Abstract
Untreated adult obstetric brachial plexus injury (OBPI) patients, in general, use compensatory strategies to achieve their lost upper extremity functions; they cause some adverse effects. Our present study is a case series of 3 female adult OBPI patients, aged 46, 23 and 21 years old. They all had a modified Quad surgical procedure. All patients were assessed preoperatively and postoperatively by evaluating video recordings of standardized upper extremity movements using the modified Mallet scale. The average postoperative follow-up was 4.3 months (1 to 9 months). Total Mallet score significantly improved from 15 and 18 to 21 in two patients. Supination angle measured from active movement of these 3 patients improved from 40°, 0° and -60° to 80°, 40° and -40°, respectively. The modified Quad surgical procedure significantly improves active abduction and other shoulder functions not only in young pediatric and adolescent patients, as we have previously reported, but also in adult patients with muscle imbalance secondary to brachial plexus injury sustained at birth.
Highlights
IntroductionObstetric brachial plexus injury (OBPI) is the result of damage to the nerves during childbirth,[1,2] in some cases causing various hindrances to the correlating shoulder muscles.[2,3,4,5] The occurrence of OBPI varies from 0.9 to 5.8 per 1000 live births.[6,7,8,9,10] Due to the muscle imbalances created, sequential bony deformities occur in the joint.[2,11,12,13,14,15] Most frequently, the brachial plexus nerve roots, C56,16 in an infant with OBPI are stretched, and function will be restored naturally.[17]
It is seen that Obstetric brachial plexus injury (OBPI) effected individuals, whose nerve damage has not been repaired spontaneously, demonstrate an asymmetry that includes glenohumeral dysplasia, posterior dislocation or subluxation of the humeral head and contracture of internal rotators, which precedes substantial upper extremity motion loss and the function of the shoulder and abnormalities in elbow flexure.[2,15,19,20,21,22,23,24]
Soucacos et al.[41] reported that severe residual deformities, in general, appear in the affected upper extremity in untreated OBPI adults when compared to treated patients
Summary
Obstetric brachial plexus injury (OBPI) is the result of damage to the nerves during childbirth,[1,2] in some cases causing various hindrances to the correlating shoulder muscles.[2,3,4,5] The occurrence of OBPI varies from 0.9 to 5.8 per 1000 live births.[6,7,8,9,10] Due to the muscle imbalances created, sequential bony deformities occur in the joint.[2,11,12,13,14,15] Most frequently, the brachial plexus nerve roots, C56,16 in an infant with OBPI are stretched, and function will be restored naturally.[17]. A 21-year-old female patient with left OBPI, who had a total (C7-C8-T1) brachial plexus nerve injury (Table 1) She had shoulder dystocia and had finger movement at birth; no Horner’s Syndrome. She had limited hand to spine movement and limited ability to raise arms above head. She found difficulty in hand to mouth movement and was unable to place her affected hand to neck Her total Mallet score significantly improved from 15 to 21 after 4 months of mod Quad surgery (Table 2 and Figure 1). This patient had limited abduction movement and had difficulty in hand to mouth movement, 90° angle. There were noticeable improvements in the patient’s range of motion; especially her shoulder abduction improved after mod Quad surgery (Figure 3A, E)
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