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

We report the results of ten consecutive patients who had correction of an elbow flexion contracture of greater than 30° in brachial plexus birth injury using a modified Outerbridge-Kashiwagi procedure. All patients had minimum 23-month follow-up. Pre- and post-operative elbow range of motion and DASH scores were recorded in all patients. The operative technique for the procedure and post-operative course is discussed. Surgery was supplemented by botulinum toxin injection into the biceps brachii muscle in most cases. The average age at surgery was 14 years 10 months. The initial plexus lesion was global in eight patients and upper in two. Pre-operative flexion contractures averaged 51° (range 35 to 60) and post-operative averaged 21° (range 15 to 30). Of these patients, one had no change in active flexion, four had loss of active flexion, and five had gain of active flexion. All ten patients were satisfied with their results and stated that they would recommend the procedure to other patients. Level of evidence: IV

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

Medicine ◽

10.1097/md.0000000000021830 ◽

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

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

Neurosurgery ◽

10.1227/neu.0b013e318271ee4a ◽

2012 ◽

Vol 71 (6) ◽

pp. 1156-1161 ◽

Cited By ~ 22

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.

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

Indian Journal of Neurotrauma ◽

10.1055/s-0041-1732787 ◽

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.

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