Obstetrical Brachial Plexus Palsy: Results Following Neurolysis of Conducting Neuromas-in-Continuity

Abstract

Sixteen infants with conducting neuromas-in-continuity at primary brachial plexus exploration underwent microsurgical neurolysis of their lesions. For each patient, the immediate preoperative scores for individual joint movements were compared with scores at the last examination. In the Erb's palsy group (n = 9), significant improvement was seen in shoulder movements, elbow flexion, supination, and wrist extension (paired t test, p < 0.05). Clinically useful improvements in function was seen at the shoulder and elbow (Fisher's exact test, p < 0.05). In the total palsy group (n = 7), significant improvement in shoulder abduction, shoulder adduction, elbow flexion, and extension of the wrist, fingers, and thumb was seen (paired t test, p < 0.05), but there was no significant improvement in the proportion of patients with useful functional outcomes. Neurolysis in Erb's palsy improves both muscle grade and the functional ability of patients. Neurolysis does not provide useful functional recovery in patients with total plexus palsy.

Surgical Strategy in Obstetric Brachial Plexus Palsy: The Aachen Experience

“…4 Neurolysis is performed proximally onto the neuroforamen and distally into unaffected nerve bundles; thus, the lesional zone (fibrosis with or without neuroma) is limited in between. We agree with Clarke et al 5 that neuroma should be excised. Out of 140 cases, we have only 1 case of upper trunk neurolysis with a superb reinnervation after the release of a constricting fibrotic cuff (Fig.…”

“…* Neuromas in continuity are dangerous when left in place, 5 especially for the lower trunk. Severe functional impairment and neglect are a frequent result if they are left untreated.…”

Molecular Mechanisms to Improve Nerve Regeneration Following Damage to the Immature Peripheral Nervous System

“…While many infants spontaneously recover from brachial plexus nerve palsy, a substantial proportion of infants are left with permanent disability in an upper limb. In the United States, it has been estimated that 10,000 babies will be born with some degree of upper-limb paralysis due to brachial plexus nerve palsy each year 5 . Of these children, 60% to 80% have primarily neurapraxia, which is normally associated with spontaneous recovery, while the remaining 2000 to 4000 infants per year are left with permanent disability 6,7 .…”

Neurolysis alone as the treatment for neuroma-in-continuity with more than 50% conduction in infants with upper trunk brachial plexus birth palsy

“…3 Use of the Active Movement Scale (AMS) has provided a functional measure of upper-extremity function specifically for infants, who are not amenable to manual muscle testing. 6,8,17 Clarke et al 6 reported on 9 patients with upper trunk palsy treated by neurolysis alone and found significant improvements in shoulder movements, elbow flexion, supination, and wrist extension at a mean of 17 months' follow-up. There were no significant improvements in patients with total plexus palsy treated with neurolysis alone.…”

“…There were no significant improvements in patients with total plexus palsy treated with neurolysis alone. 6 Lin et al then directly compared neurolysis alone with neuroma resection and grafting with a followup of 4 years. Their treatment protocol before 1993 had been to use intraoperative conduction and neurolysis if distal muscle contraction was noted on stimulation.…”