Abstract
Background The trapezius muscle is often utilized as a muscle or nerve donor for repairing shoulder function in those with brachial plexus birth palsy (BPBP). To evaluate the native role of the trapezius in the affected limb, we demonstrate use of the Motion Browser, a novel visual analytics system to assess an adolescent with BPBP. Method An 18-year-old female with extended upper trunk (C5–6–7) BPBP underwent bilateral upper extremity three-dimensional motion analysis with Motion Browser. Surface electromyography (EMG) from eight muscles in each limb which was recorded during six upper extremity movements, distinguishing between upper trapezius (UT) and lower trapezius (LT). The Motion Browser calculated active range of motion (AROM), compiled the EMG data into measures of muscle activity, and displayed the results in charts. Results All movements, excluding shoulder abduction, had similar AROM in affected and unaffected limbs. In the unaffected limb, LT was more active in proximal movements of shoulder abduction, and shoulder external and internal rotations. In the affected limb, LT was more active in distal movements of forearm pronation and supination; UT was more active in shoulder abduction. Conclusion In this female with BPBP, Motion Browser demonstrated that the native LT in the affected limb contributed to distal movements. Her results suggest that sacrificing her trapezius as a muscle or nerve donor may affect her distal functionality. Clinicians should exercise caution when considering nerve transfers in children with BPBP and consider individualized assessment of functionality before pursuing surgery.
Highlights
MethodsFor brachial plexus surgeons, there are few areas more intriguing than the dynamics of how children with brachial plexus birth palsy (BPBP) use their affected arm.[1,2,3] Functionality of the affected arm is not well understood because the injury occurs in the perinatal period and the disease transforms as the child grows
To evaluate the native role of the trapezius in the affected limb, we demonstrate use of the Motion Browser, a novel visual analytics system to assess an adolescent with BPBP
lower trapezius (LT) was more active in distal movements of forearm pronation and supination; upper trapezius (UT) was more active in shoulder abduction
Summary
MethodsFor brachial plexus surgeons, there are few areas more intriguing than the dynamics of how children with brachial plexus birth palsy (BPBP) use their affected arm.[1,2,3] Functionality of the affected arm is not well understood because the injury occurs in the perinatal period and the disease transforms as the child grows. One interesting question in children with BPBP is whether the upper or lower trapezius (UT and LT, respectively) muscles are functionally active during upper extremity use. It is intriguing because there are three ways in which an innervated trapezius can be utilized in children with BPBP, leaving it in situ, denervation and use of the trapezius’ spinal accessory nerve (SAN) for distal nerve transfers, or using it directly as a muscle transfer.[5,6,7] The prevailing surgical technique of treating BPBP addresses a compromised suprascapular nerve through a posterior approach of transferring the lower portion of the SAN which innervates the LT and leaving innervation of the UT intact.[8,9]. The Motion Browser calculated active range of motion (AROM), compiled the EMG data into measures of muscle activity, and displayed the results in charts
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