Pectoralis minor transfer for elbow flexion restoration in late obstetric brachial plexus palsy

2017 ◽  
Vol 42 (5) ◽  
pp. 1137-1141 ◽  
Author(s):  
Vanessa Costil ◽  
Claudia Romana ◽  
Frank Fitoussi
Keyword(s):  
Brachial Plexus ◽  
Elbow Flexion ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Pectoralis Minor ◽  
Obstetric Brachial Plexus

Bilateral Elbow Flexion Reconstruction with Functioning Free Muscle Transfer for Obstetric Brachial Plexus Palsy

2002 ◽  
Vol 27 (5) ◽  
pp. 484-486 ◽  
Author(s):  
A. S. BALIARSING ◽  
K. DOI ◽  
Y. HATTORI
Keyword(s):  
Brachial Plexus ◽  
Elbow Flexion ◽  
Gracilis Muscle ◽  
Brachial Plexus Palsy ◽  
Muscle Transfer ◽  
Nerve Roots ◽  
Obstetric Brachial Plexus Palsy ◽  
Shoulder Joints ◽  
Muscle Transfers ◽  
Obstetric Brachial Plexus

A child suffered a bilateral obstetric brachial plexus palsy involving the C5 and C6 nerve roots. Abduction of the shoulder joints had recovered by 1 year, but elbow flexion did not recover on either side. Free gracilis muscle transfers were performed on both sides, at an interval of 6 months, to achieve elbow flexion. The spinal accessory nerve was used as the donor nerve.

Obstetric Brachial Plexus Palsy in Newborn Babies of Diabetic and Non-Diabetic Mothers

2010 ◽  
Vol 35 (5) ◽  
pp. 362-365 ◽  
Author(s):  
M.M. Al-Qattan ◽  
A.A.F. El-Sayed ◽  
A.Y. Al-Zahrani ◽  
S.A. Al-Mutairi ◽  
M.S. Al-Harbi ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Spontaneous Recovery ◽  
External Rotation ◽  
Elbow Flexion ◽  
Motor Power ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus ◽  
Shoulder External Rotation ◽  
Diabetic Mothers

Compared to non-diabetic mothers, diabetic mothers are known to deliver larger babies who are at higher risk for shoulder dystocia and obstetric brachial plexus palsy. The intrapartum forces applied during delivery of larger babies are expected to be higher. Hence, the chances of these babies for good spontaneous recovery are expected to be lower; and this is a generally believed hypothesis. The objective of this retrospective study was to compare obstetric brachial plexus palsy in newborn babies of diabetic and non-diabetic mothers. There were a total of 655 cases of obstetric palsy: 253 cases with diabetic mothers and 402 with non-diabetic mothers. The former were more likely to develop total palsy while the latter were more likely to develop extended Erb’s palsy. Newborn babies of diabetic mothers had significantly larger birth weights than those of non-diabetic mothers regardless of the type of palsy. The rate of good spontaneous recovery of the motor power of the limb in the two groups was not significantly different except in total palsy cases for shoulder external rotation and elbow flexion where the recovery was significantly better in the diabetic group. It was concluded that the generally believed hypothesis is not correct if one compares the outcome in the diabetic and non-diabetic groups for each type of palsy.

Elbow Flexion Reconstruction by Steindler Flexorplasty in Obstetric Brachial Plexus Palsy

2005 ◽  
Vol 30 (4) ◽  
pp. 424-427 ◽  
Author(s):  
M. M. AL-QATTAN
Keyword(s):  
Brachial Plexus ◽  
Selection Criteria ◽  
Elbow Flexion ◽  
Drill Hole ◽  
Flexion Contracture ◽  
Brachial Plexus Palsy ◽  
Older Children ◽  
Obstetric Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus

The results of Steindler flexorplasty in nine patients with obstetric brachial plexus palsy are reported. There were 5 girls and 4 boys with a mean age of 6 (range 2–13) years. Selection criteria for the procedure included strong (at least M4) grip strength and wrist and elbow extension, as well as the presence of the “Steindler effect”. Pre-operatively, elbow flexion was rated as M0 or M1 in three patients and M2 in the remaining six patients. Intra-operatively, the detached common flexor origin was advanced 5 to 7 cm and fixation was done to the anterior humerus either with direct suture to the periosteum (in younger children) or suturing into a drill hole in the humerus (in older children). Postoperatively, the elbow was immobilized in flexion and supination for 6 weeks. At a mean follow-up of 5 years, the results in eight patients were good with mean active elbow flexion against resistance of 110° and a mean elbow flexion contracture of 35°. The result in the remaining patient was poor (unsuccessful transfer). It is concluded that the results of the Steindler flexorplasty in obstetric brachial plexus palsy patients are good and reliable, provided patient selection is careful.

scholarly journals Evidence of the Effectiveness of Primary Brachial Plexus Surgery in Infants With Obstetric Brachial Plexus Palsy–Revisited

2017 ◽  
Vol 4 ◽  
pp. 2329048X1770939 ◽  
Author(s):  
Amel A. F. El-Sayed
Keyword(s):  
Brachial Plexus ◽  
Elbow Flexion ◽  
Motor Recovery ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Primary Surgery ◽  
Obstetric Brachial Plexus ◽  
Brachial Plexus Surgery ◽  
Surgical Group

A recent systematic review questioned the effectiveness of primary surgery in infants with obstetric brachial plexus palsy. At our center, the indication for primary surgery in infants with upper Erb’s obstetric palsy is the lack of active elbow flexion at age 4 months. The current study compares the outcome of motor recovery in 2 groups of infants with upper Erb’s palsy: one group (n = 9) treated surgically between age 4 and 5 months, and another group (n = 9) treated conservatively despite the lack of active elbow flexion at age 4 months. The only reason for not doing the surgery in the latter group was refusal by the parents. The scores of motor recovery were collected at the 2-year follow-up visit, and they were significantly better in the surgical group. The study demonstrates the effectiveness of primary surgery in infants with upper Erb’s obstetric palsy compared to conservative management.

scholarly journals Median Nerve to Biceps Nerve Transfer to Restore Elbow Flexion in Obstetric Brachial Plexus Palsy

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
M. M. Al-Qattan ◽  
T. M. Al-Kharfy
Keyword(s):  
Brachial Plexus ◽  
Median Nerve ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Erb’S Palsy ◽  
Obstetric Brachial Plexus

Median nerve to biceps nerve transfer in the arm has been reported only in adults. The following paper reports on 10 cases of this transfer in obstetric brachial plexus palsy. All patients had upper palsy (ERb’s or extended ERb’s palsy) and presented to the author late (13–19 months of age) with poor or no recovery of elbow flexion. Following the nerve transfer, nine children recovered elbow flexion (a score of 6 in one child and a score of 7 in eight children by the Toronto scale). The remaining child did not recover elbow flexion.

Elbow Flexion after Primary Reconstruction in Obstetric Brachial Plexus Palsy

2009 ◽  
Vol 34 (4) ◽  
pp. 449-458 ◽  
Author(s):  
J. K. TERZIS ◽  
Z. T. KOKKALIS
Keyword(s):  
Brachial Plexus ◽  
Elbow Flexion ◽  
Flexion Contracture ◽  
Timing Of Surgery ◽  
Primary Reconstruction ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Lateral Cord ◽  
Obstetric Brachial Plexus ◽  
Plexus Lesion

Fifty-two children (54 upper extremities) with obstetric brachial plexus palsy who underwent primary reconstruction for elbow flexion restoration were studied. The outcomes were analysed in relation to the type of brachial plexus lesion, timing of surgery, and the type of reconstruction. Overall, 42 of 54 extremities (78%) achieved good and excellent results (≥M3+). The average postoperative muscle grading for the biceps was 3.7 (SD 0.8), and the average postoperative active elbow flexion was 108° (SD 33°). The average elbow flexion contracture was 18° (SD 21°). The timing of surgery and the type of the brachial plexus injury significantly influenced the final outcome. The best results were seen in early cases (≤3 months), where the lateral cord was reconstructed from intraplexus donors. In this group, minimal flexion contracture deformity was observed. Late reconstruction (≥7 months) of the musculocutaneous nerve resulted in inferior results.

Obstetric Brachial Plexus Palsy: a Comparison of Affected Infants Delivered Vaginally By Breech or Cephalic Presentation

2010 ◽  
Vol 35 (5) ◽  
pp. 366-369 ◽  
Author(s):  
M.M. Al-Qattan ◽  
A.A.F. El-Sayed ◽  
A.Y. Al-Zahrani ◽  
S.A. Al-Mutairi ◽  
M.S. Al-Harbi ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Spontaneous Recovery ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Brachial Plexus Palsy ◽  
Phrenic Nerve Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Breech Delivery ◽  
Erb’S Palsy ◽  
Obstetric Brachial Plexus

In this retrospective study we compared obstetric brachial plexus palsy (OBPP) in two non-operated groups of newborn babies delivered vaginally by breech or cephalic presentation. There were 35 cases of OBPP in the breech group and 663 cases in the cephalic group. The former group was more likely to develop upper Erb’s palsy while the latter group was more likely to develop total palsy. The breech group also had a significantly lower mean birth weight, a significantly higher percentage of bilateral OBPP palsies and concurrent phrenic nerve palsy. Spontaneous recovery of shoulder abduction and elbow flexion in newborn babies with upper Erb’s palsy was significantly worse in the breech compared with the cephalic group. It was concluded that OBPP following vaginal breech delivery has several unique demographic features and breech babies with upper Erb’s palsy have a worse prognosis for spontaneous recovery than those in the cephalic group.

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