A cross‐sectional study of hand sensation in adults with conservatively treated obstetric brachial plexus lesion

Anguelova, Galia V.; Malessy, Martijn J. A.; Dijk, J. Gert van

doi:10.1111/dmcn.12019

Cited by 15 publications

(11 citation statements)

References 30 publications

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“…6,13,14 Co-contraction in OBPL might also be due to disturbed central motor programming, owing to factors such as deafferentation, 15 misrouting, and the fact that the lesion occurs before motor programmes have been developed fully. 5,6,16 Peripheral factors may, therefore, be involved in co-contraction in addition to central factors.…”

Section: Discussionmentioning

confidence: 99%

“…A flow chart indicating the numbers of potentially eligible participants, those examined for eligibility, confirmed eligible, and those included in the study, was published in a previous paper. 15 The protocol was approved by the Medical Ethics Committee of the Leiden University Medical Center. All participants provided informed consent.…”

Section: Methods Participantsmentioning

confidence: 99%

“…The method used to determine lesion level was described in a previous paper. 15 The patient's hand dominance was based on his or her opinion and corroborated by observing which hand they wrote with.…”

Section: Motor Function Assessmentmentioning

confidence: 99%

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Extensive motor axonal misrouting after conservative treatment of obstetric brachial plexus lesions

Anguelova

Malessy

Zwet

et al. 2014

Develop Med Child Neuro

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ABBREVIATIONS OBPLObstetric brachial plexus lesion ROM Range of motion AIM The aim of this cross-sectional study was to assess systematically motor function and motor misrouting in adults with conservatively treated obstetric brachial plexus lesion (OBPL).METHOD Seventeen adults with OBPL (median age 38y; five males, 12 females) and 16comparison participants (median age 26y; eight males, eight females) were investigated. Motor function in the group with OBPL was assessed through passive and active motion, muscle strength of the deltoid, biceps, and triceps muscles, and Mallet aggregate score and five subscores. Motor misrouting was quantified by electrically stimulating each of 10 arm muscles and recording activity from the other nine in response to this. Motor function and motor misrouting were statistically analysed using the Mann-Whitney U test and Spearman's correlation coefficient.RESULTS Motor function testing showed excellent strength but poor functional Mallet scores.Participants with OBPL had significantly more motor misrouting than comparison participants (Mann-Whitney U=31.5 [df=28], p<0.001, median difference=À4.00, 95% confidence interval [CI]=À7.00 to À1.00). Most misrouting was observed when stimulating the biceps (Mann-Whitney U=38.5 [df=31], p<0.001, median difference=À3.00, 95% CI À3.00 to À1.00), deltoid (Mann-Whitney U=68.5 [df=31], p=0.003, median difference=À1.0, 95% CI=À4.00 to 0.00 <0.001) and brachioradialis muscles (Mann-Whitney U=72.0 [df=31], p=0.002, median difference <0.001, 95% CI=À3.00 to 0.00 <0.001). There were no significant correlations between the presence of motor misrouting and impairment of motor function.

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Section: Discussionmentioning

confidence: 99%

Section: Methods Participantsmentioning

confidence: 99%

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Extensive motor axonal misrouting after conservative treatment of obstetric brachial plexus lesions

Anguelova

Malessy

Zwet

et al. 2014

Develop Med Child Neuro

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“…Axons that successfully pass the neuroma in continuity are likely to end up in a different basal lamina tube from the original. This process is called misrouting and may cause the phenomenon of cocontraction [37]. Root avulsion, the most severe type of lesion, is a total disconnection between peripheral nervous system and the spinal cord.…”

Section: Obstetrical Brachial Plexus Injurymentioning

confidence: 99%

Surgical Treatment of Brachial Plexus Injury

Haninec¹,

Mencl²

2017

Peripheral Nerve Regeneration - From Surgery to New Therapeutic Approaches Including Biomaterials and Cell-Based Therapies Deve

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In recent years, brachial plexus injury has been attracting increasing attention, partly because of an increasing incidence arising out of higher survival rates for patients after polytrauma. Brachial plexus injury is one of the hardest and most mutilating injuries. Owing to advances in microsurgical techniques, we can achieve success in restoring motor function for these patients. The purpose of this chapter is to introduce the reader with various microsurgical techniques, including nerve fascicle transfers and end-to-side neurorrhaphy (ETSN), which can be used for brachial plexus reconstruction based on personal experience with 1130 nerve reconstructions performed by the first author (PH) between 1993 and 2017. Another goal of brachial plexus surgery is the resolution of severe intractable pain which can develop in up to 20% of cases. Dorsal root entry zone (DREZ) thermocoagulation is a very effective method for treatment of severe neuropathic pain.

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“…Moreover, adults with OBPP have reported many problems, including pain, impaired sensation, and limitation of function, which interfered with activities of daily living. 3 For these reasons, the study of adults with conservatively managed OBPP by Anguelova et al 4 is timely, and suggests that the commonly held view that sensory recovery is good in people with OBPP should be revised. A systematic investigation by this group of sensory function in adults with OBPP has shown that sensory discrimination, assessed using Semmes-Weinstein monofilaments and two-point discrimination, was worse in people with OBPP than in a comparison group.…”

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confidence: 99%

Hand sensation in adults with conservatively treated obstetric brachial plexus lesion

Galea

2012

Develop Med Child Neuro

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This commentary is on the original article by Anguelova et al. on pages 257-263 of this issue.The prognosis of obstetric brachial plexus palsy (OBPP) has been considered as being very good, with reports of complete or almost complete spontaneous recovery in the majority of patients. However, a systematic review 1 showed that this claim was not based on scientifically sound evidence. A recent prospective study reported that one in five children with OBPP had permanent neurological deficit at 18 months of age 2 and that this was the case even after surgical repair. The assessment of function in many studies of OBPP, whether of natural recovery or recovery after surgery, has tended to focus on motor activity, such as the degree of active range of motion and strength. In contrast, few studies have reported on sensory recovery, and the general conclusion is that sensibility is less affected than motor function. It is highly desirable to test sensation, as somatosensory feedback is critical for good hand function. Moreover, adults with OBPP have reported many problems, including pain, impaired sensation, and limitation of function, which interfered with activities of daily living. 3For these reasons, the study of adults with conservatively managed OBPP by Anguelova et al. 4 is timely, and suggests that the commonly held view that sensory recovery is good in people with OBPP should be revised. A systematic investigation by this group of sensory function in adults with OBPP has shown that sensory discrimination, assessed using Semmes-Weinstein monofilaments and two-point discrimination, was worse in people with OBPP than in a comparison group. However scores for object recognition and locognosia were similar between groups. These findings are explained by suggesting that in OBPP, reinnervation almost always occurs to some degree.Because OBPP occurs at a critical period, it is salutary to reflect on the substantial changes that take place in the central nervous system during infancy. Developing sensory and motor systems expect specific experiences through the environment to help shape their connectivity. Activitydependent mechanisms during critical periods in postnatal life are key factors in development of sensory and motor systems. Information travelling from the receptors in the skin to the cortex maintains an orderly relationship of neighbouring sites in the periphery. This results in maps of the body surface in the component nuclei of the somatosensory system: i.e. the cuneate and gracile nuclei in the brainstem, and the ventroposterolateral nucleus of the thalamus, as well as in the primary somatosensory cortex, areas 3b, 1, and other areas. Neuronal activity is required for topographical specification and refinement of these maps. Thus a loss of (or disordered) peripheral sensory input might be expected to lead to disordered central representations. This is certainly the case in adult monkeys following a peripheral nerve lesion. However, such a lesion in infant monkeys does not appear to affect cortical representa...

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A cross‐sectional study of hand sensation in adults with conservatively treated obstetric brachial plexus lesion

Cited by 15 publications

References 30 publications

Extensive motor axonal misrouting after conservative treatment of obstetric brachial plexus lesions

Extensive motor axonal misrouting after conservative treatment of obstetric brachial plexus lesions

Surgical Treatment of Brachial Plexus Injury

Hand sensation in adults with conservatively treated obstetric brachial plexus lesion

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