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DOI: 10.1055/s-0044-1787151
Long-Term Hand and Shoulder Function in Children following Early Surgical Intervention for a Birth-Related Upper Brachial Plexus Injury
Abstract
Purpose To better understand the long-term hand and shoulder outcomes of upper brachial plexus birth injuries.
Methods We evaluated shoulder and hand function in 32 patients (13 males; 19 females) with a C5/C6 birth injury history). All patients had undergone primary nerve surgery as infants, and 12 underwent a simultaneous shoulder procedure as they presented with a fixed internal rotation contracture of the shoulder. On average, all patients were evaluated and examined 15 years postoperatively. The shoulder function was evaluated using the Miami Shoulder Scale. Hand function was measured by the 9-hole peg test (9-HPT) and statistical analysis included comparison of 9-HPT time against normative data using the Student's t-test.
Results The cohort includes 22 right-hand-dominant and 10 left-hand-dominant patients. Mean age at surgery was 10 months; mean age at follow-up was 15 years ± 2 years 2 months. Cumulative shoulder function was “good” or “excellent” (Miami score) in 23 patients. For 9-HPT, 23 out of 32 patients seen had an involved hand with a significant alteration in function.
Conclusion Early nerve surgery in cases of upper brachial plexus birth injuries result in the desired outcome. To ensure timely and targeted therapy for any residual deficits, it is imperative that limitations in hand function among children with an Erb's palsy.
Publication History
Received: 01 September 2023
Accepted: 29 April 2024
Article published online:
21 June 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Georg Thieme Verlag KG
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References
- 1 Raducha JE, Cohen B, Blood T, Katarincic J. A review of brachial plexus birth palsy: injury and rehabilitation. R I Med J (2013) 2017; 100 (11) 17-21
- 2 Immerman I, Alfonso DT, Ramos LE. et al. Hand function in children with an upper brachial plexus birth injury: results of the nine-hole peg test. Dev Med Child Neurol 2012; 54 (02) 166-169
- 3 Pondaag W, Malessy MJA. Evidence that nerve surgery improves functional outcome for obstetric brachial plexus injury. J Hand Surg Eur Vol 2021; 46 (03) 229-236
- 4 Hale HB, Bae DS, Waters PM. Current concepts in the management of brachial plexus birth palsy. J Hand Surg Am 2010; 35 (02) 322-331
- 5 Kirjavainen MO, Nietosvaara Y, Rautakorpi SM. et al. Range of motion and strength after surgery for brachial plexus birth palsy. Acta Orthop 2011; 82 (01) 69-75
- 6 Daly MC, Bauer AS, Lynch H, Bae DS, Waters PM. Treatment and Outcomes of Brachial Plexus Birth Injury (TOBI) Study Group. Outcomes of late microsurgical nerve reconstruction for brachial plexus birth injury. J Hand Surg Am 2020; 45 (06) 555.e1-555.e9
- 7 Grossman JA, DiTaranto P, Yaylali I, Alfonso I, Ramos LE, Price AE. Shoulder function following late neurolysis and bypass grafting for upper brachial plexus birth injuries. J Hand Surg [Br] 2004; 29 (04) 356-358
- 8 Hulleberg G, Elvrum AK, Brandal M, Vik T. Outcome in adolescence of brachial plexus birth palsy. 69 individuals re-examined after 10–20 years. Acta Orthop 2014; 85 (06) 633-640
- 9 O'Berry P, Brown M, Phillips L, Evans SH. Obstetrical brachial plexus palsy. Curr Probl Pediatr Adolesc Health Care 2017; 47 (07) 151-155
- 10 Gilbert A. Long-term evaluation of brachial plexus surgery in obstetrical palsy. Hand Clin 1995; 11 (04) 583-594 , discussion 594–595
- 11 Poole JL, Burtner PA, Torres TA. et al. Measuring dexterity in children using the Nine-hole peg test. J Hand Ther 2005; 18 (03) 348-351