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Outcomes with suprascapular nerve reconstruction in obstetrical brachial plexus patients
Julia K Terzis1, Ioannis Kostas
1Norfolk, Va. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School and International Institute of Reconstructive Microsurgery.
Insights
Suprascapular nerve reconstruction effectively restores shoulder abduction in infants with obstetrical brachial plexus palsy. Early surgical intervention significantly improves functional outcomes for shoulder stability and movement.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Reconstructive Surgery
Background:
- Obstetrical brachial plexus palsy (OBPP) significantly impacts shoulder function.
- Restoration of shoulder abduction is crucial for functional recovery in OBPP.
- Suprascapular nerve reconstruction is a key surgical consideration for OBPP.
Observation:
- This study reviewed 53 cases of OBPP treated with suprascapular nerve reconstruction.
- Surgical interventions were performed between 1978 and 2002.
- Patient outcomes were assessed using muscle grading and Mallet scores.
Findings:
- Excellent results (96%) were observed for supraspinatus muscle function and good results (75%) for infraspinatus.
- Mean postoperative muscle grading was 3.71 for supraspinatus and 2.94 for infraspinatus.
- Early surgery (within 6 months) demonstrated superior outcomes compared to later interventions.
Implications:
- Suprascapular nerve neurotization is a valuable procedure for upper limb reanimation in OBPP.
- Combined axillary nerve neurotization enhances shoulder abduction.
- Optimal outcomes are associated with high injury severity, upper root involvement, and timely surgical repair.
Background:
Restoration of shoulder abduction is very important following obstetrical brachial plexus paralysis. The purpose of this report is to present the authors' experience of suprascapular nerve reconstruction in 53 cases of obstetrical brachial plexus palsy.
Methods:
From 1978 to 2002, 170 children with obstetrical brachial plexus palsy were seen at the authors' institution. One hundred nine children underwent surgical treatment, and 53 of them had suprascapular nerve reconstruction.
Results:
The overall results were good or excellent in 96 percent of patients for the supraspinatus muscle and 75 percent for the infraspinatus muscle. The overall mean postoperative muscle grading was 3.71 +/- 0.7 for the supraspinatus muscle and 2.94 +/- 0.8 for the infraspinatus muscle (p < 0.05). By using the Mallet score, 23 patients (46 percent) achieved Mallet grade III and 24 patients (48 percent) achieved Mallet grade IV shoulder abduction function. Evaluating external rotation function, 21 patients (42 percent) achieved Mallet grade III and 20 patients (40 percent) achieved Mallet grade IV. Early surgery (<6 months) yielded significantly better results than late surgery (>6 months).
Conclusions:
Suprascapular nerve neurotization is a worthwhile procedure and is a high priority in upper limb reanimation for restoration of glenohumeral joint stability, shoulder abduction, and external rotation. Concomitant neurotization of the axillary nerve yields improved outcomes in shoulder abduction function. The best results are seen in patients with high severity scores, when only the upper two roots are involved, and when direct neurotization of the suprascapular nerve is performed within 6 months after the injury.
