Ultrasonography for neonatal brachial plexus palsy

2014 ◽  
Vol 14 (5) ◽  
pp. 527-531 ◽  
Author(s):  
Jacob Rahul Joseph ◽  
Michael A. DiPietro ◽  
Deepak Somashekar ◽  
Hemant A. Parmar ◽  
Lynda J. S. Yang
Keyword(s):  
Brachial Plexus ◽  
Functional Results ◽  
Operative Management ◽  
Brachial Plexus Palsy ◽  
Nerve Reconstruction ◽  
Nerve Roots ◽  
Unaffected Side ◽  
Neonatal Brachial Plexus Palsy ◽  
Preoperative Mapping ◽  
Supraclavicular Fossa

Ultrasonography has previously been reported for use in the evaluation of compressive or traumatic peripheral nerve pathology and for its utility in preoperative mapping. However, these studies were not performed in infants, and they were not focused on the brachial plexus. The authors report a case in which ultrasonography was used to improve operative management of neonatal brachial plexus palsy (NBPP). An infant boy was born at term, complicated by right-sided shoulder dystocia. Initial clinical evaluation revealed proximal arm weakness consistent with an upper trunk injury. Unlike MRI or CT myelography that focus on proximal nerve roots, ultrasonography of the brachial plexus in the supraclavicular fossa was able to demonstrate a small neuroma involving the upper trunk (C-5 and C-6) and no asymmetry in movement of the diaphragm or in the appearance of the rhomboid muscle when compared with the unaffected side. However, the supra- and infraspinatus muscles were significantly asymmetrical and atrophied on the affected side. Importantly, ultrasound examination of the shoulder revealed posterior glenohumeral laxity. Instead of pursuing the primary nerve reconstruction first, timely treatment of the shoulder subluxation prevented formation of joint dysplasia and formation of a false glenoid, which is a common sequela of this condition. Because the muscles innervated by proximal branches of the cervical nerve roots/trunks were radiographically normal, subsequent nerve transfers were performed and good functional results were achieved. The authors believe this to be the first report describing the utility of ultrasonography in the surgical treatment planning in a case of NBPP. Noninvasive imaging, in addition to thorough history and physical examination, reduces the intraoperative time required to determine the extent and severity of nerve injury by allowing improved preoperative planning of the surgical strategy. Inclusion of ultrasonography as a preoperative modality may yield improved outcomes for children with NBPP.

scholarly journals Comparative accuracies of electrodiagnostic and imaging studies in neonatal brachial plexus palsy

2019 ◽  
Vol 23 (1) ◽  
pp. 119-124 ◽  
Author(s):  
Brandon W. Smith ◽  
Kate W. C. Chang ◽  
Lynda J. S. Yang ◽  
Mary Catherine Spires
Keyword(s):  
Brachial Plexus ◽  
Preoperative Planning ◽  
Brachial Plexus Palsy ◽  
Nerve Reconstruction ◽  
Nerve Roots ◽  
Electrodiagnostic Testing ◽  
Neonatal Brachial Plexus Palsy ◽  
Age At Surgery ◽  
The Mean ◽  
Lesion Localization

OBJECTIVEThe incorporation of ancillary testing in the preoperative setting for patients with neonatal brachial plexus palsy (NBPP) remains controversial, but the recommendation for early nerve reconstruction when a baby has a preganglionic lesion at the lower nerve roots is generally accepted. At some specialty centers, nerve surgeons use preoperative electrodiagnostic testing (EDX) and imaging to aid in lesion localization and the preoperative planning of the nerve reconstruction. EDX and imaging have been evaluated for their abilities to detect pre- and postganglionic lesions, but their accuracies have never been compared directly in the same set of patients. The aim of the present study was to evaluate the accuracy of imaging and EDX in an NBPP population.METHODSA retrospective review was conducted of 54 patients with operative NBPP seen between 2007 and 2017. The patients underwent EDX and imaging: EDX was performed, and the results were reviewed by board-certified electrodiagnosticians, and imaging was reviewed by board-certified neuroradiologists. The gold standard was considered to be the findings at surgical exploration. Descriptive and analytical statistics were utilized to compare the accuracies of imaging and EDX.RESULTSThe mean age at surgery was 6.94 mos (± 4 mos). Fifteen patients (28%) were Narakas grade I–II, and 39 (72%) were Narakas grade III–IV. For all nerve roots, the overall accuracy of detecting preganglionic lesions was 74% for EDX and 69% for imaging. The overall sensitivity of detecting preganglionic lesions by EDX was 31%, but the specificity was 90%. The overall sensitivity of detecting preganglionic lesions by imaging was 66%, and the overall specificity was 70%. However, at C8, EDX was 37.5% sensitive and 87.5% specific, whereas imaging was 67.7% sensitive but only 29.4% specific.CONCLUSIONSEDX outperformed imaging with regard to specificity and accuracy of identifying preganglionic injuries. This finding is especially relevant in the lower nerve roots, given that lower plexus preganglionic lesions are an accepted indication for early intervention.

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.

Neonatal Brachial Plexus Palsy

2018 ◽  
Author(s):  
Raymond Tse ◽  
Angelo B. Lipira
Keyword(s):  
Brachial Plexus ◽  
Multiple Root ◽  
Surgical Reconstruction ◽  
Delayed Presentation ◽  
Brachial Plexus Palsy ◽  
Nerve Reconstruction ◽  
Nerve Transfers ◽  
Neonatal Brachial Plexus Palsy ◽  
Severity Of Injury ◽  
Technical Details

Neonatal brachial plexus palsy occurs in approximately 1 in 1000 live births. The extent of involvement and severity of injury are variable. The chapter discusses assessment, nonsurgical treatment, and surgical treatment of neonatal brachial plexus palsy. The approach to surgical exploration is detailed and a number of scenarios are presented so that the principles of primary nerve reconstruction (including nerve graft and nerve transfers) can be illustrated. The scenarios include upper plexus injury, pan-plexus injury, multiple root avulsions, isolated deficits, delayed presentation, and failed reconstruction. Technical details of nerve grafting and nerve transfers are described. Secondary musculoskeletal consequences of brachial plexus palsy are also discussed, including strategies for prevention and options for secondary surgical reconstruction.

scholarly journals “ALL IN ONE OR (W)HOLE IN ONE REPAIR” for Adult Total Brachial Plexus Palsy

2021 ◽  
Author(s):  
V. Purushothaman ◽  
K. Vinoth Kumar ◽  
Sabari Girish Ambat ◽  
R. Venkataswami
Keyword(s):  
Brachial Plexus ◽  
Hand Function ◽  
The Body ◽  
Salvage Procedure ◽  
Brachial Plexus Palsy ◽  
Nerve Reconstruction ◽  
Muscle Transfer ◽  
Young Males ◽  
Elbow Function ◽  
Better Than

Abstract Background Total brachial plexus palsy (TBPP) accounts for nearly 50% of all brachial plexus injuries. Since achieving a good functional hand was almost impossible, the aim was settled to get a good shoulder and elbow function. It was Gu, who popularized the concept of utilizing contralateral C7 (CC7) with vascularized ulnar nerve graft (VUNG) to get some hand function. We have modified it to suit our patients by conducting it as a single-stage procedure, thereby trying to get a functional upper limb. Methods From 2009 to 2014, we had 20 TBPP patients. We feel nerve reconstruction is always better than any other salvage procedure, including free muscle transfer. We modified Gu's concept and present our concept of total nerve reconstruction as “ALL IN ONE OR (W)HOLE IN ONE REPAIR.” Results All patients able to move their reconstructed limbs independently or with the help of contralateral limbs. Three patients developed hook grip and one patient was able to incorporate limbs to do bimanual jobs. One important observation is that all the reconstructed limbs regain the bulk, and to a certain extent, the attitude and appearance looks normal, as patients no longer hide it or hang it in a sling. Conclusion Adult brachial plexus injury itself is a devastating injury affecting young males. By doing this procedure, the affected limb is not dissociated from the rest of the body and rehabilitation can be aimed to get a supportive limb.

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