Blog Elements - International Journal of Paediatric Orthopaedics

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Shoulder Rebalancing Surgery for Brachial Plexus Birth Palsy (BPBP)

Volume 7 | Issue 1 | January-April 2021 | Page: 45-54 | Rujuta Mehta, Qaisur Rabbi, Praveen Bhardwaj, Maulin M. Shah, Dhiren Ganjwala Authors: Rujuta Mehta MS Ortho. DNB Ortho. [1], Qaisur Rabbi MBBS, DNB Ortho. [2], Praveen Bhardwaj MS Orth., DNB Ortho. FNB [3], Maulin M. Shah MS Ortho. [4], Dhiren Ganjwala MS Ortho. [5] [1] Department of […]

Primary Nerve Reconstruction in Brachial Plexus Birth Palsy: Current Concepts

Volume 7 | Issue 1 | January-April 2021 | Page: 37-44 | Parag B. Lad, Nischal Naik, Bharat K. Kadadi, P. S. Bhandari, Mukund R. Thatte Authors: Parag B. Lad D Ortho., MS Ortho. [1], Nischal Naik M.Ch. [2], Bharat K. Kadadi MS Ortho. [3], P. S. Bhandari M.Ch. [4], Mukund R. Thatte M.Ch. [5] […]

Shoulder Rebalancing Surgery for Brachial Plexus Birth Palsy (BPBP)

Primary Nerve Reconstruction in Brachial Plexus Birth Palsy: Current Concepts

Full Sized Blog Element (Big Preview Pic)

Shoulder Rebalancing Surgery for Brachial Plexus Birth Palsy (BPBP)

Volume 7 | Issue 1 | January-April 2021 | Page: 45-54 | Rujuta Mehta, Qaisur Rabbi, Praveen Bhardwaj, Maulin M. Shah, Dhiren Ganjwala

Authors: Rujuta Mehta MS Ortho. DNB Ortho. [1], Qaisur Rabbi MBBS, DNB Ortho. [2],
Praveen Bhardwaj MS Orth., DNB Ortho. FNB [3], Maulin M. Shah MS Ortho. [4], Dhiren Ganjwala MS Ortho. [5]

[1] Department of Orthopaedics, HOD Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India.
[2] Department of Paediatric Orthopaedic Surgery, Center for the Rehabilitation of the Paralysed, CRPBangladesh.
[3] Department of Orthopaedics, Consultant Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
[4] Department of Paediatric Orthopaedic Surgery, Orthokids Clinic, Ahmedabad
[5] Ganjwala Orthopedic Hospital, Ahmedabad, Gujrat, India.

Address of Correspondence
Dr. Rujuta Mehta,
HOD Bai Jerbai Wadia Hospital for Children, Consultant Paediatric Orthopedic and Paediatric
Upper Limb Surgeon- Nanavati Superspeciality Hospital, Jaslok Hospital and Shushrusha Hospital.
E-mail: rujutabos@gmail.com

Abstract

Shoulder dysplasia is common constituting 80% of sequelae secondary to BPBP. Muscle imbalance due to uninhibited co-contractions and eccentric forces across the shoulder joint are the main causes of shoulder sequelae. This leads to limitation of shoulder movements and gleno-humeral deformity. This article discusses the presentations, investigations and treatment approach to various severities of deformities resulting from the muscular imbalance about the shoulder in BPBP.

Keywords: Shoulder sequelae, Rebalancing conjoint transfer, Salvage surgery.

References

1) Waters PM, Smith GR, Jaramillo D. Glenohumeral deformity secondary to brachial plexus birth palsy. J Bone Joint Surg Am. 1998; 80(5): 668-77.
2)M L Pearl, B W Edgerton. Glenoid deformity secondary to brachial plexus birth palsy J Bone Joint Surg Am. 1998 May;80(5):659-67. doi: 10.2106/00004623-199805000-00006.
3)Susan V Duff, Sudarshan Dayanidhi, Scott H Kozin. Asymmetrical shoulder kinematics in children with brachial plexus birth palsy. Clin Biomech (Bristol, Avon). 2007 Jul; 22(6):630-8. doi: 10.1016/j.clinbiomech.2007.02.002.
4) Dahlin LB, Erichs K, Andersson C et al. Incidence of early posterior shoulder dislocation
in brachial plexus birth palsy. J Brachial Plex Peripher Nerve Inj. 2007; 16: 2:24.
5) Ezaki M, Malungpaishrope K, Harrison RJ, Mills JK, Oishi SN, Delgado M, Bush PA, Browne RH. Botulinum toxin A injection as an adjunct in the treatment of posterior shoulder subluxation in neonatal brachial plexus palsy. The Journal of Bone and Joint surgery. American Volume, 01 Sep 2010, 92(12):2171-2177.
6): Bertelli JA. Lengthening of subscapularis and transfer of the lower trapezius in the correction of recurrent internal rotation contracture following obstetric brachial plexus palsy. J Bone Joint Surg Br. 2009 Jul;91(7):943-8.
7) Scott H. Kozin, MD Correlation Between External Rotation of the Glenohumeral Joint and Deformity after Brachial Plexus Birth Palsy. J Pediatr Orthop • Volume 24, Number 2, March/April 2004.
8) Donald S. Bae, Peter M. Waters and David Zurakowski. Reliability of Three Classification Systems Measuring Active Motion in Brachial Plexus Birth Palsy. J Bone Joint Surg Am. 2003; 85:1733-1738.
9) Staphanie A. Russo, Scott Kozin, Dav Zlotolov. Motion Necessary to achieve Mallet Internal Rotation Positions in Children with Brachial Plexus Birth Palsy. J Pediatr Orthop, January 2019 – Volume 39 – Issue 1 – p 14-21.
10) Rahul K Nath, Chandra Somasundaram, Sonya E Melcher, Meera Bala Arm rotated medially with supination the ARMS variant: Description of its surgical correction. Disorders volume 10, Article number: 32 (2009).
11) Gilbert A. Obstetrical brachial plexus palsy. In: Tubiana R, ed. The Hand. W B Saunders: Philadelphia: 576-601.
12) Hunter JD. Franklin K. Hughes PM. The ultrasound diagnosis of posterior shoulder dislocation associated with Erb’s palsy. Pediatr Radioi. 1998:28: 510-1.
13) Vathana T, Rust S, Mills J, Wilkes D, Browne R, Carter PR, Ezaki M. Intra observer and inter observer reliability of two ultrasound measures of humeral head position in infants with neonatal brachial plexus palsy. J Bone Joint Surg Am. 2007 Aug;89 (8):1710-5.
14) Sanchez TR, Chang J, Bauer A, Joyce NC, Patel CV. Dynamic sonographic evaluation of posterior shoulder dislocation secondary to brachial plexus birth palsy injury. J Ultrasound Med. 2013 Sep;32(9):1531-4.
15) Andrea S. Bauer, Justin F. Lucas, Nasser Heyrani, Ryan L. Anderson, Leslie A. Kalish, and Michelle A. James. Ultrasound Screening for Posterior Shoulder Dislocation in Infants with Persistent Brachial Plexus Birth Palsy. J Bone Joint Surg Am. 2017; 99:778-83.
16). Donohue KW, Little KJ, Gaughan JP, Kozin SH, Norton BD, Zlotolow DA. Comparison of ultrasound and MRI for the diagnosis of glenohumeral dysplasia in brachial plexus birth palsy. The Journal of Bone and Joint Surgery. American Volume. 2017 Jan;99(2):123-132
17) van der Sluijs JA, van Ouwerkerk WJ, de Gast A, Wuisman P, Nollet F, Manoliu RA. Retroversion of the humeral head in children with an obstetric brachial plexus lesion. Journal of Bone and Joint Surgery. British Volume (London). 2002 May;84(4):583-587
18) Pearl ML, Batech M, van de Bunt F. Humeral retroversion in children with shoulder internal rotation contractures secondary to upper-trunk neonatal brachial plexus palsy. The Journal of Bone and Joint Surgery. American Volume. 2016 Dec;98(23):1988-1995
19) Verchere C, Durlacher K, Bellows D, Pike J, Bucevska M. An early shoulder repositioning program in birth-related brachial plexus injury: a pilot study of the Sup-ER protocol. Hand (New York, N.Y.), 01 Jun 2014, 9(2):187-195.
20) Shah MM, Naik N, Patel T, Gupta G, Makadia A. Minimally Invasive Subscapularis Release: A Novel Technique and Results. J Pediatr Orthop. 2020;40(6): e466-e472.
21) Waters PM. Management of shoulder deformities in brachial plexus birth injuries. J Pediatr Orthop. 2010;30: S53–6
22) Waters PM, Bae DS. The early effects of tendon transfers and open capsulorrhaphy on Glenohumeral deformity in Brachial Plexus Birth palsy. J Bone Joint Surg Am. 2008; 90:2171–9.
23) James Hui, Ian Torode. Changing Glenoid Version After Open Reduction of Shoulders in Children with Obstetric Brachial Plexus Palsy. Journal of Pediatric Orthopaedics 23:109–113 ,2003.
24) Kirkos JM, Kyrkos MJ, Kapetanos GA, Haritidis JH. Brachial Plexus Palsy secondary to birth injuries: Long term results of anterior release and tendon transfers around the shoulder. J Bone Joint Surg Br.2005; 87:231–5
25) Anderson KA, O’Dell MA, James MA. Shoulder Tech Hand Up Extrem Surg. 2006 Jun;10(2):60-7
26) Gilbert A. Long-term evaluation of brachial plexus surgery in obstetrical palsy. Hand Clinics. 1995 Nov;11(4):583-594; discussion 94-5
27) Chuang DC, Hae-Shya M, Wei F. A new strategy of muscle transposition for shoulder deformity caused by Obstetric brachial plexus palsy. Plast Recontr Surg. 1998; 101:686–94
28) Abzug JM, Kozin SH, Waters PM. Open Glenohumeral Joint Reduction and Latissimus Dorsi and Teres Major Tendon Transfers for Infants and Children Following Brachial Plexus Birth Palsy. Tech Hand Up Extrem Surg. 2017 Jun;21(2):30-36
29) Mehta Rujuta, Johari Ashok, Maheshwari Ratna. Role of muscle transfers and tendon transfers in birth brachial plexus injury. Current Orthopaedic Practice: January/February 2015 – Volume 26 – Issue 1 – p 9-14 doi: 10.1097/BCO.0000000000000191 SPECIAL FOCUS: International Orthopaedics.
30) Thatte MR, Agashe MV, Rao A, Rathod CM, Mehta Rujuta. cases. Indian J Plast Surg. 2011 Jan;44(1):21-8.
31) Elhassan B, Bishop A, Shin A, Spinner R. injury Hand Surg Am. 2010 Jul;35(7):1211-9. doi: 10.1016/j.jhsa.2010.05.001.
32) Bertelli JA. adults. Microsurgery. 2011 May;31(4):263-7. doi: 10.1002/micr.20838. Epub 2010 Dec 3
33) J M Kirkos , I A Papadopoulos. Late treatment of brachial plexus palsy secondary to birth injuries: rotational osteotomy of the proximal part of the humerus. J Bone Joint Surg Am. 1998;80(10):1477-83.
34)Al-Qattan MM. Rotation osteotomy of the humerus for Erb’s palsy in children with humeral head deformity. J Hand Surg Am. 2002;27(3):479–83.
35) Venkatramani H, Bhardwaj P, Sabapathy SR. Birth Brachial Plexus Palsy. In: Agarwal K. ed. Text book of Plastic & Reconstructive & Aesthetic Surgery. Vol 2. First edition Delhi: Thieme, 2017: p 665-695.
36) Waters PM, Bae DS. The effect of derotational humeral osteotomy on global shoulder function in brachial plexus birth palsy. J Bone Joint Surg Am. 2006;88(5):1035–42.
37) Donald S Bae, Peter M Waters. External rotation humeral osteotomy for brachial plexus birth palsy. Tech Hand Up Extrem Surg. 2007;11(1):8-14.
38) M M Al-Qattan, H Al-Husainan, A Al-Otaibi, M S El-Sharkawy. Long-term results of low rotation humeral osteotomy in children with Erb’s obstetric brachial plexus palsy. J Hand Surg Eur Vol. 2009;34(4):486-92.
39) Abzug JM, Chafetz RS, Gaughan JP, Ashworth S, Kozin SH. Shoulder function after medial approach and derotational humeral osteotomy in patients with brachial plexus birth palsy. J Pediatr Orthop. 2010;30(5):469-74.
40) Dodwell E, O’Callaghan J, Anthony A, Jellicoe P, Shah M, Curtis C, et al. Combined glenoid anteversion osteotomy and tendon transfers for brachial plexus birth palsy: Early outcomes. The Journal of Bone and Joint Surgery. American Volume. 2012 Dec; 94(23):2145-2152
41) Peter M Waters, Donald S Bae. Effect of tendon transfers and extra-articular soft-tissue balancing on glenohumeral development in brachial plexus birth palsy. J Bone Joint Surg Am. 2005 Feb;87(2):320-5.

How to Cite this Article: Mehta R, Rabbi Q, Bhardwaj P, Shah MM, Ganjwala D | Shoulder Rebalancing Surgery for Brachial Plexus Birth Palsy (BPBP) | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 45-54.

(Article Text HTML) (Download PDF)

Primary Nerve Reconstruction in Brachial Plexus Birth Palsy: Current Concepts

Volume 7 | Issue 1 | January-April 2021 | Page: 37-44 | Parag B. Lad, Nischal Naik, Bharat K. Kadadi, P. S. Bhandari, Mukund R. Thatte

Authors: Parag B. Lad D Ortho., MS Ortho. [1], Nischal Naik M.Ch. [2], Bharat K. Kadadi MS Ortho. [3],
P. S. Bhandari M.Ch. [4], Mukund R. Thatte M.Ch. [5]

[1] Jupiter Hospital, Thane, Maharashtra, India.
[2] Divyam Hospital, Ahmedabad, Gujarat, India.
[3] Bengaluru Hand Centre & Manipal Hospitals, Bangalore, Karnataka, India.
[4] Brij Lal Super specialty Hospital, Haldwani, Nainital, Uttarakhand, India.
[5] Bombay Hospital & Medical Research Centre, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Mukund R Thatte,
Plastic Surgeon, Bombay Hospital & Medical Research Centre, Mumbai, Maharashtra, India.
E-mail: mthatte@gmail.com

Abstract

This article discusses the role of primary nerve surgery for Brachial Plexus Birth Palsy (BPBP). Spontaneous recovery in brachial plexus birth palsy is known and in such cases the prognosis is good. However, the incidence of such recovery is 30 – 90%. In some infants however, the course of motor recovery is inadequate necessitating nerve repair. BPBP presents clinically as a lower motor neuron type of upper limb monoplegia at birth. Indications of primary nerve reconstruction or distal nerve transfer, the technique of exploration of brachial plexus, common anatomical variations and the methods for identification of intact roots are discussed in detail.
Keywords: Primary nerve reconstruction, Brachial Plexus Birth Palsy (BPBP), Nerve transfer, co-contractions, Brachial plexus surgery.

References

1. Pondaag W, Malessy MJ, van Dijk JG, Thomeer RT. Natural history of obstetric brachial plexus palsy: a systematic review. Dev Med Child Neurol. 2004;46(2):138-144.
2. Kao JT, Sharma S, Curtis CG, Clarke HM. The role of the brachioradialis H reflex in the management and prognosis of obstetrical brachial plexus palsy. Handchir Mikrochir Plast Chir. 2003;35(2):106-111.
3. Thatte MR, Mehta R. Obstetric brachial plexus injury. Indian J Plast Surg. 2011;44(3):380-389.
4. Somashekar D, Yang LJ, Ibrahim M, Parmar HA. High-resolution MRI evaluation of neonatal brachial plexus palsy: A promising alternative to traditional CT myelography. AJNR Am J Neuroradiol. 2014;35(6):1209-1213
5. Vanderhave KL, Bovid K, Alpert H, et al. Utility of electrodiagnostic testing and computed tomography myelography in the preoperative evaluation of neonatal brachial plexus palsy. J Neurosurg Pediatr. 2012;9(3):283-289.
6. Narakas AO. Obstetrical brachial plexus injury. The paralyzed hand. 1987.
7. Kawabata H, Shibata T, Matsui Y, Yasui N. Use of intercostal nerves for neurotization of the musculocutaneous nerve in infants with birth-related brachial plexus palsy. J Neurosurg. 2001;94(3):386-391
8. Kendall FP, McCreary EK, Provance PG, Rodgers M, Romani WA. Muscles, testing and function: with posture and pain. Baltimore, MD: Williams & Wilkins; 1993.
9. Curtis C, Stephens D, Clarke HM, Andrews D. The active movement scale: an evaluative tool for infants with obstetrical brachial plexus palsy. The Journal of hand surgery. 2002 May 1;27(3):470-1.
10. Gilbert A, Raimondi P. Indications of Plexus Reconstruction in Obstetrical Paralysis. Journal of Peripheral Nerve Surgery (Volume 2, No. 1, July 2018).;2:9.
11. Borschel GH, Clarke HM. Obstetrical brachial plexus palsy. Plast Reconstr Surg. 2009;124(1 Suppl):144e-155e.
12. Waters PM. Obstetric brachial plexus injuries: evaluation and management. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 1997 Jul 1;5(4):205-14.
13. Al-Qattan MM. The outcome of Erb’s palsy when the decision to operate is made at 4 months of age. Plast Reconstr Surg. 2000;106(7):1461-1465.
14. Lee HY, Chung IH, Sir WS, et al. Variations of the ventral rami of the brachial plexus. J Korean Med Sci. 1992;7(1):19-24.
15. Roger Cornwall, Peter M Waters. Pediatric Brachial Plexus Surgery. Text book of Green’s operative hand surgery,7th Edition, Elsevier,2017;1391-1424.
16. Emamhadi M, Chabok SY, Samini F, et al. Anatomical Variations of Brachial Plexus in Adult Cadavers; A Descriptive Study. Arch Bone Jt Surg. 2016;4(3):253-258.
17. Thatte MR, Agashe M, Rathod C, Lad P, Mehta R. An approach to the supraclavicular and infraclavicular aspects of the brachial plexus. Tech Hand Up Extrem Surg. 2011;15(3):188-197.
18. Thatte MR, A Hiremath, N Nayak. “Obstetric Brachial Plexus Palsy. Diagnosis and Management Strategy.” Journal of Peripheral Nerve Surgery (Volume 1, No. 1, July 2017) 2: 9.
19. Malessy MJ, Pondaag W. Nerve repair/reconstruction strategies for neonatal brachial plexus palsies. Practical Management of Pediatric and Adult Brachial Plexus Palsies E-Book. 2011 Aug 22;6:86.
20. Gilbert A, Tassin JL. Réparationchirurgicale du plexus brachial dans la paralysieobstétricale [Surgical repair of the brachial plexus in obstetric paralysis]. Chirurgie. 1984;110(1):70-75.
21. Pondaag W, Malessy MJ. The evidence for nerve repair in obstetric brachial plexus palsy revisited. Biomed Res Int. 2014;2014:434619.
22. Gilbert A. Long-term evaluation of brachial plexus surgery in obstetrical palsy. Hand Clin. 1995;11(4):583-595.
23. Oberlin C, Béal D, Leechavengvongs S, et al. Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg Am. 1994;19(2):232-237.
24. Thatte MR, Nayak NS, Hiremath AS. Management of Birth Brachial Plexus Injury Including Use of Distal Nerve Transfers. J Hand Surg Asian Pac Vol. 2020;25(3):267-275.
25. Ghanghurde BA, Mehta R, Ladkat KM, Raut BB, Thatte MR. Distal transfers as a primary treatment in obstetric brachial plexus palsy: a series of 20 cases. J Hand Surg Eur Vol. 2016;41(8):875-881.
26. Tse R, Kozin SH, Malessy MJ, Clarke HM. International Federation of Societies for Surgery of the Hand Committee report: the role of nerve transfers in the treatment of neonatal brachial plexus palsy. J Hand Surg Am. 2015;40(6):1246-1259.
27. Gilbert A. Long-term evaluation of brachial plexus surgery in obstetrical palsy. Hand Clin. 1995;11(4):583-595.
28. Al-Qattan MM, Clarke HM, Curtis CG. The prognostic value of concurrent Horner’s syndrome in total obstetric brachial plexus injury. J Hand Surg Br. 2000;25(2):166-167.
29. Chen L, Gu YD, Hu SN, Xu JG, Xu L, Fu Y. Contralateral C7 transfer for the treatment of brachial plexus root avulsions in children – a report of 12 cases. J Hand Surg Am. 2007;32(1):96-103.
30. Gilbert A. Results of repair to the obstetrical plexus. Brachial plexus injuries. London: Martin Duniz. 2001 Jun 21:211-5.

How to Cite this Article: Lad PB, Naik N, Kadadi BK, Bhandari PS, Thatte MR | Primary Nerve Reconstruction in Brachial Plexus Birth Palsy: Current Concepts | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 37-44.

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Shoulder Rebalancing Surgery for Brachial Plexus Birth Palsy (BPBP)

Primary Nerve Reconstruction in Brachial Plexus Birth Palsy: Current Concepts

Shoulder Rebalancing Surgery for Brachial Plexus Birth Palsy (BPBP)

Primary Nerve Reconstruction in Brachial Plexus Birth Palsy: Current Concepts

Full Sized Blog Element (Big Preview Pic)

Shoulder Rebalancing Surgery for Brachial Plexus Birth Palsy (BPBP)

Authors: Rujuta Mehta MS Ortho. DNB Ortho. [1], Qaisur Rabbi MBBS, DNB Ortho. [2],
Praveen Bhardwaj MS Orth., DNB Ortho. FNB [3], Maulin M. Shah MS Ortho. [4], Dhiren Ganjwala MS Ortho. [5]

Abstract

References

(Article Text HTML) (Download PDF)

Primary Nerve Reconstruction in Brachial Plexus Birth Palsy: Current Concepts

Authors: Parag B. Lad D Ortho., MS Ortho. [1], Nischal Naik M.Ch. [2], Bharat K. Kadadi MS Ortho. [3],
P. S. Bhandari M.Ch. [4], Mukund R. Thatte M.Ch. [5]

Abstract

References

(Article Text HTML) (Download PDF)

License

Publisher