Glenohumeral arthrodesis in upper and total brachial plexus palsy

Abstract

We have compared the functional outcome after glenohumeral fusion for the sequelae of trauma to the brachial plexus between two groups of adult patients reviewed after a mean interval of 70 months. Group A (11 patients) had upper palsy with a functional hand and group B (16 patients) total palsy with a flail hand. All 27 patients had recovered active elbow flexion against resistance before shoulder fusion. Both groups showed increased functional capabilities after glenohumeral arthrodesis and a flail hand did not influence the post-operative active range of movement. The strength of pectoralis major is a significant prognostic factor in terms of ultimate excursion of the hand and of shoulder strength. Glenohumeral arthrodesis improves function in patients who have recovered active elbow flexion after brachial plexus palsy even when the hand remains paralysed.

Functional Outcome of Glenohumeral Fusion in Brachial Plexus Palsy: A Report of 54 Cases

“…14 This study found that the type of bone graft significantly influenced outcomes, with a massive corticocancellous bone graft having significantly higher fusion rates (P Ͻ .001). This study compared cancellous versus corticocancellous graft.…”

Transfer of the recovered biceps to the long flexors of the digits to restore grip function following complete traumatic brachial plexus palsy

“…Shoulder outcome in terms of functional range may not be as good after glenohumeral arthrodesis as that seen after neurotisation from C5/C6 or the contralateral C7 [2]. Although glenohumeral arthrodesis may be seen as an acceptance of failure of the primary nerve repair, it clearly has a place in the management of complete lesions to provide stability, particularly where scapulothoracic musculature is preserved [3,4]. Glenohumeral fusion was carried out prior to the biceps transfer in two patients.…”

Results of spinal accessory to suprascapular nerve transfer in 110 patients with complete palsy of the brachial plexus

“…16 Recently, however, it was demonstrated that previous harvesting of the spinal accessory nerve did not interfere with range of abduction or external rotation recovery following shoulder arthrodesis. 2 Chammas et al 11 performed shoulder arthrodesis in 27 patients with brachial plexus palsy and identified no differences relating to whether the spinal accessory nerve had previously been transferred or the serratus anterior was paralyzed. They did find differences in the range of recovery of shoulder abduction depending on whether the upper portion of the pectoralis major was functional or paralyzed.…”