Significant improvement in nerve conduction, arm length, and upper extremity function after intraoperative electrical stimulation, neurolysis, and biceps tendon lengthening in obstetric brachial plexus patients

Nath, Rahul K.; Somasundaram, Chandra

doi:10.1186/s13018-015-0191-y

Cited by 9 publications

(10 citation statements)

References 27 publications

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“…She also had elbow flexion contractures. Serial casting/Ilizarov stretching was indicated, and the patient had biceps tendon lengthening (BTL) procedure 37 at age 28.…”

Section: Case Reportsmentioning

confidence: 99%

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Clinical and Functional Outcome of Modified Quad Surgery in Adult Obstetric Brachial Plexus Injury Patients: Case Reports

Nath

Goel

Somasundaram

2019

Clinics and Practice

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Untreated adult obstetric brachial plexus injury (OBPI) patients, in general, use compensatory strategies to achieve their lost upper extremity functions; they cause some adverse effects. Our present study is a case series of 3 female adult OBPI patients, aged 46, 23 and 21 years old. They all had a modified Quad surgical procedure. All patients were assessed preoperatively and postoperatively by evaluating video recordings of standardized upper extremity movements using the modified Mallet scale. The average postoperative follow-up was 4.3 months (1 to 9 months). Total Mallet score significantly improved from 15 and 18 to 21 in two patients. Supination angle measured from active movement of these 3 patients improved from 40°, 0° and -60° to 80°, 40° and -40°, respectively. The modified Quad surgical procedure significantly improves active abduction and other shoulder functions not only in young pediatric and adolescent patients, as we have previously reported, but also in adult patients with muscle imbalance secondary to brachial plexus injury sustained at birth.

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“…She also had elbow flexion contractures. Serial casting/Ilizarov stretching was indicated, and the patient had biceps tendon lengthening (BTL) procedure 37 at age 28.…”

Section: Case Reportsmentioning

confidence: 99%

“…We described the detailed mod Quad procedure in our previous publication. In addition, one patient had a BTL procedure 37 to improve her affected arm length.…”

Section: Case Reportsmentioning

confidence: 99%

Clinical and Functional Outcome of Modified Quad Surgery in Adult Obstetric Brachial Plexus Injury Patients: Case Reports

Nath

Goel

Somasundaram

2019

Clinics and Practice

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“…When a Z-lengthening is performed, the elbow should be immobilized for 4 weeks or more to avoid reconstructive failure. [36][37][38]…”

Section: Techniques Of Selective Elbow Flexor Lengtheningmentioning

confidence: 99%

“…Functional elbow flexor lengthening significantly enhances the fluid control of elbow motion and improves hand placement in properly selected patients. 38,39…”

Section: Elbow With Dynamic Deformitymentioning

confidence: 99%

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Spastic Paralysis of the Elbow and Forearm

Gharbaoui

Kania

Cole

2016

Seminars in Plastic Surgery

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).Spasticity presents as muscular hypertonia and hyperexcitability of the stretch reflex, which are typical of upper motor neuron syndrome. 1,2 Physiopathologically, spasticity is due to the medullar and supramedullar alteration of the afferent and efferent pathways. Treatment is multidisciplinary and involves the collaboration of rehabilitators, neurophysiologists, neurologists, pediatricians, orthopaedic surgeons, and psychologists, who all contribute with their different therapeutic aspects and characteristics (which can be pharmacological, peripheral neurological blockages, surgical, etc.). 2,3 The characteristic posture of the upper extremities in spastic cerebral palsy is the inward rotation of the shoulder, flexion of the elbow and pronated forearm, flexion of the wrist with ulnar deviation, and the deformity of the fingers (flexion contracture, swan-neck, and thumbs-in-palm). [4][5][6] The primary objectives in these patients will be to improve communication with their surroundings, to perform activities of daily living, and to increase mobility and walking. Control of Spasticity Nonsurgical Management OptionsThe treatment of spasticity is highly dependent on the time since injury and the prognosis for recovery. In the period of neurologic recovery, temporizing interventions are most appropriate because permanent changes may result in the chronic imbalance of forces across joints. The prevention of additional complications, such as disuse muscle atrophy, joint contractures, heterotopic ossification, and peripheral neuropathies, is critical in optimizing functional outcome. 2,4,7 Several treatment choices are available, including cast and splint use, oral drug therapy, intrathecal baclofen, chemodenervation, neurolytic blocks, phenol blocks, and botulinum toxin (BoNT) blocks. 2,6,7 Cast and Splint UseIn addition to a variety of medical regimens to be discussed, various casting or splinting techniques can provide temporary relief of spasticity. Casting helps maintain muscle fiber length and diminishes muscle tone by decreasing sensory input and providing a structural impediment to spastic contracture. Changed on a weekly basis, serial casts can be used to correct joint contractures and is successful for contractures present < 6 months. Although there is some effect on spasticity, this is generally not a practical treatment modality. Dynamic splinting has a very limited role in treating spastic contractures and may even exacerbate the situation by triggering increased muscle tone. Both dynamic splints and serial casting may be very helpful after surgical release to correct the residual static component. As an adjunct, local anesthetic nerve blocks are helpful prior to cast application as they relieve spasticity and improve limb positioning. [6][7][8][9] Oral Drug Therapy Several oral antispastic agents may be used during this period; however, it is critical to understand the strengths Keywords ► spasticity ► hypertonia ► cerebral palsy ► nonsurgical treatment ► surgical treatment AbstractAs the physiologic ...

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Developing a decision aid for youth with brachial plexus birth injuries facing treatment decisions for an elbow flexion contracture

Parsons

Davidge

et al. 2021

PM&R

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Background A common sequela of brachial plexus birth injury (BPBI) is an elbow flexion contracture. Youth with BPBI and their families face rehabilitation or surgical decisions that ideally entail careful deliberation of the risks and benefits of treatment within the context of the child's and family's functional and appearance‐related goals. Objective To develop a patient decision aid (PtDA) following International Patient Decision Aid Standards to help these youth and their families make treatment decisions. Design Mixed‐methods study. Setting Brachial plexus clinic in a pediatric tertiary care center. Participants Five young adults (21–24 years), 14 youth (8–19 years) and their parents, 15 families (children 2–16 years), and 19 clinicians from a brachial plexus clinic participated in the PtDA development. Seventeen other youth (8–18 years) facing treatment decisions regarding their elbow contracture field tested the PtDA prototype. Interventions Not applicable. Main Outcome Measures In‐depth interviews and participant observation to conduct a decisional needs assessment of young adults, youth, parents, and health care professionals involved in these shared decisions. Cognitive interviews to field test the PtDA prototype. Results Evidence from previously conducted knowledge synthesis and the youth‐focused decisional needs assessment qualitative data informed the development of new PtDA prototype, which included a questionnaire‐based values clarification method for youth to rate what matters most to them regarding their elbow function, appearance, psychosocial impact, and treatment options. The majority (90%) of youth >11 years who field tested the PtDA prototype understood its content, whereas only 29% of those between 8 and 11 years demonstrated independent comprehension. The majority (69%) responded that they would prefer to use the PtDA on their own either at home or in the clinic waiting room. Conclusions This new PtDA can be used to help youth with BPBI and their families to make a personal value‐based informed decision regarding treatment options for their elbow flexion contracture.

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Significant improvement in nerve conduction, arm length, and upper extremity function after intraoperative electrical stimulation, neurolysis, and biceps tendon lengthening in obstetric brachial plexus patients

Cited by 9 publications

References 27 publications

Clinical and Functional Outcome of Modified Quad Surgery in Adult Obstetric Brachial Plexus Injury Patients: Case Reports

Clinical and Functional Outcome of Modified Quad Surgery in Adult Obstetric Brachial Plexus Injury Patients: Case Reports

Spastic Paralysis of the Elbow and Forearm

Developing a decision aid for youth with brachial plexus birth injuries facing treatment decisions for an elbow flexion contracture

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