Management of infant brachial plexus injuries

Shenaq, Saleh M.; Bullocks, Jamal M.; Dhillon, Gupreet; Lee, Rita T.; Laurent, John P.

doi:10.1016/j.cps.2004.09.001

Cited by 33 publications

(23 citation statements)

References 96 publications

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“…The decreased humeral head retroversion in the current cohort coupled with the decreased passive and active external shoulder rotation typically reported for OBPP 41; 44 mirrors the increased retroversion with decreased active internal rotation in athletes of overhand sports 52 . The large differences in version seen in the current study must be balanced against much smaller differences (Δ=10.3°) reported previously for a similar population 46 .…”

Section: Discussionsupporting

confidence: 56%

“…Children who do not recover completely are left with shoulder muscle imbalance, contracture, disuse, and significant glenoid-humeral deformities 20; 24; 40; 41; 50 . The persisting sequelae are wide ranging, severely restrict the arm function, limit activities of daily living independence 43 , and reduce the quality of life for patients and their caregivers 31; 43 .…”

Section: Introductionmentioning

confidence: 99%

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Three-dimensional humeral morphologic alterations and atrophy associated with obstetrical brachial plexus palsy

Sheehan

Brochard

Behnam

et al. 2014

Journal of Shoulder and Elbow Surgery

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Background Obstetrical Brachial Plexus Palsy (OBPP) is a common birth injury, resulting in severe functional losses. Yet, little is known about how OBPP affects the 3D humeral morphology. Thus, the purpose of this study was to measure the 3D humeral architecture in children with unilateral OBPP. Methods Thirteen individuals (4F/9M, age=11.8±3.3 years, Mallet score=15.1±3.0) participated in this IRB-approved study. A three-dimensional T1-weighted gradient-recalled-echo magnet resonance image set was acquired for both upper limbs (involved/non-involved). Humeral size, version, and inclination were quantified from 3D humeral models derived from these images. Results The involved humeral head was significantly less retroverted and in declination (medial humeral head pointed anteriorly and inferiorly), relative to the non-involved side. Osseous atrophy was present in all three dimensions and affected the entire humerus. The inter-rater reliability was excellent (ICC = 0.96–1.00). Discussion This study demonstrated that both humeral atrophy and bone shape deformities associated with OBPP are not limited to the axial plane, but are three-dimensional phenomena. Incorporating information related to these multiplanar, 3D, humeral deformities into surgical planning could potentially improve functional outcomes following surgery. The documented reduction in retroversion is an osseous adaptation, which may help maintain glenohumeral congruency by partially compensating for the internal rotation of the arm. The humeral head declination is a novel finding and may be an important factor to consider when developing OBPP management strategies, as it has been shown to lead to significant supraspinatus inefficiencies and increased required elevation forces. Level of evidence Anatomic Study, Imaging

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Section: Discussionsupporting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Three-dimensional humeral morphologic alterations and atrophy associated with obstetrical brachial plexus palsy

Sheehan

Brochard

Behnam

et al. 2014

Journal of Shoulder and Elbow Surgery

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“…Patient management can often be improved by informed consent based on risk assessment and improved postoperative care with early referral for nerve injuries. 43,45 Early referral is essential for patients with complex regional pain syndrome, 31 peripheral nerve injuries caused by regional anaesthesia, 40 and in infant brachial plexus injuries 38 and spinal accessory nerve injuries. 9 Corticosteroids, such as dexamethasone, may be used intra-operatively in order to reduce swelling, pain and trismus after third molar surgery.…”

Section: Is Prevention Possible?mentioning

confidence: 99%

Managing iatrogenic trigeminal nerve injury: a case series and review of the literature

Renton

Yılmaz

2012

International Journal of Oral and Maxillofacial Surgery

105

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“…This indicates involvement of the sympathetic chain and probable avulsion injury. 11 It is important to determine whether the level of the nerve injury is preganglionic or postganglionic. The degree and type of postganglionic neural injury is defined by Sunderland 12 as neurapraxia, axonotmesis, and neurotmesis, as opposed to preganglionic nerve root avulsions.…”

Section: Overview and Backgroundmentioning

confidence: 99%

Late Reconstruction of Brachial Plexus Birth Palsy

Sibbel¹,

Bauer²,

James³

2014

Journal of Pediatric Orthopaedics

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Brachial plexus birth palsy (BPBP) presents to the physician on a clinical spectrum, and may substantially impair the child. Potential interventions to improve function for the child with BPBP include physical therapy, microsurgical nerve reconstruction and nerve transfers, soft-tissue balancing and reconstruction with musculotendinous transfers, and osteotomies. Some interventions, such as nerve reconstruction, are best performed in infancy; others, such as muscle transfers and osteotomies, are performed to treat manifestations of this condition that appear later in childhood. Although controversy continues to exist regarding the natural history and surgical management of these patients, recent literature has improved our understanding of surgical indications, anticipated outcomes, and potential complications. On the basis of current evidence, we present here the recommendations for surgical intervention in the upper extremity of children with BPBP, and encourage early referral to a brachial plexus specialist to establish care.

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Management of infant brachial plexus injuries

Cited by 33 publications

References 96 publications

Three-dimensional humeral morphologic alterations and atrophy associated with obstetrical brachial plexus palsy

Three-dimensional humeral morphologic alterations and atrophy associated with obstetrical brachial plexus palsy

Managing iatrogenic trigeminal nerve injury: a case series and review of the literature

Late Reconstruction of Brachial Plexus Birth Palsy

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