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Spinal Nerves: Plexus I

Spinal Nerves: Plexus I

Nerve plexuses are networks of interlacing nerves that serve as communication hubs to distribute and organize nerve action across various body regions. The nerve plexuses are organized into the cervical plexus located in the neck region, brachial plexus in the shoulder area, lumbar plexus found in the lower back, sacral plexus situated in the pelvis, and coccygeal plexus located in the coccygeal region.
The Cervical Plexus
The cervical plexus, formed by the anterior rami of the first four...

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Updated: Sep 21, 2025

Surface Electromyographic Biofeedback as a Rehabilitation Tool for Patients with Global Brachial Plexus Injury Receiving Bionic Reconstruction

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Can the Sup-ER Protocol Decrease the Prevalence and Severity of Elbow Flexion Deformity in Brachial Plexus Birth

Leeor Yefet¹, Doria Bellows², Marija Bucevska¹

¹The University of British Columbia, Vancouver, Canada.

Hand (New York, N.Y.)

|June 6, 2022

Summary

The Sup-ER protocol, designed for brachial plexus birth injuries (BPBIs), may unintentionally reduce elbow flexion contractures. This study found fewer contractures in children treated with the Sup-ER protocol compared to existing data.

Keywords:

brachial plexus diagnosis evaluation nerve outcomes pediatric research & health outcomes treatment

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Structured Motor Rehabilitation After Selective Nerve Transfers

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Published on: August 15, 2019

Area of Science:

Pediatric Orthopedics
Neuromuscular Disorders
Rehabilitation Medicine

Background:

Brachial plexus birth injuries (BPBIs) frequently cause functional deficits, including elbow flexion contractures in up to 48% of cases.
The Sup-ER protocol, utilizing a custom long-arm orthosis, is established for optimizing glenohumeral joint positioning in BPBI management.
This study explores the impact of the Sup-ER protocol on elbow flexion contractures, an outcome not directly targeted by the intervention.

Purpose of the Study:

To investigate the prevalence and severity of elbow flexion contractures in children with BPBI treated with the Sup-ER protocol.
To compare the incidence of elbow flexion contractures in this cohort against previously published data.

Main Methods:

A prospective cross-sectional cohort study was conducted on 16 children (age ≥ 4 years) with BPBI requiring the Sup-ER protocol.
Passive and active elbow range of motion (flexion and extension) were assessed bilaterally.
Elbow flexion contracture was defined as a passive extension deficit exceeding 5° from neutral.

Main Results:

The mean maximal passive elbow extension in the affected arm was -6.2°, with 6 out of 16 patients meeting the >5° contracture definition.
No patients exhibited severe elbow flexion contractures (>30°).
The mean age of onset for contractures in the affected group was 22 months.

Conclusions:

Treatment with the Sup-ER protocol appears to be associated with a reduced prevalence and severity of elbow flexion contractures in children with severe BPBI.
These findings suggest a potential secondary benefit of the Sup-ER protocol in managing elbow joint complications.
Further research is warranted to confirm these observations and elucidate the underlying mechanisms.