◽  
HENRI CARLIOZ
Keyword(s):  
Surgical Treatment ◽  
Brachial Plexus ◽  
Brachial Plexus Birth Palsy ◽  
Birth Palsy

‘Switch’ technique to restore pronation and radial deviation in 17 patients with brachial plexus birth palsy

2019 ◽  
Vol 44 (9) ◽  
pp. 905-912
Author(s):  
Türker Özkan ◽  
Hasan Utkan Aydin ◽  
Ömer Berköz ◽  
Safiye Özkan ◽  
Erol Kozanoğlu
Keyword(s):  
Brachial Plexus ◽  
Performance Measure ◽  
Occupational Performance ◽  
Level Of Evidence ◽  
Ulnar Deviation ◽  
Canadian Occupational Performance Measure ◽  
Brachial Plexus Birth Palsy ◽  
Activity Performance ◽  
Birth Palsy

We report outcomes of 17 children with brachial plexus birth palsy that underwent extensor carpi ulnaris to brachioradialis and brachioradialis to abductor pollicis longus transfers to correct supination and ulnar deviation deformity. Mean age at the time of surgery was 8.7 years and mean follow-up time was 21 months (8–44). These patients had marked increases in active forearm rotation and Canadian Occupational Performance Measure scores. Activity performance score on the measure increased from 1.1 to 6.7 and satisfaction score increased from 0.8 to 8.7 at final follow-up. We conclude from our patient series that these tendon transfers are effective in correction of the supination and ulnar deviation deformities in brachial plexus birth palsy. Level of evidence: IV

Subscapularis Z-lengthening in children with brachial plexus birth palsy loses efficiency at mid-term follow-up: a retrospective cohort study

2015 ◽  
Vol 40 (4) ◽  
pp. 783-790 ◽  
Author(s):  
Anne Sophie Kruit ◽  
Fouzia Choukairi ◽  
Anuj Mishra ◽  
Andrew Gaffey ◽  
Andrea Jester
Keyword(s):  
Cohort Study ◽  
Brachial Plexus ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Brachial Plexus Birth Palsy ◽  
Birth Palsy

scholarly journals Reliability of Towel Test for Elbow Flexion Assessment in Brachial Plexus Birth Palsy

2021 ◽  
Author(s):  
J. Terrence Jose Jerome ◽  
S. Vanathi ◽  
G. Ramesh Prabu ◽  
K. Thirumagal
Keyword(s):  
Brachial Plexus ◽  
False Negative ◽  
Elbow Flexion ◽  
Statistical Correlation ◽  
Left Hand ◽  
Left Handed ◽  
Brachial Plexus Birth Palsy ◽  
Birth Palsy

Abstract Background and Objectives The towel test is a reliable and straightforward technique to find elbow flexion in brachial plexus birth palsy. This study evaluates the role and reliability of towel test in children at 6 and 9 months of age. Materials and Methods We conducted the towel test in 30 consecutive children at 6 and 9 months of their ages between 2015 and 2020. We recorded the results along with the side involved in these children and the mother’s handedness. Based on the results of towel tests, we did a statistical correlation. Results Sixteen of the 30 children were boys. Twelve of the 30 children had left-side involvement. Four mothers were left handed. Four (13%) infants (male = 3; female = 1) had false-negative towel test at 6 and 9 months. There is a significant correlation between the left-hand mother’s and infant who had false-negative towel test (p < 0.01) Conclusion The towel test is reliable and straightforward to assess the elbow flexion at 6 and 9 months. It can be falsely negative in 13% of children because of handedness. Mother’s handedness is crucial and should be recorded during the children assessment. Alternate tests will further evaluate the elbow flexion in such false-negative towel-tested brachial plexus birth palsy children.

scholarly journals The Prevalence, Rate of Progression, and Treatment of Elbow Flexion Contracture in Children with Brachial Plexus Birth Palsy

2012 ◽  
Vol 94 (5) ◽  
pp. 403-409 ◽  
Author(s):  
Lindsey C Sheffler ◽  
Lisa Lattanza ◽  
Yolanda Hagar ◽  
Anita Bagley ◽  
Michelle A James
Keyword(s):  
Brachial Plexus ◽  
Prevalence Rate ◽  
Elbow Flexion ◽  
Flexion Contracture ◽  
Brachial Plexus Birth Palsy ◽  
Rate Of Progression ◽  
Birth Palsy
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