Abstract:Brachial plexus injury (BPI) is one of the most serious peripheral nerve injuries, resulting in severe and persistent impairments of the upper limb and disability in adults and children alike. With the relatively mature early diagnosis and surgical technique of brachial plexus injury, the demand for rehabilitation treatment after brachial plexus injury is gradually increasing. Rehabilitation intervention can be beneficial to some extent during all stages of recovery, including the spontaneous recovery period, … Show more
“…It is worth noting that brachial plexus injuries typically require a lengthy recovery period due to the complexity of the injuries and the slow recovery tempo. Studies show that complete recovery of overall function of the upper limb following Erb's palsy sometimes can only occur late over the child's first 2 years, and even when recovery is incomplete, the sequelae remain minimal without 13,15 hindering the function of the limb involved.…”
Erb-Duchenne paralysis is a neurological condition characterized by paralysis of the arm which occurs due to injury of the upper trunk of C5-C6 of the brachial plexus and can lead to disturbances in movement and sensation. Erb-Duchenne paralysis commonly presents with a “Waiter’s Tip” deformity characterized by elbow extension, medial rotation of the arm, forearm pronation, and wrist flexion. Management of Erb-Duchenne paralysis may involve strengthening exercises, range of motion exercises, manual therapy, and neuromuscular electrical stimulation. However, in most cases, the diagnosis of Erb-Duchenne paralysis is not detected early enough for rehabilitation outcomes to be maximized. We herein report a case of a 6-months old child who had Erb-Duchenne paralysis in the left upper limb. The aim of this case report is to highlight the importance of early detection and rehabilitation of Erb-Duchenne paralysis. Furthermore, the report also discusses the physiotherapy techniques that can be used to optimize outcomes.
“…It is worth noting that brachial plexus injuries typically require a lengthy recovery period due to the complexity of the injuries and the slow recovery tempo. Studies show that complete recovery of overall function of the upper limb following Erb's palsy sometimes can only occur late over the child's first 2 years, and even when recovery is incomplete, the sequelae remain minimal without 13,15 hindering the function of the limb involved.…”
Erb-Duchenne paralysis is a neurological condition characterized by paralysis of the arm which occurs due to injury of the upper trunk of C5-C6 of the brachial plexus and can lead to disturbances in movement and sensation. Erb-Duchenne paralysis commonly presents with a “Waiter’s Tip” deformity characterized by elbow extension, medial rotation of the arm, forearm pronation, and wrist flexion. Management of Erb-Duchenne paralysis may involve strengthening exercises, range of motion exercises, manual therapy, and neuromuscular electrical stimulation. However, in most cases, the diagnosis of Erb-Duchenne paralysis is not detected early enough for rehabilitation outcomes to be maximized. We herein report a case of a 6-months old child who had Erb-Duchenne paralysis in the left upper limb. The aim of this case report is to highlight the importance of early detection and rehabilitation of Erb-Duchenne paralysis. Furthermore, the report also discusses the physiotherapy techniques that can be used to optimize outcomes.
“…At the same time, at present, a clear rehabilitation process for the treatment of brachial plexus injuries has not been developed yet ( 20 ). Despite much knowledge exists on the mechanisms of nerve injury and regeneration, the current literature lacks guidance and solid treatment algorithms for the postoperative management of UN injuries especially within the pediatric population ( 10 , 19 , 21 ), which instead could be crucial to preserve intrinsic motor function, while preventing hand deformities or sensory abnormalities.…”
BackgroundPeripheral nerve injuries (PNIs) of the upper limb are very common events within the pediatric population, especially following soft tissue trauma and bone fractures. Symptoms of brachial plexus nerve injuries can differ considerably depending on the site and severity of injury. Compared to median and radial nerves, the ulnar nerve (UN) is the most frequently and severely injured nerve of the upper extremity. Indeed, due to its peculiar anatomical path, the UN is known to be particularly vulnerable to traumatic injuries, which result in pain and substantial motor and sensory disabilities of the forearm and hand. Therefore, timely and appropriate postoperative management of UN lesions is crucial to avoid permanent sensorymotor deficits and claw hand deformities leading to lifelong impairments. Nevertheless, the literature regarding the rehabilitation following PNIs is limited and lacks clear evidence regarding a solid treatment algorithm for the management of UN lesions that ensures full functional recovery.Case presentationThe patient is a 11-year-old child who experienced left-hand pain, stiffness, and disability secondary to a domestic accident. The traumatic UN lesion occurred about 8 cm proximal to Guyon’s canal and it was surgically treated with termino-terminal (end-to-end) neurorrhaphy. One month after surgery, the patient underwent multimodal rehabilitative protocol and both subjective and functional measurements were recorded at baseline (T0) and at 3- (T1) and 5-month (T2) follow-up. At the end of the rehabilitation protocol, the patient achieved substantial reduction in pain and improvement in quality of life. Of considerable interest, the patient regained a complete functional recovery with satisfactory handgrip and pinch functions in addition with a decrease of disability in activities of daily living.ConclusionA timely and intensive rehabilitative intervention done by qualified hand therapist with previous training in the rehabilitation of upper limb neuromuscular disorders is pivotal to achieve a stable and optimal functional recovery of the hand, while preventing the onset of deformities, in patients with peripheral nerve injuries of the upper limb.
“…Brachial plexus avulsion injury (BPAI) is very di cult to treat despite advances in technology, and treatment results are not always satisfactory. The modern-day management of BPAI involves a combination of various neurotization with intraplexus and extraplexus ipsilateral/contralateral nerve donors, which include the spinal accessory nerve, phrenic nerve, intercostal nerves, and contralateral C7 nerve (CC7) [1][2][3][4][5]. The spinal accessory nerve is mainly used for direct neurotization of the suprascapular [6][7].…”
Purpose
The purpose of this study is to present our long term follow up outcome on the use of the contralateral C7 (CC7) transfer to reinnervate three recipient nerves in the patients with total brachial plexus avulsion injury (BPAI).
Methods
We retrospectively reviewed data from 13 patients with total BPAI. All of the 13 patients were confirmed with phrenic nerve and spinal accessary nerve total injury on the affected side. 5 patients were 20 years or younger and 8 were older than 20 years at the time of surgery. In 1st stage, the entire CC7 was harvested and was transferred to pedicled ulnar nerve and the suprascapular nerve with sural nerve grafted. It was performed less than 6 months after injury in 10 patients; 3 underwent the procedure more than 6 months but less than 12 months. The ulnar nerve was transferred to median nerve and biceps branch in the 2nd stage about 4 to 8 months after the 1st stage.
Results
The recovery rate was 84.62% (11/13) for shoulder abduction, 53.85% (7/13) for shoulder external rotation, 84.62% (11/13) for elbow flexion, 61.54% (8/13) for wrist and finger flexor and 53.85% (7/13) in median nerve area sensation. The recovery of median nerve in younger group was significantly better than the elder group (p < 0.05).
Conclusions
The use of CC7 transfer for simultaneous repair of suprascapular nerve, median nerve and biceps branch is an effective procedure in treating total BPAI. This technique may become an option for treatment of total BPAI combined with phrenic nerve and spinal accessary nerve injured case.
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