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Functional outcome at 5 years in children with obstetrical brachial plexus palsy with and without microsurgical
C Strömbeck1, L Krumlinde-Sundholm, H Forssberg
1Department of Neuropediatrics, Astrid Lindgren Children's Hospital, Karolinska Hospital, Stockholm, Sweden.
Insights
Early surgery for obstetrical brachial plexus palsies (OBPP) did not improve outcomes for most children. Waiting for late recovery showed better results for shoulder movement in some cases, suggesting a conservative approach for OBPP management.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Obstetrical brachial plexus palsies (OBPP) affect newborns, potentially leading to long-term functional deficits.
- Surgical intervention timing and necessity for OBPP remain debated among specialists.
- Previous studies have yielded conflicting results regarding the efficacy of early surgical reconstruction.
Purpose of the Study:
- To evaluate the long-term sensory and motor function in children with OBPP at 5 years of age.
- To determine the impact of nerve reconstruction surgery on functional outcomes.
- To identify factors influencing recovery, such as lesion severity and timing of intervention.
Main Methods:
- Retrospective analysis of 247 children with OBPP examined at age 5.
- Classification of patients based on injured nerve distribution, early muscle activity (biceps/deltoid at 3 months), and surgical history.
- Assessment of shoulder range of motion, hand sensory and motor function, grip strength, and bimanual function.
Main Results:
- Operated children with C5-6 palsies showed significantly better shoulder range of movement compared to non-operated children.
- No significant differences in overall outcomes were observed between operated and non-operated groups for other parameters.
- Extensive lesions (C5-Th1) correlated with more root avulsions and decreased hand function.
- Outcome was not influenced by the number of root avulsions in upper-plexus palsies or the timing of surgery (before/after 6 months).
Conclusions:
- Early surgical intervention for OBPP did not consistently improve functional outcomes, except for shoulder movement in C5-6 palsies.
- The study suggests that waiting for late recovery may be beneficial, challenging the necessity of early surgery in cases with no initial biceps or deltoid muscle activity.
- Correlation between extensive lesions, root avulsions, and poorer hand function highlights the importance of lesion assessment in OBPP management.
Abstract:
Between 1987 and 1998, 470 patients visited the national clinic for obstetrical brachial plexus palsies at the Karolinska Hospital, Stockholm, Sweden. This study reports on 247 children examined at 5 years of age using a special protocol for testing the sensory and motor function of the hand. The children were distributed in various groups depending on the number of injured nerves, whether they had some muscle activity in their biceps or deltoid muscles at 3 months of age, and whether any operations with nerve reconstruction had been performed. The shoulder range of movement in C5-6 palsies was significantly better in the group which had been operated on (operated group), but otherwise there were no differences between children who had been operated on (non-operated group) and those who had not. A decrease in grip strength and bimanual function in level C5-6 palsies was found, though these roots should not innervate the distal hand. Outcome was not influenced by the number of avulsions in upper-plexus palsies or whether the operation took place before or after the age of 6 months. The group with extensive lesions (C5-Th1) had the most root avulsions, showing a correlation between increased avulsions and decreased hand function. This study does not support operating on children with no activity of the biceps and deltoid muscles at 3 months of age, as other authors have concluded. Rather, it favours waiting for a late recovery.