Nerve reconstruction in patients with obstetric brachial plexus injury results in worsening of glenohumeral deformity

Nath, Rahul K.; Liu, X.

doi:10.1302/0301-620x.91b5.21878

Cited by 10 publications

(7 citation statements)

References 34 publications

(38 reference statements)

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“…Because of higher SD values of the brachialis and the biceps brachii, the elbow flexion can be seen later than expected. In parallel with our views, Nath and Liu claim that surgical interventions that performed between 3 and 6 months of age might impair the recovery potential of injured brachial plexus (Nath and Liu,2009). Our results suggest that the decision of surgical intervention in OBPP based on a certain time course might lead to wrong conclusions.…”

Section: Discussionsupporting

confidence: 75%

Motor nerve lengths of twenty‐seven muscles in upper extremity

et al. 2011

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The purpose of this study is to determine the lengths of motor nerves in the upper extremity. Motor nerves of 27 muscles in 10 cadavers (16 extremities) were dissected from their roots at the level of intervertebral foramen to the entry point of the nerves to the corresponding muscles. Distance between acromion and the lateral epicondyle of the humerus was also measured in all cadavers. Nerve length of the coracobrachialis muscle was the shortest (18.26 ± 1.64 cm), while the longest was the nerve of the extensor indicis (59.51 ± 4.80 cm). The biceps brachii, the extensor digitorum communis, and the brachialis muscles showed highest coefficient of variation that makes these nerve lengths of muscles inconsistent about their lengths. This study also offers quotients using division of the lengths of each nerve to acromion-the lateral epicondyle distance. Knowledge of the nerve lengths in the upper extremity may provide a better understanding the reinnervation sequence and the recovery time in the multilevel injuries such as brachial plexus lesions. Quotients may be used to estimate average lengths of nerves of upper extremity in infants and children. Moreover, reliability of the biceps brachii as a determinant factor for surgery in obstetrical brachial plexus lesions should be reconsidered due to its highest variation coefficient.

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Section: Discussionsupporting

confidence: 75%

Motor nerve lengths of twenty‐seven muscles in upper extremity

et al. 2011

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“…These studies reported excellent results with botulinum toxin A combined with appropriate physiotherapy in those cases with co-contraction-related functional disabilities [14,25,26]. Some authors also described results of worsening of glenohumeral deformity in cases in which surgery was performed early for upper type palsies [27,28]. A better understanding of the co-contraction mechanisms between the shoulder abductors and adductors as well as the elbow flexors and extensors led some surgeons to re-evaluate their decisions about early nerve surgery based on elbow flexion or shoulder abduction.…”

Section: Discussionmentioning

confidence: 99%

“…Passive ranges of motion are always assessed before surgery and therefore should have yielded satisfactory ranges; however the postoperative gains (only 8.1° as compared to 45° and 48° for the other groups) were significantly less than expected. As mentioned above, Nath and Liu found that the glenohumeral deformity is worsened if the patient had a previous history of neural surgery [28], and a glenohumeral deformity may affect the external rotation more significantly than abduction. This may be evidence for the aforementioned study.…”

Section: Discussionmentioning

confidence: 99%

Does primary brachial plexus surgery alter palliative tendon transfer surgery outcomes in children with obstetric paralysis?

Aydın

Bi̇çer

Özkan

et al. 2011

BMC Musculoskelet Disord

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BackgroundThe surgical management of obstetrical brachial plexus palsy can generally be divided into two groups; early reconstructions in which the plexus or affected nerves are addressed and late or palliative reconstructions in which the residual deformities are addressed. Tendon transfers are the mainstay of palliative surgery. Occasionally, surgeons are required to utilise already denervated and subsequently reinnervated muscles as motors. This study aimed to compare the outcomes of tendon transfers for residual shoulder dysfunction in patients who had undergone early nerve surgery to the outcomes in patients who had not.MethodsA total of 91 patients with obstetric paralysis-related shoulder abduction and external rotation deficits who underwent a modified Hoffer transfer of the latissimus dorsi/teres major to the greater tubercle of the humerus tendon between 2002 and 2009 were retrospectively analysed. The patients who had undergone neural surgery during infancy were compared to those who had not in terms of their preoperative and postoperative shoulder abduction and external rotation active ranges of motion.ResultsIn the early surgery groups, only the postoperative external rotation angles showed statistically significant differences (25 degrees and 75 degrees for total and upper type palsies, respectively). Within the palliative surgery-only groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles. The significant differences between the early surgery groups and the palliative surgery groups with total palsy during the preoperative period diminished postoperatively (p < 0.05 and p > 0.05, respectively) for abduction but not for external rotation. Within the upper type palsy groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles.ConclusionsIn this study, it was found that in patients with total paralysis, satisfactory shoulder abduction values can be achieved with tendon transfers regardless of a previous history of neural surgery even if the preoperative values differ.

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“…Although these procedures can improve function and stop the exacerbation of glenohumeral dysplasia, they have not been shown to stimulate joint remodeling [9]. A recent study by our institute showed that OBPI patients who underwent nerve reconstructions developed more serious shoulder complications and required more secondary surgical procedures to address these deformities [19]. Humeral osteotomy is commonly applied to treat OBPI and has been shown to improve shoulder position [20, 21].…”

Section: Discussionmentioning

confidence: 99%

Triangle tilt surgery as salvage procedure for failed shoulder surgery in obstetric brachial plexus injury

2010

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PurposeThe study was conducted to review the effects of triangle tilt surgery in children with OBPI (obstetric brachial plexus injury) who had previously undergone several operative procedures at other hospitals before presenting at our institute.MethodsThe study included a group of 48 OBPI patients who had undergone previous operative procedures at outside hospitals by other surgeons. Patients were assessed for shoulder function using their radiological reports and the modified Mallet functional scale. The same patients underwent the triangle tilt procedure at our institution and were re-evaluated for shoulder function.ResultsThe results of the study showed an increase in Mallet scores from 11.88 points to 15.17 points (p < 0.01), improvement in PHHA (percentage of humeral head anterior to the glenoid) from 14% to 25% (p < 0.05), enhancement in glenoid version from −32° to −25° (p < 0.01), and a decrease in the SHEAR (scapular hypoplasia, elevation, and rotation) deformity after surgery.ConclusionThe data obtained demonstrated that the triangle tilt procedure significantly enhanced shoulder function and glenohumeral congruity in these patients as evidenced by the improvements in Mallet scores, PHHA, glenoid version, and SHEAR deformity.

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Nerve reconstruction in patients with obstetric brachial plexus injury results in worsening of glenohumeral deformity

Cited by 10 publications

References 34 publications

Motor nerve lengths of twenty‐seven muscles in upper extremity

Motor nerve lengths of twenty‐seven muscles in upper extremity

Does primary brachial plexus surgery alter palliative tendon transfer surgery outcomes in children with obstetric paralysis?

Triangle tilt surgery as salvage procedure for failed shoulder surgery in obstetric brachial plexus injury

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