scholarly journals Results of Sever- L’ Episcopo procedure for obstetric brachial plexus palsy

2016 ◽  
Vol 3 (1) ◽  
pp. 50
Author(s):  
Karthi Sundar V. ◽  
Anil Kumar S.V.
Keyword(s):  
Brachial Plexus ◽  
External Rotation ◽  
Social Stigma ◽  
Functional Results ◽  
Functional Improvement ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus ◽  
Teres Major

<p class="abstract"><strong>Background:</strong> The reported incidence of obstetric brachial plexus palsy (OBPP) varies from 0.3 to 2.5 per 1000 live births<strong></strong>resulting in internal rotation deformity and weak abduction of the involved side shoulder<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> To retrospectively analyse the functional results of the Sever- L‘ Episcopo procedure for OBPP with a minimum follow-up of 2 years to a maximum of 13 years using modified Mallet scoring system for shoulder.<strong></strong></p><p class="abstract"><strong>Results:</strong> A significant improvement in the range of abduction and the restoration of external rotation of shoulder was achieved with Sever- L’Episcopo procedure<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The results of secondary reconstruction of a dysfunctional shoulder by means of a Lattismus dorsi &amp; Teres major transfer as described by Sever- L’Episcopo is definitely beneficial. However this procedure will improve, but will not normalize, function. Apart from functional improvement this procedure corrects a deformity thereby easing the psycho-social stigma associated with it<span lang="EN-IN">.</span></p>

An adjustable shoulder abduction orthosis for the post-operative management of tendon transfers: A preliminary study

2008 ◽  
Vol 32 (2) ◽  
pp. 129-135 ◽  
Author(s):  
Suat Erel ◽  
İbrahim Engin Şimşek ◽  
Çiğdem Ayhan ◽  
Nilgün Bek ◽  
Yavuz Yakut ◽  
...  
Keyword(s):  
External Rotation ◽  
Operative Management ◽  
Shoulder Abduction ◽  
Rehabilitation Center ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Musculus Latissimus Dorsi ◽  
Obstetric Brachial Plexus ◽  
Teres Major ◽  
Preliminary Study

Transfer of Musculus Latissimus dorsi/M. Teres major to the rotator cuff with or without M. Subscapularis/M. Pectoralis release is a widely used procedure for restoring shoulder abduction and external rotation in squeal of obstetric brachial plexus palsy. After the operation a shoulder abduction orthosis in maximal external rotation and 90 – 100° abduction is utilized following six weeks of immobilization in a shoulder spica cast for protecting the newly transferred muscle from undue elongation. However this in turn may cause contracture of the external rotators. To overcome this problem, a modified shoulder abduction splint with adjustable internal-external rotation/abduction-adduction ranges was developed in the orthotics department of a rehabilitation center. The custom molded adjustable shoulder abduction orthosis is described and the preliminary results are compared with former applications.

Latissimus Dorsi Transfer for External Rotation Weakness of the Shoulder in Obstetric Brachial Plexus Palsy

2003 ◽  
Vol 28 (5) ◽  
pp. 405-408 ◽  
Author(s):  
M. M. Al-QATTAN
Keyword(s):  
Brachial Plexus ◽  
Latissimus Dorsi ◽  
External Rotation ◽  
Skeletal Development ◽  
Shoulder Abduction ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Latissimus Dorsi Transfer ◽  
Obstetric Brachial Plexus ◽  
Shoulder External Rotation

This report describes the results of latissimus dorsi transfer for weakness of shoulder external rotation in 12 children with obstetric brachial plexus palsy. Selection criteria for the muscle transfer procedure included good passive external rotation of the shoulder, normal skeletal development of the shoulder joint, and adequate power of the deltoid. In addition to measuring the ranges of motion of joints before and after surgery, a modified Mallet grading system was utilized for the functional assessment of shoulder external rotation. At a mean follow-up of 4 years, two of the 12 children had recurrence of the shoulder deformity. In the remaining 10 children, the mean active external rotation was 30° (range, 20–60°), mean shoulder abduction was 140° (range, 90–170°), and all children had achieved a modified Mallet score of 4.

Management strategies for shoulder reconstruction in obstetric brachial plexus injury with special reference to loss of internal rotation after surgery

2012 ◽  
Vol 37 (8) ◽  
pp. 772-779 ◽  
Author(s):  
M. Sibinski ◽  
T. E. J. Hems ◽  
D. A. Sherlock
Keyword(s):  
Soft Tissue ◽  
Brachial Plexus ◽  
Internal Rotation ◽  
External Rotation ◽  
Management Strategies ◽  
Shoulder Function ◽  
Obstetric Brachial Plexus ◽  
Teres Major ◽  
Shoulder Reconstruction

We assessed the outcomes in 24 of 25 children (mean age 3 years) who had soft-tissue shoulder reconstruction procedures for obstetric brachial plexus injuries. All had latissimus dorsi and teres major transfers to strengthen external rotation combined with subscapularis lengthening, reduction of posterior dislocation or subluxation, and humeral osteotomy, if necessary. At a mean follow-up of 3.8 years, the mean Mallet score improved from 12.3 preoperatively to 17.4 postoperatively, active external rotation improved from 21° to 32°, and passive external rotation improved from 26° to 67°. The shoulder remained in joint in all patients. Active internal rotation deteriorated in nine shoulders, two requiring secondary internal rotation osteotomy. Combined soft tissue rebalancing and bony procedures gives reliable shoulder function improvement. Care is required regarding the effect on internal rotation.

Functional Scoring System for Obstetric Brachial Plexus Palsy

2000 ◽  
Vol 25 (1) ◽  
pp. 41-45 ◽  
Author(s):  
H. BASHEER ◽  
V. ZELIC ◽  
F. RABIA
Keyword(s):  
Brachial Plexus ◽  
Scoring System ◽  
Good Recovery ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Upper Limb Function ◽  
Obstetric Brachial Plexus ◽  
Good Score ◽  
New Scoring

We suggest a new scoring system that measures the upper limb function both as a unit and in separate parts. Our system was designed to study the recovery in patients with obstetric brachial plexus palsy (OBPP). It measures active limb movements and compares them with the normal side to obtain a ratio, which is then converted to a score. Fifty-two patients with OBPP were studied with a follow-up of 2 years. The progress of the patients was monitored using the system. Thirty-seven patients (71%) achieved very good recovery, eight patients (15%) achieved a good score, and five patients (10%) achieved a poor score. Most of the recovery occurred before the age of 6 months.

Surgical Correction of Supination Deformity in Children with Obstetric Brachial Plexus Palsy

2002 ◽  
Vol 27 (1) ◽  
pp. 20-23 ◽  
Author(s):  
J. BAHM ◽  
A. GILBERT
Keyword(s):  
Brachial Plexus ◽  
Treatment Plan ◽  
Final Position ◽  
Brachial Plexus Palsy ◽  
Forearm Rotation ◽  
Obstetric Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus ◽  
The Mean ◽  
Surgical Corrections

We present a series of 40 children who were operated on for supination contracture following severe obstetric brachial plexus palsy. Surgery was done at an average age of 7 years and the mean postoperative follow-up was 4 years. In the 23 cases treated by an open or closed radial osteotomy, the mean intraoperative derotation was 78°, the immediate postoperative position was 29° pronation and it stabilized at follow-up at 17° pronation. Biceps rerouting was performed in 17 cases without any recurrence of supination deformity and the final position was 22° pronation. Some active forearm rotation was obtained in a few cases. These surgical corrections are part of an overall treatment plan and allow the “begging hand” to be corrected to a more functional and less noticeable position.

Classification of Impairment of Shoulder Abduction in Obstetric Brachial Plexus Palsy and its Clinical Significance

2000 ◽  
Vol 25 (1) ◽  
pp. 46-48 ◽  
Author(s):  
Y-D. GU ◽  
L. CHEN ◽  
L-Y. SHEN
Keyword(s):  
Brachial Plexus ◽  
Shoulder Abduction ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
X Ray ◽  
Subscapularis Muscle ◽  
Dynamic Type ◽  
Obstetric Brachial Plexus ◽  
Teres Major

Shoulder abduction was studied in 25 cases of obstetric brachial plexus palsy (OBPP). According to muscle function, electromyographic features and X-ray examination, impairment of shoulder abduction could be classified into dynamic, resistant or combined types. Five cases were the dynamic type, which was characterized by paralysis of the shoulder abductors. Fifteen cases were categorized as the resistant type, with contracture of the subscapularis muscle, co-contraction of latissimus dorsi and teres major muscles and secondary disorders of the shoulder joint. Five cases were classified as the combined type in which there were both dynamic and resistant factors. Appropriate management and surgical procedures in the shoulder affected by OBPP depend on the pathological classification.

Obstetric Brachial Plexus Palsy in Newborn Babies of Diabetic and Non-Diabetic Mothers

2010 ◽  
Vol 35 (5) ◽  
pp. 362-365 ◽  
Author(s):  
M.M. Al-Qattan ◽  
A.A.F. El-Sayed ◽  
A.Y. Al-Zahrani ◽  
S.A. Al-Mutairi ◽  
M.S. Al-Harbi ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Spontaneous Recovery ◽  
External Rotation ◽  
Elbow Flexion ◽  
Motor Power ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus ◽  
Shoulder External Rotation ◽  
Diabetic Mothers

Compared to non-diabetic mothers, diabetic mothers are known to deliver larger babies who are at higher risk for shoulder dystocia and obstetric brachial plexus palsy. The intrapartum forces applied during delivery of larger babies are expected to be higher. Hence, the chances of these babies for good spontaneous recovery are expected to be lower; and this is a generally believed hypothesis. The objective of this retrospective study was to compare obstetric brachial plexus palsy in newborn babies of diabetic and non-diabetic mothers. There were a total of 655 cases of obstetric palsy: 253 cases with diabetic mothers and 402 with non-diabetic mothers. The former were more likely to develop total palsy while the latter were more likely to develop extended Erb’s palsy. Newborn babies of diabetic mothers had significantly larger birth weights than those of non-diabetic mothers regardless of the type of palsy. The rate of good spontaneous recovery of the motor power of the limb in the two groups was not significantly different except in total palsy cases for shoulder external rotation and elbow flexion where the recovery was significantly better in the diabetic group. It was concluded that the generally believed hypothesis is not correct if one compares the outcome in the diabetic and non-diabetic groups for each type of palsy.

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