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The components of shoulder and elbow movements as goals of primary reconstructive operation in obstetric brachial plexus lesions
- Department of Pediatric Neurosurgery, University Hospital No. 6, Medical University of Silesia, Medyków 16, Katowice, Poland
- Department of Physiology, Medical University of Silesia, Medyków 18, Katowice, Poland
- Department of Pediatric Neurosurgery, School of Public Health, Medical University of Silesia, Piekarska 18, Bytom, Poland
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Abstract
Most of the cases of obstetric brachial plexus lesions (OBPL) show satisfactory improvement with conservative management, but in about 25% some surgical treatment is indicated. The present paper analyzes the effects of primary reconstructive surgeries in aspect of achieving delineated intraoperatively goals.
Children operated before the age of 18 months with follow-up period longer than 1 year were selected. Therapeutic goals established during the operation were identified by analysis of initial clinical status and operative protocols. The elementary movement components in shoulder and elbow joints were classified by assessing range of motion, score in Active Movement Scale and modified British Medical Research Council scale of muscle strength. The effect was considered satisfactory when some antigravity movement was possible, and good when strength exceeded M3 or antigravity movement exceeded half of range of passive movement.
In 13 of 19 patients most of established goals were achieved at good level, in 2 at satisfactory level. Remaining 4 patients showed improvement only in some aspects of extremity function. In 2 patients improvement in some movements was accompanied by worsening of other movements.
The analysis of results separated into individual components of movements showed that goals were achieved in most of the cases, simultaneously clearly indicating which damaged structures failed to provide satisfactory function despite being addressed intraoperatively.
The good results were obtained mainly by regeneration through grafts implanted after resection of neuroma in continuity, which proves that this technique is safe in spite of unavoidable temporary regression of function postoperatively.
Abstract
Most of the cases of obstetric brachial plexus lesions (OBPL) show satisfactory improvement with conservative management, but in about 25% some surgical treatment is indicated. The present paper analyzes the effects of primary reconstructive surgeries in aspect of achieving delineated intraoperatively goals.
Children operated before the age of 18 months with follow-up period longer than 1 year were selected. Therapeutic goals established during the operation were identified by analysis of initial clinical status and operative protocols. The elementary movement components in shoulder and elbow joints were classified by assessing range of motion, score in Active Movement Scale and modified British Medical Research Council scale of muscle strength. The effect was considered satisfactory when some antigravity movement was possible, and good when strength exceeded M3 or antigravity movement exceeded half of range of passive movement.
In 13 of 19 patients most of established goals were achieved at good level, in 2 at satisfactory level. Remaining 4 patients showed improvement only in some aspects of extremity function. In 2 patients improvement in some movements was accompanied by worsening of other movements.
The analysis of results separated into individual components of movements showed that goals were achieved in most of the cases, simultaneously clearly indicating which damaged structures failed to provide satisfactory function despite being addressed intraoperatively.
The good results were obtained mainly by regeneration through grafts implanted after resection of neuroma in continuity, which proves that this technique is safe in spite of unavoidable temporary regression of function postoperatively.
Keywords
Obstetric brachial plexus lesion, Neurosurgical treatment, Nerve repair, Nerve transfer
Title
The components of shoulder and elbow movements as goals of primary reconstructive operation in obstetric brachial plexus lesions
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
366-371
Page views
337
Article views/downloads
356
DOI
10.1016/j.pjnns.2017.06.005
Bibliographic record
Neurol Neurochir Pol 2017;51(5):366-371.
Keywords
Obstetric brachial plexus lesion
Neurosurgical treatment
Nerve repair
Nerve transfer
Authors
Jerzy Luszawski
Wiesław Marcol
Marek Mandera