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 DOES COGNITIVE CAPACITY INTERFERE WITH THE OUTCOME OF OBERLIN TRANSFER?

2018 ◽  
Vol 26 (6) ◽  
pp. 394-396
Author(s):  
Fernando Antonio Silva de Azevedo Filho ◽  
William Zarza Santos ◽  
Thomaz Gê de Oliveira ◽  
Yussef Ali Abdouni ◽  
Antonio Carlos da Costa ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Traumatic Injury ◽  
Elbow Flexion ◽  
Cognitive Capacity ◽  
Cognitive Level ◽  
Level Of Evidence ◽  
Strength Recovery ◽  
Active Range Of Motion ◽  
The Relationship ◽  
Flexion Strength

ABSTRACT Objective: To determine the relationship between the functional outcome achieved following Oberlin transfer, the cognitive level of the patient, and the time elapsed between the trauma event and surgery. Methods: Eighteen patients with a traumatic injury to the brachial plexus (C5-C6 and C5-C7) were evaluated. Seventeen (94.4%) patients were males and one (5.6%) was female, with a mean age of 29.5 years (range 17-46 years). We evaluated the active range of motion, elbow flexion strength, and Disabilities of the Arm, Shoulder and Hand (DASH) and determined the correlation between the procedural outcome and the patient's cognitive level, as assessed by the Mini-Mental State Exam (MMSE). Results: We found statistically significant correlations between the MMSE scale and strength recovery (84.4%, p<0.001), which was classified as excellent, and between the MMSE and British Medical Research Council (BMRC) scales (78.4%, p>0.001), which classified cognitive level as good. Conclusions: We found a positive correlation between cognitive capacity and functional outcome of patients submitted to Oberlin surgery. The time elapsed between trauma and the surgical procedure showed an inversely proportional correlation with the strength of recovery. Level of Evidence II, Retrospective Study.

Does technical components of microanastomoses influence the functional outcome of free gracilis muscle transfer for elbow flexion in traumatic brachial plexus injury?

2021 ◽  
pp. 102827
Author(s):  
Francisco Vilmar Felix Martins-Filho ◽  
Fernanda do Carmo Iwase ◽  
Gustavo Bersani Silva ◽  
Alvaro Baik Cho ◽  
Teng Hsiang Wei ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Functional Outcome ◽  
Brachial Plexus Injury ◽  
Elbow Flexion ◽  
Gracilis Muscle ◽  
Muscle Transfer

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.

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 The Use of Dynamic Assist Orthosis for Muscle Reeducation following Brachial Plexus Injury and Reconstruction

2018 ◽  
Vol 10 (03) ◽  
pp. 172-177
Author(s):  
Shrikant Chinchalkar ◽  
Juliana Larocerie-Salgado ◽  
Jeremy Cepek ◽  
Marie-Lyne Grenier
Keyword(s):  
Brachial Plexus ◽  
Range Of Motion ◽  
Treatment Option ◽  
Muscle Atrophy ◽  
Clinical Reasoning ◽  
Brachial Plexus Injury ◽  
Elbow Flexion ◽  
Human Functioning ◽  
And Function ◽  
The Impact

AbstractTherapeutic management of brachial plexus injuries remains complex. The impact of brachial plexus injuries on everyday human functioning should not be underestimated. Early active-assisted range of motion following such injuries may prevent myostatic contractures, minimize muscle atrophy, facilitate muscle fiber recruitment, and enable a faster return to baseline strength levels. The dynamic assist elbow flexion orthosis proposed is designed to provide patients with a graded system for muscle reeducation and function. No clinical data are currently available on the use of this orthosis design; however, this article presents a treatment option based on sound clinical reasoning to facilitate rehabilitation following this devastating injury.

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

Brachialis muscle transfer for reconstructing digital flexion after brachial plexus injury or forearm injury

2017 ◽  
Vol 43 (3) ◽  
pp. 259-268 ◽  
Author(s):  
Yun-Dong Shen ◽  
Mou-Xiong Zheng ◽  
Xu-Yun Hua ◽  
Yan-Qun Qiu ◽  
Ke-Jia Hu ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Middle Finger ◽  
Muscle Transfer ◽  
Level Of Evidence ◽  
Brachialis Muscle ◽  
Donor Muscle ◽  
Injured Patients

Restoration of digital flexion after brachial plexus injury or forearm injury has been a great challenge for hand surgeons. Nerve transfer and forearm donor muscle transfer surgeries are not always feasible. The present study aimed at evaluating the effectiveness of restoring digital flexion by brachialis muscle transfer. Ten lower brachial plexus- or forearm-injured patients were enrolled. After at least 12 months following surgery, the middle-finger-to-palm distance was less than 2.5 cm in six patients. In the other four patients with less satisfactory results, secondary tenolysis surgery was performed and the middle-finger-to-palm distances were reduced to 2.0–4.0 cm. The average grasp strength was 20 ± 4 kg. Elbow flexion was not adversely affected. In conclusion, brachialis muscle transfer is an effective method for reconstructing digital flexion, not only in lower brachial plexus injury, but also in forearm injury patients. Level of evidence: IV

Clinical Outcomes After Aggressive Active Early Motion and Modified Kleinert Regimens: Comparison of 2 Consecutive Cohorts

Hand ◽  
2021 ◽  
pp. 155894472110172
Author(s):  
Kaisa Jokinen ◽  
Arja Häkkinen ◽  
Toni Luokkala ◽  
Teemu Karjalainen
Keyword(s):  
Quality Of Life ◽  
Range Of Motion ◽  
Grip Strength ◽  
Clinical Outcomes ◽  
Flexor Tendon ◽  
Hand Grip Strength ◽  
Active Motion ◽  
Hand Grip ◽  
Active Range Of Motion

Background Modern multistrand repairs can withstand forces present in active flexion exercises, and this may improve the outcomes of flexor tendon repairs. We developed a simple home-based exercise regimen with free wrist and intrinsic minus splint aimed at facilitating the gliding of the flexor tendons and compared the outcomes with the modified Kleinert regimen used previously in the same institution. Methods We searched the hospital database to identify flexor tendon repair performed before and after the new regimen was implemented and invited all patients to participate. The primary outcome was total active range of motion, and secondary outcomes were Disabilities of Arm, Shoulder, and Hand; grip strength; globally perceived function; and the quality of life. Results The active range of motion was comparable between the groups (mean difference = 14; 95% confidence interval [CI], −8 to 36; P = .22). Disabilities of Arm, Shoulder, and Hand; grip strength; global perceived function; and health-related quality of life were also comparable between the groups. There was 1 (5.3%) rupture in the modified Kleinert group and 4 (15.4%) in the early active motion group (relative risk = 0.3; 95% CI, 0.04-2.5; P = .3). Conclusions Increasing active gliding with a free wrist and intrinsic minus splint did not improve the clinical outcomes after flexor tendon injury at a mean of 38-month follow-up.

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