The Developing Shoulder Has a Limited Capacity to Recover After a Short Duration of Paralysis

Neonatal brachial plexus injuries during childbirth can cause shoulder paralysis in 1 out of every 250 births in the United States.1,2 Although 80% of these infants recover spontaneously and have no residual complications, a number of them have persistent paralysis and functional deficits.1,3,4 Surgeons are thus faced with a choice on if and when to intervene. However, the time course of persistent paralysis leading to permanent functional defects in the neonate is unclear.

Shoulder Function Following Late Neurolysis and Bypass Grafting for Upper Brachial Plexus Birth Injuries

Eleven children ranging in age from 9 to 21 months underwent late nerve reconstruction for persistent shoulder paralysis following an upper brachial plexus birth injury. Only neurolysis was performed in three patients. Neurolysis and nerve grafting bypassing the neuroma with proximal and distal end-to-side repairs was performed in the other eight. All patients were followed for 2 or more years. Two patients underwent a secondary procedure before their final follow-up evaluation. All infants demonstrated significant improvement when assessed by a modified Gilbert shoulder motion scale.

Case study: A myoelectrically controlled shoulderelbow orthosis for unrecovered brachial plexus injury

Two myoelectrically controlled battery powered shoulderelbow orthoses manufactured individually for two traumatic unilateral brachial plexus injury cases are reported. The first case was 24 years old and the other was 6 years old. Both patients had undergone unsuccessful microsurgical nerve repair procedures leaving them with elbow and shoulder paralysis and some residual hand motion. Manufactured orthoses were made of lightweight thermoplastic polyethylene. They stabilised the affected shoulder joint in the neutral position. Elbow extension and flexion were activated by a myoelectrically controlled battery powered orthosis, and the active range of motion of the elbow was between 60 and 140 degrees. These orthoses achieved elbow motions at a speed of 16 degrees per second. The rehabilitation time was 3 months in both patients. The older patient was rehabilitated using a 1kg mass, and the younger one with 0.5kg mass, throughout the full range of active elbow motions. After 21 months it was found, in both cases, that the orthotic treatment had been successful and that the patients had been given the ability to engage in twohanded activities of daily living.