Multidisciplinary Management of Brachial Plexus Birth Injuries: The Miami Experience

Grossman, John A. I.; Ditaranto, Patricia; Price, Andrew E.; Ramos, Lorna E.; Tidwell, Michael; Papazian, Óscar; Yaylali, Ilker; Bergeron, D. M.; Valencia, Herbert; Alfonso, Israel

doi:10.1055/s-2004-837258

Cited by 19 publications

(31 citation statements)

References 16 publications

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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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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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“…4 All individuals were diagnosed at birth with an upper brachial plexus injury and referred for management to our multidisciplinary programme. The majority of infants referred for evaluation are surgical candidates for either early or late procedures.…”

Section: Methodsmentioning

confidence: 99%

“…4,6 Shoulder range of motion, including total shoulder elevation and active external rotation, were measured. Zero degrees of external rotation was the position of the arm when abducted at 90 degrees, with the elbow flexed to 90 degrees and the forearm and hand pronated and pointing forward.…”

Section: Methodsmentioning

confidence: 99%

“…2,5 Furthermore, individuals with C5 ⁄ C6 lesions are rated as 'excellent' on the Gilbert-Raimondi hand classification, 6 which suggests that this classification may lack the sensitivity to diagnose more subtle deficits. 4 The nine-hole peg test (9-HPT; Anatomy Supply Partners, Atlanta, GA, USA) is a simple, commercially available test of fine upper motor function, in which pegs are inserted and removed from nine holes in a peg-board, with the performance being timed. 7 The test has been shown to have high interrater and test-retest reliability, 8 and normative data for both adult and pediatric populations have been determined.…”

Section: Interpretation Hand Function Is Impaired In Individuals Withmentioning

confidence: 99%

“…' 2 This same approach is reflected in other published series on outcome in individuals treated for C5 ⁄ C6 lesions. 4 Hand function is taken as normal and ⁄ or is not measured.…”

Section: Interpretation Hand Function Is Impaired In Individuals Withmentioning

confidence: 99%

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Hand function in children with an upper brachial plexus birth injury: results of the nine‐hole peg test

Immerman

Alfonso

Ramos

et al. 2011

Develop Med Child Neuro

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ABBREVIATION 9-HPT Nine-hole peg testAIM The aim of this study was to evaluate hand function in children with Erb upper brachial plexus palsy.METHOD Hand function was evaluated in 25 children (eight males; 17 females) with a diagnosed upper (C5 ⁄ C6) brachial plexus birth injury. Of these children, 22 had undergone primary nerve reconstruction and 13 of the 25 had undergone simultaneous and ⁄ or secondary shoulder procedures. Hand function was evaluated using the nine-hole peg test at a mean age of 9 years (SD 2y 2mo), and compared with the contralateral, uninvolved hand. Results were compared with ageand sex-matched population norms, and correlated with shoulder outcomes using the Gilbert and Miami scores.RESULTS Although shoulder function was graded as good or excellent in 24 of 25 children, hand function as measured by the nine-hole peg test was significantly altered in the involved hand in 80% (p=0.008). On average the participants took 18.8% longer to complete the task with the involved hand; this was significantly different from the expected difference of 7.2% (p=0.008). INTERPRETATION Hand function is impaired in individuals with upper brachial plexus birth injury.These results suggest that from the initiation of treatment in this population, attention should be paid to recognizing and focusing therapy on subtle limitations of hand function.

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Early Operative Intervention for Selected Cases of Brachial Plexus Birth Injury

Grossman

2006

Arch Neurol

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Multidisciplinary Management of Brachial Plexus Birth Injuries: The Miami Experience

Cited by 19 publications

References 16 publications

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

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

Hand function in children with an upper brachial plexus birth injury: results of the nine‐hole peg test

Early Operative Intervention for Selected Cases of Brachial Plexus Birth Injury

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