scholarly journals Median and/or Ulnar Nerve Fascicle Transfer for the Restoration of Elbow Flexion in Upper Neonatal Brachial Plexus Palsy

2014 ◽  
Vol 4 (2) ◽  
pp. e8
Author(s):  
Kevin J. Little ◽  
Dan A. Zlotolow ◽  
Francisco Soldado ◽  
Roger Cornwall ◽  
Scott H. Kozin
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Elbow Flexion ◽  
Brachial Plexus Palsy ◽  
Neonatal Brachial Plexus Palsy ◽  
Nerve Fascicle

Functional Recovery of Elbow Flexion Following Median and/or Ulnar Nerve Fascicle Transfer in Upper Trunk Neonatal Brachial Plexus Palsy

2012 ◽  
Vol 37 (8) ◽  
pp. 46-47
Author(s):  
Kevin J. Little ◽  
Francisco Soldado ◽  
Dan A. Zlotolow ◽  
Roger Cornwall ◽  
Scott H. Kozin
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Functional Recovery ◽  
Elbow Flexion ◽  
Brachial Plexus Palsy ◽  
Neonatal Brachial Plexus Palsy ◽  
Nerve Fascicle

scholarly journals Effect of fascicle composition on ulnar to musculocutaneous nerve transfer (Oberlin transfer) in neonatal brachial plexus palsy

2018 ◽  
Vol 22 (2) ◽  
pp. 181-188 ◽  
Author(s):  
Brandon W. Smith ◽  
Nicholas J. Chulski ◽  
Ann A. Little ◽  
Kate W. C. Chang ◽  
Lynda J. S. Yang
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Published Data ◽  
Brachial Plexus Palsy ◽  
Wrist Flexion ◽  
Neonatal Brachial Plexus Palsy ◽  
Nerve Fascicle ◽  
Transfer Group

OBJECTIVENeonatal brachial plexus palsy (NBPP) continues to be a problematic occurrence impacting approximately 1.5 per 1000 live births in the United States, with 10%–40% of these infants experiencing permanent disability. These children lose elbow flexion, and one surgical option for recovering it is the Oberlin transfer. Published data support the use of the ulnar nerve fascicle that innervates the flexor carpi ulnaris as the donor nerve in adults, but no analogous published data exist for infants. This study investigated the association of ulnar nerve fascicle choice with functional elbow flexion outcome in NBPP.METHODSThe authors conducted a retrospective study of 13 cases in which infants underwent ulnar to musculocutaneous nerve transfer for NBPP at a single institution. They collected data on patient demographics, clinical characteristics, active range of motion (AROM), and intraoperative neuromonitoring (IONM) (using 4 ulnar nerve index muscles). Standard statistical analysis compared pre- and postoperative motor function improvement between specific fascicle transfer (1–2 muscles for either wrist flexion or hand intrinsics) and nonspecific fascicle transfer (> 2 muscles for wrist flexion and hand intrinsics) groups.RESULTSThe patients’ average age at initial clinic visit was 2.9 months, and their average age at surgical intervention was 7.4 months. All NBPPs were unilateral; the majority of patients were female (61%), were Caucasian (69%), had right-sided NBPP (61%), and had Narakas grade I or II injuries (54%). IONM recordings for the fascicular dissection revealed a donor fascicle with nonspecific innervation in 6 (46%) infants and specific innervation in the remaining 7 (54%) patients. At 6-month follow-up, the AROM improvement in elbow flexion in adduction was 38° in the specific fascicle transfer group versus 36° in the nonspecific fascicle transfer group, with no statistically significant difference (p = 0.93).CONCLUSIONSBoth specific and nonspecific fascicle transfers led to functional recovery, but that the composition of the donor fascicle had no impact on early outcomes. In young infants, ulnar nerve fascicular dissection places the ulnar nerve at risk for iatrogenic damage. The data from this study suggest that the use of any motor fascicle, specific or nonspecific, produces similar results and that the Oberlin transfer can be performed with less intrafascicular dissection, less time of surgical exposure, and less potential for donor site morbidity.

Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries

2004 ◽  
Vol 16 (5) ◽  
pp. 313-318
Author(s):  
Thomas H. Tung ◽  
Christine B. Novak ◽  
Susan E. Mackinnon
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Elbow Flexion ◽  
Musculocutaneous Nerve ◽  
Nerve Transfers ◽  
Brachialis Muscle ◽  
Nerve Fascicle ◽  
The Mean ◽  
Mean Time ◽  
Flexion Strength

Object In this study the authors evaluated the outcome in patients with brachial plexus injuries who underwent nerve transfers to the biceps and the brachialis branches of the musculocutaneous nerve. Methods The charts of eight patients who underwent an ulnar nerve fascicle transfer to the biceps branch of the musculocutaneous nerve and a separate transfer to the brachialis branch were retrospectively reviewed. Outcome was assessed using the Medical Research Council (MRC) grade to classify elbow flexion strength in conjunction with electromyography (EMG). The mean patient age was 26.4 years (range 16–45 years) and the mean time from injury to surgery was 3.8 months (range 2.5–7.5 months). Recovery of elbow flexion was MRC Grade 4 in five patients, and Grade 4+in three. Reinnervation of both the biceps and brachialis muscles was confirmed on EMG studies. Ulnar nerve function was not downgraded in any patient. Conclusions The use of nerve transfers to reinnervate the biceps and brachialis muscle provides excellent elbow flexion strength in patients with brachial plexus nerve injuries.

scholarly journals Oberlin transfer compared with nerve grafting for improving early supination in neonatal brachial plexus palsy

2018 ◽  
Vol 21 (2) ◽  
pp. 178-184 ◽  
Author(s):  
Kate W. C. Chang ◽  
Thomas J. Wilson ◽  
Miriana Popadich ◽  
Susan H. Brown ◽  
Kevin C. Chung ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Elbow Flexion ◽  
Nerve Grafting ◽  
Brachial Plexus Palsy ◽  
Nerve Reconstruction ◽  
Early Recovery ◽  
Treatment Groups ◽  
Neonatal Brachial Plexus Palsy ◽  
Significant Difference ◽  
Transfer Group

OBJECTIVEThe use of nerve transfers versus nerve grafting for neonatal brachial plexus palsy (NBPP) remains controversial. In adult brachial plexus injury, transfer of an ulnar fascicle to the biceps branch of the musculocutaneous nerve (Oberlin transfer) is reportedly superior to nerve grafting for restoration of elbow flexion. In pediatric patients with NBPP, recovery of elbow flexion and forearm supination is an indicator of resolved NBPP. Currently, limited evidence exists of outcomes for flexion and supination when comparing nerve transfer and nerve grafting for NBPP. Therefore, the authors compared 1-year postoperative outcomes for infants with NBPP who underwent Oberlin transfer versus nerve grafting.METHODSThis retrospective cohort study reviewed patients with NBPP who underwent Oberlin transfer (n = 19) and nerve grafting (n = 31) at a single institution between 2005 and 2015. A single surgeon conducted intraoperative exploration of the brachial plexus and determined the surgical nerve reconstruction strategy undertaken. Active range of motion was evaluated preoperatively and postoperatively at 1 year.RESULTSNo significant difference between treatment groups was observed with respect to the mean change (pre- to postoperatively) in elbow flexion in adduction and abduction and biceps strength. The Oberlin transfer group gained significantly more supination (100° vs 19°; p < 0.0001). Forearm pronation was maintained at 90° in the Oberlin transfer group whereas it was slightly improved in the grafting group (0° vs 32°; p = 0.02). Shoulder, wrist, and hand functions were comparable between treatment groups.CONCLUSIONSThe preliminary data from this study demonstrate that the Oberlin transfer confers an advantageous early recovery of forearm supination over grafting, with equivalent elbow flexion recovery. Further studies that monitor real-world arm usage will provide more insight into the most appropriate surgical strategy for NBPP.

Elbow flexion in neonatal brachial plexus palsy: a meta-analysis of graft versus transfer

2019 ◽  
Vol 35 (6) ◽  
pp. 929-935
Author(s):  
Muhibullah S. Tora ◽  
Nathan Hardcastle ◽  
Pavlos Texakalidis ◽  
Jeremy Wetzel ◽  
Joshua J. Chern
Keyword(s):  
Brachial Plexus ◽  
Meta Analysis ◽  
Elbow Flexion ◽  
Brachial Plexus Palsy ◽  
Neonatal Brachial Plexus Palsy

scholarly journals Elbow Flexion in Neonatal Brachial Plexus Palsy: A Meta-Analysis of Graft Versus Transfer

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Muhibullah S Tora ◽  
Nathan Hardcastle ◽  
Pavlos Texakalidis ◽  
Jeremy Wetzel ◽  
Joshua J Chern
Keyword(s):  
Brachial Plexus ◽  
Functional Recovery ◽  
Meta Analysis ◽  
Donor Site ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Active Movement ◽  
Nerve Grafting ◽  
Brachial Plexus Palsy ◽  
Neonatal Brachial Plexus Palsy

Abstract INTRODUCTION Functional elbow flexion recovery is one of the main goals of neonatal brachial plexus palsy (NBPP) reconstruction. The current neurosurgical treatment options include nerve grafting and nerve transfer. The goal of the present study is to compare functional elbow flexion recovery in NBPP following nerve grafting or nerve transfer. METHODS The present study conducted a systematic literature review and meta-analysis according to PRISMA guidelines. A search was conducted on Pubmed for eligible studies published until November of 2018. Odds Ratios (OR) and 95% confidence intervals (CI) were calculated to compare functional elbow flexion outcomes between nerve graft and nerve transfer. A random-effects model meta-analysis was conducted. A Medical Research Council (MRC) score = 3 or Active Movement Scale (AMS) = 5 was considered functional recovery of elbow flexion. RESULTS The present study included 194 patients from 1990 2015 across five observational trials. Only pediatric patients with obstetric brachial plexus injury were included. The mean patient age at surgery varied between studies from 5.7 to 11.9 mo and mean follow-up from 12 to 70 mo. No complications or cases of donor site morbidity were reported. Functional recovery occurred with nerve transfer in 95.2% of patients (n = 59/62) and with nerve grafting in 96.4% of patients (n = 54/56). Overall, the outcomes for elbow flexion between the groups appeared similar (OR: 1.15, 95% CI: 0.19-7.08, I2: 2.9%). CONCLUSION The optimal approach to brachial plexus reconstruction in NBPP continues to be the subject of debate. As one of the most important outcomes, the present meta-analysis finds that functional recovery of elbow flexion does not appear to differ between nerve grafting and nerve transfer.

Distal nerve transfer versus supraclavicular nerve grafting: comparison of elbow flexion outcome in neonatal brachial plexus palsy with C5-C7 involvement

2017 ◽  
Vol 33 (9) ◽  
pp. 1571-1574 ◽  
Author(s):  
Carlos O. Heise ◽  
Mario G. Siqueira ◽  
Roberto S. Martins ◽  
Luciano H. Foroni ◽  
Hugo Sterman-Neto
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Nerve Grafting ◽  
Brachial Plexus Palsy ◽  
Neonatal Brachial Plexus Palsy ◽  
Distal Nerve

C5-8 neonatal brachial plexus palsy. Operative findings, reconstructive strategy and outcome

2020 ◽  
Vol 45 (8) ◽  
pp. 798-804
Author(s):  
Aude Lombard ◽  
Manon Bachy ◽  
Frank Fitoussi
Keyword(s):  
Brachial Plexus ◽  
External Rotation ◽  
Elbow Flexion ◽  
Active Movement ◽  
Brachial Plexus Palsy ◽  
Level Of Evidence ◽  
Neonatal Brachial Plexus Palsy ◽  
Brachial Plexus Repair ◽  
Operative Findings

From 1998 to 2014, we performed primary brachial plexus repair in 260 children with neonatal brachial plexus palsy. Thirty-three presented with a C5-8 palsy and 24 were reviewed for this study. The surgical strategy was to focus on repairing the upper trunk. Secondary surgical procedures were performed in 21 patients, mainly for shoulder external rotation deficit or weak wrist extension. After a mean follow-up of 9.7 years (range 3 to 19), the median Mallet score for the shoulder was 9.5 and the mean Raimondi score for the hand was 3.3. Median active movement scale was 5, 7 and 5.5 for the deltoid, biceps and triceps, respectively. We conclude that primary C5-8 brachial plexus reconstruction provides restoration of elbow flexion and most patients have a sensitive and functional hand. We also found that secondary surgery to improve shoulder and wrist function is often necessary, which should initially be explained to the family. Level of evidence: IV

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