Outcome after later combined brachial plexus and shoulder surgery after birth trauma

Abstract

Of 22 infants aged between 11 and 29 months who underwent a combined reconstruction of the upper brachial plexus and shoulder for the sequelae of a birth injury, 19 were followed up for two or more years. The results were evaluated using a modified Gilbert scale. Three patients required a secondary procedure before follow-up. Three patients had a persistent minor internal rotation contracture. All improved by at least two grades on a modified Gilbert scale.

Shoulder Function Following Late Neurolysis and Bypass Grafting for Upper Brachial Plexus Birth Injuries

“…All children were evaluated a minimum of 2 years following their latest procedure. Results are reported using the modified Gilbert system for documenting shoulder function (Grossman et al, 2003; Table 2). …”

“…Shoulder function was evaluated using a modified Gilbert system (Grossman et al, 2003) which, in spite of some limitations, is generally accepted as a reliable measure of outcome following surgery for obstetric palsies.…”

Nerve Transfers in Brachial Plexus Birth Palsies: Indications, Techniques, and Outcomes

“…In addition, many series include variable injury patterns, concomitant nerve grafting, and secondary procedures [7,8,12,24].…”

“…Lack of elbow flexion against gravity is the primary indication for microsurgery. The timing of surgery for upper trunk lesions remains controversial and varies between 3 and 8 months [7][8][9][10][11][12]. In contrast, infants who have global lesions should undergo early microsurgery by 3 months of age [7][8][9].…”

Early Operative Intervention for Selected Cases of Brachial Plexus Birth Injury

“…19,20,22,23 While none of the referenced studies are prospective or randomized against a control group in whom established musculoskeletal procedures (contracture release, tendon transfer, etc) are performed after 2.5 to 5 years of age, the reported results show a dramatic improvement over the outcome when surgical treatment was not available.…”