A systematic review of outcomes of contralateral C-7 transfer for the treatment of traumatic brachial plexus injury: an international comparison

2017 ◽  
Vol 126 (3) ◽  
pp. 922-932 ◽  
Author(s):  
Alexandra L. Mathews ◽  
Guang Yang ◽  
Kate Wan-Chu Chang ◽  
Kevin C. Chung
Keyword(s):  
Systematic Review ◽  
Brachial Plexus ◽  
Elbow Flexion ◽  
Current Data ◽  
Asian Countries ◽  
Wrist Flexion ◽  
Surgical Strategies ◽  
Future Studies ◽  
Finger Flexion ◽  
Sensory Recovery

OBJECTIVE The effectiveness of contralateral C-7 (CC7) transfer is controversial, yet this procedure has been performed around the world to treat brachial plexus injuries. The authors performed a systematic review to study whether Asian countries reported better outcomes after CC7 transfer compared with “other” countries. METHODS A systematic literature search using PubMed, EMBASE, and 3 Chinese databases was completed. Patient outcomes of CC7 transfer to the median and musculocutaneous (MC) nerves were collected and categorized into 2 groups: Asia and “other” countries. China was included as a subcategory of Asia because investigators in China published the majority of the collected studies. To compare outcomes among studies, we created a normalized Medical Research Council (MRC) scale. RESULTS For median nerve outcomes, Asia reported that 41% of patients achieved an MRC grade of ≥ M3 of wrist flexion compared with 62% in “other” countries. For finger flexion, Asia found that 41% of patients reached an MRC grade of ≥ M3 compared with 38% in “other” countries. Asia reported that 60% of patients achieved ≥ S3 sensory recovery, compared with 32% in “other” countries. For MC nerve outcomes, 75% of patients from both Asia and “other” countries reached M4 and M3 in elbow flexion. CONCLUSIONS Current data did not demonstrate that studies from Asian countries reported better outcomes of CC7 transfer to the median and MC nerves. Future studies should focus on comparing outcomes of different surgical strategies for CC7 transfer.

scholarly journals Investigation Into the Optimal Number of Intercostal Nerve Transfers for Musculocutaneous Nerve Reinnervation: A Systematic Review

Hand ◽  
2017 ◽  
Vol 13 (6) ◽  
pp. 621-626 ◽  
Author(s):  
Hyuma A. Leland ◽  
Beina Azadgoli ◽  
Daniel J. Gould ◽  
Mitchel Seruya
Keyword(s):  
Systematic Review ◽  
Brachial Plexus ◽  
Donor Site ◽  
Elbow Flexion ◽  
Donor Site Morbidity ◽  
Intercostal Nerve ◽  
Optimal Number ◽  
Musculocutaneous Nerve ◽  
Nerve Transfers ◽  
Meta Analyses

Background: The purpose of this study was to systematically review outcomes following intercostal nerve (ICN) transfer for restoration of elbow flexion, with a focus on identifying the optimal number of nerve transfers. Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify studies describing ICN transfers to the musculocutaneous nerve (MCN) for traumatic brachial plexus injuries in patients 16 years or older. Demographics were recorded, including age, time to operation, and level of brachial plexus injury. Muscle strength was scored based upon the British Medical Research Council scale. Results: Twelve studies met inclusion criteria for a total of 196 patients. Either 2 (n = 113), 3 (n = 69), or 4 (n = 11) ICNs were transferred to the MCN in each patient. The groups were similar with regard to patient demographics. Elbow flexion ≥M3 was achieved in 71.3% (95% confidence interval [CI], 61.1%-79.7%) of patients with 2 ICNs, 67.7% (95% CI, 55.3%-78.0%) of patients with 3 ICNs, and 77.0% (95% CI, 44.9%-93.2%) of patients with 4 ICNs ( P = .79). Elbow flexion ≥M4 was achieved in 51.1% (95% CI, 37.4%-64.6%) of patients with 2 ICNs, 42.1% (95% CI, 29.5%-55.9%) of patients with 3 ICNs, and 48.4% (95% CI, 19.2%-78.8%) of patients with 4 ICNs ( P = .66). Conclusions: Previous reports have described 2.5 times increased morbidity with each additional ICN harvest. Based on the equivalent strength of elbow flexion irrespective of the number of nerves transferred, 2 ICNs are recommended to the MCN to avoid further donor-site morbidity.

scholarly journals Importance of the Wrist Extensor Muscle Training: Two Cases of Elbow Flexorplasty following Traumatic Brachial Plexus Injuries

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Shigeki Kubota ◽  
Tadashi Kubo ◽  
Hiromi Kameda ◽  
Yoshiyasu Itoh
Keyword(s):  
Brachial Plexus ◽  
Elbow Flexion ◽  
Wrist Flexion ◽  
Postoperative Rehabilitation ◽  
Wrist Extensor ◽  
Antagonist Muscles ◽  
Extensor Muscles ◽  
Muscle Groups ◽  
Flexion Strength

The modified Steindler procedure—a reconstructive surgery used to restore elbow flexion following upper brachial plexus injuries—involves shifting the origins of the muscle groups responsible for wrist flexion and forearm pronation originating from the medial epicondyle to the proximal direction to be used as flexors of the elbow. In the postoperative rehabilitation, we focused on strengthening not only the transferred muscle but also the wrist extensor muscles as antagonist muscles. After reconstruction surgery for elbow flexion via the modified Steindler procedure for traumatic brachial plexus injury, we performed long-term rehabilitation to strengthen the antagonist muscles. As a result, in two cases, excellent elbow flexion strength and gripping strength were achieved, confirming the importance of the antagonist muscles.

scholarly journals Gracilis free muscle transfer for restoration of function after complete brachial plexus avulsion

2004 ◽  
Vol 16 (5) ◽  
pp. 1-9 ◽  
Author(s):  
Kimberly A. Barrie ◽  
Scott P. Steinmann ◽  
Alexander Y. Shin ◽  
Robert J. Spinner ◽  
Allen T. Bishop
Keyword(s):  
Brachial Plexus ◽  
Upper Extremity ◽  
Elbow Flexion ◽  
Muscle Transfer ◽  
Muscle Flaps ◽  
Wrist Extension ◽  
Finger Flexion ◽  
Vascular Insufficiency ◽  
Flexion Strength

Object The authors report the functional outcomes after functioning free muscle transfer (FFMT) for restoration of the upper-extremity movement after brachial plexus injury (BPI). Methods The authors conducted a retrospective review of 36 gracilis FFMT procedures performed in 27 patients with BPI between 1990 and 2000. Eighteen patients underwent a single gracilis FFMT procedure for restoration of either elbow flexion (17 cases) or finger flexion (one case). Nine patients underwent a double free muscle transfer for simultaneous restoration of elbow flexion and wrist extension (first muscle) and finger flexion (second muscle), combined with direct triceps neurotization. The results obtained in 29 cases of FFMT in which the follow-up period was 1 year are reported. Neurotization of the donor muscle was performed using the musculocutaneous nerve (one case), spinal accessory nerve (12 cases), or multiple intercostal motor nerves (16 cases). Two second-stage muscle flaps failed secondary to vascular insufficiency. Mean electromyography-measured reinnervation time was 5 months. At a minimum follow-up period of 1 year, five muscles achieved less than or equal to Grade M2, eight Grade M3, four Grade M4, and 12 Grade M5. Transfer for combined elbow flexion and wrist extension compared with elbow flexion alone lowered the overall results for elbow flexion strength. Seventy-nine percent of the FFMTs for elbow flexion alone (single transfer) and 63% of similarly innervated muscles transferred for combined motion achieved at least Grade M4 elbow flexion strength. Conclusions Functioning free muscle transfer is a viable reconstructive option for restoration of upper-extremity function in the setting of severe BPI. It is possible to achieve good to excellent outcomes in terms of muscle grades with the simultaneous reconstruction of two functions by one FFMT, making restoration of basic hand function possible. More reliable results are obtained when a single FFMT is performed for a single function.

scholarly journals The Use of Botulinum Toxin Injection for Brachial Plexus Birth Injuries: A Systematic Review of the Literature

Hand ◽  
2018 ◽  
Vol 14 (2) ◽  
pp. 150-154 ◽  
Author(s):  
Patrick J. Buchanan ◽  
John A. I. Grossman ◽  
Andrew E. Price ◽  
Chandan Reddy ◽  
Mustafa Chopan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Botulinum Toxin ◽  
Brachial Plexus ◽  
Internal Rotation ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Injection ◽  
Elbow Flexion ◽  
Complete Recovery ◽  
Birth Injuries ◽  
Flexion Extension

Background: Most brachial plexus birth injuries (BPBIs) are caused by traction on the brachial plexus during a difficult delivery. Fortunately, the possibility of complete recovery from such an incident is relatively high, with only 10% to 30% of patients having prolonged and persistent disability. These patients have muscle imbalances and co-contractions typically localized around the shoulder and elbow. These imbalances and co-contractures cause abnormal motor performances and bone/joint deformities. Typically, physical/occupational therapies are the conventional therapeutic modalities but are often times inadequate. Botulinum toxin A (BTX-A) injections into targeted muscles have been used to combat the muscular imbalances and co-contractions. Methods: With compliance to PRISMA guidelines, a systematic review was performed to identify studies published between 2000 and 2017 that used BTX-A to treat neonatal brachial plexus palsies. Results: Ten studies were included, involving 325 patients. Three groups of indications for the use of BTX-A were identified: (1) internal rotation/adduction contracture of the shoulder; (2) elbow flexion lag/elbow extension lag; and (3) forearm pronation contracture. Conclusions: The included studies show an overall beneficial effect of BTX-A in treating co-contractures seen in patients with BPBI. Specifically, BTX-A is shown to reduce internal rotation/adduction contractures of the shoulder, elbow flexion/extension contractures, and forearm pronation contractures. These beneficial effects are blunted when used in older patients. Nevertheless, BTX-A is a useful treatment for BPBIs with a relatively low-risk profile.

scholarly journals Digital storytelling: a systematic review

2020 ◽  
Vol 2 (2) ◽  
pp. 97
Author(s):  
Nur Fatin Nabila Abd Rahman ◽  
Rofiza Aboo Bakar
Keyword(s):  
Systematic Review ◽  
Teaching And Learning ◽  
Digital Storytelling ◽  
Tertiary Education ◽  
Asian Countries ◽  
Teaching Techniques ◽  
Educational Tools ◽  
Future Studies ◽  
Education Levels ◽  
English Speaking

Digital storytelling (DST) is one of the helpful educational tools in the teaching and learning process. Nonetheless, there is a scarcity of systematic reviews to enlighten how it was applied and what was done in this area. This paper performed a systematic review of five articles on using DST to foster English speaking skills among learners.  This research established continuous interest in the background of South-East Asian countries, including learners at the pre-school till tertiary education levels.  DST has been used in the humanities and social sciences as either a stand-alone teaching or in conjunction with other teaching techniques. The review classified two directions (ideal and reflective) as well as six outcomes: affective, intellectual, educational, technical, linguistics, and communal. Hence, this study synthesizes and discusses further two issues: affective motivating passion and a creative, imaginative, and resourceful platform. It is hoped this study able to discuss potential explanations for these issues and offer insights for future studies.

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.

Elbow flexion reconstruction with nerve transfer or grafting in patients with brachial plexus injuries: A systematic review and comparison study

Microsurgery ◽  
2019 ◽  
Vol 40 (1) ◽  
pp. 79-86
Author(s):  
Egemen Ayhan ◽  
Francisco Soldado ◽  
César G. Fontecha ◽  
Jayme A. Bertelli ◽  
Gursel Leblebicioglu
Keyword(s):  
Systematic Review ◽  
Brachial Plexus ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Comparison Study

Contralateral C7 Transfer to Lower Trunk Via a Subcutaneous Tunnel Across the Anterior Surface of Chest and Neck for Total Root Avulsion of the Brachial Plexus

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. ons252-ons263
Author(s):  
Juntao Feng ◽  
Tao Wang ◽  
Yudong Gu ◽  
Liang Chen ◽  
Gaomeng Zhang ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Action Potentials ◽  
Anterior Surface ◽  
Wrist Flexion ◽  
Lower Trunk ◽  
Finger Flexion ◽  
Compound Muscle Action Potentials ◽  
Abductor Digiti Minimi ◽  
Subcutaneous Tunnel ◽  
Operative Delay

Abstract OBJECTIVE We investigate an innovative and efficacious procedure for restoring wrist flexion, finger flexion, and hand sensation by passing the contralateral C7 through a subcutaneous tunnel across the anterior surface of the chest and neck. METHODS Four patients (3 men, 1 woman) with total brachial plexus avulsion were treated from November 2005 to July 2007, their ages ranging from 18 to 36 years (average, 26 years). The operative delay was from 23 days to 5 months (mean, 2 months). The contralateral C7 nerve root was employed to repair the injured lower trunk or the C8-T1 spinal nerves via the subcutaneous tunnel across the anterior surface of the chest and neck. Direct neurorrhaphy was performed on the C8-T1 residual nerve roots in 2 patients. In the other 2 patients, a nerve graft of 4.5 cm in length was used to restore function of the affected lower trunk. RESULTS Postoperative electromyography at 26 and 38 months recorded compound muscle action potentials and motor unit potentials in the abductor digiti minimi and the flexor pollicis longus in all cases. On clinical examination digital flexion scored M1-M3, carpal flexion M2-M4, and hand sensation S1-S3. CONCLUSION Transfer of the contralateral C7 to the lower trunk proved to be a safe and feasible procedure. Compared with the traditional transfer of the contralateral C7 to the median nerve, it might help patients gain better restoration of wrist flexion, finger flexion, and hand sensation.

Systematic review on outcome of free functioning muscle transfers for elbow flexion in brachial plexus injuries

2019 ◽  
Vol 44 (6) ◽  
pp. 620-627 ◽  
Author(s):  
Tina Munn Yi Lee ◽  
Sreedharan Sechachalam ◽  
Mala Satkunanantham
Keyword(s):  
Systematic Review ◽  
Brachial Plexus ◽  
Surgical Techniques ◽  
Case Series ◽  
Elbow Flexion ◽  
Delayed Presentation ◽  
Muscle Transfer ◽  
Muscle Transfers ◽  
Useful Power ◽  
Functional Muscle Transfer

Elbow flexion is widely regarded as the most important function to restore in brachial plexus injuries. Free functioning muscle transfer surgery is indicated in patients with delayed presentation or failure of other primary procedures. Results of the transfer surgeries have been reported in the form of case series, but no further studies are available. This systematic review aims to provide a deeper understanding of this complex surgery and consists of 19 articles that include 364 patients. Data on injury characteristics, surgical techniques, complications as well as outcome measures were analysed. Our results show that functional muscle transfer for elbow flexion enables 87% and 65% of patients to achieve a useful power grade of ≥ 3 and ≥ 4, respectively, although other important outcome factors should be considered.

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