scholarly journals Assessment of Biceps Muscle Functional Recovery as a Predictor of Outcome in Neonatal Brachial plexus Palsy

2019 ◽  
Vol 12 (3) ◽  
pp. 1023-1031
Author(s):  
Hala Atta Youssef ◽  
Amira Ahmed Mohamed ◽  
Ashraf Mohamed Azmy ◽  
William Mikael Morcos ◽  
Eman R. Youness
Keyword(s):  
Brachial Plexus ◽  
Functional Recovery ◽  
Muscle Activity ◽  
World Health ◽  
Time Interval ◽  
Biceps Muscle ◽  
Brachial Plexus Palsy ◽  
Motor Assessment ◽  
Obstetrical Brachial Plexus Palsy ◽  
Neonatal Brachial Plexus Palsy

Obstetrical brachial plexus palsy is a traction lesion of a part of the brachial plexus during delivery. According to the World Health Organization, prevalence is generally 1-2% worldwide. The aim of the study is to assess the time interval to biceps muscle functional recovery in relation to outcome in neonatal brachial plexus palsy. This study was conducted on 60 neonates admitted to the department of neonatal intensive care unit and outpatient follow up clinic of El Galaa Teaching Hospital, Cairo, Egypt with neonatal brachial plexus palsy. All cases were subjected to full history tasking, assessment of gestational age, thorough clinical examination, physical and neurologic examination of the affected upper extremity function including; motor assessment of biceps muscle by medical research council for grading muscle activity. Our results showed that C5-C6 injury was found in 42 patients (70%), C5-C6-C7 affection in 15 patients (25%) and three patients (5%) had total injury without associated Horner's syndrome. Motor assessment of biceps muscle activity at time of delivery revealed, that 10 patients (16.7%) had M0- grade, 34 patients (56.7%) had M1 grade and 16 patients (26.7%) had M2 grade. We conclude that majority of patients with neonatal obstetrical brachial plexus palsy had spontaneous recovery with normal function in the first three months of life. The time interval to biceps muscle recovery is an important prognostic factor in neonatal obstetrical brachial plexus palsy, as its failure to recover anti-gravity biceps function by 3 to 6 months of age is a poor prognostic sign.

scholarly journals Elbow Flexion in Neonatal Brachial Plexus Palsy: A Meta-Analysis of Graft Versus Transfer

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Muhibullah S Tora ◽  
Nathan Hardcastle ◽  
Pavlos Texakalidis ◽  
Jeremy Wetzel ◽  
Joshua J Chern
Keyword(s):  
Brachial Plexus ◽  
Functional Recovery ◽  
Meta Analysis ◽  
Donor Site ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Active Movement ◽  
Nerve Grafting ◽  
Brachial Plexus Palsy ◽  
Neonatal Brachial Plexus Palsy

Abstract INTRODUCTION Functional elbow flexion recovery is one of the main goals of neonatal brachial plexus palsy (NBPP) reconstruction. The current neurosurgical treatment options include nerve grafting and nerve transfer. The goal of the present study is to compare functional elbow flexion recovery in NBPP following nerve grafting or nerve transfer. METHODS The present study conducted a systematic literature review and meta-analysis according to PRISMA guidelines. A search was conducted on Pubmed for eligible studies published until November of 2018. Odds Ratios (OR) and 95% confidence intervals (CI) were calculated to compare functional elbow flexion outcomes between nerve graft and nerve transfer. A random-effects model meta-analysis was conducted. A Medical Research Council (MRC) score = 3 or Active Movement Scale (AMS) = 5 was considered functional recovery of elbow flexion. RESULTS The present study included 194 patients from 1990 2015 across five observational trials. Only pediatric patients with obstetric brachial plexus injury were included. The mean patient age at surgery varied between studies from 5.7 to 11.9 mo and mean follow-up from 12 to 70 mo. No complications or cases of donor site morbidity were reported. Functional recovery occurred with nerve transfer in 95.2% of patients (n = 59/62) and with nerve grafting in 96.4% of patients (n = 54/56). Overall, the outcomes for elbow flexion between the groups appeared similar (OR: 1.15, 95% CI: 0.19-7.08, I2: 2.9%). CONCLUSION The optimal approach to brachial plexus reconstruction in NBPP continues to be the subject of debate. As one of the most important outcomes, the present meta-analysis finds that functional recovery of elbow flexion does not appear to differ between nerve grafting and nerve transfer.

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

scholarly journals Medical Decision-Making among Adolescents with Neonatal Brachial Plexus Palsy and Their Families

2013 ◽  
Vol 131 (6) ◽  
pp. 880e-887e ◽  
Author(s):  
Lee Squitieri ◽  
Bradley P. Larson ◽  
Kate W.-C. Chang ◽  
Lynda J.-S. Yang ◽  
Kevin C. Chung
Keyword(s):  
Decision Making ◽  
Brachial Plexus ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Brachial Plexus Palsy ◽  
Neonatal Brachial Plexus Palsy
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