A Study on Brachial Birth Palsy

Clark, Lauren; Taylor, Alfred S.; Prout, Thomas P.

doi:10.1097/00000441-190510000-00013

Cited by 73 publications

(25 citation statements)

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“…[4][5][6] In the last 50 years, the development of microsurgical techniques and a greater understanding of peripheral nerve physiology contributed to improved surgical results with autologous grafts. The current philosophy regarding management of peripheral nerve injuries is early and aggressive surgical intervention for maximal functional restoration.…”

Section: Discussionmentioning

confidence: 99%

Nerve allograft transplantation for functional restoration of the upper extremity: case series

Elkwood

Holland

Arbes

et al. 2011

The Journal of Spinal Cord Medicine

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Background: Major trauma to the spinal cord or upper extremity often results in severe sensory and motor disturbances from injuries to the brachial plexus and its insertion into the spinal cord. Functional restoration with nerve grafting neurotization and tendon transfers is the mainstay of treatment. Results may be incomplete due to a limited supply of autologous material for nerve grafts. The factors deemed most integral for success are early surgical intervention, reconstruction of all levels of injury, and maximization of the number of axonal conduits per nerve repair. Objective: To report the second series of nerve allograft transplantation using cadaveric nerve graft and our experience with living-related nerve transplants. Participants: Eight patients, seven men and one woman, average age 23 years (range 18-34), with multi-level brachial plexus injuries were selected for transplantation using either cadaveric allografts or living-related donors. Methods: Grafts were harvested and preserved in the University of Wisconsin Cold Storage Solution at 5°C for up to 7 days. The immunosuppressive protocol was initiated at the time of surgery and was discontinued at approximately 1 year, or when signs of regeneration were evident. Parameters for assessment included mechanism of injury, interval between injury and treatment, level(s) of deficit, post-operative return of function, pain relief, need for revision surgery, complications, and improvement in quality of life. Results: Surgery was performed using living-related donor grafts in six patients, and cadaveric grafts in two patients. Immunosuppression was tolerated for the duration of treatment in all but one patient in whom early termination occurred due to non-compliance. There were no cases of graft rejection as of most recent followup. Seven patients showed signs of regeneration, demonstrated by return of sensory and motor function and/or a migrating Tinel's sign. One patient was non-compliant with the post-operative regimen and experienced minimal return of function despite a reduction in pain. Conclusions: Despite the small number of subjects, it appears that nerve allograft transplantation may be performed safely, permitting non-prioritized repair of long-segment peripheral nerve defects and maximizing the number of axonal conduits per nerve repair. For patients with long, multi-level brachial plexus injuries or combined upper and lower extremity nerve deficits, the use of nerve allograft allows a more complete repair that may translate into greater functional restoration than autografting alone.

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Section: Discussionmentioning

confidence: 99%

Nerve allograft transplantation for functional restoration of the upper extremity: case series

Elkwood

Holland

Arbes

et al. 2011

The Journal of Spinal Cord Medicine

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“…Hence, Erb's point is where the C5 and C6 nerve roots join, and classic Erb's palsy involves an extended, inter nally rotated arm, volarflected wrist, and extended fin gers. This posture was originally described as the 'police man's tip' posture, but was later changed to the more socially acceptable 'waiter's tip' hand [ 14,15].…”

Section: Introductionmentioning

confidence: 99%

“…Additional reports during the early 1900s resulted in many surgeons advocat ing early brachial plexus surgery in children who did not improve spontaneously [15,17,18]. However, in 1925, Sever [19] reported on 1.100 cases of obstetrical brachial plexus palsies in which he concluded there was no differ ence in outcome between surgically treated patients and those who were conservatively managed.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Surgically Treated Birth-Related Brachial Plexus Injuries in Twenty Cases

Sherburn¹,

Kaplan²,

Kaufman³

et al. 1997

Pediatr Neurosurg

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Birth-related brachial plexus injury occurs in 0.19–2.5 per 1,000 live births, of which 70–92% improve with conservative management. With the advent of microsurgical techniques, patients who fail expectant treatment may benefit from brachial plexus exploration and reconstruction. From 1991 to 1996, 87 patients were referred to the multidisciplinary brachial plexus clinic at St. Louis Children’s Hospital. Twenty patients were selected for surgical management. The average age at surgery was 10.5 months (range 3–35, median = 8), with an average follow-up of 23.9 months (range 7–45, median = 24). Two patients were lost to follow-up. Surgical procedures included neurolysis (n = 8), neurotization (n = 2), nerve grafting (n = 5), and a combination (n = 3) of the above. Two patients underwent exploration without repair. Intercostal nerves, pectoral nerves, and C4 roots were used for neurotizations, and the sural nerve was used for nerve grafting. Results from 18 patients were available for follow-up review. Fifteen patients (83% demonstrated clinical improvement postoperatively. Of the 3 patients without improvement, 2 underwent exploration without repair, and one underwent neurolysis of the axillary nerve. Of patients undergoing reconstruction, 93% had improved strength postoperatively. No subjects had worsening neurologic status, and there were no complications. These results suggest that surgery for birth-related brachial plexus injury may show favorable outcomes if patients are selected appropriately. Patients undergoing neurolysis and nerve grafting had more favorable outcomes than those undergoing neurotization.

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“…1,2 In the majority of cases delivery of the upper shoulder is blocked by the mother's pubic symphysis (shoulder dystocia). If additional traction is applied to the child's head, the angle between the neck and the shoulder is forcefully widened, overstretching the ipsilateral brachial plexus.…”

mentioning

confidence: 99%