The results of decompression of the musculocutaneous nerve entrapment in children with obstetric brachial plexus palsy
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ORIGINAL ARTICLE
The results of decompression of the musculocutaneous nerve entrapment in children with obstetric brachial plexus palsy Tüzün Fırat 1
&
Kıvanç Delioğlu 1 & Yasin Tunç 1 & Akın Üzümcügil 2 & Mehmet Yörübulut 3 & Gürsel Leblebicioğlu 4
Received: 8 July 2020 / Accepted: 21 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Elbow flexion is a key indicator of functional recovery in obstetric brachial plexus palsy (OBPP). However, lack of flexion could be a result of an entrapped musculocutaneous nerve during the healing period. The purpose of this study was to investigate the possible compression of the musculocutaneous nerve and outcomes of decompression. Methods The study included 11 children aged with a mean age of 10.9 ± 2.7 months (range, 8–16 months) with Narakas 2 involvement OBPP, who had insufficient elbow flexion but had satisfactory shoulder abduction. Prior to surgery, magnetic resonance imaging (MRI) was performed to identify the entrapment. The children were evaluated pre-operatively and at 3 and 12 months postoperatively using the Active Movement Scale and Faradic Excitability Test. The musculocutaneous nerve was explored and decompressed in all the children. Regular physiotherapy and a home exercise programme were prescribed after surgery. Results The MRI findings were consistent with the surgical exploration in all the infants. Statistical analyses showed that decompression of the musculoskeletal nerve improved active movement scale scores on elbow flexion and faradic excitability test values of biceps brachii within 3 months after surgery. Conclusion Children with delayed elbow flexion and satisfactory shoulder abduction may have an entrapped musculocutaneous nerve in the proximal arm and decompression of the nerve improves elbow function. Keywords Obstetric brachial plexus palsy . Elbow flexion . Musculocutaneous nerve . Entrapment . Rehabilitation
Introduction Obstetric brachial plexus palsy (OBPP) is an injury that occurs due to traction and compression of several parts of the brachial plexus with an incidence of between 0.4 and 3 per 1000 live births [4, 7]. OBPP leads to disability due to pathological Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00381-020-04828-8) contains supplementary material, which is available to authorized users. * Tüzün Fırat [email protected]; [email protected] 1
Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altındağ, Ankara, Turkey
2
Faculty of Medicine, Department of Orthopaedics and Traumatology, Hacettepe University, Sıhhiye, Ankara, Turkey
3
Department of Radiology, Acıbadem Hospital, Çankaya, Ankara, Turkey
4
Hand Clinic, Rabindranath Tagore Street, Çankaya, Ankara, Turkey
changes in the skeletal muscles, in the joints and also affects cortical structures [1, 3]. Regular physiotherapy approaches and primary and secondary surgeries are employed to reduce the level of disability and increase function [4, 28]. Since its first
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