Skip to main content
Top
Published in: Child's Nervous System 5/2016

01-05-2016 | Original Paper

Functional outcomes of infants with Narakas grade 1 birth-related brachial plexus palsy undergoing neurotization compared with infants who did not require surgery

Authors: Scott L. Zuckerman, Laura A. Allen, Camille Broome, Nadine Bradley, Charlie Law, Chevis Shannon, John C. Wellons III

Published in: Child's Nervous System | Issue 5/2016

Login to get access

Abstract

Purpose

This study aimed to investigate the functional outcomes of infants who underwent neurotization for shoulder abduction and elbow flexion in Narakas grade 1 birth-related brachial plexus palsy (BRBPP) and compare this cohort to children who progressed past the point of needing intervention.

Methods

A cohort study was conducted at a single center between 1999 and 2010. Two-hundred and eight infants were identified with BRBPP that presented for neurosurgical care as infants. Of those, 38 (18 %) received neurosurgical intervention with approximate 2-year follow-up. Only infants undergoing cranial nerve XI to suprascapular nerve neurotization for shoulder abduction (SA) weakness and medial pectoral nerve to musculocutaneous nerve neurotization for elbow flexion (EF) weakness were included. In addition, 30 infants who improved past the need for surgical intervention and had been followed for close to 24 months were identified for comparison. Descriptive statistics and exploratory analysis were performed using SAS 9.2 and JMP 9.0.2.

Results

Shoulder abduction For SA, there were no differences in age at presentation between the operative (6–9 months) and non-operative (5–9 months) groups (p = 0.99). Infants in the operative cohort had significantly worse initial function (p = 0.008). At 2-year follow-up, the two groups had become similar (p = 1.0).
Elbow flexion For EF, there were no differences in age at presentation between the operative (6–8 months) and non-operative (5–8.5 months) groups (p = 0.98). Infants in the operative cohort had significantly worse initial function (p = 0.002). At 2-year follow-up, those two groups had become similar (p = 0.26).

Conclusions

Infants undergoing neurotization for Narakas grade 1 brachial plexus injury had similar long-term function to those who had improved and never required surgery. The preoperative exam findings were significantly different between the intervened and non-intervened groups, while the postoperative exam findings were not.
Appendix
Available only for authorised users
Literature
2.
go back to reference Al-Qattan MM (2000) The outcome of Erb’s palsy when the decision to operate is made at 4 months of age. Plast Reconstr Surg 106:1461–1465CrossRefPubMed Al-Qattan MM (2000) The outcome of Erb’s palsy when the decision to operate is made at 4 months of age. Plast Reconstr Surg 106:1461–1465CrossRefPubMed
3.
go back to reference Al-Qattan MM, El-Sayed AA (2014) The use of the phrenic nerve communicating branch to the fifth cervical root for nerve transfer to the suprascapular nerve in infants with obstetric brachial plexus palsy. BioMed research international 2014:153182. doi:10.1155/2014/153182 PubMedPubMedCentral Al-Qattan MM, El-Sayed AA (2014) The use of the phrenic nerve communicating branch to the fifth cervical root for nerve transfer to the suprascapular nerve in infants with obstetric brachial plexus palsy. BioMed research international 2014:153182. doi:10.​1155/​2014/​153182 PubMedPubMedCentral
5.
8.
go back to reference Bialocerkowski A, Gelding B (2006) Lack of evidence of the effectiveness of primary brachial plexus surgery for infants (under the age of two years) diagnosed with obstetric brachial plexus palsy. Int J Evid-Based Healthc 4:264–287. doi:10.1111/j.1479-6988.2006.00052.x PubMed Bialocerkowski A, Gelding B (2006) Lack of evidence of the effectiveness of primary brachial plexus surgery for infants (under the age of two years) diagnosed with obstetric brachial plexus palsy. Int J Evid-Based Healthc 4:264–287. doi:10.​1111/​j.​1479-6988.​2006.​00052.​x PubMed
11.
go back to reference DiTaranto P, Campagna L, Price AE, Grossman JA (2004) Outcome following nonoperative treatment of brachial plexus birth injuries. J Child Neurol 19:87–90PubMed DiTaranto P, Campagna L, Price AE, Grossman JA (2004) Outcome following nonoperative treatment of brachial plexus birth injuries. J Child Neurol 19:87–90PubMed
12.
go back to reference Dumont CE, Forin V, Asfazadourian H, Romana C (2001) Function of the upper limb after surgery for obstetric brachial plexus palsy. J Bone Joint Surg Br Vol 83:894–900CrossRef Dumont CE, Forin V, Asfazadourian H, Romana C (2001) Function of the upper limb after surgery for obstetric brachial plexus palsy. J Bone Joint Surg Br Vol 83:894–900CrossRef
13.
go back to reference El-Gammal TA, Abdel-Latif MM, Kotb MM, El-Sayed A, Ragheb YF, Saleh WR, Geith MA, Abdel-Ghaffar HS (2008) Intercostal nerve transfer in infants with obstetric brachial plexus palsy. Microsurgery 28:499–504. doi:10.1002/micr.20545 CrossRefPubMed El-Gammal TA, Abdel-Latif MM, Kotb MM, El-Sayed A, Ragheb YF, Saleh WR, Geith MA, Abdel-Ghaffar HS (2008) Intercostal nerve transfer in infants with obstetric brachial plexus palsy. Microsurgery 28:499–504. doi:10.​1002/​micr.​20545 CrossRefPubMed
14.
go back to reference El-Gammal TA, El-Sayed A, Kotb MM, Ragheb YF, Saleh WR, Elnakeeb RM, El-Sayed Semaya A (2010) Total obstetric brachial plexus palsy: results and strategy of microsurgical reconstruction. Microsurgery 30:169–178. doi:10.1002/micr.20726 CrossRefPubMed El-Gammal TA, El-Sayed A, Kotb MM, Ragheb YF, Saleh WR, Elnakeeb RM, El-Sayed Semaya A (2010) Total obstetric brachial plexus palsy: results and strategy of microsurgical reconstruction. Microsurgery 30:169–178. doi:10.​1002/​micr.​20726 CrossRefPubMed
18.
go back to reference Gosk J, Rutowski R, Urban M, Wiacek R, Mazurek P (2011) Our experience with surgical treatment of perinatal brachial plexus palsy—results in different types of lesions. Ortopedia, Traumatologia, Rehabilitacja 13:457–468CrossRefPubMed Gosk J, Rutowski R, Urban M, Wiacek R, Mazurek P (2011) Our experience with surgical treatment of perinatal brachial plexus palsy—results in different types of lesions. Ortopedia, Traumatologia, Rehabilitacja 13:457–468CrossRefPubMed
19.
go back to reference Greenwald AG, Schute PC, Shiveley JL (1984) Brachial plexus birth palsy: a 10-year report on the incidence and prognosis. J Pediatr Orthop 4:689–692CrossRefPubMed Greenwald AG, Schute PC, Shiveley JL (1984) Brachial plexus birth palsy: a 10-year report on the incidence and prognosis. J Pediatr Orthop 4:689–692CrossRefPubMed
21.
go back to reference Hoeksma AF, ter Steeg AM, Nelissen RG, van Ouwerkerk WJ, Lankhorst GJ, de Jong BA (2004) Neurological recovery in obstetric brachial plexus injuries: an historical cohort study. Dev Med Child Neurol 46:76–83CrossRefPubMed Hoeksma AF, ter Steeg AM, Nelissen RG, van Ouwerkerk WJ, Lankhorst GJ, de Jong BA (2004) Neurological recovery in obstetric brachial plexus injuries: an historical cohort study. Dev Med Child Neurol 46:76–83CrossRefPubMed
22.
go back to reference Jerome JT (2012) Anterior deltopectoral approach for axillary nerve neurotisation. J Orthop Surg (Hong Kong) 20:66–70 Jerome JT (2012) Anterior deltopectoral approach for axillary nerve neurotisation. J Orthop Surg (Hong Kong) 20:66–70
24.
go back to reference Kawai H, Akita S (2004) Shoulder muscle reconstruction in the upper type of the brachial plexus injury by partial radial nerve transfer to the axillary nerve. Tech Hand Up Extrem Surg 8:51–55CrossRefPubMed Kawai H, Akita S (2004) Shoulder muscle reconstruction in the upper type of the brachial plexus injury by partial radial nerve transfer to the axillary nerve. Tech Hand Up Extrem Surg 8:51–55CrossRefPubMed
25.
go back to reference Kirjavainen M, Remes V, Peltonen J, Kinnunen P, Poyhia T, Telaranta T, Alanen M, Helenius I, Nietosvaara Y (2007) Long-term results of surgery for brachial plexus birth palsy. J Bone Joint Surg Am Vol 89:18–26. doi:10.2106/JBJS.E.00430 CrossRef Kirjavainen M, Remes V, Peltonen J, Kinnunen P, Poyhia T, Telaranta T, Alanen M, Helenius I, Nietosvaara Y (2007) Long-term results of surgery for brachial plexus birth palsy. J Bone Joint Surg Am Vol 89:18–26. doi:10.​2106/​JBJS.​E.​00430 CrossRef
26.
27.
go back to reference Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P (2003) Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases. J Hand Surg 28:633–638CrossRef Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P (2003) Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases. J Hand Surg 28:633–638CrossRef
31.
go back to reference Little KJ, Zlotolow DA, Soldado F, Cornwall R, Kozin SH (2014) Early functional recovery of elbow flexion and supination following median and/or ulnar nerve fascicle transfer in upper neonatal brachial plexus palsy. J Bone Joint Surg Am Vol 96:215–221. doi:10.2106/JBJS.L.01405 CrossRef Little KJ, Zlotolow DA, Soldado F, Cornwall R, Kozin SH (2014) Early functional recovery of elbow flexion and supination following median and/or ulnar nerve fascicle transfer in upper neonatal brachial plexus palsy. J Bone Joint Surg Am Vol 96:215–221. doi:10.​2106/​JBJS.​L.​01405 CrossRef
34.
go back to reference McNeely PD, Drake JM (2003) A systematic review of brachial plexus surgery for birth-related brachial plexus injury. Pediatric Neurosurg 38:57–62CrossRef McNeely PD, Drake JM (2003) A systematic review of brachial plexus surgery for birth-related brachial plexus injury. Pediatric Neurosurg 38:57–62CrossRef
35.
go back to reference Michelow BJ, Clarke HM, Curtis CG, Zuker RM, Seifu Y, Andrews DF (1994) The natural history of obstetrical brachial plexus palsy. Plast Reconstr Surg 93:675–680 discussion 681CrossRefPubMed Michelow BJ, Clarke HM, Curtis CG, Zuker RM, Seifu Y, Andrews DF (1994) The natural history of obstetrical brachial plexus palsy. Plast Reconstr Surg 93:675–680 discussion 681CrossRefPubMed
36.
go back to reference Narakas AO (1987) Injuries of the brachial plexus and neighboring peripheral nerves in vertebral fractures and other trauma of the cervical spine. Der Orthopade 16:81–86PubMed Narakas AO (1987) Injuries of the brachial plexus and neighboring peripheral nerves in vertebral fractures and other trauma of the cervical spine. Der Orthopade 16:81–86PubMed
37.
go back to reference Noaman HH, Shiha AE, Bahm J (2004) Oberlin’s ulnar nerve transfer to the biceps motor nerve in obstetric brachial plexus palsy: indications, and good and bad results. Microsurgery 24:182–187. doi:10.1002/micr.20037 CrossRefPubMed Noaman HH, Shiha AE, Bahm J (2004) Oberlin’s ulnar nerve transfer to the biceps motor nerve in obstetric brachial plexus palsy: indications, and good and bad results. Microsurgery 24:182–187. doi:10.​1002/​micr.​20037 CrossRefPubMed
38.
go back to reference Noetzel MJ, Park TS, Robinson S, Kaufman B (2001) Prospective study of recovery following neonatal brachial plexus injury. J Child Neurol 16:488–492CrossRefPubMed Noetzel MJ, Park TS, Robinson S, Kaufman B (2001) Prospective study of recovery following neonatal brachial plexus injury. J Child Neurol 16:488–492CrossRefPubMed
41.
go back to reference Pondaag W, Malessy MJ, van Dijk JG, Thomeer RT (2004) Natural history of obstetric brachial plexus palsy: a systematic review. Dev Med Child Neurol 46:138–144CrossRefPubMed Pondaag W, Malessy MJ, van Dijk JG, Thomeer RT (2004) Natural history of obstetric brachial plexus palsy: a systematic review. Dev Med Child Neurol 46:138–144CrossRefPubMed
43.
go back to reference Sjoberg I, Erichs K, Bjerre I (1988) Cause and effect of obstetric (neonatal) brachial plexus palsy. Acta Paediatr Scand 77:357–364CrossRefPubMed Sjoberg I, Erichs K, Bjerre I (1988) Cause and effect of obstetric (neonatal) brachial plexus palsy. Acta Paediatr Scand 77:357–364CrossRefPubMed
44.
go back to reference Smith NC, Rowan P, Benson LJ, Ezaki M, Carter PR (2004) Neonatal brachial plexus palsy. Outcome of absent biceps function at three months of age. J Bone Joint Surg Am Vol 86-A:2163–2170 Smith NC, Rowan P, Benson LJ, Ezaki M, Carter PR (2004) Neonatal brachial plexus palsy. Outcome of absent biceps function at three months of age. J Bone Joint Surg Am Vol 86-A:2163–2170
45.
go back to reference Strombeck C, Krumlinde-Sundholm L, Forssberg H (2000) Functional outcome at 5 years in children with obstetrical brachial plexus palsy with and without microsurgical reconstruction. Dev Med Child Neurol 42:148–157CrossRefPubMed Strombeck C, Krumlinde-Sundholm L, Forssberg H (2000) Functional outcome at 5 years in children with obstetrical brachial plexus palsy with and without microsurgical reconstruction. Dev Med Child Neurol 42:148–157CrossRefPubMed
49.
51.
go back to reference Vekris MD, Lykissas MG, Beris AE, Manoudis G, Vekris AD, Soucacos PN (2008) Management of obstetrical brachial plexus palsy with early plexus microreconstruction and late muscle transfers. Microsurgery 28:252–261. doi:10.1002/micr.20493 CrossRefPubMed Vekris MD, Lykissas MG, Beris AE, Manoudis G, Vekris AD, Soucacos PN (2008) Management of obstetrical brachial plexus palsy with early plexus microreconstruction and late muscle transfers. Microsurgery 28:252–261. doi:10.​1002/​micr.​20493 CrossRefPubMed
52.
go back to reference Waters PM (1997) Obstetric brachial plexus injuries: evaluation and management. J Am Acad Orthop Surg 5:205–214CrossRefPubMed Waters PM (1997) Obstetric brachial plexus injuries: evaluation and management. J Am Acad Orthop Surg 5:205–214CrossRefPubMed
53.
go back to reference Waters PM (1999) Comparison of the natural history, the outcome of microsurgical repair, and the outcome of operative reconstruction in brachial plexus birth palsy. J Bone Joint Surg Am Vol 81:649–659 Waters PM (1999) Comparison of the natural history, the outcome of microsurgical repair, and the outcome of operative reconstruction in brachial plexus birth palsy. J Bone Joint Surg Am Vol 81:649–659
54.
go back to reference Wellons JC, Tubbs RS, Pugh JA, Bradley NJ, Law CR, Grabb PA (2009) Medial pectoral nerve to musculocutaneous nerve neurotization for the treatment of persistent birth-related brachial plexus palsy: an 11-year institutional experience. J Neurosurg Pediatr 3:348–353. doi:10.3171/2008.11.PEDS08166 CrossRefPubMed Wellons JC, Tubbs RS, Pugh JA, Bradley NJ, Law CR, Grabb PA (2009) Medial pectoral nerve to musculocutaneous nerve neurotization for the treatment of persistent birth-related brachial plexus palsy: an 11-year institutional experience. J Neurosurg Pediatr 3:348–353. doi:10.​3171/​2008.​11.​PEDS08166 CrossRefPubMed
55.
go back to reference Witoonchart K, Leechavengvongs S, Uerpairojkit C, Thuvasethakul P, Wongnopsuwan V (2003) Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part I: an anatomic feasibility study. J Hand Surg 28:628–632CrossRef Witoonchart K, Leechavengvongs S, Uerpairojkit C, Thuvasethakul P, Wongnopsuwan V (2003) Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part I: an anatomic feasibility study. J Hand Surg 28:628–632CrossRef
58.
go back to reference Zuckerman SL, Eli IM, Shah MN, Bradley N, Stutz CM, Park TS, Wellons JC 3rd (2014) Radial to axillary nerve neurotization for brachial plexus injury in children: a combined case series. J Neurosurg Pediatr 14:518–526. doi:10.3171/2014.7.PEDS13435 CrossRefPubMed Zuckerman SL, Eli IM, Shah MN, Bradley N, Stutz CM, Park TS, Wellons JC 3rd (2014) Radial to axillary nerve neurotization for brachial plexus injury in children: a combined case series. J Neurosurg Pediatr 14:518–526. doi:10.​3171/​2014.​7.​PEDS13435 CrossRefPubMed
Metadata
Title
Functional outcomes of infants with Narakas grade 1 birth-related brachial plexus palsy undergoing neurotization compared with infants who did not require surgery
Authors
Scott L. Zuckerman
Laura A. Allen
Camille Broome
Nadine Bradley
Charlie Law
Chevis Shannon
John C. Wellons III
Publication date
01-05-2016
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 5/2016
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-016-3039-9

Other articles of this Issue 5/2016

Child's Nervous System 5/2016 Go to the issue