Nerve Transfers for Adult Traumatic Brachial Plexus Palsy (Brachial Plexus Nerve Transfer)

Adult traumatic brachial plexus injuries can have devastating effects on upper extremity function. Although neurolysis, nerve repair, and nerve grafting have been used to treat injuries to the plexus, nerve transfer makes use of an undamaged nerve to supply motor input over a relatively short distance to reinnervate a denervated muscle. A review of several recent innovations in nerve transfer surgery for brachial plexus injuries is illustrated with surgical cases performed at this institution. Approval obtained from Hospital for Special Surgery Institutional Review Board Level IV: series with no or a historical control group.     

Secondary Procedures for Elbow Flexion Restoration in Late Obstetric Brachial Plexus Palsy

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.     

Combined Intrauterine Vascular Insufficiency and Brachial Plexus Palsy: A Case Report

A unique case of combined intrauterine vascular insufficiency and complete brachial plexus palsy is described in a newborn delivered by cesarean section. Intrauterine vascular insufficiency resulted in a right below elbow amputation at 3 weeks of age. Amputation length was preserved after a pedicled thoracoabdominal flap. Function of the C5, C6, and C7 nerve roots returned to normal by 3 months of age.     

26例臂丛神经鞘瘤的显微手术治疗

目的探讨臂丛神经鞘瘤显微手术的治疗要点。方法回顾性总结2000年1月～2009年10月我院收治的26例臂丛神经鞘瘤患者的临床资料,其中臂丛上干11例,中干10例,内侧束2例,外侧束1例,C5-71例,C6-71例,均实行显微镜下手术切除。结果 26例患者臂丛神经鞘瘤均完整切除,术后无臂丛神经受损表现。病理提示Antoni A型18例,Antoni B型8例。随访6个月到10年,无一例复发。结论臂丛神经鞘瘤的显微外科手术治疗应尽量避开神经纤维,保护好神经干,逐层剥离包膜,将瘤体完整切除,多能获得较满意的疗效。     

Upper Extremity Size Differences in Brachial Plexus Birth Palsy

The purpose of this investigation was to determine size differences between affected and unaffected upper extremities in patients with brachial plexus birth palsy (BPBP). Forty-eight patients with BPBP underwent measurements of the bilateral upper extremities. Average age at the time of evaluation was 47 months. In addition, patients or families were asked “How important is the difference in arm size and appearance to you?” Active motion was assessed using the modified Mallet classification, Toronto Test Score, and Hospital for Sick Children Active Movement Scale. Correlation between ratios of affected to unaffected limb lengths and girths and measures of active motion were assessed using Spearman’s rank correlation coefficient. Upper arm, forearm, and hand lengths of the affected limbs were, on average, 95%, 94%, and 97% of the contralateral unaffected side, respectively. Upper arm girth, forearm girth, and hand width were, on average, 97%, 98%, and 95% of the contralateral side, respectively. All differences achieved statistical significance (p < 0.01). Furthermore, over 37% of patients or families reported that limb differences were “very” or “extremely important” to them. No statistically significant correlation between age and limb length discrepancy was noted. Furthermore, there were no correlations between upper limb discrepancies and measures of active motion in individual patients. Patients with BPBP and persistent neurological deficits may expect the affected upper extremity to be on average approximately 95% the length and girth of the contralateral limb. These differences do not correlate with patient age or clinical measurements of active movement.