Triangle tilt surgery for treatment of obstetric brachial plexus injury

Record ID 32014000406
Authors' recommendations: Obstetric brachial plexus injury (OBPI) is a stretch injury to the nerves supplying the arm. It is associated with traumatic or difficult vaginal birth. The incidence is approximately 0.15% of live births in the United States. Most children heal spontaneously within the first few weeks or months of life, but persistent injuries may require surgical correction. OBPI commonly results in abnormalities in certain movements including abduction (moving the arm away from the body), external rotation (rotating the arm away from the midline), flexion (bending) of the elbow, and supination (turning the arm from a palm-down to a palm-up position). The scapula (shoulder blade) articulates with both the clavicle (collarbone) and the humerus (bone of the upper arm). Two superolateral bony processes of the scapula, the acromion and the coracoid processes, have ligamentous attachments to the lateral head of the clavicle. The glenoid fossa is a lateral concavity of the scapula that forms the scapular side of the joint between the scapula and the humerus. The brachial plexus lies inferior to the clavicle as it passes from the spinal cord in the lower neck to the axilla (underarm). The plexus is a network of motor and sensory nerves that carries all innervation to the upper extremity. Depending on the extent of injury to the plexus, the hand, arm, or shoulder may be affected by weakness and/or limited range of motion, impairing activities of daily living and the ability to participate in recreational activities. Although the shoulder joints are fully formed at birth, bones in children have greater plasticity than those of adults. Rapid limb growth, unbalanced weakness of muscles, immaturity of bone, and growth impairment caused by asymmetric neurological damage result in secondary bony deformities, instability of the glenohumeral joint with loss of function, and arthritis. However, early surgical repair may restore the natural position of the shoulder and allow remodeling of bone and return of function. The Mallet system is commonly used to assess patients with OBPI. It evaluates the ability to perform 5 movements: external rotation, abduction, hand-to-mouth, hand-to-lower spine, and hand-to-back of neck. Children > 2 years of age can follow the instructions for Mallet testing. The Nath modification of the Mallet system includes 2 additional assessments: the resting position of the arm and the ability to supinate.
Project Status: Completed
Year Published: 2013
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: United States
MeSH Terms
  • Humans
  • Brachial Plexus
  • Neurosurgical Procedures
Organisation Name: HAYES, Inc.
Contact Address: 157 S. Broad Street, Suite 200, Lansdale, PA 19446, USA. Tel: 215 855 0615; Fax: 215 855 5218
Contact Name:
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Copyright: 2013 Winifred S. Hayes, Inc
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