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Palliative Surgery in Obstetrical Brachial Plexus Palsy

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Pediatric Hand Surgery

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Abstract

The chance of recovering functional defects of obstetrical palsy through nerve surgical procedures has not reduced the role of palliative or secondary surgery, also called “functional surgery.” Although nerve injury at birth is not a progressive lesion, growth changes of the upper limb and skeletal adaptations can significantly influence recovery, especially during adolescence, when body size changes and creates an imbalance that can impair already achieved functions. In particular, skeletal deformities can decrease joint range of motion as much as muscle imbalance due to nerve palsy. Secondary surgery would aim to achieve some essential functions of the upper limb (a satisfactory shoulder motion in external and internal rotation, a significant active flexion-extension of the elbow, good wrist control, and an opposable thumb with adequate hand grasp). Depending on patient’s age, there are definite steps to perform surgery. In the article, indications to correct deformities induced by sequelae of obstetrical palsy of the upper arm are reported.

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References

  1. Gilbert A, editor. Brachial plexus injuries. London: Martin Dunitz Ltd; 2001.

    Google Scholar 

  2. Nixon M, Trail J. Management of shoulder problems following obstetric brachial plexus injury. Shoulder Elbow. 2014;6:12–7.

    Article  PubMed  Google Scholar 

  3. Waters PM. Comparison of the natural history, the outcome of microsurgical repair and the outcome of operative reconstruction in brachial plexus birth palsy. J Bone Joint Surg Am. 1999;81(5):649–59.

    Article  CAS  PubMed  Google Scholar 

  4. Mallet J. Paralysie obstétricale. Rev Chir Orthop Réparatrice Appar Mot. 1972;58(Suppl 1):166–8.

    Google Scholar 

  5. Haerle M, Gilbert A. Management of complete obstetric brachial plexus lesions. J Pediatr Orthop. 2004;24:194–200.

    Article  PubMed  Google Scholar 

  6. Sénès FM, Catena N, Sénès J. Nerve transfer in delayed obstetrical palsy repair. J Brachial Plex Peripher Nerve Inj. 2015;10(1):e2–e14.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Immermann I, Valencia H, Di Taranto P, Del Sole EM, Glait S, Price AE, Grossmann JA. Subscapular slide correction of the shoulder internal rotation contracture after brachial plexus birth injury: technique and outcomes. Tech Hand Up Extrem Surg. 2013;17(1):52–6.

    Article  Google Scholar 

  8. Azburg JM, Kozin SH, Waters PM. Open glenohumeral joint reduction and latissimus dorsi and teres major tendon transfers for infants and children following brachial plexus birth palsy. Tech Hand Up Extrem Surg. 2017;21(2):30–6.

    Article  Google Scholar 

  9. Breton A, Mainard L, De Gasperi M, Barbary S, Maurice E, Dautel G. Arthroscopic release of shoulder contracture secondary to obstetric brachial plexus palsy: retrospective study of children with an average follow up of 4.5 years. Orthop Traumatol Surg Res. 2012;98:638–44.

    Article  CAS  PubMed  Google Scholar 

  10. Waters PM, Bae DS. Effect of tendon transfers and extraarticular soft tissue balancing on glenohumeral development in brachial plexus birth palsy. J Bone Joint Surg. 2005;87A(2):320–5.

    Article  Google Scholar 

  11. Birch R. Late sequelae at the shoulder in obstetrical palsy in children. In: Randelli M, Karlsson J, editors. Surgical techniques in orthopaedics and traumatology: shoulder, vol. 3. Paris: Elsevier; 2001. 55-200-E-210.

    Google Scholar 

  12. Waters PM, Bae DS. The early effect of tendon transfers an open capsulorrhaphy on glenohumeral deformity in brachial plexus birth palsy. J Bone Joint Surg Am. 2008;90:2171–9.

    Article  PubMed  Google Scholar 

  13. Pagnotta A, Haerle M, Gilbert A. Long term results on abduction and external rotation after latissimus dorsi transfer for sequelae of obstetric palsy. Cain Orthop Relat Res. 2004;426:199–205.

    Google Scholar 

  14. Ozben H, Atalar AC, Bilsel K, Demirhan M. Transfer of latissimus dorsi and teres major tendons without subscapularis release for the treatment of obstetrical brachial plexus sequela. J Shoulder Elbow Surg. 2011;20(8):1265–74.

    Article  PubMed  Google Scholar 

  15. Chomiak J, Dungl P, Ostadal M, Frydychova M, Burian M. Muscle transfers in children and adults improve external rotation in cases of obstetrical brachial plexus paralysis: a comparative study. Int Orthop. 2014;38(4):803–10.

    Article  PubMed  Google Scholar 

  16. Abzug JM, Chafetz RS, Gaughan JP, Ashworth S, Kozin SH. Shoulder function after medial approach and derotational humeral osteotomy in patients with brachial plexus birth palsy. J Pediatr Orthop. 2010;30(5):469–74.

    Article  PubMed  Google Scholar 

  17. McRae MC, Borschel GH. Transfer of triceps motor branches of the radial nerve to axillary nerve with or without other nerve transfers provides antigravity shoulder abduction in pediatric brachial plexus injury. Hand (NY). 2012;7(2):186–90.

    Article  Google Scholar 

  18. Aly A, Bahm J, Schuind F. Percutaneous humeral derotational osteotomy in obstetrical palsy: a new technique. J Hand Surg Eur. 2014;39(5):549–52.

    Article  CAS  Google Scholar 

  19. Chen L, Gu YD, Hu SN. Applying transfer of and/or latissimus dorsi with teres major for reconstruction of abduction and external rotation of the shoulder in obstetrical brachial plexus palsy. J Reconstr Microsurg. 2002;18(4):275–80.

    Article  CAS  PubMed  Google Scholar 

  20. Gilbert A, Brockman R, Carlioz H. Surgical treatment of brachial plexus birth palsy. Clin Orthop. 1991;264:39–47.

    Article  Google Scholar 

  21. Terzis JK, Kokkalis ZT. Primary and secondary shoulder reconstruction in obstetric brachial plexus palsy. Injury. 2008;39S:S5–S14.

    Article  Google Scholar 

  22. Frich LH, Schmidt PH, Torfing T. Glenoid morphology in obstetrical brachial plexus lesion: a three dimensional computed tomography study. J Shoulder Elbow Surg. 2017;26(8):1374–82.

    Article  PubMed  Google Scholar 

  23. Di Mascio L, Chin FK, Fox M, Sinisi M. Glenoplasty for complex shoulder subluxation and dislocation in children with obstetric brachial plexus palsy. J Bone Joint Surg Br. 2011;93:102–7.

    Article  PubMed  Google Scholar 

  24. Murison J, Jehanno P, Fitoussi F. Nerve transfer to biceps to restore elbow flexion and supination in children with obstetrical brachial plexus palsy. J Child Orthop. 2017;11(6):455–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Kawabata H, Shibata T, Matsui Y, Yasui N. Use of intercostals nerves for neurotization of the musculocutaneous nerve in infants with birth related brachial plexus palsy. J Neurosurg. 2001;94(3):386–91.

    Article  CAS  PubMed  Google Scholar 

  26. Chwei Chin Chuang D, Hattori Y, Ma HS, Chen HC. The reconstruction strategy for improving elbow function in late obstetrical brachial plexus palsy. Plast Reconstr Surg. 2003;109(1):116–26.

    Article  Google Scholar 

  27. El Gammal T, El Sayed A, Kobt MM, Saleh WR, Ragheb YF, Refai O, Morsy MM. Free functioning gracilis transplantation for reconstruction of elbow and hand function in late obstetrical brachial plexus palsy. Microsurgery. 2015;35(5):350–5.

    Article  PubMed  Google Scholar 

  28. Nath RK, Boutros SG, Somasundaram C. Eplasty. 2017:e34.

    Google Scholar 

  29. Senes FM, Catena N, Dapelo E, Senes J. Nerve transfer for elbow extension in obstetrical brachial plexus palsy. Ann Acad Med Singap. 2016;45(5):221–4.

    Article  PubMed  Google Scholar 

  30. Poyhia TH, Koivikko MP, Peltonen J, Kirjavainen MO, Lamminen AE, Mietosvaara AY. Muscle changes in brachial plexus birth injury with elbow flexion contracture: an MRI study. Pediatr Radiol. 2007;37:173–9.

    Article  PubMed  Google Scholar 

  31. Sheffler L, Lattanza L, Hagar Y, Bagley A, James MA. The prevalence, rate of progression and treatment of elbow flexion contracture in children with brachial plexus birth palsy. J Bone Joint Surg A. 2012;94:403–9.

    Article  Google Scholar 

  32. Ho ES, Roy T, Stephens D, Clarke HM. Serial casting and splinting of elbow contracture in children with obstetrical brachial plexus palsy. J Hand Surg Am. 2010;35(1):84–91.

    Article  PubMed  Google Scholar 

  33. Garcia Lopez A, Sebastian P, Martinez LF. Anterior release of elbow flexion contractures in children with obstetrical brachial plexus lesions. J Hand Surg Am. 2012;37(8):1660–4.

    Article  PubMed  Google Scholar 

  34. Vekris MD, Pafilas D, Lykissas MG, Soucacos PN, Beris AE. Correction of elbow flexion contracture in late obstetrical brachial plexus palsy through arthrodiastasis of the elbow (Ioannina method). Tech Hand Up Extrem Surg. 2010;14(1):14–20.

    Article  PubMed  Google Scholar 

  35. Senes FM, Catena N, Dapelo E, Senes J. Correction of elbow flexion contracture by means of olecranon resection and anterior arthrolysis in obsttetrical brachial plexus sequelae. J Pediatr Orthop B. 2017;26(1):14–20.

    Article  PubMed  Google Scholar 

  36. Amrani A, Dendane MA, El Alami ZF. Pronator teres transfer to correct pronation deformity of the forearm after an obstetrical brachial plexus injury. J Bone Joint Surg Br. 2009;91(5):616–8.

    Article  CAS  PubMed  Google Scholar 

  37. Ruhmann O, Hierner R. Z plasty and rerouting of the biceps tendon with interosseous membrane release to restore pronation in paralytic supination posture and contracture of the forearm. Oper Orthop Traumatol. 2009;21(2):157–69.

    PubMed  Google Scholar 

  38. Metsaars WP, Nagels J, Pijls BG, Langenhoff JM, Nelissen RG. Treatment of supination deformity for obstetric brachial plexus injury: a systematic review and meta-analysis. J Hand Surg Am. 2014;39(10):1948–58.

    Article  CAS  PubMed  Google Scholar 

  39. Gladstein AZ, Sachleben B, Ho ES, Anthony A, Clarke HM, Hopyan S. Forearm pronation osteotomy for supination contracture secondary to obstetrical brachial plexus palsy: a retrospective cohort study. J Pediatr Orthop. 2017;37(6):e357–63.

    Article  PubMed  Google Scholar 

  40. Van Kooten EO, Ishaque MA, Winters HA, Ritt MJ, Van der Sluijs HA. Pronating radius osteotomy for supination deformity in children with obstetric brachial plexus palsy. Tech Hand Up Extrem Surg. 2008;12(1):34–7.

    Article  PubMed  Google Scholar 

  41. Manfrini M, Valdiserri L. Proximal radio ulnar arthrosis in the treatment of supination deformity resulting from obstetrical paralysis. Ital J Orthop Traumatol. 1985;11(3):309–13.

    CAS  PubMed  Google Scholar 

  42. Van Alphen NA, Van Doorn Loogman MH, Mass H, Van der Sluijs JA, Ritt MJ. Restoring wrist extension in obstetric palsy of the brachial plexus by transferring wrist flexors to wrist extensors. J Pediatr Rehabil Med. 2013;6(1):53–7.

    PubMed  Google Scholar 

  43. Al Quattan MM. Tendon transfer to reconstruct wrist extension in children with obstetric brachial plexus palsy. J Hand Surg Br. 2003;28(2):153–7.

    Article  Google Scholar 

  44. Raimondo PL. Evaluation of results in obstetrical brachial plexus palsy: the hand. In: Proceedings of international meeting of brachial plexus palsy, Helen, The Netherlands; 1993.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Hand Surgery and Rehabilitation, San Giuseppe Multimedica Hospital, Milan University, Milano, Italy

    Filippo M. Senes

  2. UOSD Microchirurgia Ricostruttiva e Chirurgia della Mano, IRCCS Istituto Giannina Gaslini, Genova, Italy

    Nunzio Catena

  3. Scuola di Specializzazione in Ortopedia e Traumatologia, Università degli Studi di Torino, Torino, Italy

    Chiara Arrigoni

Authors
  1. Filippo M. Senes
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  2. Nunzio Catena
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  3. Chiara Arrigoni
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Correspondence to Filippo M. Senes .

Editor information

Editors and Affiliations

  1. Department of Hand Surgery and Rehabilitation, S. Giuseppe MultiMedica Hospital, Milan University, Milano, Italy

    Giorgio Pajardi

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Senes, F.M., Catena, N., Arrigoni, C. (2023). Palliative Surgery in Obstetrical Brachial Plexus Palsy. In: Pajardi, G. (eds) Pediatric Hand Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-30984-7_24

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  • DOI: https://doi.org/10.1007/978-3-031-30984-7_24

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-30983-0

  • Online ISBN: 978-3-031-30984-7

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