open access

Vol 51, No 5 (2017)
Original research articles
Submitted: 2017-03-25
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The components of shoulder and elbow movements as goals of primary reconstructive operation in obstetric brachial plexus lesions

Jerzy Luszawski, Wiesław Marcol, Marek Mandera
DOI: 10.1016/j.pjnns.2017.06.005
·
Neurol Neurochir Pol 2017;51(5):366-371.

open access

Vol 51, No 5 (2017)
Original research articles
Submitted: 2017-03-25

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.

Get Citation

Keywords

Obstetric brachial plexus lesion, Neurosurgical treatment, Nerve repair, Nerve transfer

About this article
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

Vol 51, No 5 (2017)

Pages

366-371

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

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