scholarly journals Surgical Managementof Brachial Plexus Injury

2018 ◽  
Vol 11 (4) ◽  
pp. 2079-2084
Author(s):  
Mahadewa Tjokorda
Keyword(s):  
Retrospective Study ◽  
Young Adult ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Elbow Flexion ◽  
Brachial Plexus Palsy ◽  
Shoulder Stabilization ◽  
Surgical Strategies ◽  
Disability Rate ◽  
Brachial Plexus Surgery

Brachial plexus injury is an injury of the shoulder nerve that often happens in young adult. It has a relatively high disability rate. The clinical outcomes of brachial plexus surgery to date are still disappointing, especially for the total plexus injury that affects the C5-T1. However, expectations remain with the advance of technology and more recent surgery techniques, specifically the emergence of distal neural transfer. This was a retrospective study with 9 brachial plexus injury patients, since 2012-2017. The aim to evaluate surgical strategies outcome of the management. The principle of handling brachial plexus palsy when conservatives fail is surgery, like autologous graft, neural transfer, neurolysis, and direct suture. Improvement of elbow flexion is the utmost priority and shoulder stabilization as well. Various techniques are used lately, but to date, they have not been able to improve the functioning of the patient's fingers.

scholarly journals Evidence of the Effectiveness of Primary Brachial Plexus Surgery in Infants With Obstetric Brachial Plexus Palsy–Revisited

2017 ◽  
Vol 4 ◽  
pp. 2329048X1770939 ◽  
Author(s):  
Amel A. F. El-Sayed
Keyword(s):  
Brachial Plexus ◽  
Elbow Flexion ◽  
Motor Recovery ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Primary Surgery ◽  
Obstetric Brachial Plexus ◽  
Brachial Plexus Surgery ◽  
Surgical Group

A recent systematic review questioned the effectiveness of primary surgery in infants with obstetric brachial plexus palsy. At our center, the indication for primary surgery in infants with upper Erb’s obstetric palsy is the lack of active elbow flexion at age 4 months. The current study compares the outcome of motor recovery in 2 groups of infants with upper Erb’s palsy: one group (n = 9) treated surgically between age 4 and 5 months, and another group (n = 9) treated conservatively despite the lack of active elbow flexion at age 4 months. The only reason for not doing the surgery in the latter group was refusal by the parents. The scores of motor recovery were collected at the 2-year follow-up visit, and they were significantly better in the surgical group. The study demonstrates the effectiveness of primary surgery in infants with upper Erb’s obstetric palsy compared to conservative management.

scholarly journals MICROSURGICAL TRANSFER OF THE GRACILIS MUSCLE FOR ELBOW FLEXION IN BRACHIAL PLEXUS INJURY IN ADULTS: RETROSPECTIVE STUDY OF EIGHT CASES

2011 ◽  
Vol 46 (5) ◽  
pp. 534-539
Author(s):  
Luiz Koiti Kimura ◽  
Alexandre Tadeu do Nascimento ◽  
Roberto Capócio ◽  
Rames Mattar ◽  
Marcelo Rosa Rezende ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Elbow Flexion ◽  
Gracilis Muscle

Does technical components of microanastomoses influence the functional outcome of free gracilis muscle transfer for elbow flexion in traumatic brachial plexus injury?

2021 ◽  
pp. 102827
Author(s):  
Francisco Vilmar Felix Martins-Filho ◽  
Fernanda do Carmo Iwase ◽  
Gustavo Bersani Silva ◽  
Alvaro Baik Cho ◽  
Teng Hsiang Wei ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Functional Outcome ◽  
Brachial Plexus Injury ◽  
Elbow Flexion ◽  
Gracilis Muscle ◽  
Muscle Transfer

Transfer of a Motor Fascicle From the Ulnar Nerve to the Branch of the Radial Nerve Destined to the Long Head of the Triceps for Restoration of Elbow Extension in Brachial Plexus Surgery

Neurosurgery ◽  
2011 ◽  
Vol 70 (2) ◽  
pp. E516-E520 ◽  
Author(s):  
Leandro Pretto Flores
Keyword(s):  
Computed Tomography ◽  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Radial Nerve ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Elbow Extension ◽  
Long Head ◽  
Brachial Plexus Surgery

Abstract BACKGROUND AND IMPORTANCE: Restoration of elbow extension has not been considered of much importance regarding functional outcomes in brachial plexus surgery; however, the flexion of the elbow joint is only fully effective if the motion can be stabilized, what can be achieved solely if the triceps brachii is coactivated. To present a novel nerve transfer of a healthy motor fascicle from the ulnar nerve to the nerve of the long head of the triceps to restore the elbow extension function in brachial plexus injuries involving the upper and middle trunks. CLINICAL PRESENTATION: Case 1 is a 32-year-old man sustaining a right brachial extended upper plexus injury in a motorcycle accident 5 months before admission. The computed tomography myelogram demonstrated avulsion of the C5 and C6 roots. Case 2 is a 24-year-old man who sustained a C5-C7 injury to the left brachial plexus in a traffic accident 4 months before admission. Computed tomography myelogram demonstrated signs of C6 and C7 root avulsion. The technique included an incision at the medial border of the biceps, in the proximal third of the involved arm, followed by identification of the ulnar nerve, the radial nerve, and the branch to the long head of the triceps. The proximal stump of a motor fascicle from the ulnar nerve was sutured directly to the distal stump of the nerve of the long head of the triceps. Techniques to restore elbow flexion and shoulder abduction were applied in both cases. Triceps strength Medical Research Council M4 grade was obtained in both cases. CONCLUSION: The attempted nerve transfer was effective for restoration of elbow extension in primary brachial plexus surgery; however, it should be selected only for cases in which other reliable donor nerves were used to restore elbow flexion.

Minimum Ten-Year Outcomes of Partial Ulnar Nerve Transfer for Restoration of Elbow Flexion in Patients with Upper Brachial Plexus Injury

2019 ◽  
Vol 24 (03) ◽  
pp. 283-288
Author(s):  
Yusuke Nagano ◽  
Daisuke Kawamura ◽  
Alaa Terkawi ◽  
Atsushi Urita ◽  
Yuichiro Matsui ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Functional Outcomes ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
The Mean ◽  
Flexion Strength

Background: Partial ulnar nerve transfer to the biceps motor branch of the musculocutaneous nerve (Oberlin’s transfer) is a successful approach to restore elbow flexion in patients with upper brachial plexus injury (BPI). However, there is no report on more than 10 years subjective and objective outcomes. The purpose of this study was to clarify the long-term outcomes of Oberlin’s transfer based on the objective evaluation of elbow flexion strength and subjective functional evaluation of patients. Methods: Six patients with BPI who underwent Oberlin’s transfer were reviewed retrospectively by their medical records. The mean age at surgery was 29.5 years, and the mean follow-up duration was 13 years. The objective functional outcomes were evaluated by biceps muscle strength using the Medical Research Council (MRC) grade at preoperative, postoperative, and final follow-up. The patient-derived subjective functional outcomes were evaluated using the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at final follow-up. Results: All patients had MRC grade 0 (M0) or 1 (M1) elbow flexion strength before operation. Four patients gained M4 postoperatively and maintained or increased muscle strength at the final follow-up. One patient gained M3 postoperatively and at the final follow-up. Although one patient achieved M4 postoperatively, the strength was reduced to M2 due to additional disorder. The mean score of QuickDASH was 36.5 (range, 7–71). Patients were divided into two groups; three patients had lower scores and the other three patients had higher scores of QuickDASH. Conclusions: Oberlin’s transfer is effective in the restoration of elbow flexion and can maintain the strength for more than 10 years. Patients with upper BPI with restored elbow flexion strength and no complicated nerve disorders have over ten-year subjective satisfaction.

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