Recovery of shoulder abduction in traumatic brachial plexus palsy: a systematic review and meta-analysis of nerve transfer versus nerve graft

Hardcastle, Nathan; Texakalidis, Pavlos; Nagarajan, Purva; Tora, Muhibullah S; Boulis, Nicholas M.

doi:10.1007/s10143-019-01100-9

Cited by 10 publications

(19 citation statements)

References 16 publications

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“…As we know, shoulder stabilization, restoration of abduction, and external rotation are important as more distal functions will be affected by the condition of the shoulder. To achieve this, various techniques have been proposed and used, such as nerve reconstruction in early stages using intra- or extraplexus donors [ 26 ] and secondary procedures including arthrodesis, tendon transfers, and muscle transfers [ 27 – 29 ]. One study showed that when 30° of shoulder abduction was achieved, shoulder subluxation was usually corrected [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Functional outcome of contralateral C7 nerve transfer combined with free functional gracilis transplantation to repair total brachial plexus avulsion: a report of thirty-nine cases

Chen

Qin

Wang

et al. 2022

International Orthopaedics (SICOT)

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Purpose Treatment of total brachial plexus avulsion (TBPA) is a challenge in the clinic, especially the restoration of hand function. The current main surgical order is from proximal to distal joints. The purpose of this study was to demonstrate the outcomes of “distal to proximal” surgical method. Methods Thirty-nine patients underwent contralateral C7 (CC7) nerve transfer to directly repair the lower trunk (CC7-LT) and phrenic nerve transfer to the suprascapular nerve (PN-SSN) during the first stage, followed by free functional gracilis transplantation (FFGT) for elbow flexion and finger extension. Muscle strength of upper limb, degree of shoulder abduction and elbow flexion, and Semmes–Weinstein monofilament test and static two-point discrimination of the hand were examined according to the modified British Medical Research Council (mBMRC) scoring system. Results The results showed that motor recovery reached a level of M3 + or greater in 66.7% of patients for shoulder abduction, 87.2% of patients for elbow flexion, 48.7% of patients for finger extension, and 25.6% of patients for finger flexion. The mean shoulder abduction angle was 45.5° (range 0–90°), and the average elbow flexion angle was 107.2° (range 0–142°), with 2.5 kg average flexion strength (range 0.5–5 kg). In addition, protective sensibility (≥ S2) was found to be achieved in 71.8% of patients. Conclusion In reconstruction of TBPA, CC7 transfer combined with free functional gracilis transplantation is an available treatment method. It could help patients regain shoulder joint stability and the function of elbow flexion and finger extension and, more importantly, provide finger sensation and partial finger flexion function. However, the pick-up function was unsatisfied, which needed additional surgery.

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Section: Discussionmentioning

confidence: 99%

Functional outcome of contralateral C7 nerve transfer combined with free functional gracilis transplantation to repair total brachial plexus avulsion: a report of thirty-nine cases

Chen

Qin

Wang

et al. 2022

International Orthopaedics (SICOT)

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“…In these additional readings, one can learn more information regarding nerve transfer including their uses, [31,32] suggested adjunct procedures, [32] efficacy and outcomes, [33] and comparison to nerve grafts [34].…”

Section: "State-of-the-art Nerve Transfers" (Additional Reading)mentioning

confidence: 99%

“…Topic overview [31] A review investigating the use of distal nerve transfers to the ulnar nerve in cubital tunnel syndrome [32] A review of nerve transfer use in peripheral nerve injury and suggestion of concomitant Schwann cell transplantation to aid in regeneration [33] A systematic review assessing the efficacy and outcome correlations of nerve transfer in patients with brachial plexus and axillary nerve injury [34] A systematic review evaluating nerve graft vs. nerve transfer regarding shoulder abduction recovery in patients with brachial plexus palsy…”

Section: Referencementioning

confidence: 99%

Frontiers of Brachial Plexus Injury: Future Revolutions in the Field

Rosen¹,

Hong²,

Klaudt-Moreau³

et al. 2022

Brachial Plexus Injury - New Techniques and Ideas

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The field of brachial plexus surgery has undergone dramatic changes in the past 40 years. Most of these have been incremental in nature. We have seen increased use of nerve grafts and nerve transfers. We have seen the introduction of robotic limb replacements for the most severe flail limbs where surgical intervention has failed. In some cases, we have seen an increase in the use of computer simulation and virtual reality to train surgeons to plan and execute surgeries. More recently, we have seen the introduction of technologies derived from regenerative medicine research.

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“…The absence of spontaneous recovery within six months usually leads to surgical exploration. 24,25 Late surgeries (> 9 or 12 months) have worse outcomes. 1,9,26 The treatment of a brachial plexus injuries is technically demanding, and the outcomes of nerve reconstructions will be apparent approximately 1 to 2 years after surgery.…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…This combination results in rates of elbow flexion > or ¼ to M3 of 93.1% to 96% and 74% to 82.5% for shoulder abduction of > or ¼ to M3. 24,28,30,33,34 2) Lower trunk injuries (C8-T1): the functional outcomes in the hand are significantly less successful compared with those in the shoulder and elbow, because hand recovery is more complex. The treatment aims to restore a functional grip and fist either with nerve or tendon transfers.…”

Section: Secondary Reconstructionmentioning

confidence: 99%

Lesiones del plexo braquial en adultos: Una revisión narrativa de la literatura

Ananías

Pino

2022

Revista Chilena de Ortopedia y Traumatología

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ResumenLa patología traumática del plexo braquial comprende un amplio espectro de lesiones potencialmente devastadoras para la funcionalidad de los pacientes. El objetivo del presente trabajo es realizar una revisión narrativa de la literatura enfocada en el diagnóstico y estudio de las lesiones del plexo braquial en adultos, además de entregar nociones básicas sobre el manejo de esta compleja patología. Nivel de evidencia: Nivel V.

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Recovery of shoulder abduction in traumatic brachial plexus palsy: a systematic review and meta-analysis of nerve transfer versus nerve graft

Cited by 10 publications

References 16 publications

Functional outcome of contralateral C7 nerve transfer combined with free functional gracilis transplantation to repair total brachial plexus avulsion: a report of thirty-nine cases

Functional outcome of contralateral C7 nerve transfer combined with free functional gracilis transplantation to repair total brachial plexus avulsion: a report of thirty-nine cases

Frontiers of Brachial Plexus Injury: Future Revolutions in the Field

Lesiones del plexo braquial en adultos: Una revisión narrativa de la literatura

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