David M Fisher1, Gregory H Borschel, Christine G Curtis, Howard M Clarke. 1. Toronto, Ontario, Canada From the Division of Plastic Surgery and Division of Physiotherapy, Department of Rehabilitation Services, The Hospital for Sick Children, and Department of Surgery, University of Toronto.
Abstract
BACKGROUND: The purpose of this study was to answer two questions. First, are there obstetrical brachial plexus palsy patients with no elbow flexion at 3 months who go on to recover useful upper extremity function without surgical intervention? Second, are there patients with evidence of elbow flexion at 3 months who do benefit from brachial plexus reconstruction? METHODS: The authors retrospectively reviewed a sample drawn from 253 consecutive patients at The Hospital for Sick Children obstetrical brachial plexus database from 1993 to 1996. Inclusion criteria were examination at age 3 months and either complete spontaneous recovery or repeated examination after age 3 years. Two hundred nine patients satisfied the inclusion criteria. Patients were distributed into four groups: group A, no elbow flexion at age 3 months (operative management); group B, elbow flexion present at 3 months (operative management); group C, no elbow flexion at age 3 months (nonoperative management); and group D, elbow flexion present at 3 months (nonoperative management). RESULTS: Groups A, B, and C showed significant intragroup improvements in both elbow flexion (p < 0.0001) and total limb motion scores (the sum of 15 individual joint motions) (p < 0.0001) with time. No differences were noted among groups A, B, and C for either elbow flexion or total limb motion scores at final follow-up. CONCLUSIONS: Early elbow flexion alone is not a sufficient criterion to recommend a nonoperative approach. In addition, spontaneous recovery of useful upper extremity function has been observed in a carefully selected subset of patients without elbow flexion at 3 months.
BACKGROUND: The purpose of this study was to answer two questions. First, are there obstetrical brachial plexus palsypatients with no elbow flexion at 3 months who go on to recover useful upper extremity function without surgical intervention? Second, are there patients with evidence of elbow flexion at 3 months who do benefit from brachial plexus reconstruction? METHODS: The authors retrospectively reviewed a sample drawn from 253 consecutive patients at The Hospital for Sick Children obstetrical brachial plexus database from 1993 to 1996. Inclusion criteria were examination at age 3 months and either complete spontaneous recovery or repeated examination after age 3 years. Two hundred nine patients satisfied the inclusion criteria. Patients were distributed into four groups: group A, no elbow flexion at age 3 months (operative management); group B, elbow flexion present at 3 months (operative management); group C, no elbow flexion at age 3 months (nonoperative management); and group D, elbow flexion present at 3 months (nonoperative management). RESULTS: Groups A, B, and C showed significant intragroup improvements in both elbow flexion (p < 0.0001) and total limb motion scores (the sum of 15 individual joint motions) (p < 0.0001) with time. No differences were noted among groups A, B, and C for either elbow flexion or total limb motion scores at final follow-up. CONCLUSIONS: Early elbow flexion alone is not a sufficient criterion to recommend a nonoperative approach. In addition, spontaneous recovery of useful upper extremity function has been observed in a carefully selected subset of patients without elbow flexion at 3 months.
Authors: Apurva S Shah; Leslie A Kalish; Donald S Bae; Allan E Peljovich; Roger Cornwall; Andrea S Bauer; Peter M Waters Journal: Iowa Orthop J Date: 2019
Authors: Eduardo Araújo Figueiredo; Fernando Sellitti Chiabai de Freitas; Júlio Inácio Parente Neto; Yussef Ali Abdouni; Antônio Carlos da Costa Journal: Rev Bras Ortop (Sao Paulo) Date: 2022-01-21