Combined intrauterine vascular insufficiency and brachial plexus palsy: A case report.
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ABSTRACT:
SUBMITTER: Sinclair C
PROVIDER: S-EPMC2529139 | biostudies-other | 2008 Jun
REPOSITORIES: biostudies-other
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Project description:Injuries causing fracture dislocation of shoulder and brachial plexus palsy are extremely rare. As per authors' knowledge, three part fracture of proximal humerus with shoulder dislocation and brachial plexus palsy has not been reported in the literature.A 53 year old female sustained a three part fracture of right proximal humerus along with dislocation of shoulder joint and brachial plexus palsy following a fall from a flight of stairs. Fracture was managed by plating of proximal humerus and brachial palsy was followed up with electrodiagnostic studies and regular physiotherapy. Fracture united by three months and patient had near complete recovery of brachial palsy. Authors have discussed diagnostic modalities and management options in the article.Clinician should always look for clinical evidence of brachial plexus injury in patients with anterior shoulder dislocation. Signs of nerve injury with shoulder fracture dislocation are easily overlooked or incorrectly attributed to pain due to bony injury. Subsequent loss of shoulder function in elderly is often thought to be due to immobilization and stiffness. Clinical suspicion can help in diagnosing the often missed neurological injuries and can help in improving outcomes.
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Project description:Adult traumatic brachial plexus injuries can have devastating effects on upper extremity function. Although neurolysis, nerve repair, and nerve grafting have been used to treat injuries to the plexus, nerve transfer makes use of an undamaged nerve to supply motor input over a relatively short distance to reinnervate a denervated muscle. A review of several recent innovations in nerve transfer surgery for brachial plexus injuries is illustrated with surgical cases performed at this institution.
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Project description:Shoulder fusion for sequelae of obstetrical brachial plexus injury is reported as a valuable surgical solution with very good results and functional range of motion. It is traditionally performed in open fashion. Few reports describe the technique of arthroscopic shoulder fusion, but nearly all of them were done in cases with traumatic brachial plexus injury that have normal joint anatomy. This report describes and discusses the arthroscopic shoulder fusion technique in cases with disorganized glenohumeral joint secondary to obstetric brachial plexus injury. An illustrative case example is presented.
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Project description:Introduction: Many adults who had a severe Narakas IV obstetric brachial plexus injury (OBPI) suffer from extensive impairments in daily living due to limited hand-arm function. The dramatic loss of axonal support at this very early age of development often render the entire extremity a biologic wasteland and reconstructive methods and therapies often fail to recover any functional hand use. In this scenario bionic reconstruction, including an elective amputation and a subsequent prosthetic fitting, may enable functional improvement in adults suffering from the consequences of such severe brachial plexus injuries. We here describe our experience in treating such patients and lay out the surgical rational and rehabilitation protocol exemplified in one patient. Case Presentation/Methods: A 27-year-old adult with a unilateral OBPI contacted our center. He presented with globally diminished function of the affected upper extremity with minimal hand activity, resulting in an inability to perform various tasks of daily living. No biological reconstructive efforts were available to restore meaningful hand function. An interdisciplinary evaluation, including a psychosocial assessment, was used to assess eligibility for bionic reconstruction. Before the amputation and after the prosthetic fitting functional assessments and self-reported questionnaires were performed. Results: One month after the amputation and de-rotation osteotomy of the humerus the patient was fitted with a myoelectric prosthesis. At the 1.5 year-follow-up assessment, the patient presented with a distinct improvement of function: the ARAT improved from 12 to 20 points, SHAP score improved from 8 to 29, and the DASH value improved from 50 to 11.7. The average wearing times of the prosthesis were 5 to 6 h per day (on 4-5 days a week). Discussion: The options for adults suffering from the consequences of severe OBPIs to improve function are limited. In selected patients in whom the neurological deficit is so severe that biologic hand function is unsatisfactory, an elective amputation and subsequent restoration of the hand with mechatronic means may be an option. The follow-up results indicate that this concept can indeed lead to solid hand function and independence in daily activities after amputation, subsequent prosthetic fitting, and rehabilitation.
| S-EPMC9397750 | biostudies-literature
Project description:PurposeRight obstetric brachial plexus injuries (OBPI) often lead to left-handedness before limb function is restored post-surgery. A pertinent question arises about promoting a transition from left to right-handedness. We hypothesized that, with the decrease in neuroplasticity, handedness switching is not only difficult, but also reduces handedness-speech lateralization, impaired motor adaptability, and compromised language proficiency.MethodsWe retrospectively analyzed clinical data from January 1996 to January 2012 at our hospital. Participants were divided into intervention or control groups based on handedness switching. We compared handedness and computed lateral quotient (LQ) and lateralization index (LI) for handedness-speech center. Additionally, we assessed dominant hand's writing speed, language function, and IQ. Associations between absolute LI and LQ values, writing speed, language scores, and IQ were examined.ResultsNineteen extended Erb's palsy participants were enrolled, eight in the intervention group, and 11 in the control. No right-handed individuals were found in either cohort. The intervention group had significantly lower LQ and LI values, and fewer achieved normal writing speed. Yet, no notable disparities in language scores or IQ emerged. Notably, we established correlations between motor finesse, handedness degree, and handedness-speech lateralization.ConclusionFor right extended Erb's palsy, shifting handedness is nearly unfeasible, and such an endeavor could trigger a reduction in handedness-speech lateralization magnitude and diminished motor finesse.
| S-EPMC10800742 | biostudies-literature
Project description:The purpose of this investigation was to determine size differences between affected and unaffected upper extremities in patients with brachial plexus birth palsy (BPBP). Forty-eight patients with BPBP underwent measurements of the bilateral upper extremities. Average age at the time of evaluation was 47 months. In addition, patients or families were asked "How important is the difference in arm size and appearance to you?" Active motion was assessed using the modified Mallet classification, Toronto Test Score, and Hospital for Sick Children Active Movement Scale. Correlation between ratios of affected to unaffected limb lengths and girths and measures of active motion were assessed using Spearman's rank correlation coefficient. Upper arm, forearm, and hand lengths of the affected limbs were, on average, 95%, 94%, and 97% of the contralateral unaffected side, respectively. Upper arm girth, forearm girth, and hand width were, on average, 97%, 98%, and 95% of the contralateral side, respectively. All differences achieved statistical significance (p < 0.01). Furthermore, over 37% of patients or families reported that limb differences were "very" or "extremely important" to them. No statistically significant correlation between age and limb length discrepancy was noted. Furthermore, there were no correlations between upper limb discrepancies and measures of active motion in individual patients. Patients with BPBP and persistent neurological deficits may expect the affected upper extremity to be on average approximately 95% the length and girth of the contralateral limb. These differences do not correlate with patient age or clinical measurements of active movement.
| S-EPMC2584210 | biostudies-other
Project description:BackgroundNeonatal brachial plexus palsy (NBPP) is a serious complication of high-risk deliveries with controversy surrounding timing of corrective nerve surgery. This review systematically examines the existing literature and investigates correlations between age at time of upper trunk brachial plexus microsurgery and surgical outcomes.MethodsA systematic screening of PubMed, Cochrane, Web of Science, and CINAHL databases using PRISMA-IPD guidelines was conducted in January 2020 to include full-text English papers with microsurgery in upper trunk palsy, pediatric patients. Spearman rank correlation analysis and two-tailed t-tests were performed using individual patient data to determine the relationship between mean age at time of surgery and outcome as determined by the Mallet, Medical Research Council (MRC), or Active Movement Scale (AMS) subscores.ResultsTwo thousand nine hundred thirty six papers were screened to finalize 25 papers containing individual patient data (n = 256) with low to moderate risk of bias, as assessed by the ROBINS-I assessment tool. Mallet subscore for hand-to-mouth and shoulder abduction, AMS subscore for elbow flexion and external rotation, and MRC subscore for elbow flexion were analyzed alongside the respective age of patients at surgery. Spearman rank correlation analysis revealed a significant negative correlation (ρ = -0.30, p < .01, n = 89) between increasing age (5.50 ± 2.09 months) and Mallet subscore for hand-to-mouth (3.43 ± 0.83). T-tests revealed a significant decrease in Mallet hand-to-mouth subscores after 6 months (p < .05) and 9 months (p < .05) of age. No significant effects were observed for Mallet shoulder abduction, MRC elbow flexion, or AMS elbow flexion and external rotation.ConclusionThe cumulative evidence suggests a significant negative correlation between age at microsurgery and Mallet subscores for hand-to-mouth. However, a similar correlation with age at surgery was not observed for Mallet shoulder abduction, MRC elbow flexion, AMS external rotation, and AMS elbow flexion subscores.
| S-EPMC9305151 | biostudies-literature
Project description:While most obstetric brachial plexus palsy patients recover arm and hand function, the residual nerve weakness leads to muscle imbalances about the shoulder which may cause bony deformities. In this paper we describe abnormalities in the developing scapula and the glenohumeral joint. We introduce a classification for the deformity which we term Scapular Hypoplasia, Elevation and Rotation. Multiple anatomic parameters were measured in bilateral CT images and three-dimensional CT reconstruction of the shoulder girdle of 30 obstetric brachial plexus palsy patients (age range 10 months-10.6 years). The affected scapulae were found to be hypoplastic by an average of 14% while the ratio of the height to the width of the body of scapula (excluding acromion) were not significantly changed, the acromion was significantly elongated by an average of 19%. These parameters as well as subluxation of the humeral head (average 14%) and downward rotation in the scapular plane were found to correlate with the area of scapula visible over the clavicle. This finding provides a classification tool for diagnosis and objective evaluation of the bony deformity and its severity in obstetric brachial plexus palsy patients.
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Project description:Several factors associated with B glenoid are also linked with obstetrical brachial plexus palsy (OBPP). The purpose of this observational study was to determine the incidence of OBPP risk factors in type B patients. A cohort of 154 patients (68% men, 187 shoulders) aged 63 ± 17 years with type B glenoids completed a questionnaire comprising history of perinatal characteristics related to OBPP. A literature review was performed following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to estimate the incidence of OBPP risk factors in the general population. Twenty-seven patients (18%) reported one or more perinatal OBPP risk factors, including shoulder dystocia (n = 4, 2.6%), macrosomia >4 kg (n = 5, 3.2%), breech delivery (n = 6, 3.9%), fetal distress (n = 8, 5.2%), maternal diabetes (n = 2, 1.3%), clavicular fracture (n = 2, 1.3%), and forceps delivery (n = 4, 2.6%). The comparison with the recent literature suggested that most perinatal OBPP risk factors were within the normal range, although the incidence of shoulder dystocia, forceps and vaginal breech deliveries exceeded the average rates. Perinatal factors related to OBPP did not occur in a higher frequency in patients with Walch type B OA compared to the general population, although some of them were in the high normal range.
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Project description: Not available
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