scholarly journals Extending the Indications for Primary Nerve Surgery in Obstetrical Brachial Plexus Palsy

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Stuart A. Bade ◽  
Jenny C. Lin ◽  
Christine G. Curtis ◽  
Howard M. Clarke
Keyword(s):  
Brachial Plexus ◽  
Surgical Intervention ◽  
External Rotation ◽  
Shoulder Function ◽  
Small Subset ◽  
Brachial Plexus Palsy ◽  
Surgical Indications ◽  
Obstetrical Brachial Plexus Palsy ◽  
Spontaneous Improvement ◽  
Nerve Surgery

Purpose.This study identifies a small subset of patients with obstetrical brachial plexus palsy who, while they do not meet common surgical indications, may still benefit from primary nerve surgery.Methods.Between April 2004 and April 2009, 17 patients were offered primary nerve surgery despite not meeting the standard surgical indications of the authors. The authors performed a retrospective analysis of these 17 patients using prospectively collected data.Results.This group of 17 patients were identified as having poor shoulder function at about 9 months of age despite passing the Cookie Test. Fourteen patients underwent surgical intervention and three families declined surgery. All patients in the operative group regained some active external rotation after surgery. Five patients in this group have required further interventions. Two of the three patients for whom surgery was declined have had no subsequent spontaneous improvement in active external rotation.Discussion.The commonly used indications for primary nerve surgery in obstetrical brachial plexus palsy may not adequately identify all patients who may benefit from surgical intervention. Patients who pass the Cookie Test but have poor spontaneous recovery of active shoulder movements, particularly external rotation, may still benefit from primary nerve surgery.

EARLY COMBINED NEUROSURGERY AND ORTHOPAEDIC SURGERY IN NEONATAL BRACHIAL PLEXUS PALSY

Hand Surgery ◽  
2011 ◽  
Vol 16 (02) ◽  
pp. 155-159 ◽  
Author(s):  
Ram Palti ◽  
Maxim D. Horwitz ◽  
Nicholas C. Smith ◽  
Michael A. Tonkin
Keyword(s):  
Brachial Plexus ◽  
Neurological Deficit ◽  
Orthopaedic Surgery ◽  
Shoulder Function ◽  
Brachial Plexus Palsy ◽  
Combined Procedure ◽  
Neonatal Brachial Plexus Palsy ◽  
Nerve Surgery ◽  
Plexus Lesion ◽  
Glenohumeral Dislocation

Three cases are presented in which neurosurgical reconstruction of a Neonatal Brachial Plexus Palsy was combined with orthopaedic reconstruction of a posterior glenohumeral dislocation. The authors believe that a combined procedure is indicated if the neurological deficit meets the criteria for neural reconstruction and the complication of a posterior glenohumeral dislocation has occurred prior to nerve surgery. Two children with C5–6 lesions and a third child with a pan-plexus lesion obtained good shoulder function following the combined reconstruction.

scholarly journals Obstetric Brachial Plexus Palsy: The Mallet Grading System for Shoulder Function—Revisited

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
M. M. Al-Qattan ◽  
A. A. F. El-Sayed
Keyword(s):  
Brachial Plexus ◽  
External Rotation ◽  
Shoulder Function ◽  
Shoulder Abduction ◽  
Grading System ◽  
Brachial Plexus Palsy ◽  
Older Children ◽  
Obstetric Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus ◽  
Shoulder External Rotation

The Mallet grading system is a commonly used functional scoring system to assess shoulder abduction/external rotation deficits in children with obstetric brachial plexus palsy. One feature of the Mallet score is that each grade is translated into certain degrees of deficiencies in both shoulder abduction and external rotation. The aim of the current study is to investigate the percentage of children in which the Mallet score could not be applied because of a discrepancy between the deficiency of shoulder abduction and shoulder external rotation. The study group included 50 consecutive unoperated older children (over 5 years of age) with Erb’s palsy and deficits in shoulder movements. The Mallet score could be applied in 40 cases (80%). In the remaining 10 cases (20%), the Mallet score could not be applied either because shoulder abduction had a better grade than the grade of shoulder external rotation (n=7) or vice versa (n=3). It was concluded that documenting the deficits in shoulder abduction and external rotation are best done separately and this can be accomplished by using other grading systems.

Percutaneous humeral derotational osteotomy in obstetrical brachial plexus palsy: a new technique

2013 ◽  
Vol 39 (5) ◽  
pp. 549-552 ◽  
Author(s):  
A. Aly ◽  
J. Bahm ◽  
F. Schuind
Keyword(s):  
Brachial Plexus ◽  
Plate Fixation ◽  
Significant Proportion ◽  
Shoulder Function ◽  
New Technique ◽  
Open Approach ◽  
Brachial Plexus Palsy ◽  
Obstetrical Brachial Plexus Palsy ◽  
Derotational Osteotomy ◽  
A New Technique

Thirty three per cent of children with obstetrical brachial plexus palsy with incomplete neurological recovery develop shoulder internal contracture associated with osseous deformity. Some of the older children are treated by humeral derotational osteotomy. The classical technique of open approach to the humeral diaphysis and plate fixation imposes a longitudinal scar and carries significant risks (nonunion, nerve palsy); a secondary procedure for plate removal is necessary in a significant proportion of patients. The authors report a new technique of percutaneous humeral osteotomy with osteosynthesis by Hoffmann external fixator. In six cases bone healing was obtained at an average of 45 days, without adverse complication. The postoperative results showed improved shoulder function. This new technique is simple and safe; it represents a new option for the treatment of sequelae of obstetrical brachial plexus palsy.

Nerve graft versus nerve transfer for neonatal brachial plexus: shoulder outcomes

2021 ◽  
Vol 27 (1) ◽  
pp. 87-92
Author(s):  
Brandon W. Smith ◽  
Kate W. C. Chang ◽  
Sravanthi Koduri ◽  
Lynda J. S. Yang
Keyword(s):  
Brachial Plexus ◽  
Clinical Data ◽  
External Rotation ◽  
Nerve Transfer ◽  
Shoulder Function ◽  
Nerve Transfers ◽  
Shoulder Flexion ◽  
Significant Difference ◽  
Transfer Strategies ◽  
Shoulder External Rotation

OBJECTIVEThe decision-making in neonatal brachial plexus palsy (NBPP) treatment continues to have many areas in need of clarification. Graft repair was the gold standard until the introduction of nerve transfer strategies. Currently, there is conflicting evidence regarding outcomes in patients with nerve grafts versus nerve transfers in relation to shoulder function. The objective of this study was to further define the outcomes for reconstruction strategies in NBPP with a specific focus on the shoulder.METHODSA cohort of patients with NBPP and surgical repairs from a single center were reviewed. Demographic and standard clinical data, including imaging and electrodiagnostics, were gathered from a clinical database. Clinical data from physical therapy evaluations, including active and passive range of motion, were examined. Statistical analysis was performed on the available data.RESULTSForty-five patients met the inclusion criteria for this study, 19 with graft repair and 26 with nerve transfers. There were no significant differences in demographics between the two groups. Understandably, there were no patients in the nerve grafting group with preganglionic lesions, resulting in a difference in lesion type between the cohorts. There were no differences in preoperative shoulder function between the cohorts. Both groups reached statistically significant improvements in shoulder flexion and shoulder abduction. The nerve transfer group experienced a significant improvement in shoulder external rotation, from −78° to −28° (p = 0.0001), whereas a significant difference was not reached in the graft group. When compared between groups, there appeared to be a trend favoring nerve transfer in shoulder external rotation, with the graft patients improving by 17° and the transfer patients improving by 49° (p = 0.07).CONCLUSIONSIn NBPP, patients with shoulder weakness experience statistically significant improvements in shoulder flexion and abduction after graft repair or nerve transfer, and patients with nerve transfers additionally experience significant improvement in external rotation. With regard to shoulder external rotation, there appear to be some data supporting the use of nerve transfers.

scholarly journals Peripartum and neonatal factors associated with the persistence of neonatal brachial plexus palsy at 1 year: a review of 382 cases

2016 ◽  
Vol 17 (5) ◽  
pp. 618-624 ◽  
Author(s):  
Thomas J. Wilson ◽  
Kate W. C. Chang ◽  
Suneet P. Chauhan ◽  
Lynda J. S. Yang
Keyword(s):  
Brachial Plexus ◽  
Prediction Algorithm ◽  
University Of Michigan ◽  
Brachial Plexus Palsy ◽  
Factors Associated ◽  
Neonatal Brachial Plexus Palsy ◽  
Active Range Of Motion ◽  
Wide Range ◽  
Nerve Surgery ◽  
The University

OBJECTIVE Neonatal brachial plexus palsy (NBPP) occurs due to the stretching of the nerves of the brachial plexus before, during, or after delivery. NBPP can resolve spontaneously or become persistent. To determine if nerve surgery is indicated, predicting recovery is necessary but difficult. Historical attempts explored the association of recovery with only clinical and electrodiagnostic examinations. However, no data exist regarding the neonatal and peripartum factors associated with NBPP persistence. METHODS This retrospective cohort study involved all NBPP patients at the University of Michigan between 2005 and 2015. Peripartum and neonatal factors were assessed for their association with persistent NBPP at 1 year, as defined as the presence of musculoskeletal contractures or an active range of motion that deviated from normal by > 10° (shoulder, elbow, hand, and finger ranges of motion were recorded). Standard statistical methods were used. RESULTS Of 382 children with NBPP, 85% had persistent NBPP at 1 year. A wide range of neonatal and peripartum factors was explored. We found that cephalic presentation, induction or augmentation of labor, birth weight > 9 lbs, and the presence of Horner syndrome all significantly increased the odds of persistence at 1 year, while cesarean delivery and Narakas Grade I to II injury significantly reduced the odds of persistence. CONCLUSIONS Peripartum/neonatal factors were identified that significantly altered the odds of having persistent NBPP at 1 year. Combining these peripartum/neonatal factors with previously published clinical examination findings associated with persistence should allow the development of a prediction algorithm. The implementation of this algorithm may allow the earlier recognition of those cases likely to persist and thus enable earlier intervention, which may improve surgical outcomes.

scholarly journals Obstetrical brachial plexus palsy: 22 cases

2011 ◽  
Vol 54 ◽  
pp. e203-e204
Author(s):  
A.A. Eloumri ◽  
O. Elhilali ◽  
F.Z. Arfaoui ◽  
H. Abid ◽  
N. Hajjaj-Hassouni
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Palsy ◽  
Obstetrical Brachial Plexus Palsy
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