Supination Contractures in Brachial Plexus Birth Palsy: Long-Term Upper Limb Function and Recurrence After Forearm Osteotomy or Nonsurgical Treatment

Metsaars, Wieneke P.; Henseler, Jan Ferdinand; Nagels, Jochem; Nelissen, Rob G H H

doi:10.1016/j.jhsa.2017.06.002

Cited by 8 publications

(6 citation statements)

References 21 publications

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“…This differs from the findings of a meta-analysis by Metsaars et al, who suggested that recurrence was higher in younger patients with a range of motion of shoulder and hand strength ROM. They also reported a recurrence rate of 41%, which was higher than the rates reported here [ 21 ]. Several factors contribute to the recurrence of deformity after forearm osteotomy in patients with supination contractures, including fibrosis and osseous remodeling, along with growth retardation and biceps contractures [ 21 ].…”

Section: Discussioncontrasting

confidence: 82%

“…They also reported a recurrence rate of 41%, which was higher than the rates reported here [ 21 ]. Several factors contribute to the recurrence of deformity after forearm osteotomy in patients with supination contractures, including fibrosis and osseous remodeling, along with growth retardation and biceps contractures [ 21 ].…”

Section: Discussioncontrasting

confidence: 82%

“…However, the recurrence rates in patients who underwent radial bone osteotomy with interosseous membrane release were lower in our sample than those reported in the literature. Metsaars et al did not find a difference between patients treated with mid-distal radius osteotomy, ulnar osteotomy, or combined radius and ulnar osteotomy in active or passive motions, muscle strength, or functional scores at the final follow-up [ 21 ]. However, the recurrence rate in that study was 41%.…”

Section: Discussionmentioning

confidence: 99%

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Clinical and psychosocial outcomes following correction of supination deformity in obstetrical brachial plexus palsy patients: A retrospective study

Hamdi

Doubi

Abalkhail

et al. 2022

BMC Musculoskelet Disord

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Background Forearm supination contracture is the mostAQ common deformity of the forearm following obstetric brachial plexus palsy (OBPP). Supination deformities in OBPP may be corrected by performing forearm osteotomy; however, the high recurrence rate limits patient satisfaction. Apart from the cosmetic impairment of this deformity, there are no previous reports on the clinical and psychosocial outcomes of forearm osteotomy in patients with supination deformities secondary to OBPP. Therefore, our study aimed to assess the clinical, functional, and psychosocial outcomes following forearm pronation osteotomy in OBPP patients with supination deformity. Methods This retrospective study was conducted after a chart review of all OBPP sequelae with supination forearm deformity in patients who underwent forearm pronating osteotomy from 2006 to 2018. Data relating to OBPP were gathered, and functional and psychosocial outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire through interviews Results This study included 60 patients with a mean age of 8.7 years at the time of surgery. A total of 46 patients had lesions involving C5-T1 (76.7%). The mean preoperative supination deformity position was 68.5°, the mean amount of correction was 98.9°, and the mean forearm position was 30.5°, postoperatively. In the DASH assessment scale used postoperatively, 24 patients (42.9%) reported no restrictions on their daily activities, 25 patients (44.6%) believed that their social activities were unaffected, and 20 patients (35.7%) strongly disagreed with feeling less capable or less confident due to arm, shoulder, or hand problems. The factors significantly affecting position at the final follow-up were the amount of correction (p = 0.011), postoperative position (p = 0.005), and degree of pronation achieved (p = 0.02). The amount of correction significantly affected both self-confidence (p = 0.049) and activities of daily living (p = 0.033). Conclusion In conclusion, our study showed that the position at the final follow-up, the degree of pronation achieved intraoperatively, and the postoperative position significantly affected the position at follow-up and the outcome assessment. The amount of intraoperative correction was significantly associated with higher self-confidence and normal activities of daily living.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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Clinical and psychosocial outcomes following correction of supination deformity in obstetrical brachial plexus palsy patients: A retrospective study

Hamdi

Doubi

Abalkhail

et al. 2022

BMC Musculoskelet Disord

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“…We observed correction of supination and ulnar deviation deformities during the early course of the follow-up period. Compared with other methods to restore pronation, this intervention provides less increase in active forearm rotation range of motion (Metsaars et al., 2014, 2017a, 2017b). This limitation of the extent of correction can also explain the low incidence of recurrence in our series.…”

Section: Discussionmentioning

confidence: 99%

‘Switch’ technique to restore pronation and radial deviation in 17 patients with brachial plexus birth palsy

Özkan

Aydın

Berköz

et al. 2019

J Hand Surg Eur Vol

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We report outcomes of 17 children with brachial plexus birth palsy that underwent extensor carpi ulnaris to brachioradialis and brachioradialis to abductor pollicis longus transfers to correct supination and ulnar deviation deformity. Mean age at the time of surgery was 8.7 years and mean follow-up time was 21 months (8–44). These patients had marked increases in active forearm rotation and Canadian Occupational Performance Measure scores. Activity performance score on the measure increased from 1.1 to 6.7 and satisfaction score increased from 0.8 to 8.7 at final follow-up. We conclude from our patient series that these tendon transfers are effective in correction of the supination and ulnar deviation deformities in brachial plexus birth palsy. Level of evidence: IV

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“…Although the etiology remains unclear, recent data in murine models have suggested that early denervation of the biceps results in muscle sarcomere shortening, precipitating the contracture. 23,24 These data suggest that diligence is needed in identifying and intervening against loss of elbow extension AROM in both conservatively and operatively managed patients. Furthermore, if muscle shortening due to early biceps brachii denervation is a driving force behind elbow flexion contracture, early reinnervation of the biceps brachii to avoid development of contracture may represent an additional indication for surgery.…”

Section: Discussionmentioning

confidence: 99%

Recovery of Shoulder, Elbow, and Forearm Movement After Nerve Reconstruction for Neonatal Brachial Plexus Palsy

Muhlestein,

Chang,

Justice

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: There is a relative dearth of published data with respect to recovery of upper extremity movement after nerve reconstruction for neonatal brachial plexus palsy (NBPP). This study aimed to demonstrate long-term recovery of active range of motion (AROM) at the shoulder, elbow, and forearm after nerve reconstruction for NBPP and to compare that with patients managed nonoperatively. METHODS: We interrogated a prospectively collected database of all patients evaluated for NBPP at a single institution from 2005 to 2020. AROM measurements for shoulder, elbow, and forearm movements were collected at every visit up to 5 years of follow-up and normalized between 0 and 1. We used generalized estimated equations to predict AROM for each movement within local age windows over 5 years and compared the operative and nonoperative cohorts at each age interval. RESULTS: In total, >13 000 collected datapoints representing 425 conservatively and 99 operatively managed children were included for analysis. At 5 years, absolute recovery of AROM after nerve reconstruction was ∼50% for shoulder abduction and forward flexion, ∼65% for shoulder external rotation, and ∼75% for elbow flexion and forearm supination, with ∼20% loss of elbow extension AROM. Despite more limited AROM on presentation for the operative cohort, at 5 years, there was no significant difference between the groups in AROM for shoulder external rotation, elbow extension, or forearm supination, and, in Narakas grade 1–2 injury, shoulder abduction and forward flexion. CONCLUSION: We demonstrate recovery of upper extremity AROM after nerve surgery for NBPP. Despite more severe presenting injury, operative patients had similar recovery of AROM when compared with nonoperative patients for shoulder external rotation, elbow extension, forearm supination, and, for Narakas grade 1–2 injury, shoulder abduction and forward flexion.

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Supination Contractures in Brachial Plexus Birth Palsy: Long-Term Upper Limb Function and Recurrence After Forearm Osteotomy or Nonsurgical Treatment

Cited by 8 publications

References 21 publications

Clinical and psychosocial outcomes following correction of supination deformity in obstetrical brachial plexus palsy patients: A retrospective study

Clinical and psychosocial outcomes following correction of supination deformity in obstetrical brachial plexus palsy patients: A retrospective study

‘Switch’ technique to restore pronation and radial deviation in 17 patients with brachial plexus birth palsy

Recovery of Shoulder, Elbow, and Forearm Movement After Nerve Reconstruction for Neonatal Brachial Plexus Palsy

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