Utility of ultrasound in noninvasive preoperative workup of neonatal brachial plexus palsy

Somashekar, Deepak K.; Pietro, Michael A. Di; Joseph, Jacob R.; Yang, Lynda J.‐S.; Parmar, Hemant

doi:10.1007/s00247-015-3524-4

Cited by 24 publications

(20 citation statements)

References 21 publications

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“…MRI permits clear visualization of the shape of the glenohumeral joint and can therefore distinguish candidates for shoulder tendon transfers (mild glenohumeral dysplasia) versus humeral osteotomy (moderate or severe glenohumeral dysplasia) [40]. Ultrasound can be used to detect infantile shoulder dislocation [41]. An ultrasound of the shoulder is recommended in all infants with incomplete recovery at 6 months and particularly in infants with progressive loss of shoulder external rotation with the arm at the side as this may indicate glenohumeral subluxation or dislocation.…”

Section: Discussionmentioning

confidence: 99%

The natural history and management of brachial plexus birth palsy

Buterbaugh

Shah

2016

Curr Rev Musculoskelet Med

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Brachial plexus birth palsy (BPBP) is an upper extremity paralysis that occurs due to traction injury of the brachial plexus during childbirth. Approximately 20 % of children with brachial plexus birth palsy will have residual neurologic deficits. These permanent and significant impacts on upper limb function continue to spur interest in optimizing the management of a problem with a highly variable natural history. BPBP is generally diagnosed on clinical examination and does not typically require cross-sectional imaging. Physical examination is also the best modality to determine candidates for microsurgical reconstruction of the brachial plexus. The key finding on physical examination that determines need for microsurgery is recovery of antigravity elbow flexion by 3-6 months of age. When indicated, both microsurgery and secondary shoulder and elbow procedures are effective and can substantially improve functional outcomes. These procedures include nerve transfers and nerve grafting in infants and secondary procedures in children, such as botulinum toxin injection, shoulder tendon transfers, and humeral derotational osteotomy.

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Section: Discussionmentioning

confidence: 99%

The natural history and management of brachial plexus birth palsy

Buterbaugh

Shah

2016

Curr Rev Musculoskelet Med

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“…Ultrasound has been used to examine the peripheral nerves of the upper limb in adults . Some researchers are using ultrasound to visualize the brachial plexus in children . However, there are no large‐sample studies on normal cervical nerve root values in children.…”

Section: Introductionmentioning

confidence: 99%

Sonographic measurements of normal C5‐C8 nerve roots in children

Wang

2020

Muscle and Nerve

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Introduction The aim of this study was to use ultrasound to measure the cervical nerve roots in normal children to determine normal reference values. Methods A total of 441 children of different ages at the Children's Hospital of Chongqing Medical University were examined by ultrasound. The diameter, circumference, and cross‐sectional area of the nerve roots were measured. Results Ultrasonographic measurements were consistent with the ranking C5 < C6 < C7. The C8 nerve root was thicker than C7 in 60% of the participants. The nerve root measurements increased with increasing age, height, weight, and body surface area. Discussion Normal reference ranges of the cervical nerve roots in children of different ages were established, and can serve as the basis for measurement in future studies.

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“…51 Physicians should use the information from electrodiagnostic/imaging studies and physical examination to develop a preoperative surgical plan to optimize outcome. 19,21,25,49,50,52,56 Our results demonstrate that early forearm supination is significantly improved with Oberlin transfer compared with nerve grafting, whereas elbow flexion recovery was the same in both groups. Despite the biceps muscle being a key supinator of the forearm, previous studies have not compared forearm supination function in infants with NBPP treated with nerve transfer versus nerve grafting.…”

Section: Discussionmentioning

confidence: 56%

“…20,23,55 Our specific decision algorithm has been published. 49 Nerve transfer and nerve grafting are the primary surgical techniques for treating infants with NBPP. The specific treat- ment strategy implemented for a given patient depends on a variety of factors, including age, lesion type, lesion site, and timing of presentation.…”

Section: Discussionmentioning

confidence: 99%

Oberlin transfer compared with nerve grafting for improving early supination in neonatal brachial plexus palsy

Chang¹,

Wilson

Popadich³

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEThe use of nerve transfers versus nerve grafting for neonatal brachial plexus palsy (NBPP) remains controversial. In adult brachial plexus injury, transfer of an ulnar fascicle to the biceps branch of the musculocutaneous nerve (Oberlin transfer) is reportedly superior to nerve grafting for restoration of elbow flexion. In pediatric patients with NBPP, recovery of elbow flexion and forearm supination is an indicator of resolved NBPP. Currently, limited evidence exists of outcomes for flexion and supination when comparing nerve transfer and nerve grafting for NBPP. Therefore, the authors compared 1-year postoperative outcomes for infants with NBPP who underwent Oberlin transfer versus nerve grafting.METHODSThis retrospective cohort study reviewed patients with NBPP who underwent Oberlin transfer (n = 19) and nerve grafting (n = 31) at a single institution between 2005 and 2015. A single surgeon conducted intraoperative exploration of the brachial plexus and determined the surgical nerve reconstruction strategy undertaken. Active range of motion was evaluated preoperatively and postoperatively at 1 year.RESULTSNo significant difference between treatment groups was observed with respect to the mean change (pre- to postoperatively) in elbow flexion in adduction and abduction and biceps strength. The Oberlin transfer group gained significantly more supination (100° vs 19°; p < 0.0001). Forearm pronation was maintained at 90° in the Oberlin transfer group whereas it was slightly improved in the grafting group (0° vs 32°; p = 0.02). Shoulder, wrist, and hand functions were comparable between treatment groups.CONCLUSIONSThe preliminary data from this study demonstrate that the Oberlin transfer confers an advantageous early recovery of forearm supination over grafting, with equivalent elbow flexion recovery. Further studies that monitor real-world arm usage will provide more insight into the most appropriate surgical strategy for NBPP.

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Utility of ultrasound in noninvasive preoperative workup of neonatal brachial plexus palsy

Abstract: Ultrasound can provide useful preoperative evaluation of the post-ganglionic brachial plexus in children with neonatal brachial plexus palsy.

Cited by 24 publications

References 21 publications

The natural history and management of brachial plexus birth palsy

The natural history and management of brachial plexus birth palsy

Sonographic measurements of normal C5‐C8 nerve roots in children

Oberlin transfer compared with nerve grafting for improving early supination in neonatal brachial plexus palsy

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