1
|
Alabau-Rodriguez S, Romero-Larrauri P, Soldado F. Glenohumeral abduction contractures after residual neonatal brachial plexus injury. J Hand Surg Eur Vol 2022; 47:243-247. [PMID: 34521296 DOI: 10.1177/17531934211045509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Glenohumeral abduction contractures are common in patients with neonatal brachial plexus injury, but little has been previously published about them. We conducted a retrospective analysis of data prospectively collected from 205 consecutive children (108 female) of mean age 9.6 years with neonatal brachial plexus injury (C5-C6, 58%; C5-C7, 29%; C5-T1, 14%). Most children (69%) showed a glenohumeral abduction contracture, it being more common in those with upper neonatal brachial plexus injury.Level of evidence: III.
Collapse
Affiliation(s)
- Sergi Alabau-Rodriguez
- Hand, Elbow & Microsurgery Department, Hospital Universitari Quiron-Dexeus, Barcelona, Spain
| | | | - Francisco Soldado
- International Pediatric Hand Surgery and Microsurgery Institute, Barcelona University Childrens Hospital, Barcelona, Spain
| |
Collapse
|
2
|
Pehlivanoglu T, Erşen A, Bayram S, Atalar AC, Demirhan M. Arthroscopic versus open release of internal rotation contracture in the obstetrical brachial plexus paralysis (OBPP) sequela. J Shoulder Elbow Surg 2019; 28:28-35. [PMID: 30195621 DOI: 10.1016/j.jse.2018.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 06/01/2018] [Accepted: 06/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Latissimus dorsi (LD) and teres major (TM) tendon transfers are effective surgical procedures to improve shoulder abduction and external rotation for children with obstetrical brachial plexus palsy (OBPP). Open pectoralis major (PM) tendon Z-plasty and arthroscopic subscapularis (SS) release are 2 options for the release of internal rotation contractures to enhance muscle transfers. This study compared the functional results of LD and TM tendon transfers with open PM tendon Z-plasty or arthroscopic SS release. METHODS The study included 24 patients who underwent LD and TM tendon transfers for OBPP (9 arthroscopic SS release, 15 open PM tendon Z-plasty) with a mean follow-up of 41.33 months (range, 36-60 months) and 47.2 months (range, 36-60 months), respectively. Functional evaluation was made according to range of motion and Mallet scoring system. RESULTS Shoulder abduction-external rotation degrees and scores in all sections of the Mallet scoring system significantly increased in both groups (P < .001). Postoperatively, the arthroscopic SS release group had significantly better abduction degrees (P = .003), total Mallet scores (P < .001), and superior abduction (P = .043), active external rotation (P = .043), hand-to-head (P = .043), and hand-to-mouth (P < .001) scores for the Mallet scoring system. DISCUSSION Transfer of LD together with TM tendons combined with one of the internal rotation contracture release procedures yielded good clinical and functional results in patients younger than age 7, regardless of the type of release method. However, arthroscopic SS release, although requiring an experienced surgeon, revealed better clinical and functional outcomes and is considered to be a less invasive and superior method.
Collapse
Affiliation(s)
- Tuna Pehlivanoglu
- Department of Orthopaedic Surgery and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Erşen
- Department of Orthopaedic Surgery and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Serkan Bayram
- Department of Orthopaedic Surgery and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ata Can Atalar
- Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Acıbadem University, Istanbul, Turkey.
| | - Mehmet Demirhan
- Department of Orthopaedic Surgery and Traumatology, School of Medicine, Koç University, Istanbul, Turkey
| |
Collapse
|
3
|
|
4
|
Gharbaoui IS, Gogola GR, Aaron DH, Kozin SH. Perspectives on glenohumeral joint contractures and shoulder dysfunction in children with perinatal brachial plexus palsy. J Hand Ther 2016; 28:176-83; quiz 184. [PMID: 25835253 DOI: 10.1016/j.jht.2014.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/01/2014] [Accepted: 12/03/2014] [Indexed: 02/09/2023]
Abstract
Shoulder joint deformities continue to be a challenging aspect of treating upper plexus lesions in children with perinatal brachial plexus palsy (PBPP). It is increasingly recognized that PBPP affects the glenohumeral joint specifically, and that abnormal scapulothoracic movements are a compensatory development. The pathophysiology and assessment of glenohumeral joint contractures, the progression of scapular dyskinesia and skeletal dysplasia, and current shoulder imaging techniques are reviewed.
Collapse
Affiliation(s)
- Idris S Gharbaoui
- Fondren Orthopedic Group, 7401 South Main St, Houston, TX 77030, USA.
| | - Gloria R Gogola
- Shriners Hospitals for Children, Houston, 6977 Main St, Houston, TX 77030, USA
| | - Dorit H Aaron
- Aaron & Winthrop Hand Therapy Services Inc., 2723 Amherst, Houston, TX 77005, USA
| | - Scott H Kozin
- Shriners Hospitals for Children, Philadelphia, 3551 N. Broad St, Philadelphia, PA 19140, USA
| |
Collapse
|
5
|
External Rotation Osteotomy of the Humerus to Salvage the Failed Latissimus Dorsi Transfer in Children With Erb Birth Palsy and Supple Congruent Shoulders. Ann Plast Surg 2014; 75:625-8. [PMID: 25180949 DOI: 10.1097/sap.0000000000000331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Management of the failed latissimus dorsi muscle transfer to restore shoulder external rotation has received little attention in the literature. We report on 6 children with Erb birth palsy and supple congruent shoulders and who underwent external rotation osteotomy to salvage a failed latissimus dorsi transfer. It is standard of care to do humerus osteotomies only to children with significant deformities of the glenohumeral joint. In the current article, the osteotomy was performed despite the presence of supple congruent shoulders because the osteotomy seemed the best and simplest option available. The functional outcome was satisfactory; with all patients reaching the occiput easily. Furthermore, there were improvement of the standing posture and improvement of the elbow flexion contracture. We conclude that the osteotomy procedure is a simple and effective option of management after a failed latissimus dorsi transfer.
Collapse
|
6
|
Terzis JK, Karypidis D, Mendoza R, Kokkalis ZT, Diawara N. Morphometric analysis of the effect of scapula stabilization on obstetric brachial plexus paralysis patients. Hand (N Y) 2014; 9:303-14. [PMID: 25191160 PMCID: PMC4152441 DOI: 10.1007/s11552-014-9640-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Scapular position and size deficiency is evident in obstetric brachial plexus paralysis (OBPP) patients due to the absence of balanced muscular forces acting on the scapula. Scapula stabilization (SS) procedures aim to restore a balanced musculature and anatomic position and to augment shoulder function and enhance developmental potential. METHODS Retrospective chart review of 106 patients with OBPP between March 1979 and March 2007 was performed. Forty-one female and 27 male were included in the study. In 38 patients, the paralysis was global, 13 had Erb's paralysis with C7 root involvement; in 18 patients, the lesion was limited to C5 and C6. X-rays were evaluated, and scapula dimensions were manually measured at several stages. Shoulder abduction (SA) and external rotation (SER) outcomes were also recorded. RESULTS Mean improvement was 85.68° in shoulder abduction and 36.74° in shoulder external rotation. SA and SER improvement was significantly better in those who underwent SS procedures compared to those who did not (mean improvement was increased by 9.15° and 8.54°, respectively). Improvement was noted in all scapular dimensions, in all groups, postoperatively. However, the mean improvement in scapular height, big width, small width, and oblique axis discrepancies was 4.92, 14.04, 12.66, and 13.89 %, respectively, higher in patients who underwent SS procedures compared to those who did not. CONCLUSION Dimensional discrepancies and functional outcomes are improved by SS procedures. Maximal results are attained in patients who have undergone both primary and secondary shoulder reconstruction before age 2.
Collapse
Affiliation(s)
- Julia K. Terzis
- />Department of Plastic Surgery, New York University Medical Center, New York, NY USA
- />International Institute of Reconstructive Microsurgery, 27-28 Thomson Ave., Long Island City, NY 11101 USA
| | - Dimitrios Karypidis
- />International Institute of Reconstructive Microsurgery, 27-28 Thomson Ave., Long Island City, NY 11101 USA
| | - Ricardo Mendoza
- />International Institute of Reconstructive Microsurgery, 27-28 Thomson Ave., Long Island City, NY 11101 USA
| | - Zinon T. Kokkalis
- />First Department of Orthopaedics, Athens University School of Medicine, “Attikon” University Hospital, 1 Rimini, Chaidari, Athens, 12462 Greece
| | - Norou Diawara
- />Mathematics & Statistics Department, Old Dominion University, 4700 Elkhorn Ave, Norfolk, VA 23529 USA
| |
Collapse
|
7
|
Noaman HH. Anterior shoulder release and tendon transfer as 1-stage procedure for treatment of internal rotation contracture deformity in obstetric brachial plexus injuries. Ann Plast Surg 2014; 71:510-8. [PMID: 24126339 DOI: 10.1097/sap.0b013e3182a1b02d] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Children who had internal rotation contracture deformities of the shoulder secondary to obstetric brachial plexus palsy were studied. The outcomes of anterior shoulder release and tendon transfer in 1-stage procedure were analyzed. METHODS Anterior shoulder release and tendon transfer in 2 separate incisions as 1 procedure were performed in 76 patients for improvement of shoulder function. Anterior shoulder release was performed through the deltopectoral incision, starting with the coracoid process that extended 5 cm caudally. Osteotomy of the coracoid process subperiosteally with retaining the pectoralis minor attached to the periosteum. Z-plasty of the subscapularis and resuturing of the pectoralis minor short head of biceps and coracobrachialis to their original position were performed in all cases. A separate second incision in the posterior axillary fold was carried out to perform rerouting of the latissimus dorsi and teres major tendons with a mean follow-up of 5.6 years (range, 1-7 years). RESULTS The average active external rotation with the arm at the side increased from -26 + 15 degrees preoperatively to 67 + 17 degrees postoperatively (average gain, 85 degrees). The average shoulder abduction increased from 46 + 22 degrees preoperatively to 130 + 32 degrees postoperatively (average gain, 75 degrees). Mallet score improved from 12.3 to 22.6. CONCLUSIONS Anterior shoulder release combined with latissimus dorsi and teres major rerouting significantly improved global shoulder function.
Collapse
Affiliation(s)
- Hassan Hamdy Noaman
- From the Hand and Reconstructive Microsurgical Unit, Orthopaedic Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| |
Collapse
|
8
|
Obstetric brachial plexus palsy: the mallet grading system for shoulder function--revisited. BIOMED RESEARCH INTERNATIONAL 2014; 2014:398121. [PMID: 24527447 PMCID: PMC3909974 DOI: 10.1155/2014/398121] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/27/2013] [Accepted: 12/28/2013] [Indexed: 11/26/2022]
Abstract
The Mallet grading system is a commonly used functional scoring system to assess shoulder abduction/external rotation deficits in children with obstetric brachial plexus palsy. One feature of the Mallet score is that each grade is translated into certain degrees of deficiencies in both shoulder abduction and external rotation. The aim of the current study is to investigate the percentage of children in which the Mallet score could not be applied because of a discrepancy between the deficiency of shoulder abduction and shoulder external rotation. The study group included 50 consecutive unoperated older children (over 5 years of age) with Erb's palsy and deficits in shoulder movements. The Mallet score could be applied in 40 cases (80%). In the remaining 10 cases (20%), the Mallet score could not be applied either because shoulder abduction had a better grade than the grade of shoulder external rotation (n = 7) or vice versa (n = 3). It was concluded that documenting the deficits in shoulder abduction and external rotation are best done separately and this can be accomplished by using other grading systems.
Collapse
|
9
|
Abdel-Ghani H, Hamdy KA, Basha N, Tarraf YN. Tendon transfer for treatment of internal rotation contracture of the shoulder in brachial plexus birth palsy. J Hand Surg Eur Vol 2012; 37:781-6. [PMID: 22736741 DOI: 10.1177/1753193412451401] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We retrospectively analyzed 63 patients with internal rotation contracture of the shoulder secondary to brachial plexus birth palsy treated with subscapularis sliding combined with either latissimus dorsi transfer (group A: n = 18) or latissimus dorsi and teres major transfer (group B: n = 45) to the rotator cuff. The mean age at time of surgery was 43 months (SD 21 months; range 8 months to 9 years). We used a modification of the Gilbert shoulder grading system for assessment. All patients showed statistically significant improvement of active shoulder abduction and external rotation without significant differences between the two groups. Significant external rotation contracture of the shoulder (inability to touch the abdomen with the wrist extended) occurred in 42 of 63 patients, and there was a greater incidence of external rotation contracture in group B. We conclude that surgery should be restricted to latissimus dorsi transfer without teres major transfer to avoid external rotation contractures. Our modification of the Gilbert grading system appears to be valid and applicable.
Collapse
Affiliation(s)
- H Abdel-Ghani
- Paediatric Orthopaedic Unit, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | | | | | | |
Collapse
|
10
|
Vilaça PR, Uezumi MK, Zoppi Filho A. Centering osteotomy for treatment of posterior shoulder dislocation in obstetrical palsy. Orthop Traumatol Surg Res 2012; 98:199-205. [PMID: 22342551 DOI: 10.1016/j.otsr.2011.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 08/09/2011] [Accepted: 09/19/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND The main objective of this study is to describe a new surgical technique that, through a gleno-humeral approach, reduces the incongruent joint while a humeral head centering osteotomy achieves shoulder stabilization. A humeral medial derotational osteotomy is performed associated with the articular reduction. PATIENTS AND METHODS Fourteen patients with obstetrical palsy presenting a posterior humeral head dislocation were submitted to a centering osteotomy procedure. Our study included patients with: (1) more than 1.5 years postoperative follow-up, (2) presence of humeral head posterior dislocation. The exclusion criteria were the following: (1) patients with total flaccid paralysis, (2) low paralysis and (3) any kind of active infection at the time of the procedure. RESULTS Before treatment, in all patients, the shoulder joint was posteriorly dislocated and in internal rotation. All patients went on to have successful healing at the osteotomy site. In all cases, an improvement in the functional Mallet scale was observed. In all patients, except one, the posterior dislocation was corrected. In two cases, a second surgery (external derotation osteotomy) was performed to improve the upper extremity's position. CONCLUSIONS Articular congruency, after posterior dislocations of the humeral head, is achieved by humeral head centering osteotomy in patients with obstetrical palsy late deformities and also improves function. LEVEL OF EVIDENCE Level IV; case series.
Collapse
Affiliation(s)
- P R Vilaça
- Shoulder and Elbow Group, Associação Beneficente Nossa Senhora do Pari, Hospital do Pari, Rua Hannemann, 234 São Paulo, SP, Brazil.
| | | | | |
Collapse
|
11
|
Does primary brachial plexus surgery alter palliative tendon transfer surgery outcomes in children with obstetric paralysis? BMC Musculoskelet Disord 2011; 12:74. [PMID: 21489264 PMCID: PMC3088905 DOI: 10.1186/1471-2474-12-74] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 04/13/2011] [Indexed: 11/10/2022] Open
Abstract
Background The surgical management of obstetrical brachial plexus palsy can generally be divided into two groups; early reconstructions in which the plexus or affected nerves are addressed and late or palliative reconstructions in which the residual deformities are addressed. Tendon transfers are the mainstay of palliative surgery. Occasionally, surgeons are required to utilise already denervated and subsequently reinnervated muscles as motors. This study aimed to compare the outcomes of tendon transfers for residual shoulder dysfunction in patients who had undergone early nerve surgery to the outcomes in patients who had not. Methods A total of 91 patients with obstetric paralysis-related shoulder abduction and external rotation deficits who underwent a modified Hoffer transfer of the latissimus dorsi/teres major to the greater tubercle of the humerus tendon between 2002 and 2009 were retrospectively analysed. The patients who had undergone neural surgery during infancy were compared to those who had not in terms of their preoperative and postoperative shoulder abduction and external rotation active ranges of motion. Results In the early surgery groups, only the postoperative external rotation angles showed statistically significant differences (25 degrees and 75 degrees for total and upper type palsies, respectively). Within the palliative surgery-only groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles. The significant differences between the early surgery groups and the palliative surgery groups with total palsy during the preoperative period diminished postoperatively (p < 0.05 and p > 0.05, respectively) for abduction but not for external rotation. Within the upper type palsy groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles. Conclusions In this study, it was found that in patients with total paralysis, satisfactory shoulder abduction values can be achieved with tendon transfers regardless of a previous history of neural surgery even if the preoperative values differ.
Collapse
|
12
|
Our experience with secondary reconstruction of external rotation in obstetrical brachial plexus palsy. Plast Reconstr Surg 2010; 126:951-963. [PMID: 20811228 DOI: 10.1097/prs.0b013e3181e603d3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Restoration of shoulder external rotation is very important for upper extremity function. The purpose of this study was to present the authors' experience with secondary restoration of external rotation in patients with obstetrical brachial plexus palsy. METHODS From 1978 to 2002, 46 children underwent secondary surgery for restoration of external rotation. Outcomes were analyzed in relation to various factors, including the type of procedure, muscle transfer only versus nerve reconstruction and muscle transfer, denervation time, type of injury (Erb versus global palsy), and severity score. In addition, the effect of restoration of external rotation on the final outcome of shoulder abduction was assessed. RESULTS There was significant improvement in every case (p < 0.01) between preoperatively and postoperatively. The overall mean postoperative Mallet score for the group undergoing muscle transfer only was 3.95, whereas in the nerve reconstruction and muscle transfer group, the score was 3.88 (p >0.05). The resulting gain in external rotation was 99 degrees versus 93.8 degrees. In both populations, a very significant improvement (p <0.0001) was identified in the final outcome of shoulder abduction (109 degrees after muscle transfer versus 48.3 degrees before muscle transfer, and 112 degrees postoperatively after neurotization and muscle transfer versus 43.8 degrees before any surgery). Patients with Erb palsy had a better but not significant result (p >0.05; p = 0.94), compared with those with global palsy in both Mallet score (3.77 versus 3.76) and final active external rotation (81.7 degrees versus 77.6 degrees). CONCLUSION Secondary surgery for the restoration of external rotation is a rewarding procedure, which also significantly improves the final outcome of shoulder abduction.
Collapse
|
13
|
Total obstetric brachial plexus palsy in children with internal rotation contracture of the shoulder, flexion contracture of the elbow, and poor hand function: improving the cosmetic appearance of the limb with rotation osteotomy of the humerus. Ann Plast Surg 2010; 65:38-42. [PMID: 20548233 DOI: 10.1097/sap.0b013e3181a72f9e] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rotation osteotomy of the humerus has been described by several authors to treat the internal rotation contracture of the shoulder in Erb palsy. The main aim of the osteotomy in Erb patients is to bring the functioning hand to the face which greatly improves function. The author has performed the rotation humeral osteotomy in children with total obstetric brachial plexus palsy aiming for the improvement of the cosmetic appearance of the limb rather than improvement function. This article specifically reports on this group of patients.Over the last 15 years, the author has performed rotation humeral osteotomy in 13 children (mean age 6 years; range, 4.5-9 years) with total obstetric brachial plexus palsy aiming for improvement of the cosmetic appearance of the limb rather than improvement of function. All children had a triad of severe internal rotation contracture of the shoulder, severe flexion contracture of the elbow, and poor hand function.After a mean follow-up of 2 years following the humeral osteotomy, all patients/parents were satisfied with the result and a panel of plastic surgeons confirmed the significant improvement in aesthetics. Reasons for this improvement following the osteotomy were as follows: the child no longer needed to stand with shoulder slightly abducted, the antecubital fossa became visible in the standing position, and the forearm no longer appeared excessively pronated. Of more importance, was the improvement in elbow flexion contracture which had major contribution in improving limb appearance and the perception of length discrepancy between the affected and the contralateral normal limb.The humeral osteotomy improves the cosmetic appearance of children with total palsy and the triad of severe internal rotation contracture of the shoulder, severe flexion contracture of the elbow and poor hand function.
Collapse
|
14
|
Al-Qattan MM, El-Sayed AAF, Al-Zahrani AY, Al-Mutairi SA, Al-Harbi MS, Al-Mutairi AM, Al-Kahtani FS. Obstetric brachial plexus palsy in newborn babies of diabetic and non-diabetic mothers. J Hand Surg Eur Vol 2010; 35:362-5. [PMID: 20181773 DOI: 10.1177/1753193410362645] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Compared to non-diabetic mothers, diabetic mothers are known to deliver larger babies who are at higher risk for shoulder dystocia and obstetric brachial plexus palsy. The intrapartum forces applied during delivery of larger babies are expected to be higher. Hence, the chances of these babies for good spontaneous recovery are expected to be lower; and this is a generally believed hypothesis. The objective of this retrospective study was to compare obstetric brachial plexus palsy in newborn babies of diabetic and non-diabetic mothers. There were a total of 655 cases of obstetric palsy: 253 cases with diabetic mothers and 402 with non-diabetic mothers. The former were more likely to develop total palsy while the latter were more likely to develop extended Erb's palsy. Newborn babies of diabetic mothers had significantly larger birth weights than those of non-diabetic mothers regardless of the type of palsy. The rate of good spontaneous recovery of the motor power of the limb in the two groups was not significantly different except in total palsy cases for shoulder external rotation and elbow flexion where the recovery was significantly better in the diabetic group. It was concluded that the generally believed hypothesis is not correct if one compares the outcome in the diabetic and non-diabetic groups for each type of palsy.
Collapse
Affiliation(s)
- M M Al-Qattan
- Department of Surgery and Department of Obstetrics and Gynecology, King Saud University, Riyadh, Saudi Arabia.
| | | | | | | | | | | | | |
Collapse
|
15
|
Al-Qattan MM, El-Sayed AAF, Al-Zahrani AY, Al-Mutairi SA, Al-Harbi MS, Al-Mutairi AM, Al-Kahtani FS. Narakas classification of obstetric brachial plexus palsy revisited. J Hand Surg Eur Vol 2009; 34:788-91. [PMID: 19786407 DOI: 10.1177/1753193409348185] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Narakas classified babies with obstetric palsy into four groups: upper Erb's, extended Erb's, total palsy, and total palsy with a Horner. Over the last 15 years, it was noted at our obstetric palsy clinic that good spontaneous recovery in newborns with extended Erb's palsy (C5, C6, C7 injury) was more likely if they recovered active wrist extension against gravity before 2 months of age. A hypothesis was made that newborns with extended Erb's palsy (Narakas Group II) may be subclassified into two groups according to this 'early recovery of wrist extension.' In a retrospective study of 581 cases with strict inclusion criteria, the hypothesis was found to be true: patients with extended Erb's and 'early recovery of wrist extension' have significantly higher percentages of good spontaneous recovery of limb function than those with extended Erb's and 'no early recovery of wrist extension' (P<0.0001 by chi-squared test).
Collapse
Affiliation(s)
- M M Al-Qattan
- Department of Surgery, King Saud University, Riyadh, Saudi Arabia.
| | | | | | | | | | | | | |
Collapse
|
16
|
Al-Qattan MM, Al-Husainan H, Al-Otaibi A, El-Sharkawy MS. Long-term results of low rotation humeral osteotomy in children with Erb's obstetric brachial plexus palsy. J Hand Surg Eur Vol 2009; 34:486-92. [PMID: 19675029 DOI: 10.1177/1753193409104552] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Seventeen children with Erb's (C5/6 and C5/6/7 types) obstetric brachial plexus palsy who underwent low rotation humeral osteotomy to treat internal rotation contracture of the shoulder were recalled back to the clinic at a mean of 10 (range 8-14) years after surgery. Eight were male and nine female with mean age of 16 (range 13-20) years. The osteotomy procedure was done at a mean age of 6 (range 5-8) years. Preoperative, early postoperative, and late postoperative motor assessments were compared. There was no recurrence of the internal rotation posturing of the shoulder and there was maintenance of the improvements in elbow extension deficit and forearm rotation. The most surprising finding was a significant (P = 0.003) decrease in shoulder abduction on long-term follow-up (the mean shoulder abduction was 135 degrees , 146 degrees and 109 degrees measured pre-, early post- and late postoperatively, respectively). There was no correlation between changes in shoulder abduction and the radiological score of the shoulder.
Collapse
Affiliation(s)
- M M Al-Qattan
- Department of Surgery, King Saud University, Riyadh, Saudi Arabia.
| | | | | | | |
Collapse
|
17
|
Al-Qattan MM. An obstetric brachial plexus data sheet. J Hand Microsurg 2009; 1:32-8. [PMID: 23129929 DOI: 10.1007/s12593-009-0005-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 03/15/2009] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Several reputed obstetric brachial plexus clinics use their own protocols and indications for surgery. This study is to present and explain the obstetric brachial plexus data sheet used at our institution. METHODS The data sheet is composed of 5 main parts: (1) the basic database which includes the name, age, type and side of palsy, maternal history, birth history and other complications of the traumatic delivery; (2) motor assessment of the limb; (3) preoperative investigations; (4) description of intraoperative brachial plexus findings and type of nerve procedure performed; and (5) secondary surgery to the shoulder, elbow, forearm, wrist and hand. RESULTS The data sheet was found useful in documenting the assessment and events in infants and older children. CONCLUSION An obstetric brachial plexus data sheet is presented and it may be modified and used by other centers.
Collapse
|
18
|
Outcomes of Secondary Shoulder Reconstruction in Obstetrical Brachial Plexus Palsy. Plast Reconstr Surg 2008; 122:1812-1822. [DOI: 10.1097/prs.0b013e31818cc1fc] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
Nath RK, Paizi M. Scapular deformity in obstetric brachial plexus palsy: a new finding. Surg Radiol Anat 2007; 29:133-40. [PMID: 17262175 PMCID: PMC1820760 DOI: 10.1007/s00276-006-0173-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2006] [Accepted: 11/29/2006] [Indexed: 12/17/2022]
Abstract
While most obstetric brachial plexus palsy patients recover arm and hand function, the residual nerve weakness leads to muscle imbalances about the shoulder which may cause bony deformities. In this paper we describe abnormalities in the developing scapula and the glenohumeral joint. We introduce a classification for the deformity which we term Scapular Hypoplasia, Elevation and Rotation. Multiple anatomic parameters were measured in bilateral CT images and three-dimensional CT reconstruction of the shoulder girdle of 30 obstetric brachial plexus palsy patients (age range 10 months–10.6 years). The affected scapulae were found to be hypoplastic by an average of 14% while the ratio of the height to the width of the body of scapula (excluding acromion) were not significantly changed, the acromion was significantly elongated by an average of 19%. These parameters as well as subluxation of the humeral head (average 14%) and downward rotation in the scapular plane were found to correlate with the area of scapula visible over the clavicle. This finding provides a classification tool for diagnosis and objective evaluation of the bony deformity and its severity in obstetric brachial plexus palsy patients.
Collapse
Affiliation(s)
- Rahul K Nath
- Texas Nerve and Paralysis Institute, 2201 W. Holcombe Blvd., Ste. 225, Houston, TX 77030, USA.
| | | |
Collapse
|
20
|
Aydin A, Ozkan T, Onel D. Does preoperative abduction value affect functional outcome of combined muscle transfer and release procedures in obstetrical palsy patients with shoulder involvement? BMC Musculoskelet Disord 2004; 5:25. [PMID: 15291961 PMCID: PMC514557 DOI: 10.1186/1471-2474-5-25] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2004] [Accepted: 08/03/2004] [Indexed: 11/26/2022] Open
Abstract
Background Obstetric palsy is the injury of the brachial plexus during delivery. Although many infants with plexopathy recover with minor or no residual functional deficits, some children don't regain sufficient limb function because of functional limitations, bony deformities and joint contractures. Shoulder is the most frequently affected joint with internal rotation contracture causing limitation of abduction, external rotation. The treatment comprises muscle release procedures such as posterior subscapularis sliding or anterior subscapularis tendon lengtening and muscle transfers to restore the missing external rotation and abduction function. Methods We evaluated whether the preoperative abduction degree affects functional outcome. Between 1998 and 2002, 46 children were operated on to restore shoulder abduction and external rotation. The average age at surgery was 7.6 years and average follow up was 40.8 months. We compared the postoperative results of the patients who had preoperative abduction less than 90° (Group I: n = 37) with the patients who had preoperative abduction greater than 90° (Group II: n = 9), in terms of abduction and external rotation function with angle measurements and Mallet classification. We inquired whether patients in Group I needed another muscle transfer along with latissimus dorsi and teres major transfers. Results In Group I the average abduction improved from 62.5° to 131.4° (a 68.9° ± 22.9°gain) and the average external rotation improved from 21.4° to 82.6° (a 61.1° ± 23°gain). In Group II the average abduction improved from 99.4°to 140°(a40.5° ± 16°gain) and the average external rotation improved from 33.2°to 82.7° (a 49.5° ± 23.9° gain). Although there was a significant difference between Group I and II for preoperative abduction (p = 0.000) and abduction gain in degrees (p = 0.001), the difference between postoperative values of both groups was not significant (p = 0.268). There was also no significant difference between the two groups in the preoperative external rotation, the external rotation gain and the postoperative external rotation (p = 0.163, p = 0.181 and p = 0.803, respectively). Conclusions Obstetric palsy patients with shoulder sequela who had a preoperative abduction less than 90°hadas good functional results using latissimus dorsi, teres major muscle transfer and subscapularis muscle release as the patients who hada preoperative abduction greater than 90°.
Collapse
Affiliation(s)
- Atakan Aydin
- Department of Plastic and Reconstructive Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Turker Ozkan
- Department of Plastic and Reconstructive Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Defne Onel
- Department of Plastic and Reconstructive Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|