Tendon Lengthening Surgery for Elbow Flexion Contractures in Brachial Plexus Birth Palsy
Javier Gutierrez-Pereira1, Antonio Garcia-Lopez1
1Department of Orthopaedic Surgery, Hospital General Universitario de Alicante, Spanish National Reference Center for Brachial Plexus Surgery, Alicante, Spain.
Insights
Surgical release using partial tenotomy of the brachialis and biceps brachii muscles effectively treats severe elbow flexion contractures in brachial plexus birth palsy patients. This procedure provides significant, sustained gains in elbow extension without major complications.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Brachial Plexus Injury Management
Background:
- Elbow flexion contracture is a common complication of brachial plexus birth palsy.
- Severe contractures often necessitate surgical intervention beyond conservative orthotic management.
Purpose of the Study:
- To evaluate the efficacy of surgical elbow release for contractures exceeding 30° in brachial plexus birth palsy.
- The study focused on partial tenotomy of brachialis and biceps brachii muscles with lacertus fibrosus division.
Main Methods:
- Conducted anterior elbow releases on 36 patients with C5-C6 brachial plexus injuries and 30°-80° flexion contractures.
- Procedures included lacertus fibrosus section and partial brachialis tendon lengthening; biceps tenotomy was used in severe cases.
- Minimum 12-month follow-up with pre-operative elbow flexion strength grade 4+ and no joint deformities.
Main Results:
- Achieved an average elbow extension gain of 31° after a mean follow-up of 41 months.
- Flexion strength was maintained in all patients, and extension gains were sustained.
- No major or minor complications or reinterventions were reported.
Conclusions:
- Partial tenotomy of brachialis and biceps brachii muscles combined with lacertus fibrosus section is effective for elbow contractures >30°.
- Successful outcomes were observed in patients with functioning triceps and adequate pre-operative extension strength.
Purpose:
Flexion contracture of the elbow is a common deformity associated with brachial plexus birth palsy and is often managed with preventive night orthoses. For severe cases, however, surgical interventions may become necessary. This study evaluated the effectiveness of surgically releasing elbow flexion contractures exceeding 30° through partial tenotomy of the brachialis and biceps brachii muscles, along with a division of the lacertus fibrosus.
Methods:
We performed 36 anterior elbow releases on patients with injury to the upper trunk (C5-C6) of the brachial plexus and elbow flexion contractures between 30° and 80°. All releases involved lacertus fibrosus section and partial lengthening of the distal portion of the brachialis tendon. In severe cases, biceps brachii tenotomy was also performed. All participants had a minimum follow-up of 12 months and preoperative elbow flexion strength of at least grade 4 on the British Medical Research Council scale, with no deformities in the shape of the ulnohumeral joint or radial head subluxation.
Results:
Following a mean follow-up of 41 months, the average extension gain was 31° (range, 10°-50°). All patients maintained their flexion strength. Except for two participants with weaker triceps, the mean elbow extension gain was sustained throughout the follow-up period. There were no major or minor complications or reinterventions in the study.
Conclusions:
Partial tenotomy of the brachialis and biceps brachii muscles, coupled with lacertus fibrosus section, is an effective treatment for elbow contractures exceeding 30° flexion. This method is successful in individuals with a functioning triceps brachii and elbow extension strength of at least grade 3 on the British Medical Research Council scale.
Type Of Study/Level Of Evidence:
Therapeutic IV.
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