Nerve transfer to biceps to restore elbow flexion and supination in children with obstetrical brachial plexus palsy

Abstract

PurposeNerve transfers to restore elbow flexion have been described for traumatic brachial plexus palsy in adults. Indications are less frequent in infants and the results are less published.MethodsTen patients with obstetrical brachial plexus palsy were operated on for lack of flexion against gravity with ulnar or median nerve transfer to biceps motor branch. The primary endpoint was improvement in elbow flexion and supination.ResultsMean age at surgery was 12.5 months and mean follow-up was 2.6 years. The Active Movement Scale (AMS) was used to evaluate elbow flexion and forearm supination. At the last follow-up, the average AMS score improved from 0.3 to 5.7 for elbow flexion and from 0.6 to 5.8 for forearm supination. There was no statistical correlation between the age at surgery and the AMS score 18 months post-operatively.ConclusionsNerve transfer to the biceps motor branch can improve elbow flexion and forearm supination in selected patients with upper lesions and can be safely performed until the age of two years.

Avaliação dos resultados a longo prazo da cirurgia de Oberlin na paralisia braquial obstétrica

“…Similarly, there was no relationship with the age of surgery, as Murison's study also observed. 24 A larger sample could add more evidence to those observations. Still, as this is an infrequent indication, multicenter studies gathering experiences from various specialized groups could be conducted to achieve this purpose.…”

“…By performing the nerve suture closer to the muscle to be reinnervated, this technique allows the performance of primary surgeries in children up to 2 years of life with functional results, as observed by other authors. 24 For this reason, the method under study may be used to treat children who only present themselves to a specialized service later than 1 year of age. Similar to the other studies in the literature, no sensory or motor dysfunction in the hands of patients due to fascicular transfer of the ulnar nerve was observed in the present study.…”

“…The AMS was developed to evaluate younger children with OP, being used by several authors. 2 24 However, the MRC scale, even though it is not as specific, is more widespread and preferred by other authors. 15 23 Despite the differences in graduation between the scales, we observed a correspondence between the two in the long-term result of elbow flexion muscle strength.…”

“…Por realizar a sutura nervosa mais próxima ao músculo a ser reinervado, essa técnica permite a realização de cirurgias primárias em crianças até os 2 anos de vida com resultados funcionais, como observado por outros autores. 24 Decorrente a esse fato, o método em estudo torna viável o tratamento de crianças que apenas se apresentam a um serviço especializado com mais de um ano de vida. Semelhante aos demais estudos na literatura, não foi observada no presente estudo qualquer disfunção, sensitiva ou motora, na mão dos pacientes decorrente da transferência fascicular do nervo ulnar.…”

Starting A Peripheral Nerve Surgery Unit in an Area of Limited Resources - Our Experience

“…The workhorse of brachial plexus repair surgery is still largely the neurotization transfers and nerve grafting [5,6,13,17,19,23,24,29,38,42,44,48,50,51]. The muscles of the shoulder and the biceps brachii have classically been the main targets for repair of brachial plexus injuries [17,29,38,48]. However, there is now more importance on equally focusing on restoring at least elbow extension for functionality and even newer attempts at selective reinnervation of the median nerve for prehensile hand function or pincer grip [33,39,42].…”