Elbow Flexion Contractures in Childhood in Obstetric Brachial Plexus Lesions: A Longitudinal Study of 20 Neurosurgically Reconstructed Infants with 8-Year Follow-up

Sluijs, Maaike J. van der; Ouwerkerk, Willem-Jan R. van; Sluijs, J.A. van der; Royen, Barend J. van

doi:10.1055/s-0035-1549368

Cited by 6 publications

(9 citation statements)

References 24 publications

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“…Our study confirms longitudinal and cross-sectional studies in BPBI which found no effect of imbalance in infancy on later contracture formation. 13 , 14 …”

Section: Discussionmentioning

confidence: 99%

“…This study includes 16 patients from a previous longitudinal study on the relation between infant MRI findings and infant muscle function and childhood contractures and muscle force. 14 The right arm was affected in 60 children. In 58 children included in this study surgical plexus reconstruction in infancy had been performed according to standard criteria.…”

Section: Methodsmentioning

confidence: 99%

“… 12 In longitudinal studies in children with a BPBI no relation between residual muscle function and elbow contractures has been found. 13 , 14 The aim of the present cross-sectional clinical study is, following the hypotheses of Guerin and Delpech, to test which factor is more related to flexion contracture formation of the elbow in children with a unilateral BPBI: the extent of denervation or residual muscle function/imbalance.…”

Section: Introductionmentioning

confidence: 99%

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What influences contracture formation in lower motor neuron disorders, severity of denervation or residual muscle function? An analysis of the elbow contracture in 100 children with unilateral Brachial Plexus Birth Injury

Sluijs

Bunt

et al. 2018

Journal of Children's Orthopaedics

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Abstract:PurposeAs in other neuromuscular disorders, both denervation and muscle paresis/imbalance are implicated as aetiological factors for contractures in children with a Brachial Plexus Birth Injury (BPBI). Although both factors are related, it is unclear which factor is dominant. The aim of this study is to assess whether contracture formation in children is predominantly related to denervation or to residual muscle function/imbalance. This might be relevant for understanding contracture formation in other neuromuscular disorders.MethodsA total of 100 children (61 boys; mean age 10.4 years, 4 to 18) with unilateral BPBI were included in this cross-sectional study. Severity of the denervation was classified according to Narakas. Muscle function of flexors and extensors of both elbows was measured (in Newtons) using a hand-held dynamometer and flexion contractures were measured with a goniometer. The relation between denervation, muscle function/muscle balance and flexion contracture was assessed using univariate and multivariate analysis.ResultsOf the children, 57 were Narakas class I, 13 class II and 30 class III. Mean flexion contracture was 25° (90° to −5°). At the affected side the forearm flexion force was 47% and extension force was 67% of the force of the unaffected side. Contractures were more severe in children with higher Narakas classifications (p = 0.001), after neurosurgery (Mann-Whitney U test, p = 0.009) and were related to age (Spearman’s Rho = −0.3, p = 0.008) and to paresis of the extensors (Rho = 0.4, p = 0.000). Flexor paresis as a percentage of unaffected side (Rho = 0.06, p = 0.6) and muscle balance had no influence.ConclusionIn BPBI, elbow contractures are related to the severity of the neurological lesion, not to residual muscle function.Level of evidenceLevel II – prognostic study

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“…Our study confirms longitudinal and cross-sectional studies in BPBI which found no effect of imbalance in infancy on later contracture formation. 13 , 14 …”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

What influences contracture formation in lower motor neuron disorders, severity of denervation or residual muscle function? An analysis of the elbow contracture in 100 children with unilateral Brachial Plexus Birth Injury

Sluijs

Bunt

et al. 2018

Journal of Children's Orthopaedics

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“…In one, a higher Narakas classification was linked to worse elbow flexion contracture. 55 In another, no such correlation could be established. 14 Al-Qattan noted a striking absence of shoulder and elbow contractures in the rare group of OBPP associated with breech delivery.…”

Section: Theories Regarding Pathogenesis Of Contracturesmentioning

confidence: 96%

The Pathogenesis of Glenohumeral Deformity and Contracture Formation in Obstetric Brachial Plexus Palsy—A Review

Olofsson

Chu

McGrath

2019

J Brachial Plex Peripher Nerve Inj

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Contractures of the shoulder joint and glenohumeral joint dysplasia are well known complications to obstetrical brachial plexus palsy. Despite extensive description of these sequelae, the exact pathogenesis remains unknown. The prevailing theory to explain the contractures and glenohumeral joint dysplasia states that upper trunk injury leads to nonuniform muscle recovery and thus imbalance between internal and external rotators of the shoulder. More recently, another explanation has been proposed, hypothesizing that denervation leads to reduced growth of developing muscles and that reinnervation might suppress contracture formation. An understanding of the pathogenesis is desirable for development of effective prophylactic treatment. This article aims to describe the current state of knowledge regarding these important complications.

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“…17,19 Previous literature has also described contractures as deformities >5°, ≥10°, or >10° from zero. [22][23][24] For our documentation and analysis, we chose to define elbow flexion contractures with the lowest threshold published definition: > 5° from neutral.…”

Section: Range Of Motionmentioning

confidence: 99%

Can the Sup-ER Protocol Decrease the Prevalence and Severity of Elbow Flexion Deformity in Brachial Plexus Birth Injuries?

Yefet

Bellows

Bucevska

et al. 2022

Hand (New York, N,Y.)

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Background: Brachial plexus birth injuries (BPBIs) can often result in functional and cosmetic deficits including, according to a recent scoping review, elbow flexion contractures in up to 48%. A treatment algorithm that includes a custom long-arm orthosis to optimize early glenohumeral joint positioning (Sup-ER protocol) has been shown to improve shoulder range of motion. Although the protocol was not intentionally designed to affect the elbow, this study investigates the prevalence and severity of elbow flexion contractures in children treated with that protocol. Methods: This prospective cross-sectional cohort study examined 16 children aged 4 and older with BPBI severe enough to be treated with the Sup-ER protocol. Passive and active elbow flexion and extension range of motion (ROM) were assessed in both arms. Elbow flexion contractures were defined as > 5o from neutral. Results: Within the cohort of 16 patients (mean age: 7.0 years, range: 4.5-11.6 years), the mean maximal passive elbow extension was -6.2° in the affected arm and + 5.1° (hyperextension) in the unaffected arm. Zero patients had a severe elbow flexion contracture (>30o) and only 6/16 met the lowest threshold definition of elbow flexion contracture (>5o), with a mean onset at 22 months of age. Conclusions: This study suggests an unintended decreased prevalence and severity of elbow flexion contractures in children with more severe BPBI treated with the Sup-ER protocol, relative to published values.

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Elbow Flexion Contractures in Childhood in Obstetric Brachial Plexus Lesions: A Longitudinal Study of 20 Neurosurgically Reconstructed Infants with 8-Year Follow-up

Cited by 6 publications

References 24 publications

What influences contracture formation in lower motor neuron disorders, severity of denervation or residual muscle function? An analysis of the elbow contracture in 100 children with unilateral Brachial Plexus Birth Injury

What influences contracture formation in lower motor neuron disorders, severity of denervation or residual muscle function? An analysis of the elbow contracture in 100 children with unilateral Brachial Plexus Birth Injury

The Pathogenesis of Glenohumeral Deformity and Contracture Formation in Obstetric Brachial Plexus Palsy—A Review

Can the Sup-ER Protocol Decrease the Prevalence and Severity of Elbow Flexion Deformity in Brachial Plexus Birth Injuries?

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