External Rotation as a Result of Suprascapular Nerve Neurotization in Obstetric Brachial Plexus Lesions

Pondaag, Willem; Boer, Ralph de; Wijlen-Hempel, Marie S. van; Hofstede-Buitenhuis, Sonja M.; Malessy, Martijn J. A.

doi:10.1227/01.neu.0000170557.13788.d2

Cited by 108 publications

(75 citation statements)

References 25 publications

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“…Without a goniometer, the stated number of degrees may suggest a higher precision than was obtained in reality. Especially in brachial plexus lesions, compensatory movements are frequent, and the examiner should take measures to avoid compensation 25. A consensus how to assess AROM‐d should be agreed upon.…”

Section: Discussionmentioning

confidence: 99%

Outcome assessment for Brachial Plexus birth injury. Results from the iPluto world‐wide consensus survey

Pondaag

Malessy

2018

Journal Orthopaedic Research

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There is no consensus regarding strategies to optimally treat children with a brachial plexus birth injury (BPBI). Comparison of outcome data presented by different centers is impossible due to the use of (1) many different outcome measures to evaluate results; (2) different follow‐up periods after interventions; and (3) different patient ages at the time of assessment. The goal of iPluto (international PLexus oUtcome sTudy grOup) was to define a standardized dataset which should be minimally collected to evaluate upper limb function in children with BPBI. This dataset must enable comparison of the treatment results of different centers if prospectively used. Three rounds of internet surveys were used to reach consensus on the dataset. A Delphi‐derived technique was applied using a nine point Likert scale. Consensus was defined as having attained a rating of 7/8/9 by > = 75% of the participants. A total of 59 participants from five continents participated in the Second and Third Rounds of the survey. Consensus was reached regarding four elements: (1) evaluation should take place at the age of 1/3/5/7 years; range of motion in degrees should be measured for (2) passive joint movement; (3) active range of motion; and (4) the Mallet score should be determined. Consensus on how to asses and report outcome for BPBI was only reached on motor items from the “Body Function and Structure” domain. Consensus regarding additional ICF domains to obtain a more elaborate set of outcome items, should be addressed in future research. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. J Orthop Res 36:2533–2541, 2018.

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Section: Discussionmentioning

confidence: 99%

Outcome assessment for Brachial Plexus birth injury. Results from the iPluto world‐wide consensus survey

Pondaag

Malessy

2018

Journal Orthopaedic Research

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“…30 Operative management is also often recommended for those infants who lack shoulder external rotation and elbow flexion by 3 to 4 months of age. 29 Given that neurotmetic lesions or root avulsions will not spontaneously recover, work has focused on the earlier identification of such lesions by imaging as a means of improving clinical decision making. 32,35 Other work has focused on additional examination findings that suggest the poor likelihood of spontaneous recovery as a means of improving surgical stratification.…”

Section: Discussionmentioning

confidence: 99%

Peripartum and neonatal factors associated with the persistence of neonatal brachial plexus palsy at 1 year: a review of 382 cases

Wilson

Chang

Chauhan

et al. 2016

PED

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OBJECTIVE Neonatal brachial plexus palsy (NBPP) occurs due to the stretching of the nerves of the brachial plexus before, during, or after delivery. NBPP can resolve spontaneously or become persistent. To determine if nerve surgery is indicated, predicting recovery is necessary but difficult. Historical attempts explored the association of recovery with only clinical and electrodiagnostic examinations. However, no data exist regarding the neonatal and peripartum factors associated with NBPP persistence. METHODS This retrospective cohort study involved all NBPP patients at the University of Michigan between 2005 and 2015. Peripartum and neonatal factors were assessed for their association with persistent NBPP at 1 year, as defined as the presence of musculoskeletal contractures or an active range of motion that deviated from normal by > 10° (shoulder, elbow, hand, and finger ranges of motion were recorded). Standard statistical methods were used. RESULTS Of 382 children with NBPP, 85% had persistent NBPP at 1 year. A wide range of neonatal and peripartum factors was explored. We found that cephalic presentation, induction or augmentation of labor, birth weight > 9 lbs, and the presence of Horner syndrome all significantly increased the odds of persistence at 1 year, while cesarean delivery and Narakas Grade I to II injury significantly reduced the odds of persistence. CONCLUSIONS Peripartum/neonatal factors were identified that significantly altered the odds of having persistent NBPP at 1 year. Combining these peripartum/neonatal factors with previously published clinical examination findings associated with persistence should allow the development of a prediction algorithm. The implementation of this algorithm may allow the earlier recognition of those cases likely to persist and thus enable earlier intervention, which may improve surgical outcomes.

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“…Following the description of Kawabata and colleagues [9] of the use of the spinal accessory nerve as an ipsilateral nerve transfer to the suprascapular nerve in infants with upper brachial plexus birth injuries, its use has continued to expand. Total the scores for active abduction/forward flexion and active external rotation; from [7] a Maximum shoulder score=10; decrease score by 1 point for a contracture >20°T Several groups [1,6,8,11,14,19,20] have published variable experiences with the use of the distal SAN-to-SSN transfer as part of a primary or secondary plexus reconstruction in infants who fail to demonstrate spontaneous recovery of active shoulder external rotation following a period of observation. In a retrospective review of 86 infants, Pondaag et al [14] found similar clinical results and functional scores in infants undergoing C5-to-SSN bypass grafting (n=65) and those who received direct SANto-SSN (n=21) transfers performed at a mean of 5 months of age.…”

Section: Discussionmentioning

confidence: 99%

Outcome Following Spinal Accessory to Suprascapular (Spinoscapular) Nerve Transfer in Infants with Brachial Plexus Birth Injuries

Ruchelsman

Ramos

Alfonso

et al. 2009

Hand (New York, N,Y.)

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The purpose of this study is to evaluate the value of distal spinal accessory nerve (SAN) transfer to the suprascapular nerve (SSN) in children with brachial plexus birth injuries in order to better define the application and outcome of this transfer in these infants. Over a 3-year period, 34 infants with brachial plexus injuries underwent transfer of the SAN to the SSN as part of the primary surgical reconstruction. Twenty-five patients (direct repair, n=20; interposition graft, n=5) achieved a minimum follow-up of 24 months. Fourteen children underwent plexus reconstruction with SAN-to-SSN transfer at less than 9 months of age, and 11 underwent surgical reconstruction at the age of 9 months or older. Mean age at the time of nerve transfer was 11.6 months (range, 5-30 months). At latest follow-up, active shoulder external rotation was measured in the arm abducted position and confirmed by review of videos. The Gilbert and Miami shoulder classification scores were utilized to report shoulder-specific functional outcomes. The effects of patient age at the time of nerve transfer and the use of interpositional nerve graft were analyzed. Overall mean active external rotation measured 69.6°; mean Gilbert score was 4.1 and the mean Miami score was 7.1, corresponding to overall good shoulder functional outcomes. Similar clinical and shoulder-specific functional outcomes were obtained in patients undergoing early (<9 months of age, n=14) and late (>9 months of age, n=11) SAN-to-SSN transfer and primary plexus reconstruction. Nine patients (27%) were lost to follow-up and are not included in the analysis. Optimum results were achieved following direct transfer (n=20). Results following the use of an interpositional graft (n=5) were rated satisfactory. No patient required a secondary shoulder procedure during the study period. There were no postoperative complications. Distal SAN-to-SSN (spinoscapular) nerve transfer is a reliable option for shoulder reinnervation in infants with brachial plexus birth injuries. Direct transfer seems to be the optimum method. The age of the patient does not seem to significantly impact on outcome.

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External Rotation as a Result of Suprascapular Nerve Neurotization in Obstetric Brachial Plexus Lesions

Cited by 108 publications

References 25 publications

Outcome assessment for Brachial Plexus birth injury. Results from the iPluto world‐wide consensus survey

Outcome assessment for Brachial Plexus birth injury. Results from the iPluto world‐wide consensus survey

Peripartum and neonatal factors associated with the persistence of neonatal brachial plexus palsy at 1 year: a review of 382 cases

Outcome Following Spinal Accessory to Suprascapular (Spinoscapular) Nerve Transfer in Infants with Brachial Plexus Birth Injuries

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