Search Results: 1 - 10 of 100 matches for " "
All listed articles are free for downloading (OA Articles)
Page 1 /100
Display every page Item
Incidence of early posterior shoulder dislocation in brachial plexus birth palsy
Lars B Dahlin, Kristina Erichs, Charlotte Andersson, Catharina Thornqvist, Clas Backman, Henrik Düppe, Pelle Lindqvist, Marianne Forslund
Journal of Brachial Plexus and Peripheral Nerve Injury , 2007, DOI: 10.1186/1749-7221-2-24
Abstract: The incidence of brachial plexus birth lesion and occurrence of posterior shoulder dislocation was calculated based on a prospective follow up of all brachial plexus patients at an age below one in Malm? municipality, Sweden, 2000–2005.The incidence of brachial plexus birth palsy was 3.8/1000 living infants and year with a corresponding incidence of posterior shoulder dislocation (history, clinical examination and x-ray) during the first year of 0.28/1000 living infants and year, i.e. 7.3% of all brachial plexus birth palsies.All children with a brachial plexus birth lesion (incidence 3.8‰) should be screened, above the assessment of neurological recovery, during the first year of life for posterior dislocation of the shoulder (incidence 0.28‰) since such a condition may occur in 7% of children with a brachial plexus birth lesion.Brachial plexus birth lesions occur with an incidence of around 2.3–3.3/1000 live births per year [1,2]. Spontaneous recovery is common but as many as 25% of teenagers with a brachial plexus birth lesion may have secondary complications, which are mostly located in the shoulder region with the deformity, medial rotation contracture and problems with activity of daily living (ADL; [3]). An untreated medial rotation contracture may lead to posterior subluxation or dislocation since the natural history of untreated brachial plexus birth palsy with residual weakness is progressive glenohumeral deformity due to persistent muscle imbalance. Progressive deformity has also been found with increasing age [4]. Posterior shoulder dislocation can occur even before the age of one, but the etiology of such an early lesion, which include particularly birth trauma, use of splint devices or muscle imbalance, is still not clarified [5-9]. Recently, the frequency of the condition was reported in consecutive cases with brachial plexus birth palsy below the age of one [5,6]. As many as 8 (11/134) to 10% of the children may have a posterior shoulder dislocation
Muscles Transfer around the Shoulder in Cases of Brachial Plexus Birth Palsy  [PDF]
Hesham El Sobkey
Open Journal of Modern Neurosurgery (OJMN) , 2019, DOI: 10.4236/ojmn.2019.93026
Abstract: Background:Disabling internal rotation contractures are frequently experienced in children with unresolved birth brachial plexus palsies. Multiple surgical options like muscle release, tendon transfer, or humeral osteotomy are available to treat such cases. Purpose:Evaluation of the outcome of subscapularis release and latissimus dorsi and teres major tendon transfer in the management of obstetric brachial palsies in Mansoura University neurosurgical department. Study type: Retrospective observational study. Patients and Methods: Twenty-five cases who underwent subscapularis release and latissimus dorsi and teres major transfer were included in the study. All patients were subjected to complete history taking, through clinical examination. The degree of shoulder movement and disability was assessed via Modified Gilbert shoulder evaluation scale. Results: The least follow up period for our patients was 9 months. There was a clear improvement of shoulder function evaluated using Modified Gilbert shoulder evaluation scale as there were 73% of postoperative group between GIV and GV while about 84% of preoperative group were between GII and GIII. Conclusion: Tendon transfer is a valid easy procedure for correction of shoulder deformities in patients with obstetrical brachial plexus palsy. It is considered a very good option for patients who missed the chance of microsurgical repair or patients with poor shoulder recovery after surgery. Although some authors reported deterioration of shoulder function with log time follow up after tendon transfer, it is still better than those who were not operated.
Muscular and glenohumeral changes in the shoulder after brachial plexus birth palsy: an MRI study in a rat model  [cached]
Soldado Francisco,Benito-Castillo David,Fontecha Cesar G,Barber Ignasi
Journal of Brachial Plexus and Peripheral Nerve Injury , 2012, DOI: 10.1186/1749-7221-7-9
Abstract: Background Shoulder abnormalities are the major cause of morbidity in upper brachial plexus birth palsy (BPBP). We developed a rat model of upper trunk BPBP and compared our findings to previously reported animal models and to clinical findings in humans. Methods Forty-three 5-day-old newborn rats underwent selective upper trunk neurectomy of the right brachial plexus and were studied 3 to 20 weeks after surgery. The passive shoulder external rotation was measured and the shoulder joint was assessed bilaterally by a 7.2T MRI bilaterally. Results We found a marked decrease in passive shoulder external rotation, associated with a severe subscapularis muscle atrophy and contracture. None however developed the typical pattern of glenohumeral dysplasia. Conclusions In contradiction with previous reports, our study shows that the rat model is not adequate for preclinical studies of shoulder dysplasia. However, it might serve as a useful model for studies analyzing shoulder contracture occurring after upper BPBP.
Risk Factors at Birth for Permanent Obstetric Brachial Plexus Injury and Associated Osseous Deformities  [PDF]
Rahul K. Nath,Nirupama Kumar,Meera B. Avila,Devin K. Nath,Sonya E. Melcher,Mitchell G. Eichhorn,Chandra Somasundaram
ISRN Pediatrics , 2012, DOI: 10.5402/2012/307039
Abstract: Purpose. To examine the most prevalent risk factors found in patients with permanent obstetric brachial plexus injury (OBPI) to identify better predictors of injury. Methods. A population-based study was performed on 241 OBPI patients who underwent surgical treatment at the Texas Nerve and Paralysis Institute. Results. Shoulder dystocia (97%) was the most prevalent risk factor. We found that 80% of the patients in this study were not macrosomic, and 43% weighed less than 4000?g at birth. The rate of instrument use was 41% , which is 4-fold higher than the 10% predicted for all vaginal deliveries in the United States. Posterior subluxation and glenoid version measurements in children with no finger movement at birth indicated a less severe shoulder deformity in comparison with those with finger movement. Conclusions. The average birth weight in this study was indistinguishable from the average birth weight reported for all brachial plexus injuries. Higher birth weight does not, therefore, affect the prognosis of brachial plexus injury. We found forceps/vacuum delivery to be an independent risk factor for OBPI, regardless of birth weight. Permanently injured patients with finger movement at birth develop more severe bony deformities of the shoulder than patients without finger movement. 1. Introduction The incidence of obstetric brachial plexus injury (OBPI) is about 1.51 [1] per 1000 live births in the United States and reports vary from 0.38 [2] to 5.8 [3] per 1000 live births. Many of these injuries are transient; however, most of the OBPI patients never recover full function and develop permanent injuries [2, 4, 5]. In reports conducted by pediatricians and specialists, with follow-up times greater than 3 years, the reported proportion of injuries that remain permanent varies from 50 to 90% [6–8]. Risk factors for injury include shoulder dystocia, macrosomia (defined as birth weight greater than 4500?g [9–12]) instrument-assisted delivery, and downward traction of the fetal head [1, 7, 8]. Yet in a database search of over 11 million births, it was found that most children with neonatal brachial plexus palsy did not have known risk factors [1]. In obstetrics, presentation of shoulder dystocia is often emergent because the reported risk factors for its occurrence are not good predictors of it [13, 14]. Therefore we seek to examine the most prevalent risk factors found in a population of patients with permanent OBPI that necessitated surgical treatment to attempt to identify better predictors of injury and to elucidate the pathophysiology of OBPI.
Bilateral Obstetric Palsy of Brachial Plexus  [cached]
?zlem Alt?nda?,Sava? Gürsoy,Ahmet Mete
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2009,
Abstract: Obstetric Brachial Plexus Palsy (OBPP) is one of the devastating complications of difficult or assisted deliveries. Brachial plexus palsy with upper root involvement most commonly affects the external rotators and abductors. Twenty percent of obstetrical brachial plexus palsies are bilateral and they represent a more severe condition. An eight-year-old girl patient with bilateral brachial plexus palsy was described and discussed in this report. Turk J Phys Med Rehab 2009;55:126-7.
Obstetrical Brachial Plexus Palsy: Electrodiagnostical Study and Functional Outcome  [PDF]
V. Toupchizadeh,Y. Abdavi,M. Barzegar,B. Eftekharsadat
Pakistan Journal of Biological Sciences , 2010,
Abstract: Obstetrical Brachial Plexus Palsy (OBPP) is a complication of difficult delivery and resulted from excessive traction on the brachial plexus during delivery. Erb palsy, klumpke paralysis and panplexus palsy reported in 46, 0.6 and 20% of patients, respectively. Unilateral injury is more common than bilateral injury. Risk factors include macrosomia, multiparity, prior delivery of a child with OBPP, breech delivery shoulder dystocia, vacium and forceps assisted delivery and excessive maternal weight gain. The recovery rate is usually reported to be between 80 and 90%. We evaluated 42 children with OBPP. Out of them, we could follow only 28 cases during two years. Poor to moderate recovery occurred in 13 cases. Good to complete (expected) recovery occurred in 15 cases. Most of the patients were females. Right side palsy was more prevalent than left side palsy. Vaginal delivery without forceps was the most mode of delivery. Vertex was the most common presentation. Most of the patients were term. The mean weight of the birth was 3.8 kg. Erb palsy and pan-plexus palsy consisted of 71.4 and 28.6% of lesions. In patients with Erb palsy, there were preganglionic palsy in 3 (15.8%) and postganglionic palsy in 16 (84.2%) cases, while all the patients with panplexus palsy had postganglionic palsy. All patients with complete recovery (9 of 15) had Erb palsy and postganglionic lesion. Erb palsy was present in 71.4% and panplexus palsy was present in 28.6% of cases. Also, 23.8% of cases had preganglionic and 76.2% of cases had postganglionic injures.
Farah Ashrafzadeh MD,Hasan Boskabadi MD,Mohammad Faraji Rad MD,Parisa Seyyed Hosseinee
Iranian Journal of Child Neurology , 2010,
Abstract: ObjectiveConsiderable medical and legal debates have surrounded the prognosis and outcome of obstetrical brachial plexus injuries and obstetricians are oftenconsidered responsible for the injury. In this study, we assessed the factors related to the outcome of brachial plexus palsy.Material & MethodsDuring 24 months, 21 neonates with obstetrical brachial plexus injuries were enrolled.Electrophysiology studies were done at the age of three weeks. They received physiotherapy and occupational therapy. They were examined every 3 monthsfor one year and limbs function was assessed according to Mallet scores; also, maternal and neonatal factors were collected by a questionnaire.Results There were 10 boys and 11 girls.Of all, 76.2% had Erb's palsy, 19% had total brachial palsy and 4.8% hadklumpke paralysis.Risk factors including primiparity, high birth weight, shoulder dystocia, andprolonged second stage of labor were assessed.Electrophysiology studies showed neuropraxia in 52.4% and axonal injuries in42.9% of the patients.At the end of the first year, 81% of the patients had functioned recovery aroundgrade III or IV of Mallet scores.There were only significant relationships between functional improvement andneurophysiologic findings.ConclusionOutcome of obstetrical brachial injuries has a close relationship toneurophysiologic study results than other risk factors.
Delivery factors for brachial plexus palsy by newborns  [PDF]
I. Hudi?,Z. Fatu?i?,O. Sinanovi?,F. Skoki?
Medicinski Glasnik , 2007,
Abstract: Brachial plexus injuries represent a low percentage of delivery complications. Most newborns fully recover from the injury, very few retain a permanent neurological deficit whereas some remain unnoticed. An objective of this study was to establish delivery factors for brachial plexus palsy at the Clinic for Gynecology and Obstetrics and relation between the deficits with length of delivery, the length of delivery periods, induction of delivery and surgical interventions at delivery. The analysed group involved 90 newborn babies with an injury of brachial plexus made at the delivery in the period between 01.01.1996 and 31.12.2005. The controlled group included 90 newborns randomly selected. The comparison was made using an χ2 test. The incidence of injuries of plexus brachialis was 1.72 per 1,000 newborns. Analysing the length of delivery there was no difference found between the analysed and controlled group (p > 0.05). In the group of newborns with the injury of brachial plexus it was found that the second delivery period was significantly shorter (p < 0.01). In the analysed group 89 (98.8%) newborn babies were delivered vaginally and one (1.2%) was delivered by the cesarean section. 13 newborns (14.4%) from the analysed group were delivered with application of vacuum extractor and in the controlled group it was the case with one (1.2%) newborn baby (p < 0.01). The delivery of 98.8% newborns from the analysed group started spontaneously and two deliveries (1.2%) were induced. Risk factors for injuries of plexus brachialis in newborns at the Clinic for Gynaecology and Obstetrics of the University Clinical Centre Tuzla include shortened second delivery period and completion of deliveries applying the vacuum extractor.
Free functional gracilis muscle transfer in children with severe sequelae from obstetric brachial plexus palsy
J?rg Bahm, Claudia Ocampo-Pavez
Journal of Brachial Plexus and Peripheral Nerve Injury , 2008, DOI: 10.1186/1749-7221-3-23
Abstract: We describe our indications for this complex microsurgical procedure, the surgical technique and the outcome.Obstetric brachial plexus palsy may result in a severe impairment of upper limb function. Early microsurgical reconstruction is proposed in upper and total palsies with insufficient functional recovery [1]. Nevertheless, major motor functions may not recover, both in operated or not operated children.Free functional muscle transfer has been developed in the last 30 years to replace major muscle function, especially in the face and the upper limb [2,3]. Volkmann's ischemic contracture, tumor resection, and extensive palsy are possible indications.An isolated motor deficit in a major upper limb function in children suffering from obstetric brachial plexus palsy might be corrected by means of a free muscle transfer, using the gracilis muscle. Finger and elbow flexion are obvious primary goals. These were also the indications where we decided to apply this technique.We present our strategy, indications, operative technique and results.We also report the advantages of this microsurgical procedure, but also technical drawbacks and reasonable limits of indication.The experimental background was set in 1970 when Tamai [4] reported the first successful transplantation of a rectus femoris muscle to the forelimb of a dog, using microneurovascular techniques.The first clinical case was published 3 years later, when Chinese surgeons [5] transplanted part of a pectoralis major muscle to improve the hand function of a patient with Volkmann's ischemic contracture.Harii [6] started to use the technique for a paralyzed face, Manktelow [7] applied it to the forearm region, Zuker [8] for children.In the field of brachial plexus reconstruction, Doi [9] presented a new approach using two free gracilis muscle transfers to reconstruct major upper limb motors, and an extensive and impressive clinical series in children was recently published by Chuang [10].Our clinical series include
Nerve reconstruction: A cohort study of 93 cases of global brachial plexus palsy  [cached]
Bhatia Anil,Shyam Ashok,Doshi Piyush,Shah Vitrag
Indian Journal of Orthopaedics , 2011,
Abstract: Introduction: Brachial plexus injury leading to flail upper limb is one of the most disabling injuries. Neglect of the injury and delay in surgeries may preclude reinnervation of the paralysed muscles. Currently for such injuries nerve transfers are the preferred procedures. We here present a series of 93 cases of global brachial plexus palsy treated with nerve transfers. Materials and Methods: Ninety-three cases of global palsies out of 384 cases of brachial plexus injury operated by the senior surgeon (AB) were selected. Age varied from 4 to 51 years with 63 patients in 20 to 40 age group and all patients having a minimum follow up of at least 1 year post surgery ranging up to 130 months. The delay before surgery ranged from 15 days to 16 months (mean 3.2 months). The aim of the surgery was to restore the elbow flexion, shoulder abduction, triceps function and wrist and finger flexion in that order of priority. The major nerve transfers used were spinal accessory to suprascapular nerve, intercostal to musculocutaneous nerve and pectoral nerves, contralateral C7 to median and radial nerves. Nerve stumps were used whenever available (30 patients). Results: Recovery of ≥ grade 3 power was noted in biceps in 73% (68/93) of patients, shoulder abduction in 89% (43/49), pectoralis major in 100% (8/8). Recovery of grade 2 triceps power was seen in 80% (12/16) patients with nerve transfer to radial nerve. Derotation osteotomies of humerus (n=13) and wrist fusion (n=14) were the most common secondary procedures performed to facilitate alignment and movements of the affected limb. Better results were noted in 59 cases where direct nerve transfers were done (without nerve graft). Conclusion: Acceptable function (restoration of biceps power ≥3) can be obtained in more than two thirds (73%) of these global brachial plexus injuries by using the principles of early exploration and nerve transfer with rehabilitation.
Page 1 /100
Display every page Item

Copyright © 2008-2017 Open Access Library. All rights reserved.