Abstract
Background
Muscle pathology of the arm and forearm in brachial plexus birth injury (BPBI) with elbow flexion contracture has not been evaluated with MRI.
Objective
To determine whether limited range of motion of the elbow in BPBI is correlated with specific patterns of muscular pathology.
Materials and methods
For 15 BPBI patients, total active motion (TAM) of the elbow (extension–flexion) and the forearm (pronation–supination) were measured. MRI of the elbow joints and musculature allowed assessment of elbow congruency. Fatty infiltration and size reduction of the muscles were graded semiquantitatively.
Results
Mean TAM of the elbow was 113° (50°–140°) and that of the forearm 91° (10°–165°). The greater the size reduction of the brachioradialis muscle, the more diminished was elbow TAM. The more extensive the BPBI and muscle pathology of the pronator teres muscle, the more limited was the TAM of the forearm. Pathology of the supinator and brachialis muscles was evident in every patient.
Conclusion
Extensive BPBI may result in marked limitation of TAM. Elbow flexion contracture seems to be caused mainly by brachialis muscle pathology. Prosupination of the forearm is better preserved when the pronator teres is not severely affected. MRI can reliably show the extent of muscle pathology in BPBI.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Narakas A (1987) Obstetrical brachial plexus injuries. In: Lamb DW (ed) The paralysed hand. Churchill Livingstone, Edinburgh, pp 116–135
Ballinger SG, Hoffer MM (1994) Elbow flexion contracture in Erb’s palsy. J Child Neurol 9:209–210
Zancolli EA, Zancolli ER III (2000) Reconstructive surgery in brachial plexus sequelae. In: Gupta A, Kay SP, Scheker LR (eds) The growing hand. Mosby, London, pp 805–823
Waters PM (2005) Update on management of pediatric brachial plexus palsy. J Pediatr Orthop 25:116–126
Pöyhiä TH, Nietosvaara YA, Remes VM et al (2005) MRI of rotator cuff muscle atrophy in relation to glenohumeral joint incongruence in brachial plexus birth injury. Pediatr Radiol 35:402–409
American Academy of Orthopaedic Surgeons (1988) Joint motion: method of measuring and recording. Churchill Livingstone, London, pp 10–13
Mahjneh I, Lamminen AE, Udd B et al (2004) Muscle magnetic resonance imaging shows distinct diagnostic patterns in Welander and tibial muscular dystrophy. Acta Neurol Scand 110:87–93
Hoffer MM, Phipps GJ (2000) Surgery about the elbow for brachial palsy. J Pediatr Orthop 20:781–785
Kawai H (2000) Anatomy of the brachial plexus. In: Kawai H, Kawabata H (eds) Brachial plexus palsy. World Scientific Publishing, Singapore, pp 1–23
Hoeksma AF, ter Steeg AM, Nelissen RG et al (2004) Neurological recovery in obstetrical brachial plexus injuries: an historical cohort study. Dev Med Child Neurol 46:76–83
Bordalo-Rodriques M, Rosenberg ZS (2004) MR imaging of entrapment neuropathies at the elbow. Magn Reson Imaging Clin N Am 12:247–263
Fleckenstein JL, Watumull D, Conner KE et al (1993) Denervated human skeletal muscle: MR imaging evaluation. Radiology 187:213–218
Acknowledgements
This study was supported by the Pehr Oscar Klingendahl Foundation, Helsinki, Finland, and the Radiological Society of Finland.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pöyhiä, T.H., Koivikko, M.P., Peltonen, J.I. et al. Muscle changes in brachial plexus birth injury with elbow flexion contracture: an MRI study. Pediatr Radiol 37, 173–179 (2007). https://doi.org/10.1007/s00247-006-0374-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-006-0374-0