C5-8 neonatal brachial plexus palsy. Operative findings, reconstructive strategy and outcome

Lombard, Aude; Bachy, Manon; Fitoussi, F.

doi:10.1177/1753193420902361

Cited by 10 publications

(6 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A common approach to the reconstruction of the upper trunk in BPBI favors elbow flexion as the first priority, in which the anterior division is fully covered with grafts or in which a dedicated nerve transfer or graft to the musculocutaneous nerve is utilized 1,14,15 . Interestingly, although we agree that elbow flexion is the functional priority in upper-plexus injuries, that does not necessitate directing a disproportionate number of cables there.…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, Malessy and Pondaag 1 included patients with injuries of the middle trunk in their series, whereas we looked at isolated upper trunk injuries. It may not be the number of available donor nerve roots that is critical, but instead the integrity of the A common approach to the reconstruction of the upper trunk in BPBI favors elbow flexion as the first priority, in which the anterior division is fully covered with grafts or in which a dedicated nerve transfer or graft to the musculocutaneous nerve is utilized 1,14,15 . Interestingly, although we agree that elbow flexion is the functional priority in upper-plexus injuries, that does not necessitate directing a disproportionate number of cables there.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical Reconstruction of Isolated Upper Trunk Brachial Plexus Birth Injuries in the Presence of an Avulsed C5 or C6 Nerve Root

Davidge

Curtis

et al. 2021

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Background:Avulsion of either the C5 or C6 root with intact middle and lower trunks in brachial plexus birth injury is rare. In these cases, only 1 proximal root is available for intraplexal reconstruction. The purpose of the present study was to determine the outcomes of these patients when single-root reconstruction was balanced across the anterior and posterior elements of the upper trunk.Methods:We performed a retrospective cohort study of prospectively collected data for patients with brachial plexus birth injury who underwent primary nerve reconstruction between 1993 and 2014. Patients were included who had isolated upper-trunk injuries with intact middle and lower trunks. The study group had avulsion of either the C5 or C6 root. The control group had neuroma-in-continuity or ruptures of the upper trunk. Outcomes were assessed with use of the Active Movement Scale and the Brachial Plexus Outcome Measure. The Wilcoxon signed-rank test was utilized to evaluate changes across treatment.Results:Ten patients with brachial plexus birth injury were included in the avulsion cohort. Surgical reconstruction entailed neuroma resection and nerve grafting from the single available root balanced across all distal targets with or without spinal accessory-to-suprascapular nerve transfer. Significant improvements were observed across treatment for both the avulsion and control groups in terms of shoulder abduction, shoulder flexion, external rotation, elbow flexion, and supination. At a mean follow-up of 54.5 ± 8.8 months, patients in the avulsion group achieved Active Movement Scale scores of 6.8 ± 0.4 for elbow flexion and 6.5 ± 0.9 for shoulder flexion and abduction, with lesser recovery observed in external rotation (3.3 ± 2.8). All patients available for Brachial Plexus Outcome Measure assessments demonstrated functional movement.Conclusions:In the setting of avulsion of 1 upper-trunk root, nerve reconstruction by grafting of the upper trunk from the other upper-trunk root provides improved movement, high Active Movement Scale scores, and satisfactory function according to the Brachial Plexus Outcome Measure. These data provide support for a strategy that ensures the entire upper trunk is adequately reconstructed in the setting of upper-trunk lesions.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical Reconstruction of Isolated Upper Trunk Brachial Plexus Birth Injuries in the Presence of an Avulsed C5 or C6 Nerve Root

Davidge

Curtis

et al. 2021

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

show abstract

“…Primary reconstruction of the obstetric brachia plexus injury leads to a satisfying outcome in terms of motor and sensitivity of hand and elbow for most patients. A second surgical intervention is sometimes needed to improve motor functions in wrist and shoulder [9,10].…”

Section: Surgical Treatment and Outcomementioning

confidence: 99%

Factors of Cortical Plasticity in Brachial Plexus Injury

Reinsch¹,

Zdunczyk²,

Sargut³

et al. 2022

Brachial Plexus Injury - New Techniques and Ideas

View full text Add to dashboard Cite

Cortical plasticity is the brain’s capability of decoding new information through growth and reorganization over our whole life spam. It is the basis for good outcomes after reinnervation and for rehabilitation of adult and obstetric brachial plexus injury. Knowledge about cortical reorganization is crucial to reconstructive surgeons and physiotherapists that aim to give their patients a reasonable prognosis. This chapter intends to present and summarize the current literature on how to detect and quantify cortical plasticity and how research on factors that influence cortical plasticity, mainly in relation to peripheral nerve and more precise brachial plexus injury progresses. Peculiarities of adult and obstetric brachial plexus injuries and their treatment are given. We present techniques that visualize and quantify cortical plasticity with focus on functional imaging like fMRI and nTMS as well as molecular aspects. Future research is needed to understand mechanisms of how molecular changes on a synaptic level of a neuron influence the macroscopic plasticity, to improve rehabilitative resources, to understand the exact prognostic value of nTMS in brachial plexus injury and to investigate the therapeutic capability of rTMS.

show abstract

“…trunks), must be carefully assessed. During surgery, quality assessment is most commonly qualitative, based on intraoperative estimates by the surgeon under magnifying loupes or operative microscope (Lombard et al, 2020;Malessy and Pondaag, 2012). Conversely, semi-quantitative histological data, such as the percentage of intraneural fibrosis or frozen section histology stained with toluidine blue (Murji et al, 2008), do not seem to be routinely used to guide the reconstructive strategy (Comtet et al, 1993;Gschmeissner et al, 1991;Malessy and Pondaag, 2012).…”

Section: Introductionmentioning

confidence: 99%

Correlation between histopathological nerve assessment and clinical recovery in brachial plexus birth injuries

Moulinier,

Bellity,

Saghbiny

et al. 2023

J Hand Surg Eur Vol

Self Cite

View full text Add to dashboard Cite

In the management of brachial plexus birth palsies, the quality of the roots eligible for reconstruction is thought to be a key issue. The aim of the present study was to evaluate the correlations between pathological root examination and motor recovery after brachial plexus reconstructions. Quantitative histopathological analysis of intraneural fibrosis was conducted on 72 nerve transections (40 roots, 18 trunks and 14 suprascapular nerves) in 20 patients. Clinical recovery of targeted muscles after surgery was assessed by standardized functional scores. After a mean follow-up of 32 months, patients with a lower fibrosis rate for the suprascapular nerve had greater global Mallet scores (r = −0.57; p = 0.042) as well as a greater active shoulder flexion (r = −0.66; p = 0.015). Correlations were also found between C6 root and upper trunk fibrosis rate and some of the subsections of the Mallet score, active movement scale for the biceps and active elbow flexion. These results seem to confirm the relevance of intraoperative pathological evaluation of the roots and nerves after neuroma resection to optimally define the reconstruction strategy. Level of evidence: IV

show abstract

C5-8 neonatal brachial plexus palsy. Operative findings, reconstructive strategy and outcome

Cited by 10 publications

References 15 publications

Surgical Reconstruction of Isolated Upper Trunk Brachial Plexus Birth Injuries in the Presence of an Avulsed C5 or C6 Nerve Root

Surgical Reconstruction of Isolated Upper Trunk Brachial Plexus Birth Injuries in the Presence of an Avulsed C5 or C6 Nerve Root

Factors of Cortical Plasticity in Brachial Plexus Injury

Correlation between histopathological nerve assessment and clinical recovery in brachial plexus birth injuries

Contact Info

Product

Resources

About