Long-Term Hand and Shoulder Function in Children following Early Surgical Intervention for a Birth-Related Upper
Rachel N Aber1, Leslie A Grossman2, Aaron J Berger3
1Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Early nerve surgery for upper brachial plexus birth injuries leads to good shoulder function. However, hand function deficits persist in many children with Erb's palsy, requiring targeted therapy.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Upper brachial plexus birth injuries, often resulting from C5/C6 nerve damage, can lead to long-term functional deficits.
- Erb's palsy is a common consequence, affecting shoulder and hand function.
- Early surgical intervention is a standard approach for these injuries.
Purpose of the Study:
- To evaluate the long-term shoulder and hand functional outcomes in patients with upper brachial plexus birth injuries.
- To assess the effectiveness of early primary nerve surgery on functional recovery.
- To identify residual functional limitations requiring further intervention.
Main Methods:
- A cohort of 32 patients with a history of C5/C6 birth injury was evaluated.
- Shoulder function was assessed using the Miami Shoulder Scale.
- Hand function was measured using the 9-hole peg test (9-HPT) and compared to normative data.
Main Results:
- The majority of patients (23/32) demonstrated good or excellent shoulder function postoperatively.
- A significant number of patients (23/32) exhibited altered hand function on the 9-hole peg test.
- The average follow-up period was 15 years post-surgery.
Conclusions:
- Early nerve surgery for upper brachial plexus birth injuries yields favorable shoulder outcomes.
- Residual hand function deficits are common and necessitate ongoing, targeted therapy.
- Early identification of hand limitations is crucial for effective management of Erb's palsy.
Abstract:
Purpose To better understand the long-term hand and shoulder outcomes of upper brachial plexus birth injuries. Methods We evaluated shoulder and hand function in 32 patients (13 males; 19 females) with a C5/C6 birth injury history). All patients had undergone primary nerve surgery as infants, and 12 underwent a simultaneous shoulder procedure as they presented with a fixed internal rotation contracture of the shoulder. On average, all patients were evaluated and examined 15 years postoperatively. The shoulder function was evaluated using the Miami Shoulder Scale. Hand function was measured by the 9-hole peg test (9-HPT) and statistical analysis included comparison of 9-HPT time against normative data using the Student's t -test. Results The cohort includes 22 right-hand-dominant and 10 left-hand-dominant patients. Mean age at surgery was 10 months; mean age at follow-up was 15 years ± 2 years 2 months. Cumulative shoulder function was "good" or "excellent" (Miami score) in 23 patients. For 9-HPT, 23 out of 32 patients seen had an involved hand with a significant alteration in function. Conclusion Early nerve surgery in cases of upper brachial plexus birth injuries result in the desired outcome. To ensure timely and targeted therapy for any residual deficits, it is imperative that limitations in hand function among children with an Erb's palsy.
