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Stein M, Ashley B, Falk D, Gittings D, Glaser D, Levin LS. Loss of Elbow Flexion in Congenital Arthrogryposis Treated with a Bipolar Latissimus Transfer: A Case Report. JBJS Case Connect 2020; 10:e1900296. [PMID: 32910616 DOI: 10.2106/jbjs.cc.19.00296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 20-year-old man with congenital arthrogryposis presented for evaluation of biceps dysfunction. Although his left elbow was supple with 0° to 110° passive range of motion (ROM), he had no active ROM and was unable to perform basic activities of daily living such as bringing his hand to his mouth to feed himself. A bipolar latissimus transfer was performed to achieve functional active ROM. CONCLUSION Bipolar latissimus transfer is a challenging, robust flap able to restore active elbow flexion in select groups of patients with biceps dysfunction, supple elbow, and functional latissimus dorsi.
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Affiliation(s)
- Matthew Stein
- 1Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Sochol KM, Edwards G, Stevanovic M. Restoration of Elbow Flexion With a Free Functional Gracilis Muscle Transfer in an Arthrogrypotic Patient Using a Motor Nerve to Pectoralis Major. Hand (N Y) 2020; 15:739-743. [PMID: 32507010 PMCID: PMC7543222 DOI: 10.1177/1558944720923412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Patients with arthrogryposis may exhibit inability to flex the elbow. A free functional gracilis muscle transfer (FFGMT) can be used to restore elbow flexion. In our search of the available literature, we have not seen any descriptions of using a motor branch to the pectoralis major as a donor nerve to establish elbow flexion. Methods: We performed an FFGMT for restoration of elbow flexion in an arthrogrypotic patient with no active elbow flexion, who had a Medical Research Council (MRC) muscle grade of 0. Results: We report our 4.5-year outcomes. After undergoing an FFGMT for elbow flexion, our patient was able to gain an MRC grade 4 and achieve an arc of motion of 25° to 140°. Conclusion: An FFGMT for elbow flexion may be performed successfully using a motor branch to the pectoralis major.
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Affiliation(s)
- Kristen M. Sochol
- University of Southern California, Los Angeles, USA,Kristen M. Sochol, Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA 90033, USA.
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James MA, Millar KL, Manske MC, Van Heest AE. Posterior Elbow Capsulotomy and Triceps Lengthening for Elbow Extension Contracture in Children with Arthrogryposis Multiplex Congenita. JBJS Essent Surg Tech 2020; 10:ST-D-19-00030. [PMID: 32368405 DOI: 10.2106/jbjs.st.19.00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Posterior elbow capsulotomy plus triceps lengthening facilitates passive elbow flexion in children with arthrogryposis multiplex congenita, allowing independent function for activities of daily living, such as feeding and self-care of the face and hair. Description The posterior aspect of the distal end of the humerus and the olecranon are identified by palpation and exposed via a curvilinear incision over the posterior aspect of the elbow. Identifying the osseous landmarks can be challenging in some patients. The ulnar nerve is identified and protected. The triceps tendon is isolated, and z-lengthening is performed. Next, the posterior elbow capsule is incised proximal to the tip of the olecranon to expose the joint surface, and the arthrotomy is continued incrementally along the medial and lateral capsule until elbow flexion increases by ≥40°, or past 90° (maximum, 120°), with contact between the lengthened ends of the triceps tendon for repair. The triceps tendon is then repaired in the elongated position. After the wound is closed, the elbow is placed in flexion and immobilized in a cast. Alternatives Alternative treatments include passive stretching exercises to increase elbow flexion. Rationale Elbow extension contractures result in substantial limitations in the activities of daily living for children with arthrogryposis multiplex congenita. Those who fail to attain at least 90° of elbow flexion with passive stretching in the first year of life benefit from posterior elbow release and triceps lengthening. In addition, children with <30° of passive elbow flexion are at risk of developing valgus instability of the elbow from passive flexion exercises because the axis of rotation of the elbow is difficult to detect. Once passive elbow flexion is attained, such children may be candidates for tendon transfers allowing active elbow flexion.
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Affiliation(s)
- Michelle A James
- Shriners Hospital for Children-Northern California, Sacramento, California.,University of California Davis School of Medicine, Sacramento, California
| | - Kelsey L Millar
- University of California Davis School of Medicine, Sacramento, California
| | - M Claire Manske
- Shriners Hospital for Children-Northern California, Sacramento, California.,University of California Davis School of Medicine, Sacramento, California
| | - Ann E Van Heest
- Shriners Hospital for Children-Twin Cities, Minneapolis, Minnesota.,Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
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Gagnon M, Caporuscio K, Veilleux LN, Hamdy R, Dahan-Oliel N. Muscle and joint function in children living with arthrogryposis multiplex congenita: A scoping review. Am J Med Genet C Semin Med Genet 2019; 181:410-426. [PMID: 31350946 DOI: 10.1002/ajmg.c.31726] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/10/2019] [Indexed: 11/05/2022]
Abstract
Arthrogryposis multiplex congenita (AMC) is characterized by congenital joint contractures present in two or more body areas. Lack of fetal movement is the underlying cause of AMC, which can lead to abnormal connective tissue surrounding the joint resulting in stiffness and muscle atrophy. Treatment aims at improving function and mobility through surgical and/or conservative interventions. A scoping review was conducted to explore the existing knowledge of the evaluation and treatment of muscle and joint function in children with AMC. Three search engines were included and identified 1,271 articles. Eighty-seven studies met the selection criteria and were included in this review. All included studies focused on joints, 30 of which also assessed the muscle. Assessment most often included the position of the contractures (n = 72), as well as range of motion (n = 66). Interventions to improve muscle and joint function were reported in 82 of the 87 papers and included surgery (n = 70) and conservative interventions (n = 74) with bony surgery (i.e., osteotomy) the most common surgery and rehabilitation the most common conservative intervention. Recurrences of contractures were mentioned in 46 of the 68 studies providing a follow-up. Future studies should use validated measures to assess muscle and joint function, and conservative interventions should be described in greater detail and to include a longer follow-up.
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Affiliation(s)
- Marianne Gagnon
- Shriners Hospital for Children-Canada, Montreal, Québec, Canada.,Department of Surgery, Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | - Kevin Caporuscio
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | - Louis-Nicolas Veilleux
- Shriners Hospital for Children-Canada, Montreal, Québec, Canada.,Department of Surgery, Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | - Reggie Hamdy
- Shriners Hospital for Children-Canada, Montreal, Québec, Canada.,Department of Surgery, Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | - Noémi Dahan-Oliel
- Shriners Hospital for Children-Canada, Montreal, Québec, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Québec, Canada
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Cambon-Binder A, Walch A, Marcheix PS, Belkheyar Z. Bipolar transfer of the pectoralis major muscle for restoration of elbow flexion in 29 cases. J Shoulder Elbow Surg 2018; 27:e330-e336. [PMID: 30195620 DOI: 10.1016/j.jse.2018.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 06/18/2018] [Accepted: 06/23/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study evaluated the functional outcomes of bipolar pedicled pectoralis major (PM) transfer to restore elbow flexion. METHODS We retrospectively reviewed 29 transfers in 28 patients with a mean age of 31.2 years (range, 5-65 years). The loss of elbow flexion was due to brachial plexus palsy in 24 patients, elbow flexors necrosis in 4, and poliomyelitis in 1. The entire PM muscle was mobilized and fixed proximally to the coracoid process. Intraoperative positioning and postoperative immobilization of the shoulder and the elbow flexed at 60° and 120°, respectively, allowed direct distal fixation of the muscle to the biceps brachii tendon. RESULTS At the last follow-up (mean, 13 months; range, 4-37 months), 41% of the transfers (n = 12) recovered grade 4 elbow flexion strength and were able to lift 2.2 kg on average (range, 0.5-5 kg), 52% (n = 15) recovered grade 3 strength, and 7% (n = 2) had a poor result (ie, grade 2 elbow flexion). The mean active elbow flexion was 100° (ranging, 30°-150°), and the patients had 0° to 10° elbow flexion contracture. CONCLUSIONS Our results indicate that bipolar PM transfer is a reliable and effective procedure to restore elbow flexion. Flexion of the shoulder and elbow allowed the transfer to reach the elbow fold and avoided an interposition graft between the distal PM and the biceps brachii tendon.
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Affiliation(s)
- Adeline Cambon-Binder
- Department of Orthopaedic and Hand Surgery, Saint-Antoine Hospital, Sorbonne Université, Paris, France.
| | - Arnaud Walch
- Hand and Upper Limb Surgery Department, Edouard Herriot Hospital, Lyon, France
| | - Pierre-Sylvain Marcheix
- Orthopaedic and Trauma Department, Centre Hospitalier Universitaire Dupuytren, Limoges, France
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Jensen EF, Raunsbæk J, Lund JN, Rahman T, Rasmussen J, Castro MN. Development and simulation of a passive upper extremity orthosis for amyoplasia. J Rehabil Assist Technol Eng 2018; 5:2055668318761525. [PMID: 31191928 PMCID: PMC6453054 DOI: 10.1177/2055668318761525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/30/2018] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION People who are born with arthrogryposis multiplex congenita are typically not able to perform activities of daily living (ADL) due to decreased muscle mass, joint contractures and unnatural upper extremity positioning. They are, therefore, potential users of an assistive device capable of aiding in ADL and increasing their independence. A passive orthosis can support the weight of their arm against gravity, allowing them to perform movements with less effort. METHODS This study presents a prototype design with four degrees-of-freedom that uses musculoskeletal modelling to optimize the stiffness of the springs in the device to partially gravity balance the upper extremity while compensating for the usual internally rotated glenohumeral joint. A single subject-specific musculoskeletal model was developed to simulate the effects of the passive orthosis during 10 static postures during ADL. RESULTS For a given configuration using a mono- and a bi-articular spring, the simulations showed that spring stiffnesses of 400 Nm-1 and of 1029 Nm-1, respectively, were able to lower the maximal muscle activity estimated by the musculoskeletal model to a level in which the 10 postures can be realized. CONCLUSION By augmenting residual muscle strength with a partially gravity-balanced passive orthosis, ADLs may be achievable for people with arthrogryposis multiplex congenita.
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Affiliation(s)
- Erik F Jensen
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
| | - Joakim Raunsbæk
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
| | - Jan N Lund
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
| | - Tariq Rahman
- Department of Biomedical Research,
Nemours/Alfred I DuPont Hospital for Children, Wilmington, DE, USA
| | - John Rasmussen
- Department of Materials and Production,
Aalborg University, Aalborg, Denmark
| | - Miguel N Castro
- Department of Materials and Production,
Aalborg University, Aalborg, Denmark
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Wall LB, Calhoun V, Roberts S, Goldfarb CA. Distal Humerus External Rotation Osteotomy for Hand Position in Arthrogryposis. J Hand Surg Am 2017; 42:473.e1-7. [PMID: 28389082 DOI: 10.1016/j.jhsa.2017.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/13/2017] [Accepted: 03/01/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE In the amyoplasia type of arthrogryposis, a reverse pronated grasp pattern is often seen. We hypothesized that repositioning the hands, through distal humerus external rotation osteotomies (DHO), would allow for palm-to-palm grasp without arm cross-over and would improve function and parent/patient satisfaction. METHODS The medical records of all patients treated surgically for arthrogryposis were reviewed at the Shriners Hospital for Children, St. Louis, MO. From 2012 to 2014, 9 patients (14 extremities) had undergone a DHO. All patients had preoperative and postoperative video recordings of functional activities and we assessed functional changes after osteotomies. Preoperative upper extremity position was graded as 1, palms facing midline; 2, palm facing posterior; and 3, palms facing away from midline. Postoperative Pediatric Outcomes Data Collection Instrument (PODCI) questionnaires were obtained and parent satisfaction was evaluated. RESULTS Mean patient age at the time of surgery was 6.5 years. Five patients underwent bilateral DHOs. All patients had 3 or fewer additional procedures on an upper extremity during the study period. All patients had an improved resting posture of the upper extremity after DHO surgery, with a mean change of 51° (range, 15°-90°). Grasp pattern was altered in 13 extremities; there was a change in hand position of at least 1 grade and 5 had complete change from 3 to 1, palms facing away from midline to facing toward midline. There was a wide range in postoperative PODCI scores for function, but Happiness scores were high, mean 89 (range, 60-100). Parents universally stated the procedure improved the child's function "a great deal." There were 2 complications: 1 periprosthetic humerus facture with recurrence of the internal rotation and 1 patient with scarring of the triceps requiring tenolysis. CONCLUSIONS The DHO is an effective procedure for correcting the internal rotation position of the upper extremity in arthrogryposis and the surgery improves hand opposition with minimal complications. Universally, there was perceived improved function with high postoperative PODCI Happiness scores. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Gunn M, Shank TM, Eppes M, Hossain J, Rahman T. User Evaluation of a Dynamic Arm Orthosis for People With Neuromuscular Disorders. IEEE Trans Neural Syst Rehabil Eng 2015; 24:1277-1283. [PMID: 28055882 DOI: 10.1109/tnsre.2015.2492860] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper presents the results of an online survey conducted with users of a functional upper extremity orthosis called the Wilmington Robotic EXoskeleton (WREX). The WREX is a passive anti-gravity arm orthosis that allows people with neuromuscular disabilities to move their arms in three dimensions. The paper also describes the design of a novel lightweight 3-D printed WREX used for ambulatory children. Three different versions of the WREX are now offered to patients. Two can be mounted on a wheelchair and one to a body jacket for ambulatory patients. An online user survey with 55 patients was conducted to determine the benefits of the various WREXs. The survey asked ten questions related to upper extremity function with and without the WREX as well as subjective impressions of the device. Results show a statistically significant improvement in arm function for everyday tasks with the WREX.
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Werthel JD, Zargarbashi R, Valenti P. Radial clubhand with congenital absence of elbow flexors treated by pedicled latissimus dorsi bipolar transfer: report of one case. J Shoulder Elbow Surg 2015; 24:e164-8. [PMID: 25861854 DOI: 10.1016/j.jse.2015.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 01/25/2015] [Accepted: 01/31/2015] [Indexed: 02/01/2023]
Affiliation(s)
- Jean-David Werthel
- Pediatric Orthopedics Division, Chaine de l'Espoir, Paris, France; Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, Paris, France.
| | - Ramin Zargarbashi
- Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Philippe Valenti
- Pediatric Orthopedics Division, Chaine de l'Espoir, Paris, France; Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, Paris, France; Institut de la Main, Centre Orthopédique Jouvenet, Paris, France
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Chomiak J, Dungl P, Včelák J. Reconstruction of elbow flexion in arthrogryposis multiplex congenita type I: results of transfer of pectoralis major muscle with follow-up at skeletal maturity. J Pediatr Orthop 2014; 34:799-807. [PMID: 25387155 DOI: 10.1097/BPO.0000000000000204] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to analyze the results of a pectoralis major transfer to restore active elbow flexion in patients with extension elbow contracture in arthrogryposis. The hypotheses were: (1) this transfer ensures permanent useful elbow flexion; and (2) flexion elbow deformity will not progress during growth and after its cessation. METHODS Unipolar transfer of the 3 distal parts of the pectoralis major muscle was used in 9 extremities of 5 patients (age range, 5 to 9 y; average age, 6.3 y) and the results were prospectively followed in the period of 13 to 16 years. Posterior elbow release was necessary in 5 extremities to achieve passive flexion of 90 degrees before the transfer. The subjective evaluation of daily living activities and data on the physical examination of the range of movement of the elbow, muscle strength, and electrical activity of the transferred muscle were assessed. Two specimens from transferred muscles were histologically examined. RESULTS All extremities achieved the active elbow flexion. Significant improvement of function for daily living activities was achieved in 5 extremities (55.5%). It includes the following results: 1 very good with flexion of 90 degrees and a deficit of extension of 35 degrees; 2 good with flexion of 92 and 100 degrees and a lack of extension of 42 and 45 degrees; and 2 satisfactory with a limited arc of motion between 20 and 45 degrees. Four extremities remained unsatisfactory with the arc of motion of 5 to 15 degrees. Significant elbow flexion contracture of 70 to 80 degrees developed in 4 extremities. Extremities with a necessity of posterior elbow release achieved a limited range of movement or significant elbow flexion contracture. Electromyography corresponded to a partial denervation of the transferred muscle followed by reinervation. Histologic examinations showed partial atrophy with signs of ongoing regeneration. CONCLUSIONS The hypotheses of the study were not confirmed, because this muscle transfer restores useful elbow flexion without flexion deformity if the passive flexion at children's age exceeds 90 degrees without a necessity of posterior release. In these cases, bilateral pectoralis to biceps transfer is recommended. LEVEL OF EVIDENCE Level II.
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Bisneto ENF. Congenital Deformities of the Upper Limbs. Part III: Overgrowth; Undergrowth; Streeter and Others. Rev Bras Ortop 2013; 48:121-125. [PMID: 31211116 PMCID: PMC6565855 DOI: 10.1016/j.rboe.2012.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 02/10/2012] [Indexed: 11/01/2022] Open
Abstract
This article, presented in three sections, review the most commons upper limb malformations and theirs treatments. In this section three there's a discussion about overgrowth; undergrowth; Streeter Syndrome and other malformations. The bibliography is continuous since section one.
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Affiliation(s)
- Edgard Novaes França Bisneto
- Attending Physician in the Hand Group, Institute of Orthopedics and Traumatology, Hospital das Clinicas, School of Medicine, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Bisneto ENF. Deformidades congênitas dos membros superiores. Parte III: hipercrescimento; hipocrescimento; Streeter e outras. Rev Bras Ortop 2013. [DOI: 10.1016/j.rbo.2012.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Abstract
Children with arthrogryposis often lack the ability to feed themselves, largely due to limited shoulder external rotation and elbow flexion. Patients who can achieve passive elbow flexion through a surgical release but who cannot externally rotate their shoulders are still unable to reach their mouths with their hands. Combining a posterior elbow capsular release with a simultaneous humeral osteotomy in these patients places the forearm and hand in a much better position for function with minimal additional surgical exposure.
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Affiliation(s)
- Dan A Zlotolow
- Temple University School of Medicine, Shriners Hospital for Children, Philadelphia, PA, USA.
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Abstract
Even though total absence of elbow flexion in obstetric brachial plexus palsy (OBPP) is rare, weakness is a frequent problem. Numerous procedures for elbow flexion restoration in late obstetric brachial plexus palsy have been described. In this study, children with OBPP who underwent secondary reconstruction for elbow flexion restoration were studied. A retrospective review of 15 patients (16 elbows) who underwent 16 pedicled and eight free-muscle transfers for elbow flexion restoration was conducted. The mean follow-up period was 8.4 ± 2.9 years (range, 25 months to 12.2 years). The mean age at operation (elbow surgery) was 5.4 ± 1.9 years. The total arc of elbow motion was the result of the active elbow flexion less the flexion contracture. There was significant improvement in biceps muscle power from an average grading of 2.49 ± 0.80 preoperatively to 3.64 ± 0.46 postoperatively (p < 0.001). Thirteen of 16 elbows (81%) achieved good and excellent results (≥M3+); and three elbows (19%) fair results (M3- or M3). The average arc of motion was significantly improved from 36° ± 25° preoperatively to 94° ± 26° postoperatively (p < 0.001). The preoperative and postoperative average elbow flexion contracture was 10.9° ± 8.9° and 20° ± 12.2°, respectively. Pedicled and/or free-muscle transfers can significantly improve elbow flexion in late obstetric brachial plexus palsy. Choice of the procedure should be individualized and determined on the basis of the type of paralysis, availability of donor muscles, previous reconstruction, and experience of the surgeon.
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Affiliation(s)
- Julia K. Terzis
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School (EVMS), 700 Olney Road, LH 2055, Norfolk, VA 23501 USA
| | - Zinon T. Kokkalis
- Microsurgery Program, Department of Surgery, Eastern Virginia Medical School, Norfolk, VA USA
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Gogola GR, Ezaki M, Oishi SN, Gharbaoui I, Bennett JB. Long head of the triceps muscle transfer for active elbow flexion in arthrogryposis. Tech Hand Up Extrem Surg 2010; 14:121-124. [PMID: 20526167 DOI: 10.1097/bth.0b013e3181da07aa] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Arthrogryposis is a condition characterized by symmetric, nonprogressive joint contractures and weak or absent musculature that is present at birth. The amyoplasia form is the most common, and in this group, the elbow is frequently involved, typically in an extension contracture bilaterally. Active elbow flexion is weak or absent, but active extension is spared. This elbow dysfunction poses a significant disability for affected children. Sensation and cognitive development is normal in children with arthrogryposis, and as a group they demonstrate a remarkable degree of adaptability to their deformities. The goal of any treatment is to facilitate the child's functional independence. This article describes the surgical technique of transfer of the long head of the triceps into the proximal ulna to provide active elbow flexion in children with arthrogryposis. The goal of the procedure is to reliably achieve antigravity active flexion while preserving active extension. It has the advantages of technical simplicity and minimal donor site morbidity. By adding this procedure to the existing options for treating this challenging condition, a surgeon is better able to tailor intervention to an individual child's strength and available donor muscles.
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Affiliation(s)
- Gloria R Gogola
- Shriners Hospitals for Children-Houston, Houston, TX 77030, USA.
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Affiliation(s)
- Michael Bamshad
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle Children's Hospital, 1959 Northeast Pacific Street, HSC RR349, M/S Box 356320, Seattle, WA 98195. E-mail address:
| | - Ann E. Van Heest
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue, Suite R200, Minneapolis, MN 55454
| | - David Pleasure
- Departments of Neurology and Pediatrics, UC Davis School of Medicine, c/o Shriners Hospital, 2425 Stockton Boulevard, Sacramento, CA 95817
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Martin G, Perrot P, Duteille F. Traitement d’un déficit congénital bilatéral de flexion du coude chez un enfant classé arthrogrypose. ACTA ACUST UNITED AC 2009; 28:116-9. [DOI: 10.1016/j.main.2008.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 11/14/2008] [Accepted: 12/07/2008] [Indexed: 11/29/2022]
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Chomiak J, Dungl P. Reconstruction of elbow flexion in arthrogryposis multiplex congenita type I. Part I: surgical anatomy and vascular and nerve supply of the pectoralis major muscle as a basis for muscle transfer. J Child Orthop 2008; 2:357-64. [PMID: 19308568 DOI: 10.1007/s11832-008-0130-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 08/18/2008] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The anatomy and neurovascular supply of the pectoralis major muscle was studied in order to establish the safe and functional muscle transfer for the reconstruction of elbow flexion in patients with arthrogryposis multiplex congenita (AMC). METHODS Twenty pectoralis major muscles were dissected in 11 adult cadavers. The distribution of the motor end plates was studied in five pectoralis major muscles in foetuses by the detection of esterases. RESULTS The pectoralis major muscle consists of clavicular, manubrial, sternocostal, costal and abdominal parts. Each part has a distinct vascular and nerve supply. The motor nerves arise from the medial and lateral pectoral nerves. The motor end plates are localised in one zone in the clavicular and manubrial parts and in two oblique zones in the distal parts of the muscle. In 15 cases, each of the muscle parts were supplied by one nerve branch. In four cases, six nerves were distinguished and the clavicular part was supplied by two nerves. In one case, four nerves were found, with the clavicular and manubrial parts supplied by one common nerve. Three branches (13 cases) or two arterial branches (seven cases) supplied the muscle, arising from thoracoacromial and lateral thoracic arteries, respectively. The superior branch supplied the clavicular and manubrial parts, whereas the dominant pectoral branch supplied the manubrial, sternocostal and costal parts of the muscle. The inferior branch of the lateral thoracic artery supplied the abdominal part in 13 cases. In seven cases, the inferior branch failed and the abdominal part was supplied from the dominant branch. CONCLUSION This study presents guidelines for the transfer of the distal parts of the pectoralis major muscle for the reconstruction of elbow flexion. The sternocostal, costal and abdominal parts of the muscle can be released as a unit from the chest wall after dissection between the second and third rib and be transferred to the brachium. They are sufficiently supplied from the dominant pectoral branch of the thoracoacromial artery in all cases and inconstantly from the inferior branch of the lateral thoracic artery and from three motor nerves.
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Abstract
Flail elbow is a relatively uncommon cause of elbow dysfunction. It is defined as the inability to position the arm in space for useful elbow function because of structural or neurologic inadequacies. Patient function is often severely compromised and treatment options are limited with moderate levels of success depending on etiology. This article reviews the various etiologies of dysfunctional elbow instability, their treatment options, and their expected outcomes.
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Affiliation(s)
- Robert Z Tashjian
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT 84108, USA.
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