The supination deformity and associated deformities of the upper limb in severe birth lesions of the brachial plexus

Abstract

We reviewed 42 consecutive children with a supination deformity of the forearm complicating severe birth lesions of the brachial plexus. The overall incidence over the study period was 6.9% (48 of 696). It was absent in those in Narakas group I (27.6) and occurred in 5.7% of group II (13 of 229), 9.6% of group III (11 of 114) and 23.4% of group IV (18 of 77). Concurrent deformities at the shoulder, elbow, wrist and hand were always present because of muscular imbalance from poor recovery of C5 and C7, inconsistent recovery of C8 and T1 and good recovery of C6. Early surgical correction improved the function of the upper limb and hand, but there was a tendency to recurrence. Pronation osteotomy placed the hand in a functional position, and increased the arc of rotation of the forearm. The supination deformity recurred in 40% (17 of 42) of those treated by pronation osteotomy alone, probably because of remodelling of the growing bone. Children should be followed up until skeletal maturity, and the parents counselled on the likelihood of multiple operations.

The Prevalence, Rate of Progression, and Treatment of Elbow Flexion Contracture in Children with Brachial Plexus Birth Palsy

“…Our study indicated that children with brachial plexus birth palsy are at risk of developing an elbow flexion contracture regardless of the extent of the initial neurological injury, which is inconsistent with previous reports of an association between lesion severity and other sequelae of brachial plexus birth palsy 15,17,[25][26][27] . We had expected to see a greater prevalence of elbow flexion contracture in children with a weak triceps muscle (C7 involvement, or Narakas groups II and III) resulting in elbow flexor-extensor muscle imbalance.…”

“…The prevalence of shoulder contracture, glenoid deformity, posterior shoulder dislocation, and forearm supination contracture have been reported to be 56%, 33%, 9%, and 6.9%, respectively [13][14][15] . The prevalence of elbow flexion contracture, however, has yet to be established, with the prevalence in previous reports ranging widely from 4.6% to Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work.…”

“…89.5% [15][16][17] . Furthermore, there has been limited study of the prevalence of contractures of ‡30°.…”

Biceps Rerouting after Forearm Osteotomy: An Effective Treatment Strategy for Severe Supination Deformity in Obstetric Plexus Palsy

“…1,2 This supinated "beggar's hand" position is associated with poor upper limb function. [3][4][5] Pronation of the forearm, in the presence of a functional hand, is used in more daily activity tasks than supination, such as writing, drinking, and most playing activities.…”

Treatment of a brachial plexus injury using kinesiotape and exercise

“…Treatment ranges from periodic monitoring to neurosurgical repair dependent upon the severity of the injury, the speed of spontaneous recovery, boney changes, and the age of the child (Yam, Fullilove, Sinis, and Fox, 2009).…”