Complete Traumatic Brachial Plexus Palsy. Treatment and Outcome After Repair*

Bentolila, Vincent; Nizard, Rémy; Bizot, Pascal; Sedel, L.

doi:10.2106/00004623-199901000-00004

Cited by 160 publications

(87 citation statements)

References 17 publications

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“…The best outcome of neurotization can be expected in short denervation times and in the presence of proximal healthy roots (4). Moreover, neurotizations using unavulsed roots are superior to utilization of extraplexus donors (7).…”

Section: Mohammad-reda A: Early Post-operative Results After Repair Omentioning

confidence: 99%

Early post operative results after repair of traumatic brachial plexus palsy

Ahmad

2012

Turkish Neurosurgery

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AIm: Treatment options for traumatic brachial plexus injuries include nerve grafting, or neurotization. The type of lesion and the reconstructive procedures affect functional results and postoperative pain relief. mAterIAl and methOds: A total number of twenty five patients suffering from post-traumatic brachial plexus injury were included in the study. The patients underwent exploration and primary repair of the affected plexus, based on case by case policy.results: Spinal accessory nerve transfer to suprascapular nerve procedure regained 78.95% of functional muscle power, 10.50% of non functional muscle power and only 10.5 % of non innervated muscle. The Oberlin procedure regained 83.33% with elbow flexion muscle power, 16.67% with non functional muscle power. Intercostal nerve transfer to musculocutaneous nerve regained 62.5% with functional muscle power, 25% with non functional muscle power and only 12.5 % with non innervated muscle. The shoulder, elbow and wrist extension functions were significantly improved early post-operatively. In addition, the post-operative improvement of shoulder, elbow and wrist extension functions had significant negative correlations with the pre-operative elapsed time, and accompanied by a significant positive correlation with post-operative follow up period.COnClusIOn: Early intervention for traumatic brachial plexus palsy is recommended to get good results with pain relief. BulGulAr: Supraskapular sinire spinal aksesuar sinir transferi %78,95 işlevsel kas gücü, %10,50 işlevsel olmayan kas gücü ve sadece %10,5 innerve olmayan kas kazandırdı. Oberlin işlemi %83,33 dirsek fleksiyonu kas gücü ve %16,67 işlevsel olmayan kas gücü kazandırdı. Müskülokütanöz sinire interkostal sinir transferi %62,5 işlevsel kas gücü, %25 işlevsel olmayan kas gücü ve sadece%12,55 innerve olmayan kas kazandırdı. Omuz, dirsek ve bilek ekstansiyon işlevleri postoperatif erken dönemde önemli ölçüde düzeldi. Ayrıca, omuz, dirsek ve bilek ekstansiyon işlevlerinin postoperatif düzelmesinin preoperatif geçen süreyle önemli bir negatif korelasyonu bulundu ve postoperatif takip dönemiyle önemli bir pozitif korelasyonu vardı. sOnuÇ: Travmatik brakiyal pleksus palsisinde ağrı giderilmesiyle birlikte iyi sonuçlar alınması için erken girişim önerilir.

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Section: Mohammad-reda A: Early Post-operative Results After Repair Omentioning

confidence: 99%

Early post operative results after repair of traumatic brachial plexus palsy

Ahmad

2012

Turkish Neurosurgery

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“…Bentolila et al [3] pointed out that the retard between the moment of the lesion and the intervention is one of the factors' more important presage, and they added that, to reach a functional result, the retard should be minor of 4 months.…”

Section: Discussionmentioning

confidence: 99%

Restoration of Elbow Flexion by Transfer of the Phrenic Nerve to Musculocutaneous Nerve after Brachial Plexus Injuries

Ricardo¹

2007

Hand (New York, N,Y.)

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Traumatic brachial plexus injuries are a devastating injury that results in partial or total denervation of the muscles of the upper extremity. Treatment options that include neurolysis, nerve grafting, or neurotization (nerve transfer) has become an important procedure in the restoration of function in patients with irreparable preganglionic lesions. Restoration of elbow flexion is the primary goal in treating patients with severe brachial plexus injuries. Nerve transfers are used when spinal roots are avulsed, and proximal stumps are not available. In the present study, we analyze the results obtained in 20 patients treated with phrenic-musculocutaneous nerve transfer to restore elbow flexion after brachial plexus injuries. A consecutive series of 25 adult patients (21 men and 4 women) with a brachial plexus traction/crush lesion were treated with phrenicmusculocutaneous nerve transfer, but only 20 patients (18 men and 2 women) were followed and evaluated for at least 2 years postoperatively. All patients had been referred from other institutions. At the initial evaluation, eight patients received a diagnosis of C5-6 brachial plexus nerve injury, and in the other 12 patients, a complete brachial plexus injury was identified. Reconstruction was undertaken if no clinical or electrical evidence of biceps muscle function was seen by 3 months post injury. Functional elbow flexion was obtained in the majority of cases by phrenic-musculocutaneous nerve transfer (14/20, 70%). At the final follow-up evaluation, elbow flexion strength was a Medical Research Council Grade 5 in two patients, Grade 4 in four patients, Grade 3 in eight patients, and Grade 2 or less in six patients. Transfer involving the phrenic nerve to restore elbow flexion seems to be an appropriate approach for the treatment of brachial plexus root avulsion. Traumatic brachial plexus injury is a devastating injury that result in partial or total denervation of the muscles of the upper extremity. Treatment options include neurolysis, nerve grafting, or neurotization (nerve transfer). Neurotization is the transfer of a functional but less important nerve to a denervated more important nerve. It has become an important procedure in the restoration of function in patients with irreparable preganglionic lesions. Restoration of elbow flexion is the primary goal in treating patients with severe brachial plexus injuries. Nerve transfers are used when spinal roots are avulsed, and proximal stumps are not available. Newer extraplexal sources include the ipsilateral phrenic nerve as reported by Gu et al. (Chin Med J 103:267-270, 1990) and contralateral C7 as reported by Gu et al. (J Hand Surg [Br] 17(B):518-521, 1992) and Songcharoen et al. (J Hand Surg [Am] 26(A): [1058][1059][1060][1061][1062][1063][1064] 2001). These nerve transfers have been introduced to expand on the limited donors. The phrenic nerve and its anatomic position directly within the surgical field makes it a tempting source for nerve transfer. Although not always, in cases of comple...

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“…The few studies that have reported pain predominantly included patients following brachial plexus nerve injuries. 15,26,27,[48][49][50][51][52][53][54] In these studies, traumatic injuries, root avulsions, and injuries proximal to the dorsal root ganglion were associated with more pain; surgical intervention and the timing of surgery relative to injury were identified as important factors in alleviating pain. These outcome studies reported pain intensity and frequency but did not include validated patient-report questionnaires to assess the impact of the pain or impairment on the patient.…”

Section: Outcome Measuresmentioning

confidence: 99%

Neuropathic Pain in Patients with Upper-Extremity Nerve Injury

Novak

Katz²

2010

Physiotherapy Canada

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Purpose: The purpose of this review was to present an analysis of the literature of the outcome studies reported in patients following traumatic upperextremity (UE) nerve injuries (excluding amputation), to assess the presence of an association between neuropathic pain and outcome in patients following traumatic UE nerve injuries, and to provide recommendations for inclusion of more comprehensive outcome measures by clinicians who treat these patients. Summary of Key Points: A Medline and CINAHL literature search retrieved 48 articles. This review identified very few studies of patients with peripheral nerve injury that reported neuropathic pain. When pain was reported, visual analogue or numeric rating scales were most frequently used; standardized questionnaires measuring pain or psychosocial function were rarely administered. Recent evidence shows substantial long-term disability and pain in patients following peripheral nerve injury. Recommendation: To better understand neuropathic pain in patients following peripheral nerve injury, future outcome studies should include valid, reliable measures of physical impairment, pain, disability, health-related quality of life, and psychosocial functioning.Key Words: literature review, nerve injury, neuropathic pain, outcome Novak CB, Katz J. Neuropathic pain in patients with upper-extremity nerve injury. Physiother Can. 2010;62:190-201. RÉ SUMÉObjectif : L'objectif de cette revue é tait de pré senter une analyse de la documentation portant sur les é tudes ré pertorié es concernant les patients aux prises avec des lé sions nerveuses traumatiques des membres supé rieurs (excluant l'amputation), d'é valuer la pré sence d'un lien entre la douleur né vropathique et les ré sultats attendus chez les patients à la suite de lé sions nerveuses traumatiques des membres supé rieurs et de formuler des recommandations en vue d'inclure le recours à des mesures de rendement plus complè tes par les cliniciens traitant ces patients. Ré sumé des principales é tapes : Une recherche documentaire dans Medline et dans CINAHL a permis de ré pertorier 48 articles. Cette recherche a permis de constater que parmi les patients souffrant de lé sions nerveuses pé riphé riques é tudié s, trè s peu avaient signalé des douleurs né vropathiques. Lorsque de la douleur é tait signalé e, des é chelles de mesure numé riques ou des é chelles visuelles analogues é taient utilisé es le plus fré quemment et l'on faisait rarement appel à des questionnaires normalisé s pour é valuer la douleur ou la fonction psychosociale. Des faits ré cents dé montrent qu'à la suite d'une lé sion nerveuse pé riphé rique, de nombreux patients ressentent de la douleur et souffrent d'une incapacité à long terme. Recommandation : Pour mieux comprendre la douleur né vropathique qui survient à la suite d'une lé sion nerveuse pé riphé rique, les prochaines é tudes devraient inclure des mesures valables et fiables des dé ficiences physiques, de la douleur, des incapacité s, de la qualité de vie lié e à la santé et à la fonctio...

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Complete Traumatic Brachial Plexus Palsy. Treatment and Outcome After Repair*

Cited by 160 publications

References 17 publications

Early post operative results after repair of traumatic brachial plexus palsy

Early post operative results after repair of traumatic brachial plexus palsy

Restoration of Elbow Flexion by Transfer of the Phrenic Nerve to Musculocutaneous Nerve after Brachial Plexus Injuries

Neuropathic Pain in Patients with Upper-Extremity Nerve Injury

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