Surgical treatment of brachial plexus posterior cord lesion: A combination of nerve and tendon transfers,about nine patients |
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| Affiliation: | 1. Service d’orthopédie et traumatologie, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France;2. Clinique Paris Montmartre, 197, rue Marcadet, 75018 Paris, France;1. Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008 Hunan, People''s Republic of China;2. State Key Laboratory of Medical Genetics, Changsha, 410008 Hunan, People''s Republic of China;3. Neurodegenerative Disorders Research Center, Central South University, Changsha, 410008 Hunan, People''s Republic of China;2. Sports and Shoulder Service, Hospital for Special Surgery, Department of Orthopedic urgery, Weill Medical College of Cornell University, New York, NY;1. Division of Vascular Surgery, First Department of Surgery, Laiko General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece;2. Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuernberg, Germany;3. Department of Radiology, “Areteion” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece;1. Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India;2. Department of Neurosurgery, Lilavati Hospital and Research Centre, Bandra (E), Mumbai, India;3. Department of Neurosurgery, Lilavati Hospital and Research Centre, Bandra (E), Mumbai, India |
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| Abstract: | Lesions of the posterior cord of the brachial plexus are rare. The symptoms are usually described as palsy of the deltoid and triceps brachii muscles and of the extensor muscles of the wrist, thumb and fingers. If there is no recovery, our strategy is to operate on these patients 6 months after the injury using a combination of nerve and tendon transfers. We present a series of nine patients, two with a partial palsy and seven with a complete palsy of the posterior cord. We performed five nerve transfers to the axillary nerve, four using intercostal nerves and one using the ulnar nerve. Six patients benefited from a transfer to one of the nerves to the triceps brachii (medial or lateral head), five using the ulnar nerve and one using two intercostal nerves. We performed eight tendon transfers for radial palsy. The results demonstrated significant restoration of the deltoid muscle (grade 4 strength, mean active abduction of 120°). Active elbow extension was restored in all patients with an average strength measured at 5.6 kg and 48% of the contralateral strength. All tendon transfers were successful with recovery of active wrist extension (40°), long fingers extension and thumb abduction and extension (12.5 cm between the tips of index and thumb). With this method, we were able to restore function to the upper limb of patients who presented with debilitating palsy of the posterior cord of the brachial plexus. |
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| Keywords: | Plexus brachial posterior cord Tendon transfer Nerve transfer Faisceau postérieur du plexus brachial Transferts tendineux Transferts nerveux |
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