Upper limb kinematics after Latissimus Dorsi transfer in children with brachial plexus birth palsy
Nathalie Maurel1, Amadou Diop1, Pauline Lallemant-Dudek2
1Arts et Metiers Institute of Technology, EPBRO, HESAM Université, 151 Boulevard de l'Hôpital, F-75013 Paris, France.
Insights
Latissimus dorsi tendon transfer surgery improved upper limb joint motion in children with brachial plexus birth palsy. Kinematic analysis revealed improvements in specific movements, correlating with clinical outcomes.
Area of Science:
- Orthopedic surgery
- Pediatric rehabilitation
- Biomechanics
Background:
- Brachial plexus birth palsy is a common condition requiring surgical intervention.
- Latissimus dorsi tendon transfer to the infraspinatus is a recognized treatment.
- The study investigates the 3D kinematic effects of this surgical procedure.
Purpose of the Study:
- To analyze the three-dimensional kinematic effects of latissimus dorsi tendon transfer on upper limb joints.
- To correlate these kinematic changes with clinical parameters in patients with brachial plexus birth palsy.
- To evaluate the efficacy of the procedure using a novel Index of Improvement.
Main Methods:
- Electromagnetic device used for kinematic analysis of upper limb joints.
- Development of an Index of Improvement based on pre- and post-operative angles and a control group.
- Analysis of three patient groups: reproducibility (16), control (30), and operated (10).
Main Results:
- Improved humerothoracic and glenohumeral external rotations during specific Mallet tasks (external rotation, neck, abduction).
- Worsened glenohumeral external rotation during the spine and mouth tasks.
- Improved humerothoracic abduction and elbow flexion in certain tasks, with observed patient-specific differences and correlations with the Index of Improvement.
Conclusions:
- Three-dimensional kinematic analysis effectively evaluates joint angle evolution post-latissimus dorsi transfer.
- The Index of Improvement provides a rapid assessment of surgical effects per patient and angle.
- The functional outcome of the latissimus dorsi transfer is influenced by clinical parameters.
Background:
Brachial plexus birth palsy remains a frequent condition and one of its treatments is to transfer the Latissimus Dorsi tendon to the infraspinatus muscle. The aim of this study was to analyse, for the first time, the three-dimensional kinematic effects of this operation on the upper limb joints during the five Mallet tasks and their correlation with clinical parameters.
Methods:
Kinematic analysis was performed using an electromagnetic device. An Index of Improvement taking into account the angle in preop and postop, the reproducibility and the angle of a control group was developed. Three groups of patients were analysed: sixteen patients (mean: 10,5 years) for the reproducibility, thirty children (mean: 9,5 years) for the control group and ten patients (mean: 8 years 7 months) who were operated.
Findings:
The humerothoracic and glenohumeral external rotations improved during the external rotation, the neck and the abduction tasks and worsened during the spine task. The glenohumeral external rotation worsened during the mouth task. The Humerothoracic abduction improved during the abduction and the neck tasks. The elbow flexion improved for the neck task. Differences were observed between patients and correlations were obtained between the Index of Improvement and clinical parameters.
Interpretation:
Using kinematics allows to better analyse the evolution of joint angles after the latissimus dorsi transfer. The Index of Improvement allows to quickly analyse the effect of the operation for each angle and each patient. This effect depends on clinical parameters.
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