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

Grossman, John A. I.; Ditaranto, Patricia; Yaylali, Ilker; Alfonso, Israel; Ramos, Lorna E.; Price, Andrew E.

doi:10.1016/j.jhsb.2004.03.008

Cited by 38 publications

(53 citation statements)

References 18 publications

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“…Surgical technique in this series included nerve grafting and nerve transfers to the suprascapular nerve, with good results reported in all children. 29 …”

Section: Microsurgical Indicationsmentioning

confidence: 99%

“…It has been used to prevent contractures in the immediate postoperative period after microsurgery. 29,71,72 It has been used with serial casting as an adjunct to physical therapy. 73,74 The effect of the toxin is to reduce muscle tone and force to restore passive range of motion and joint alignment.…”

Section: Surgical Management Of the Shouldermentioning

confidence: 99%

“…73,74 The effect of the toxin is to reduce muscle tone and force to restore passive range of motion and joint alignment. 29,54,72 Price et al postulated that there may also be a central nervous system effect in children with BPBP similar to the effect in cerebral palsy. 75 Older patients with advanced shoulder joint deformity may best be served by a derotational humeral osteotomy to improve function.…”

Section: Surgical Management Of the Shouldermentioning

confidence: 99%

See 2 more Smart Citations

Current Concepts in the Management of Brachial Plexus Birth Palsy

Hale

Bae

Waters

2010

The Journal of Hand Surgery

212

151

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“…Surgical technique in this series included nerve grafting and nerve transfers to the suprascapular nerve, with good results reported in all children. 29 …”

Section: Microsurgical Indicationsmentioning

confidence: 99%

Section: Surgical Management Of the Shouldermentioning

confidence: 99%

Section: Surgical Management Of the Shouldermentioning

confidence: 99%

See 1 more Smart Citation

Current Concepts in the Management of Brachial Plexus Birth Palsy

Hale

Bae

Waters

2010

The Journal of Hand Surgery

212

151

View full text Add to dashboard Cite

“…40 All patients had biceps and deltoid recovery of M3 function or better. Over the last several years, Clarke and colleagues have suggested that early determination of the need for surgery in patients with NBPP likely selects some infants in whom recovery of function would occur without surgery.…”

Section: Discussionmentioning

confidence: 89%

Utility of delayed surgical repair of neonatal brachial plexus palsy

Ali

Bakar

et al. 2014

PED

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Object Neonatal brachial plexus palsy (NBPP) represents a significant health problem with potentially devastating consequences. The most common form of NBPP involves the upper trunk roots. Currently, primary surgical repair is performed if clinical improvement is lacking. There has been increasing interest in “early” surgical repair of NBPPs, occurring within 3–6 months of life. However, early treatment recommendations ignore spontaneous recovery in cases of Erb's palsy. This study was undertaken to evaluate the optimal timing of surgical repair in this group with respect to quality of life. Methods The authors formulated a decision analytical model to compare 4 treatment strategies (no repair or repair at 3, 6, or 12 months of life) for infants with persistent NBPPs. The model derives data from a critical review of published studies and projects health-related quality of life and quality-adjusted life years over a lifetime. Results When evaluating the quality of life of infants with NBPP, improved outcomes are seen with delayed surgical repair at 12 months, compared with no repair or repair at early and intermediate time points, at 3 and 6 months, respectively. ANOVA showed that the differences among the 4 groups are highly significant (F = 8369; p < 0.0001). Pairwise post hoc comparisons revealed that there are highly significant differences between each pair of strategies (p < 0.0001). Meta-regression showed no evidence of improved outcomes with more recent treatment dates, compared with older ones, for either nonsurgical or for surgical treatment (p = 0.767 and p = 0.865, respectively). Conclusions These data support a delayed approach of primary surgical reconstruction to optimize quality of life. Early surgery for NBPPs may be an overly aggressive strategy for infants who would otherwise demonstrate spontaneous recovery of function by 12 months. A randomized, controlled trial would be necessary to fully elucidate the natural history of NBPP and determine the optimal time point for surgical intervention.

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“…Most authors would agree that surgery would be indicated for patients without hand to mouth function by 6-9 months of age, as patients without return of biceps function by this age would have poor outcomes without surgical intervention. 2,9,10,12,23 Paramount to our treatment protocol in this study was the use of intraoperative nerve conduction studies as a guide to determining whether to treat patients with neurolysis alone or with neuroma resection and interposition grafting. Historically, intraoperative nerve testing has been incorporated in the treatment algorithms and also reported in the surgical methods.…”

mentioning

confidence: 99%

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

Andrisevic

Taniguchi

Partington

et al. 2014

PED

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Object The debate addressed in this article is that of surgical treatment methods for a neuroma-in-continuity. The authors of this study chose to test the hypothesis that more severe nerve injuries, as distinguished by < 50% conduction across a neuroma-in-continuity, could be treated with neuroma resection and grafting, whereas less severe nerve injuries, with > 50% conduction across the neuroma, could be treated with neurolysis alone. Methods The goal of this study was to compare preoperative and postoperative Active Movement Scale (AMS) scores in children with upper trunk brachial plexus birth injuries treated with neurolysis alone if the neuroma's conductivity was > 50% on intraoperative nerve testing. Seventeen patients (7 male, 10 female) met the criteria for inclusion in this study. Surgery was done when the patients were an average of 10 months old (range 6–19 months). The authors analyzed AMS scores from the preoperative assessment, 1-year postoperative follow-up visit, and subsequent follow-up assessment as close to 3 years after surgery as possible (referred to in this paper as > 2-year postoperative scores). Results Comparison of preoperative and 1-year follow-up data showed significant improvement in shoulder abduction, flexion, external rotation, and internal rotation; elbow flexion and supination; and wrist extension. Comparison of preoperative findings and results of assessment at > 2-year follow-up showed significant improvement in shoulder abduction, flexion, external rotation; and elbow flexion and supination. At final follow-up, useful function (AMS score of 6 or 7) was achieved for elbow flexion in 14 of 16 patients, shoulder flexion in 11 of 15 patients, shoulder abduction in 11 of 16 patients, and shoulder external rotation in 5 of 15 patients. Conclusions This report indicates that there is a subgroup of patients who can benefit clinically, with functional improvement of shoulder and elbow function, from treatment with neurolysis alone for upper trunk lesions demonstrating more than 50% conduction across the neuroma on intraoperative nerve testing. Patients with less than 50% conduction, indicating more severe disease, are treated with nerve resection and grafting in the authors' treatment algorithm.

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

Cited by 38 publications

References 18 publications

Current Concepts in the Management of Brachial Plexus Birth Palsy

Current Concepts in the Management of Brachial Plexus Birth Palsy

Utility of delayed surgical repair of neonatal brachial plexus palsy

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

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