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Long-term results of surgery for brachial plexus birth palsy
Mikko Kirjavainen1, Ville Remes, Jari Peltonen
1Department of Orthopaedics and Traumatology, Hospital for Children and Adolescents, Helsinki University Central Hospital, PL 266, 0029 HUS, Finland. mikko.kirjavainen@hus.fi
Insights
Surgical treatment for brachial plexus birth palsy offers moderate outcomes, with many patients experiencing persistent pain and needing assistance with daily activities. The extent of the initial injury significantly impacts long-term function.
Area of Science:
- Pediatric Surgery
- Neurology
- Orthopedics
Background:
- Long-term outcomes of surgical interventions for brachial plexus birth palsy (BPBP) remain underreported.
- This nationwide study in Finland investigates the results of BPBP surgery with a minimum five-year follow-up.
Purpose of the Study:
- To evaluate the long-term functional outcomes and patient satisfaction following surgical treatment of brachial plexus birth palsy.
- To identify prognostic factors influencing the results of BPBP surgery.
Main Methods:
- A cohort of 124 patients who underwent brachial plexus surgery between 1971 and 1997 were followed up.
- Follow-up included clinical and radiographic assessments after a mean of 13.3 years, alongside questionnaires on activities of daily living.
Main Results:
- Two-thirds of patients reported satisfaction, but one-third required assistance with daily living.
- Pain affected one-third of patients, often linked to clavicular nonunion; shoulder function was moderate, while elbow and hand function were good.
- Glenohumeral and radiohumeral joint incongruence were observed in 16% and 21% of assessed patients, respectively.
Conclusions:
- Surgical treatment for BPBP can lead to persistent needs for assistance and pain, with clavicular nonunion being a notable cause of pain.
- The severity of the initial brachial plexus injury is the most significant predictor of surgical outcomes.
Background:
The long-term results of surgical treatment of brachial plexus birth palsy have not been reported. We present the findings of a nationwide study, with a minimum five-year follow-up, of the outcomes of surgery for brachial plexus birth palsy in Finland.
Methods:
Of 1,717,057 newborns, 1706 with brachial plexus birth palsy requiring hospital treatment were registered in Finland between 1971 and 1997. Of these patients, 124 (7.3%) underwent surgery on the brachial plexus at a mean age of 2.8 months (range, 0.4 to 13.2 months). The most commonly performed surgical procedure was direct neurorrhaphy after neuroma resection. One hundred and twelve patients (90%) returned for a clinical and radiographic follow-up examination after a mean of 13.3 years. Activities of daily living were recorded on a questionnaire, and the affected limb was assessed with use of joint-specific functional measures.
Results:
Two-thirds (63%) of the patients were satisfied with the functional outcome, although one-third of all patients needed help in activities of daily living. One-third of the patients, including all nine with a clavicular nonunion from the surgical approach, experienced pain in the affected limb. All except four patients used the hand of the unaffected limb as the dominant hand. Shoulder function was moderate, with a mean Mallet score of 3.0. Both elbow and hand function were good, with a mean score on the Gilbert elbow scale of 3 and a mean Raimondi hand score of 4. Incongruence of the glenohumeral joint was noted in sixteen (16%) of the ninety-nine patients in whom it was assessed, and incongruence of the radiohumeral joint was noted in twenty-one (21%). The extent of the brachial plexus injury was found to be strongly associated with the final shoulder, elbow, and hand function in a multivariate analysis.
Conclusions:
Following surgical treatment of brachial plexus birth palsy, substantial numbers of the patients continued to need help performing activities of daily living and had pain in the affected limb, with the pain due to a clavicular nonunion in one-fourth of the patients. The strongest prognostic factor predicting outcome appears to be the extent of the primary plexus injury.
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