Resultado da neurotização do nervo ulnar para o músculo bíceps braquial na lesão do plexo braquial

Abstract

OBJECTIVE: To evaluate the factors influencing the results of ulnar nerve neurotization at the motor branch of the brachii biceps muscle, aiming at the restoration of elbow flexion in patients with brachial plexus injury. METHODS: 19 patients, with 18 men and 1 woman, mean age 28.7 years. Eight patients had injury to roots C5-C6 and 11, to roots C5-C6-C7. The average time interval between injury and surgery was 7.5 months. Four patients had cervical fractures associated with brachial plexus injury. The postoperative follow-up was 15.7 months. RESULTS: Eight patients recovered elbow flexion strength MRC grade 4; two, MRC grade 3 and nine, MRC <3. There was no impairment of the previous ulnar nerve function. CONCLUSION: The surgical results of ulnar nerve neurotization at the motor branch of brachii biceps muscle are dependent on the interval between brachial plexus injury and surgical treatment, the presence of associated fractures of the cervical spine and occipital condyle, residual function of the C8-T1 roots after the injury and the involvement of the C7 root. Signs of reinnervation manifested up to 3 months after surgery showed better results in the long term. Level of Evidence: IV, Case Series.

Functional Outcome of Oberlin Procedure

“…Indeed, the operated hand sometimes shows improved grip strength scores after the surgery. 1 , 2 , 9 , 13 , 14 , 17 In the present study, mean grip strength was 22.2 kg(2-42.7) which, although demonstrating a statistically significant loss of strength, mirrors results of previous studies. 7 , 9 Despite the loss of grip strength seen in the present study, overall hand function was unaffected.This result is corroborated by the patients' perceived functional deficit as assessed by the DASH score (37.87), which is in line with previously reported results.…”

“…The results of the presentstudy are similar to those reported in the literature for recovery of elbow flexion strength after the Oberlin procedure (77.7% ≥ MRC grade 3 and 50% ≥ MRC grade 4), 2 , 7 , 14 , 20 yet worse than some studies reporting 90-100% successful outcomes. 1 , 13 , 21 This disparity appears to be related to the fact that delayed surgical treatment – longer than 12 months after injury – is associated with poorer outcomes 2 , 6 , 8 , 17 , 21 where 5 patients (27.8%) in the present sample had a time elapsed between injury and surgery of over 12 months.…”

“…For patients with palsy of the upper roots of the brachial plexus (C5-C6 or C5-C7), the priority of first restoring elbow function, followed by shoulder abduction and external rotation, is well established in the literature. 2 , 4 , 8 …”

“… 6 This approach is reserved only for post-ganglionic injuries.In pre-ganglionic injuries involving root avulsion, the proximal root stumps are unavailable for grafting and surgical repair is based on nerve or tendon transfers. 2 , 6 , 9 – 12 …”

Correlation between the elbow flexion and the hand and wrist flexion after neurotization of the fascicles of the ulnar nerve to the motor branch to the biceps

“…The Oberlin procedure gained notoriety due to excellent results in elbow flexion, tested and demonstrated by several authors. Currently, it is routinely used in high partial lesions of the brachial plexus, i.e., lesions that do not affect the roots of C8 and T1, which account for approximately 40% of the lesions 8, 9…”