Impaired Growth of Denervated Muscle Contributes to Contracture Formation Following Neonatal Brachial Plexus Injury

Nikolaou, Sia; Peterson, Elizabeth; Kim, Annie; Wylie, Christopher; Cornwall, Roger

doi:10.2106/jbjs.j.00943

Cited by 125 publications

(146 citation statements)

References 28 publications

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“…Once the controlling nerve is injured, the controlled muscle is doomed to show some histological changes such as a less weight, thinned muscle fibers and more collagen fibers (Nikolaou et al, 2011). In the present study, the activity of SCs began to increase obviously at 2 w after denervation, and the number of SCs began to increase noticeably at 3 w; but such increase stopped at 2 months, and the number of SCs began to show a rapid decrease.…”

Section: Discussionsupporting

confidence: 42%

Correlation between Innervation of Skeletal Muscles and Myoblast Stem Cells

Sun

Zhu

et al. 2012

Int. J. Morphol.

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SUMMARY:In order to explore the change rule of myoblast stem cells (satellite cells, SCs) in the denervated and re-innervated muscle and to investigate the cellular mechanism of the morphological and functional changes of the muscle, denervated muscle atrophy and nerve regeneration models were established in one-month-old rats. Postoperative indexes such as muscle wet weight, cell section areas, content of collagen fibers and DNA, electrophysiology, numbers of SCs in the triceps muscle of calf were dynamically tested. After denervation, the muscle wet weight and cell area reduced rapidly, and the collagen fiber content increased slowly. The number of SCs increased at first, and then declined suddenly two months later. From 4 to 5 weeks after re-neuralization, muscle action potentials could be evoked, but the best innervation effect was found in the groups, which received re-neuralization at 2 months and 3 months after denervation. Denervation causes a progressive progress of muscle atrophy. SCs proliferate within 3 months after denervation, and then atrophy becomes irreversible from 4 months. At 4 or 5 weeks after re-neuralization, muscle action potentials can be evoked. Re-neuralization at 2 months and 3 months after denervation can achieve a good effect on the functional recovery of the atrophic muscle.

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Section: Discussionsupporting

confidence: 42%

Correlation between Innervation of Skeletal Muscles and Myoblast Stem Cells

Sun

Zhu

et al. 2012

Int. J. Morphol.

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“…The incidence of significant elbow flexion contractures in BPBP may be greater than clinicians perceive, and prevalence increases with patient age [31]. Nikolaou has shown that functional shortening of denervated muscle plays a primary role in contracture pathogenesis [32]. However, the mechanism of contracture development in denervated muscle remains unanswered [33,34].…”

Section: Natural Historymentioning

confidence: 99%

The natural history and management of brachial plexus birth palsy

Buterbaugh

Shah

2016

Curr Rev Musculoskelet Med

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Brachial plexus birth palsy (BPBP) is an upper extremity paralysis that occurs due to traction injury of the brachial plexus during childbirth. Approximately 20 % of children with brachial plexus birth palsy will have residual neurologic deficits. These permanent and significant impacts on upper limb function continue to spur interest in optimizing the management of a problem with a highly variable natural history. BPBP is generally diagnosed on clinical examination and does not typically require cross-sectional imaging. Physical examination is also the best modality to determine candidates for microsurgical reconstruction of the brachial plexus. The key finding on physical examination that determines need for microsurgery is recovery of antigravity elbow flexion by 3-6 months of age. When indicated, both microsurgery and secondary shoulder and elbow procedures are effective and can substantially improve functional outcomes. These procedures include nerve transfers and nerve grafting in infants and secondary procedures in children, such as botulinum toxin injection, shoulder tendon transfers, and humeral derotational osteotomy.

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“…Although the exact mechanism is unknown, denervation of the upper limb during the neonatal period leads to impaired growth and eventual contracture of the affected muscles 1 . As the neonatal glenohumeral joint is entirely cartilaginous, these contractures can lead to altered joint mechanics and eventually to irreversible joint deformity.…”

mentioning

confidence: 99%

Ultrasound Screening for Posterior Shoulder Dislocation in Infants with Persistent Brachial Plexus Birth Palsy

Bauer

Lucas

Heyrani

et al. 2017

The Journal of Bone and Joint Surgery

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Background: Early detection of posterior shoulder dislocation in infants with brachial plexus birth palsy (BPBP) is essential, but it may be difficult to accomplish with physical examination alone. The aim of this study was to determine the prevalence of shoulder dislocation in patients with BPBP using ultrasound and to identify which physical examination measurements correlated most with dislocation in these patients. Methods: This study was a retrospective review of data obtained in an ultrasound screening program of infants with BPBP born from January 2011 to April 2014. Physical examination included the use of the Active Movement Scale (AMS) and measurement of passive external rotation of the shoulder. Ultrasound measurements included PHHD (percentage of the humeral head displaced posterior to the axis of the scapula) and the alpha angle (intersection of the posterior scapular margin with a line tangential to the humeral head through the glenoid). Shoulder dislocation was defined as both a PHHD of >0.5 and an alpha angle of >30°. Results: Of sixty-six infants who had undergone a total of 118 ultrasound examinations (mean, 1.8; range, 1 to 5), 19 (29%) demonstrated shoulder dislocation with the shoulder positioned in internal rotation; the dislocation was first detected between 2.1 and 10.5 months of age. Infants with a dislocated shoulder demonstrated significantly less mean passive external rotation in adduction (mean, 45.8° versus 71.4°, p < 0.001) and a greater difference between internal rotation and external rotation AMS scores (mean, 5.5-point versus 3.3-point difference, p < 0.001) than those without shoulder dislocation. Passive external rotation in adduction was a better measure for discriminating between dislocation and no dislocation (area under receiver operating characteristic curve [AUC] = 0.89) than was the difference between internal and external rotation AMS scores (AUC = 0.73). A cutoff of 60° of passive external rotation in adduction (≤60° versus° >60) yielded a sensitivity of 94% and a specificity of 69%. Conclusions: Shoulder dislocation is common in infants with BPBP; 29% of the infants presenting to our tertiary care center had a dislocation during their first year of life. Ultrasound shoulder screening is appropriate for infants with BPBP. If passive external rotation in adduction is used to determine which infants should undergo ultrasound, ≤60° should be utilized as the criterion to achieve appropriate sensitivity. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Impaired Growth of Denervated Muscle Contributes to Contracture Formation Following Neonatal Brachial Plexus Injury

Cited by 125 publications

References 28 publications

Correlation between Innervation of Skeletal Muscles and Myoblast Stem Cells

Correlation between Innervation of Skeletal Muscles and Myoblast Stem Cells

The natural history and management of brachial plexus birth palsy

Ultrasound Screening for Posterior Shoulder Dislocation in Infants with Persistent Brachial Plexus Birth Palsy

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