Download PDF
CC BY 4.0 · J Brachial Plex Peripher Nerve Inj 2024; 19(01): e27-e30
DOI: 10.1055/s-0044-1787151
Original Article

Long-Term Hand and Shoulder Function in Children following Early Surgical Intervention for a Birth-Related Upper Brachial Plexus Injury

Rachel N. Aber
1   Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Leslie A. Grossman
2   Brachial Plexus Program, Nicklaus Children's Hospital, Miami, Florida, United States
,
Aaron J. Berger
3   Nicklaus Children's Hospital, Miami, Florida, United States
,
Andrew E. Price
3   Nicklaus Children's Hospital, Miami, Florida, United States
4   Orthopedic Surgery, NYU Langone Medical Center, New York, New York, United States
,
Israel Alfonso
3   Nicklaus Children's Hospital, Miami, Florida, United States
,
John A.I. Grossman
2   Brachial Plexus Program, Nicklaus Children's Hospital, Miami, Florida, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Purpose To better understand the long-term hand and shoulder outcomes of upper brachial plexus birth injuries.

Methods We evaluated shoulder and hand function in 32 patients (13 males; 19 females) with a C5/C6 birth injury history). All patients had undergone primary nerve surgery as infants, and 12 underwent a simultaneous shoulder procedure as they presented with a fixed internal rotation contracture of the shoulder. On average, all patients were evaluated and examined 15 years postoperatively. The shoulder function was evaluated using the Miami Shoulder Scale. Hand function was measured by the 9-hole peg test (9-HPT) and statistical analysis included comparison of 9-HPT time against normative data using the Student's t-test.

Results The cohort includes 22 right-hand-dominant and 10 left-hand-dominant patients. Mean age at surgery was 10 months; mean age at follow-up was 15 years ± 2 years 2 months. Cumulative shoulder function was “good” or “excellent” (Miami score) in 23 patients. For 9-HPT, 23 out of 32 patients seen had an involved hand with a significant alteration in function.

Conclusion Early nerve surgery in cases of upper brachial plexus birth injuries result in the desired outcome. To ensure timely and targeted therapy for any residual deficits, it is imperative that limitations in hand function among children with an Erb's palsy.

Keyword

brachial plexus birth injury - hand function - long-term outcomes - surgery

Supplementary Material



Publication History

Received: 01 September 2023

Accepted: 29 April 2024

Article published online:
21 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Raducha JE, Cohen B, Blood T, Katarincic J. A review of brachial plexus birth palsy: injury and rehabilitation. R I Med J (2013) 2017; 100 (11) 17-21
    PubMedGoogle Scholar
  • 2 Immerman I, Alfonso DT, Ramos LE. et al. Hand function in children with an upper brachial plexus birth injury: results of the nine-hole peg test. Dev Med Child Neurol 2012; 54 (02) 166-169
    CrossrefPubMedGoogle Scholar
  • 3 Pondaag W, Malessy MJA. Evidence that nerve surgery improves functional outcome for obstetric brachial plexus injury. J Hand Surg Eur Vol 2021; 46 (03) 229-236
    CrossrefPubMedGoogle Scholar
  • 4 Hale HB, Bae DS, Waters PM. Current concepts in the management of brachial plexus birth palsy. J Hand Surg Am 2010; 35 (02) 322-331
    CrossrefPubMedGoogle Scholar
  • 5 Kirjavainen MO, Nietosvaara Y, Rautakorpi SM. et al. Range of motion and strength after surgery for brachial plexus birth palsy. Acta Orthop 2011; 82 (01) 69-75
    CrossrefPubMedGoogle Scholar
  • 6 Daly MC, Bauer AS, Lynch H, Bae DS, Waters PM. Treatment and Outcomes of Brachial Plexus Birth Injury (TOBI) Study Group. Outcomes of late microsurgical nerve reconstruction for brachial plexus birth injury. J Hand Surg Am 2020; 45 (06) 555.e1-555.e9
    CrossrefPubMedGoogle Scholar
  • 7 Grossman JA, DiTaranto P, Yaylali I, Alfonso I, Ramos LE, Price AE. Shoulder function following late neurolysis and bypass grafting for upper brachial plexus birth injuries. J Hand Surg [Br] 2004; 29 (04) 356-358
    CrossrefPubMedGoogle Scholar
  • 8 Hulleberg G, Elvrum AK, Brandal M, Vik T. Outcome in adolescence of brachial plexus birth palsy. 69 individuals re-examined after 10–20 years. Acta Orthop 2014; 85 (06) 633-640
    CrossrefPubMedGoogle Scholar
  • 9 O'Berry P, Brown M, Phillips L, Evans SH. Obstetrical brachial plexus palsy. Curr Probl Pediatr Adolesc Health Care 2017; 47 (07) 151-155
    CrossrefPubMedGoogle Scholar
  • 10 Gilbert A. Long-term evaluation of brachial plexus surgery in obstetrical palsy. Hand Clin 1995; 11 (04) 583-594 , discussion 594–595
    CrossrefPubMedGoogle Scholar
  • 11 Poole JL, Burtner PA, Torres TA. et al. Measuring dexterity in children using the Nine-hole peg test. J Hand Ther 2005; 18 (03) 348-351
    CrossrefPubMedGoogle Scholar