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Khabyeh-Hasbani N, Hoffman AF, Meisel E, Behbahani M, Koehler SM. Glenohumeral Dysplasia Following Brachial Plexus Birth Injuries: A Review. Neurosurgery 2024:00006123-990000000-01238. [PMID: 38916346 DOI: 10.1227/neu.0000000000003062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/01/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the high morbidity associated with glenohumeral dysplasia (GHD) in children with brachial plexus birth injuries, the progression of this condition often remains unnoticed, even after correcting for the underlying brachial plexus birth injuries. GHD, driven by a multifactorial process involving disruptions in both direct and indirect neural regulation of bony and muscular structures, can lead to intermittent or permanent shoulder mobility imbalances, significantly impacting the quality of life of those affected. Recent research efforts are increasingly directed toward identifying the root causes, managing the deformity, and determining effective treatment options for correcting GHD. METHODS A comprehensive search strategy was used by the authors to identify relevant literature relating to the progression, pathoanatomy, clinical presentation, and management of GHD following brachial plexus birth injuries across various search engines, such as PubMed, Scopus, and Embase. Considering the topic's interdisciplinary nature, articles were retrieved from both neurosurgical and orthopaedic journals to enrich the review. RESULTS Given the challenges in managing patients with brachial plexus birth injuries, a multidisciplinary care team consisting of certified occupational hand therapists, neurosurgeons, plastic surgeons, and orthopedic surgeons, specializing in brachial plexus injuries should be advocated for. The aim of this collaborative effort is to correct brachial plexus birth injuries and prevent the persistence of GHD. CONCLUSION As research continues to focus on understanding the complexities of this condition, the aim of this review article is to summarize the current literature on the course of brachial plexus birth injury and the development of GHD. By doing so, we hope to provide neurosurgeons with the necessary knowledge and essential tools needed to identify and effectively treat GHD during management of brachial plexus birth injuries.
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Affiliation(s)
| | - Alexandra F Hoffman
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Erin Meisel
- Department of Orthopaedic Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Mandana Behbahani
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Steven M Koehler
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
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Delioğlu K, Uzumcugil A, Öztürk E, Bıyık KS, Ozal C, Gunel MK. Cut-off values of internal rotation in the glenohumeral joint for functional tasks in children with brachial plexus birth injury. J Hand Surg Eur Vol 2023; 48:738-746. [PMID: 36788751 DOI: 10.1177/17531934231154362] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The aim of this study was to determine the cut-off values of the range of internal rotation motion in the isolated glenohumeral joint that is required for functional tasks in children with an upper root injury of the brachial plexus. Internal rotation motion was measured using a universal goniometer in 97 participants. The Mallet Hand to Spine and Mallet Hand to Belly tasks were assessed as functional tasks that require internal rotation of the shoulder. For the Hand to Spine task, 41° passive and 30° active internal rotation were necessary to reach the S1 level. For the Hand to Belly task, 42° passive and 29° active internal rotation were required to place the palm on the belly without wrist flexion. Of our participants, 97% could touch the belly with or without wrist flexion, but 28% could not reach S1 in the Hand to Spine task. The results of this study show the necessary amount of internal rotation of the shoulder that should be considered in treatment strategies.Level of evidence: III.
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Affiliation(s)
- Kıvanç Delioğlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Akin Uzumcugil
- Faculty of Medicine, Department of Orthopedics and Traumatology, Hacettepe University, Ankara, Turkey
| | - Ebru Öztürk
- Faculty of Medicine, Department of Biostatistics, Hacettepe University, Ankara, Turkey
| | - Kubra Seyhan Bıyık
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Cemil Ozal
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Mintaze Kerem Gunel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Delioğlu K, Uzumcugil A, Gunel M. Activity-based hand-function profile in preschool children with obstetric brachial plexus palsy. HAND SURGERY & REHABILITATION 2022; 41:487-493. [DOI: 10.1016/j.hansur.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/03/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
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Delioğlu K, Ozal C, Seyhan Bıyık K, Unes S, Tuncdemir M, Uzumcugil A, Kerem Gunel M. Requirements for tele-health in children with obstetric brachial plexus palsy during Covid-19-like situations. HAND SURGERY & REHABILITATION 2021; 41:78-84. [PMID: 34655823 PMCID: PMC8531202 DOI: 10.1016/j.hansur.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/23/2021] [Accepted: 09/20/2021] [Indexed: 11/20/2022]
Abstract
The purpose of the study was to investigate families’ concerns and service requirements during the Covid-19 lockdown. In case of tele-consultation, we also aimed to assess the effects of this service on coping and the family’s worries. At end of lockdown, we contacted the parents of 67 obstetric brachial plexus palsy patients (0–10 years age) by e-mail. During lockdown, 42 of the families had had a tele-consultation with our team, while 25 reported that not receiving any service. A questionnaire consisting of 6 questions was sent to the families, and data were analyzed according to 4 age-groups. Parents' concerns varied according to the children’s age group (p = 0.001). All families replied that their children should receive remote services during Covid-19-like situations (p = 0.173). Parents of the 42 children who had tele-consultations reported that this had alleviated their worries, independently of age-group (p = 0.160). The usefulness of tele-consultation to manage the lockdown situation differed according to age-group (p = 0.002). The parents of under-3-year-olds experienced more worry during lockdown, but all respondents reported needing remote services. Although the tele-consultation alleviated the worries of almost all families, it was most useful in managing lockdown in families with under-3-year-olds.
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Affiliation(s)
- K Delioğlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Adnan Saygun Street, Altındağ, 06230, Ankara, Turkey.
| | - C Ozal
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Adnan Saygun Street, Altındağ, 06230, Ankara, Turkey.
| | - K Seyhan Bıyık
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Adnan Saygun Street, Altındağ, 06230, Ankara, Turkey.
| | - S Unes
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Adnan Saygun Street, Altındağ, 06230, Ankara, Turkey.
| | - M Tuncdemir
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Adnan Saygun Street, Altındağ, 06230, Ankara, Turkey.
| | - A Uzumcugil
- Hacettepe University, Faculty of Medicine, Department of Orthopedics and Traumatology, Adnan Saygun Street, Altındağ, 06230, Ankara, Turkey.
| | - M Kerem Gunel
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Adnan Saygun Street, Altındağ, 06230, Ankara, Turkey.
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Massamba Vuvu T, Dorniol M, Le Nen D, Thépaut M, Brochard S, Pons C. Effect of arthroscopic shoulder release on shoulder mobility and bone deformity following brachial plexus birth injury: a systematic review and meta-analysis. J Shoulder Elbow Surg 2021; 30:2428-2437. [PMID: 33567353 DOI: 10.1016/j.jse.2020.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/20/2020] [Accepted: 12/27/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Specific information to guide clinical practice is lacking for the effects of arthroscopic release on bone and joint deformities, as well as the additional benefits of tendon transfer, in children with brachial plexus birth injury. The aims of this study were (1) to evaluate changes in shoulder mobility and bone and joint deformity, (2) to evaluate the effect of release with and without tendon transfer on the same outcomes, and (3) to evaluate the perioperative and long-term complications. METHODS We conducted a systematic review and meta-analysis. Four databases were searched using relevant inclusion and exclusion criteria from inception until May 2020. The quality of articles was evaluated using the Methodological Index for Non-randomized Studies (MINORS) scale. Data regarding patients, interventions, and clinical and radiologic outcomes were reported. RESULTS Thirteen articles were included: 6 of low quality and 7 of moderate quality separated into 17 studies (266 children). The mean follow-up duration was 32.4 months (standard deviation, 15.2 months). Arthroscopic release significantly improved the Mallet score (standardized mean difference [SMD], 3.1 [95% confidence interval (CI), 1.5-4.7]; P < .001) and passive external rotation (SMD, 3.6 [95% CI, 2.3-4.9]; P = .02). The percentage of humeral head anterior (SMD, 1.3 [95% CI, 0.7-1.9]; P = .003) and glenoid retroversion (SMD, 1.4 [95% CI, 0.9-2]; P = .01) also improved. Descriptive analysis of the data suggested that concomitant tendon transfer further improved mobility. Recurrence of internal-rotation contracture was reported in 8 of 157 children. DISCUSSION This systematic review showed that arthroscopic release effectively improves both shoulder mobility and bone deformity, with few complications in young children with brachial plexus birth injury. As such, it seems reasonable to propose a stepwise approach starting with a release without transfer.
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Affiliation(s)
- Tatiana Massamba Vuvu
- Hand Surgery Unit, Orthopaedic Surgery Department, Centre Hospitalier Régional Universitaire (CHRU) La Cavale Blanche, Brest, France; Paediatric Surgery Department, Centre Hospitalier Régional Universitaire (CHRU) Morvan, Brest, France; Université de Bretagne Occidentale, Brest, France.
| | - Morgane Dorniol
- Hand Surgery Unit, Orthopaedic Surgery Department, Centre Hospitalier Régional Universitaire (CHRU) La Cavale Blanche, Brest, France; Université de Bretagne Occidentale, Brest, France
| | - Dominique Le Nen
- Hand Surgery Unit, Orthopaedic Surgery Department, Centre Hospitalier Régional Universitaire (CHRU) La Cavale Blanche, Brest, France; Université de Bretagne Occidentale, Brest, France
| | - Matthias Thépaut
- Paediatric Surgery Department, Centre Hospitalier Régional Universitaire (CHRU) Morvan, Brest, France; Université de Bretagne Occidentale, Brest, France
| | - Sylvain Brochard
- Physical Medicine and Rehabilitation Department, Centre Hospitalier Régional Universitaire (CHRU) Brest, Brest, France; Laboratoire de Traitement de l'Information Médicale, Inserm U1101, Université de Bretagne Occidentale, Brest, France; Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
| | - Christelle Pons
- Physical Medicine and Rehabilitation Department, Centre Hospitalier Régional Universitaire (CHRU) Brest, Brest, France; Laboratoire de Traitement de l'Information Médicale, Inserm U1101, Université de Bretagne Occidentale, Brest, France; Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
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Bachy M, Lallemant P, Grimberg J, Fitoussi F. Palliative shoulder and elbow surgery in obstetrical brachial plexus birth palsy. HAND SURGERY & REHABILITATION 2021; 41S:S63-S70. [PMID: 34058395 DOI: 10.1016/j.hansur.2020.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 08/29/2018] [Accepted: 05/08/2020] [Indexed: 11/26/2022]
Abstract
Palliative surgery in a child with incomplete recovery following obstetric brachial plexus birth palsy (BPBP) is common. Surgical management strategies for BPBP sequelae have the common objectives of decreasing the risk of functional limitations in the long term and improving function. There is no single treatment to deal with the sequelae of BPBP. While there is a myriad of possible clinical presentations, the ages for surgery extend from a 6- to 12-month-old infant to the mature adolescent. Numerous procedures have been described in the literature, ranging from simple soft tissue release to muscular transfers and osteotomies. The indications will depend on a combination of all these factors. In certain cases, an early intervention is recommended to prevent joint deformities, and to allow joint remodeling, often at the shoulder. In other cases, the indications are less clear, thus the expected benefit must be carefully considered. The indications for these operations must meet certain rules to be beneficial for the patient and should only be considered after a comprehensive clinical examination and a commitment from the child and the family to the therapeutic strategy.
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Affiliation(s)
- M Bachy
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, APHP, 26, Avenue du Dr Arnold Netter, 75012 Paris, France.
| | - P Lallemant
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, APHP, 26, Avenue du Dr Arnold Netter, 75012 Paris, France
| | - J Grimberg
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, APHP, 26, Avenue du Dr Arnold Netter, 75012 Paris, France
| | - F Fitoussi
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, APHP, 26, Avenue du Dr Arnold Netter, 75012 Paris, France
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Delioğlu K, Uzumcugil A, Öztürk E, Kerem Gunel M. Relative importance of factors affecting activity and upper extremity function in children with Narakas Group 2 brachial plexus birth palsy. J Hand Surg Eur Vol 2021; 46:239-246. [PMID: 33092449 DOI: 10.1177/1753193420964768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of the study was to determine the differences in upper limb function and activity/participation levels between preschool children with Narakas Groups 2a and 2b obstetric brachial plexus injury; and to determine the significance level of the factors affecting upper limb functions in these patients. Sixty-seven children, aged 3 to 7, who had not had surgical intervention, were evaluated in terms of joint movements, modified Mallet classification, Raimondi hand classification, brachial plexus outcome measure, paediatric outcome data collection instrument and stereognosis. There were significant functional differences between the groups, in favour of Group 2a. The movements affecting total function of the upper limb were: hand to spine (p < 0.001), global abduction (p < 0.001) and hand to mouth (p < 0.001), in descending order of significance. Passive internal rotation was the most important passive joint movement affecting shoulder function (p < 0.001). The results of this study suggest that more emphasis should be placed on the shoulder internal rotation in treatment strategies.Level of evidence: III.
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Affiliation(s)
- Kıvanç Delioğlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Akin Uzumcugil
- Department of Orthopedics and Traumatology, Hacettepe University, Ankara, Turkey
| | - Ebru Öztürk
- Department of Biostatistics, Hacettepe University, Ankara, Turkey
| | - Mintaze Kerem Gunel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Abstract
BACKGROUND Shoulder imbalance secondary to residual brachial plexus birth palsy requires release of internal rotation contracture and tendon transfer. Subscapularis is considered as the prime element of internal rotation contracture and various methods have been described for subscapularis lengthening. It includes open subscapularis slide or lengthening and arthroscopic release. We hypothesized that subscapularis can be released through minimally invasive approach from the medial border of scapula and thus avoiding formal open procedures and risk of weakening the internal rotation strength. METHODS Safety zones to avoid injury to important neurovascular structures while performing minimally invasive subscapularis release (MISR) were determined through cadaveric dissection. Between 2014 and 2016, 45 patients underwent MISR. A concomitant conjoined Latissimus Dorsi and Teres Major transfer was performed. Twenty patients with minimum 2-year follow-up were included in this study. Average age of patients was 6.4 years. A 5-point modified Mallet Score, degrees of active and passive rotations and abduction were used as outcome measures. Axial MRI imaging were available to classify the gleno-humeral deformity. RESULTS Mean improvement in passive external rotation was 80 degrees and in active external rotation was 43 degrees (P <0.001) at 3 months, which was maintained at final follow-up. Average shoulder abduction improved from preoperative-101 degrees to postoperative-142 degrees. Aggregate 5-point Mallet Score improved from 12.8 points (range, 11 to 16) preoperatively to 18.5 points (range, 16 to 21) postoperatively. None of the patients developed external rotation contracture. The results were comparable with other existing techniques of subscapularis release with conjoint tendon transfer. CONCLUSIONS MISR with conjoined tendon transfer is an effective way of treating internal rotation contracture in children with congruent glenohumeral joints. This procedure has shown beneficial outcomes even in patients with noncongruous glenohumeral joints, when performed in children younger than 4 years. Advantages of MISR include less risk to neurovascular structures, minimal soft tissue trauma, directly addressing the medial tight subscapularis fibers, significantly less surgical time and minimum learning curve. LEVELS OF EVIDENCE Level III-retrospective comparative study.
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Ahmed A, Zayed F, Hamouda I. Open subscapularis release for treatment of internal rotation shoulder contracture in obstetric brachial plexus palsy. AL-AZHAR ASSIUT MEDICAL JOURNAL 2020. [DOI: 10.4103/azmj.azmj_80_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Evaluation of functional outcomes and preliminary results in a case series of 15 children treated with arthroscopic release for internal rotation contracture of the shoulder joint after Erb's palsy. J Child Orthop 2016; 10:665-672. [PMID: 27734266 PMCID: PMC5145823 DOI: 10.1007/s11832-016-0773-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/22/2016] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION The purpose of this study was to evaluate shoulder function following minimally invasive subtotal subscapularis muscle and periarticular capsuloligamentous arthroscopic release in children with Erb's palsy. METHODS A prospective study was conducted on 15 consecutive children who underwent subtotal subscapularis muscle and periarticular capsuloligamentous arthroscopic release to treat internal rotation contracture of the shoulder joint after Erb's palsy. Age at surgery ranged from 24 to 38 months (average 28.3) (2.4 years). All of the patients were assessed clinically and radiologically preoperatively and postoperatively at regular intervals. The Mallet scoring system was used to analyze the results. RESULTS The mean external rotation improved from -24° to +46° (p = 0.001) at the last follow-up. Active internal rotation was preserved in all cases. At the final follow-up, there had been no loss of the external rotation gained and no recurrence of internal rotation contracture of the shoulder, and the mean Mallet score (total) had improved from 11 to 17 points (p = 0.001). CONCLUSIONS In children aged from 1 to 3 years, an arthroscopic release procedure alone may successfully restore function and yield a centered glenohumeral joint, which has a beneficial effect on glenoid remodeling. LEVEL OF EVIDENCE Level IV.
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