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  1 / 460 MEDLINE  
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PMID:28161491
Autor:Herisson O; Maurel N; Diop A; Le Chatelier M; Cambon-Binder A; Fitoussi F
Endereço:Hôpital Trousseau, Service de chirurgie orthopédique pédiatrique, 26 Avenue du Dr Arnold Netter, 75012 Paris, France. Electronic address: olivierherisson@hotmail.com.
Título:Shoulder and elbow kinematics during the Mallet score in obstetrical brachial plexus palsy.
Fonte:Clin Biomech (Bristol, Avon); 43:1-7, 2017 Mar.
ISSN:1879-1271
País de publicação:England
Idioma:eng
Resumo: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. They were asked to perform five tasks based on the Mallet scale and the kinematic data were collected using the Fastrak electromagnetic tracking device. FINDINGS: The scapulothoracic protraction and posterior tilt were significantly increased in the involved limb during the hand to mouth task (p=0.006 and p=0.015 respectively). The scapulothoracic Protraction/glenohumeral Elevation ratio was significantly increased in the involved limb during the hand to neck task (p=0.041) and the elevation task (p=0.015). The ratios of scapulothoracic Tilt on the three glenohumeral excursion angles were significantly increased during the hand to mouth task (p≤0.041). The scapulothoracic Mediolateral/glenohumeral Elevation ratio was significantly increased in the involved limb during the elevation task (p=0.038). The glenohumeral elevation excursion was significantly decreased in the involved limb during the hand to neck task (p<0.001) and the elevation task (p=0.0003). INTERPRETATION: This study gives us information about the greater contribution of the scapulothoracic joint to shoulder motion for affected arm of obstetrical brachial plexus palsy patients compared to their unaffected arm. Kinematic analysis could be useful in shoulder motion evaluation during the Mallet score and to evaluate outcomes after surgery.
Tipo de publicação: JOURNAL ARTICLE


  2 / 460 MEDLINE  
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PMID:27606502
Autor:Shen PY; Nidecker AE; Neufeld EA; Lee PS; James MA; Bauer AS
Endereço:Department of Radiology, University of California Davis Medical Center, Sacramento, CA.
Título:Non-Sedated Rapid Volumetric Proton Density MRI Predicts Neonatal Brachial Plexus Birth Palsy Functional Outcome.
Fonte:J Neuroimaging; 27(2):248-254, 2017 03.
ISSN:1552-6569
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND AND PURPOSE: The current prognostic biomarker of functional outcome in brachial plexus birth palsy is serial clinical examination throughout the first 6 months of age. This can delay surgical treatment and prolong parental anxiety in neonates who will recover spontaneously. A potentially superior biomarker is a volumetric proton density MRI performed at clinical presentation and within the first 12 weeks of life, providing a high spatial and contrast resolution examination in 4 minutes. METHODS: Nine neonates ranging in age from 4 to 9 weeks who presented with brachial plexus birth palsy were enrolled. All subjects underwent non-sedated 3 Tesla MRI with Cube Proton Density MRI sequence at the same time as their initial clinical visit. Serial clinical examinations were conducted at routine 4 week intervals and the functional performance scores were recorded. MRI findings were divided into pre-ganglionic and post-ganglionic injuries and a radiological scoring system (Shriners Radiological Score) was developed for this study. RESULTS: Proton Density MRI was able to differentiate between pre-ganglionic and post-ganglionic injuries. Radiological scores (Shriners Radiological Score) correlated better with functional performance at 6 months of age (P = .022) than the initial clinical examinations (Active Movement Scale P = .213 and Toronto P = .320). CONCLUSIONS: Rapid non-sedated volumetric Cube Proton Density MRI protocol performed at initial clinical presentation can accurately grade severity of brachial plexus birth palsy injury and predict functional performance at 6 months of age.
Tipo de publicação: JOURNAL ARTICLE


  3 / 460 MEDLINE  
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PMID:27692236
Autor:Salazard B; Philandrianos C; Tekpa B
Endereço:Service de chirurgie plastique Enfants, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France. Electronic address: dr.salazard@gmail.com.
Título:[Palsy of the upper limb: Obstetrical brachial plexus palsy, arthrogryposis, cerebral palsy].
Título:Les paralysies du membre supérieur : plexus brachial obstétrical, arthrogrypose, paralysie cérébrale..
Fonte:Ann Chir Plast Esthet; 61(5):613-621, 2016 Oct.
ISSN:1768-319X
País de publicação:France
Idioma:fre
Resumo:"Palsy of the upper limb" in children includes various diseases which leads to hypomobility of the member: cerebral palsy, arthrogryposis and obstetrical brachial plexus palsy. These pathologies which differ on brain damage or not, have the same consequences due to the early achievement: negligence, stiffness and deformities. Regular entire clinical examination of the member, an assessment of needs in daily life, knowledge of the social and family environment, are key points for management. In these pathologies, the rehabilitation is an emergency, which began at birth and intensively. Splints and physiotherapy are part of the treatment. Surgery may have a functional goal, hygienic or aesthetic in different situations. The main goals of surgery are to treat: joints stiffness, bones deformities, muscles contractures and spasticity, paresis, ligamentous laxity.
Tipo de publicação: JOURNAL ARTICLE


  4 / 460 MEDLINE  
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PMID:26829088
Autor:Elnaggar RK
Endereço:From the Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University (formerly Salamn bin Abdulaziz University), Saudi Arabia; and Department of Physical Therapy for Disturbances of Growth and Development in Children and Its Surgery, Faculty of Physical Therapy, Cairo University, Egypt.
Título:Shoulder Function and Bone Mineralization in Children with Obstetric Brachial Plexus Injury After Neuromuscular Electrical Stimulation During Weight-Bearing Exercises.
Fonte:Am J Phys Med Rehabil; 95(4):239-47, 2016 Apr.
ISSN:1537-7385
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVE: The purpose of this study was to evaluate the effects of neuromuscular electrical stimulation during weight-bearing exercises on shoulder function and bone mineral density (BMD) in children with obstetric brachial plexus injury (OBPI). DESIGN: This study was a randomized controlled trial. Forty-two children with OBPI were recruited. Their ages ranged from 3 to 5 years. They were randomly assigned either to control group (received a selected program) or study group (received the same program as the control group and neuromuscular electrical stimulation during weight bearing). Mallet grading system and dual-energy x-ray absorptiometry were used to evaluate shoulder function and BMD respectively at entry and after intervention (3 months later). RESULTS: No significant differences of the outcome measures were detected at entry. Significant differences were observed within both groups when the pre and post treatment scores within each group were compared. Finally, significant differences favoring the study group were recorded when their post treatment scores were compared. CONCLUSION: Neuromuscular electrical stimulation during weight bearing exercises is an effective and simple method to improve shoulder function and BMD in children with OBPI.
Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL


  5 / 460 MEDLINE  
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PMID:26141020
Autor:Gibon E; Romana C; Vialle R; Fitoussi F
Endereço:Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Paris, France emmanuel.gibon@gmail.com.
Título:Isolated C5-C6 avulsion in obstetric brachial plexus palsy treated by ipsilateral C7 neurotization to the upper trunk: outcomes at a mean follow-up of 9 years.
Fonte:J Hand Surg Eur Vol; 41(2):185-90, 2016 Feb.
ISSN:2043-6289
País de publicação:England
Idioma:eng
Resumo: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. The shoulder and the elbow function were assessed, as well as the Mallet Score. The mean follow-up was 9.2 years (SD 5.7). After a follow-up of 6 years, elbow flexion was restored with a range of motion ⩾130° and a motor function ⩾M3 in all patients. The average Mallet score was 18.1 (SD 1.2). This approach appears to be a viable alternative to extraplexual neurotizations for the treatment of C5-C6 nerve root avulsion.
Tipo de publicação: JOURNAL ARTICLE


  6 / 460 MEDLINE  
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PMID:26002705
Autor:Posso C
Endereço:Plastic and Reconstructive Surgery, Upper extremity Surgery - Microsurgery, University of Antioquia, Medellín, Colombia carolina.posso@gmail.com.
Título:Reply to: Gilbert A, Valbuena S, Posso C. Obstetrical brachial plexus injuries: late functional results of the Steindler procedure. J Hand Surg Eur. 2014, 39: 868-75.
Fonte:J Hand Surg Eur Vol; 40(5):543, 2015 Jun.
ISSN:2043-6289
País de publicação:England
Idioma:eng
Tipo de publicação: COMMENT; LETTER


  7 / 460 MEDLINE  
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PMID:26002704
Autor:Hems T
Endereço:Scottish National Brachial Plexus Injury Service, Royal Hospital for Sick Children, Glasgow, UK t.e.j.hems@doctors.org.uk.
Título:Re: Gilbert A, Valbuena S, Posso C. Obstetrical brachial plexus injuries: late functional results of the Steindler procedure. J Hand Surg Eur. 2014, 39: 868-75.
Fonte:J Hand Surg Eur Vol; 40(5):543, 2015 Jun.
ISSN:2043-6289
País de publicação:England
Idioma:eng
Tipo de publicação: COMMENT; LETTER


  8 / 460 MEDLINE  
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PMID:25936735
Autor:Tse R; Kozin SH; Malessy MJ; Clarke HM
Endereço:Division of Plastic Surgery, Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA. Electronic address: raymond.tse@seattlechildrens.org.
Título:International Federation of Societies for Surgery of the Hand Committee report: the role of nerve transfers in the treatment of neonatal brachial plexus palsy.
Fonte:J Hand Surg Am; 40(6):1246-59, 2015 Jun.
ISSN:1531-6564
País de publicação:United States
Idioma:eng
Resumo:Nerve transfers have gained popularity in the treatment of adult brachial plexus palsy; however, their role in the treatment of neonatal brachial plexus palsy (NBPP) remains unclear. Brachial plexus palsies in infants differ greatly from those in adults in the patterns of injury, potential for recovery, and influences of growth and development. This International Federation of Societies for Surgery of the Hand committee report on NBPP is based upon review of the current literature. We found no direct comparisons of nerve grafting to nerve transfer for primary reconstruction of NBPP. Although the results contained in individual reports that use each strategy for treatment of Erb palsy are similar, comparison of nerve transfer to nerve grafting is limited by inconsistencies in outcomes reported, by multiple confounding factors, and by small numbers of patients. Although the role of nerve transfers for primary reconstruction remains to be defined, nerve transfers have been found to be effective and useful in specific clinical circumstances including late presentation, isolated deficits, failed primary reconstruction, and multiple nerve root avulsions. In the case of NBPP more severe than Erb palsy, nerve transfers alone are inadequate to address all of the deficits and should only be considered as adjuncts if maximal re-innervation is to be achieved. Surgeons who commit to care of infants with NBPP need to avoid an over-reliance on nerve transfers and should also have the capability and inclination for brachial plexus exploration and nerve graft reconstruction.
Tipo de publicação: JOURNAL ARTICLE; REVIEW


  9 / 460 MEDLINE  
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PMID:25847723
Autor:Cheng W; Cornwall R; Crouch DL; Li Z; Saul KR
Endereço:Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC.
Título:Contributions of muscle imbalance and impaired growth to postural and osseous shoulder deformity following brachial plexus birth palsy: a computational simulation analysis.
Fonte:J Hand Surg Am; 40(6):1170-6, 2015 Jun.
ISSN:1531-6564
País de publicação:United States
Idioma:eng
Resumo:PURPOSE: Two potential mechanisms leading to postural and osseous shoulder deformity after brachial plexus birth palsy are muscle imbalance between functioning internal rotators and paralyzed external rotators and impaired longitudinal growth of paralyzed muscles. Our goal was to evaluate the combined and isolated effects of these 2 mechanisms on transverse plane shoulder forces using a computational model of C5-6 brachial plexus injury. METHODS: We modeled a C5-6 injury using a computational musculoskeletal upper limb model. Muscles expected to be denervated by C5-6 injury were classified as affected, with the remaining shoulder muscles classified as unaffected. To model muscle imbalance, affected muscles were given no resting tone whereas unaffected muscles were given resting tone at 30% of maximal activation. To model impaired growth, affected muscles were reduced in length by 30% compared with normal whereas unaffected muscles remained normal in length. Four scenarios were simulated: normal, muscle imbalance only, impaired growth only, and both muscle imbalance and impaired growth. Passive shoulder rotation range of motion and glenohumeral joint reaction forces were evaluated to assess postural and osseous deformity. RESULTS: All impaired scenarios exhibited restricted range of motion and increased and posteriorly directed compressive glenohumeral joint forces. Individually, impaired muscle growth caused worse restriction in range of motion and higher and more posteriorly directed glenohumeral forces than did muscle imbalance. Combined muscle imbalance and impaired growth caused the most restricted joint range of motion and the highest joint reaction force of all scenarios. CONCLUSIONS: Both muscle imbalance and impaired longitudinal growth contributed to range of motion and force changes consistent with clinically observed deformity, although the most substantial effects resulted from impaired muscle growth. CLINICAL RELEVANCE: Simulations suggest that treatment strategies emphasizing treatment of impaired longitudinal growth are warranted for reducing deformity after brachial plexus birth palsy.
Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T


  10 / 460 MEDLINE  
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PMID:25817754
Autor:Ho ES; Curtis CG; Clarke HM
Endereço:Division of Plastic and Reconstructive Surgery and Department of Rehabilitation Services, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Electronic address: emily.ho@sickkids.ca.
Título:Pain in children following microsurgical reconstruction for obstetrical brachial plexus palsy.
Fonte:J Hand Surg Am; 40(6):1177-83, 2015 Jun.
ISSN:1531-6564
País de publicação:United States
Idioma:eng
Resumo:PURPOSE: To determine the prevalence and characteristics of pain experienced by children who have had microsurgical reconstruction for obstetrical brachial plexus palsy (OBPP). METHODS: A prospective case series study was conducted of 65 children aged 6 to 18 years with a diagnosis of OBPP and who had microsurgery at less than 12 months of age with nerve grafting or transfer. A total of 28 patients (43%) had upper OBPP and 37 (57%) had total OBPP. We evaluated pain using the Faces Pain Scale-Revised and the Adolescent Pediatric Pain Tool. Sensory symptoms in the affected limb were also collected. Mean age was 11.0 ± 3.3 years. RESULTS: We evaluated 65 children. The point prevalence of pain (pain at the time of assessment) was 25%. The reported lifetime prevalence of pain (experienced anytime during life) was 66%. A total of 71% reported that the affected extremity felt different at least once in their lifetime. Average intensity of those with pain (n = 43) was 40 ± 19 mm on a 100-mm visual analog scale. Seventy percent of children reported that symptoms occurred every day or at least once a week. Anatomical distribution of pain was throughout the affected upper extremity irrespective of the severity of injury, with the exception of children with upper plexus injuries who did not report pain in their hand. Words typically used to describe neuropathic or musculoskeletal symptoms were chosen by the children to represent their pain. CONCLUSIONS: Children with OBPP who had microsurgical reconstruction commonly reported pain. These symptoms were typically frequent but were episodic and low in intensity. The descriptions of the type of pain include terms typical of both neuropathic and musculoskeletal origins. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
Tipo de publicação: JOURNAL ARTICLE



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