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Brachial palsy mallet

John D Jennings, Dustin A Greenhill, Scott H Kozin, Dan A Zlotolow
Brachial plexus birth palsy resolves spontaneously in a majority of patients, however, others may have serious permanent dysfunction. Although nerve transfers or grafts are early options for treatment, many children have residual deficits or present too late for such procedures. In these patients, rotational osteotomy of the humerus may restore improved function and motion. Unfortunately, traditional humeral osteotomies only provide correction in a single plane, therefore appropriate correction of the typical residual deformity is incomplete...
April 7, 2017: Techniques in Hand & Upper Extremity Surgery
Dustin A Greenhill, William R Smith, F V Ramsey, Scott H Kozin, Dan A Zlotolow
BACKGROUND: In children with brachial plexus birth palsy (BPBP) undergoing tendon transfers to augment shoulder external rotation, it is unclear whether transfer of the latissimus dorsi with its combined latissimus dorsi and teres major (cLT) versus isolated teres major (iTM) tendon transfer yield different outcomes. METHODS: Records of patients with BPBP who underwent shoulder tendon transfers to augment external rotation were retrospectively reviewed. Transfer type (cLT or iTM) was considered indiscriminate by virtue of surgeon preference...
March 27, 2017: Journal of Pediatric Orthopedics
A García Ron, R Gallardo, B Huete Hernani
INTRODUCTION: Obstetric brachial plexus palsy (OBPP) usually has a favourable prognosis. However, nearly one third of all severe cases have permanent sequelae causing a high level of disability. In this study, we explore the effectiveness of ultrasound-guided injection of botulinum toxin A (BoNT-A) and describe the procedure. PATIENTS AND METHODS: We designed a prospective, descriptive study including patients with moderate to severe OBPP who were treated between January 2010 and December 2014...
March 24, 2017: Neurología: Publicación Oficial de la Sociedad Española de Neurología
Olivier Herisson, Nathalie Maurel, Amadou Diop, Morgane Le Chatelier, Adeline Cambon-Binder, Franck Fitoussi
BACKGROUND: The physical signs of obstetrical brachial plexus palsy range from temporary upper-limb dysfunction to a lifelong impairment and deformity in one arm. The aim of this study was to analyze the kinematics of the upper limb and to evaluate the contribution of glenohumeral and scapulothoracic joints of obstetrical brachial plexus palsy children. METHODS: Six children participated in this study: 2 males and 4 females with a mean age of 11.7years. Three patients had a C5, C6 lesion and 3 had a C5, C6, C7 lesion...
January 15, 2017: Clinical Biomechanics
Judy Mahon, Ailish Malone, Damien Kiernan, Dara Meldrum
Kinematics, measured by 3D upper limb motion analysis (3D-ULMA), can potentially increase understanding of movement patterns by quantifying individual joint contributions. Reliability in children with obstetric brachial plexus palsy (OBPP) has not been established. OBJECTIVE: This study aimed to determine between session reliability and measurement errors of 3D-ULMA using the acromion method (AM) in children with OBPP. APPROACH: Ten participants (mean 10 years, range 7-15 years, Narakas classification I-III) completed 3D-ULMA on two occasions, mean interval of 8...
January 31, 2017: Physiological Measurement
Rahul K Nath, Chandra Somasundaram
AIM: To compare outcomes of our revision surgical operations in obstetric brachial plexus palsy (OBPP) patients to results of conventional operative procedures at other institutions. METHODS: We analyzed our OBPP data and identified 10 female and 10 male children aged 2.0 to 11.8 years (average age 6.5 years), who had prior conventional surgical therapies at other clinics. Of the 20 patients, 18 undergone triangle tilt, 2 had only mod Quad. Among 18 patients, 8 had only triangle tilt and 10 had also mod Quad as revision surgeries with us...
November 18, 2016: World Journal of Orthopedics
Yasser A Safoury, Mohamed Eldesoky, Enas E Abutaleb, Mohamed Raafat, Ahmed M Gaber
BACKGROUND: The transfer latissimus dorsi and teres major tendons to rotator cuff have been developed to rebalance the muscular dysfunction and improve shoulder range of motion in children with obstetrical brachial plexus palsy (OBPP). No previous study reported the ideal postoperative physical therapy program for these cases. AIM: The aim of the present study was to design appropriate postoperative physical therapy (PT) program after latissimus dorsi and teres major tendons transfer to rotator cuff in OBPP to improve upper limb function...
November 10, 2016: European Journal of Physical and Rehabilitation Medicine
B A Ghanghurde, R Mehta, K M Ladkat, B B Raut, M R Thatte
UNLABELLED: The purpose of this study was to examine the results of spinal accessory nerve to suprascapular nerve (with or without axillary nerve neurotization) and an Oberlin transfer as primary treatment in children with Narakas type I obstetric brachial plexus injuries, when parents refused to consent to conventional nerve trunk-/root-level reconstruction. A total of 20 children with poor shoulder abduction and no biceps antigravity function but with good hand function were treated with spinal accessory nerve to suprascapular nerve and an Oberlin transfer at a mean age of 5...
October 2016: Journal of Hand Surgery, European Volume
Menno van der Holst, C W P Gerco van der Wal, Ron Wolterbeek, Willem Pondaag, Thea P M Vliet Vlieland, Rob G H H Nelissen
OBJECTIVE: Irrespective of treatment history, shoulder dysfunction may occur in children with neonatal brachial plexus palsy. Following internal contracture release and/or muscle tendon transfer (ICR/MTT) shoulder function gain is possible. This study describes the outcomes of ICR/MTT for children with neonatal brachial plexus palsy, with or without prior nerve surgery (a group with prior nerve surgery and a group without prior nerve surgery). PATIENTS AND METHODS: The study included children who underwent an ICR/MTT with a minimum follow-up of 6 months...
July 18, 2016: Journal of Rehabilitation Medicine
Anne Sophie Kruit, Fouzia Choukairi, Anuj Mishra, Andrew Gaffey, Andrea Jester
PURPOSE: The aim of this study was to evaluate early and mid-term clinical outcomes after isolated subscapularis Z-lengthening in children with shoulder internal rotation contractures resulting from brachial plexus birth palsy. METHODS: Children with brachial plexus birth palsy treated with subscapularis tendon Z-lengthening from 2001 to 2011 were retrospectively reviewed. Over this period, 31 patients were identified. Primary outcome was improvement in Mallet score after surgery, and secondary outcome measures were active range of motion and Mallet sub-scores...
April 2016: International Orthopaedics
Dustin A Greenhill, Robert Lukavsky, Sandra Tomlinson-Hansen, Scott H Kozin, Dan A Zlotolow
BACKGROUND: The Mallet scale, Active Movement Scale (AMS), and Toronto Test are validated for use in children with brachial plexus birth palsy (BPBP). However, the inability to compare these evaluation systems has led to difficulty gauging treatment efficacy and interpreting available literature in which multiple scoring systems are reported. Given the critical importance of physical examination, we compared 3 scoring systems to clarify statistical relationships between current validated evaluation methods...
December 2, 2015: Journal of Pediatric Orthopedics
Elias Naoum, Elie Saghbini, Elias Melhem, Ismat Ghanem
INTRODUCTION: The purpose of this paper was to evaluate the results on shoulder function following isolated proximal subscapularis release in children with Erb's palsy. METHODS: A retrospective study was conducted on 64 consecutive children with Erb's palsy who underwent a Carlioz proximal subscapularis release between 2001 and 2012. Fifty children with complete records and a minimum follow-up of 2 years were included for evaluation. Age at surgery ranged from 1...
October 2015: Journal of Children's Orthopaedics
Menno van der Holst, Thea P M Vliet Vlieland, Michiel A J van de Sande, Janneke C van Egmond-van Dam, Henricus M Vermeulen, Rob G H H Nelissen
PURPOSE: This study aimed to translate and cross-culturally adapt the Pediatric Outcome Data Collecting Instrument (PODCI) into the Dutch language and evaluate its measurement properties among children (age 3-10) with Neonatal Brachial Plexus Palsy (NBPP). METHODS: The PODCI was translated and adapted according to international guidelines and administered to 10 children with NBPP before and after surgery and thereafter twice again. Subsequently, the Mallet-score, Assisting Hand Assessment and active Range of Motion (aROM) were recorded...
2015: Journal of Pediatric Rehabilitation Medicine
Menno van der Holst, Thea P M Vliet Vlieland, Jorit J L Meesters, W Peter Bekkering, Jochem Nagels, Rob G H H Nelissen
PURPOSE: Shoulder function in children with Neonatal Brachial Plexus Palsy (NBPP) can be impaired. Functional gain is possible by an internal contracture release and muscle tendon transfer (ICL+MTT) for external rotation. This study evaluates the functional results of this intervention. METHODS: Assessments were done pre-operatively and 3, 6 and 12 months thereafter and included joint-mobility (ROM), muscle strength, arm function (Assisting Hand Assessment (AHA) and Mallet-score), Quality of Life (QoL) (Pediatric Outcome Data Collecting Instrument (PODCI)) and parental satisfaction...
2015: Journal of Pediatric Rehabilitation Medicine
Cigdem Sarac, Bouke J Duijnisveld, Amber van der Weide, Jan W Schoones, Martijn J A Malessy, Rob G H H Nelissen, Thea P M Vliet Vlieland
BACKGROUND: Symptoms of a neonatal brachial plexus palsy (NBPP) can vary widely among individuals and numerous clinical studies have been performed to identify the natural history and to improve treatment. The aim of this study was to identify and describe all outcome measures used in clinical studies on patients with an NBPP and categorize these outcome measures according to the International Classification of Functioning, Disability and Health (ICF). METHOD: Electronic searches of different databases were carried out...
2015: Journal of Pediatric Rehabilitation Medicine
Pablo Andrés-Cano, Miguel Ángel Toledo, David Michael Farrington, Juan José Gil
OBJECTIVES: Internal rotation contracture of the shoulder is a common complication in children with brachial plexus birth palsy (BPBP), causing early functional limitation and glenohumeral dysplasia. Arthroscopic arthrolysis has recently been described as a treatment for the sequelae of this condition. METHODS: Review of five patients who underwent shoulder arthroscopy by anterior capsulotomy and partial tenotomy of the subscapularis. Both clinical and functional assessments were made (Mallet classification)...
October 2015: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
E Gibon, C Romana, R Vialle, F Fitoussi
Cervical root avulsions are the worst pattern of injury in obstetrical brachial plexus injury (OBPI). The prognosis is poor and the treatment is mainly surgical with extraplexual neurotizations or muscle transfers. We present the outcomes of a technique performed in our institution to treat C5-C6 avulsion in obstetrical brachial plexus injury. This technique consists of a total ipsilateral C7 neurotization to the upper trunk. Ten babies with isolated C5-C6 root avulsion were operated on; we were able to review nine of them at over 12 months follow-up...
February 2016: Journal of Hand Surgery, European Volume
Mitchel Seruya, Shi Hong Shen, Sibon Fuzzard, Christopher J Coombs, David B McCombe, Bruce R Johnstone
BACKGROUND: The authors evaluated long-term shoulder function in patients with neonatal brachial plexus palsy undergoing suprascapular nerve reconstruction with cervical root grafting or spinal accessory nerve transfer. METHODS: A retrospective review was performed on all infants presenting with neonatal brachial plexus palsy between 1994 and 2010. Functional outcomes were compared by type of suprascapular nerve reconstruction. RESULTS: Seventy-four patients met the inclusion criteria (46 transfers, 28 grafts)...
May 2015: Plastic and Reconstructive Surgery
Rahul K Nath, Chandra Somasundaram
AIM: To systematically review and analyze the overall impact and effectiveness of bony surgical procedures, the triangle tilt and humeral surgery in a comparative manner in permanent obstetric brachial plexus injury (OBPI) patients. METHODS: We conducted a literature search and identified original full research articles of OBPI patients treated with a secondary bony surgery, particularly addressing the limitation of shoulder abduction and functions. Further, we analyzed and compared the efficacy and the surgical outcomes of 9 humeral surgery papers with 179 patients, and 4 of our secondary bony procedure, the triangle tilt surgical papers with 86 patients...
January 18, 2015: World Journal of Orthopedics
Emily A Eismann, Kevin J Little, Tal Laor, Roger Cornwall
BACKGROUND: Following neonatal brachial plexus palsy, the Putti sign-obligatory tilt of the scapula with brachiothoracic adduction-suggests the presence of glenohumeral abduction contracture. In the present study, we utilized magnetic resonance imaging (MRI) to quantify this glenohumeral abduction contracture and evaluate its relationship to shoulder joint deformity, muscle atrophy, and function. METHODS: We retrospectively reviewed MRIs of the thorax and shoulders obtained before and after shoulder rebalancing surgery (internal rotation contracture release and external rotation tendon transfer) for twenty-eight children with unresolved neonatal brachial plexus palsy...
January 21, 2015: Journal of Bone and Joint Surgery. American Volume
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