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1.
Hand (N Y) ; 19(6): 961-966, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39166705

RESUMEN

INTRODUCTION: Our study aims to characterize the results of Monteggia fractures treated in our practice and to determine factors associated with good or poor outcomes. METHODS: A retrospective review of children aged 17 and under with acute, subacute, or chronic Monteggia fractures who were treated at our institution was performed. The primary outcomes were initial reduction and maintenance of joint reduction, while the secondary outcomes were elbow flexion/extension and forearm supination/pronation. RESULTS: Seventeen patients with Monteggia fractures were identified. Two patients were excluded: 1 was lost to follow-up and 1 had congenital absence of the elbow flexors. Thus, our final cohort was 15 patients (acute n = 3, subacute n = 4, chronic group n = 8). Median final follow-up was 1.9 years (range = 34 days-8 years). CONCLUSION: Preoperative range of motion (ROM) was the most important factor in determining postoperative ROM in this cohort of patients with chronic Monteggia fractures. All patients who presented with excellent preoperative ROM, regardless of their timing category, had an excellent ROM outcome. Time from initial injury also played an important role. All patients in the acute and subacute categories had good or excellent postoperative ROM. Patients who were further from the initial injury were more likely to present with worse preoperative ROM and, in turn, had worse outcomes with postoperative ROM.


Asunto(s)
Articulación del Codo , Fractura de Monteggia , Rango del Movimiento Articular , Humanos , Fractura de Monteggia/cirugía , Fractura de Monteggia/fisiopatología , Masculino , Estudios Retrospectivos , Femenino , Niño , Rango del Movimiento Articular/fisiología , Adolescente , Enfermedad Crónica , Articulación del Codo/cirugía , Articulación del Codo/fisiopatología , Preescolar , Supinación/fisiología , Resultado del Tratamiento , Enfermedad Aguda , Pronación/fisiología , Fijación Interna de Fracturas/métodos , Estudios de Seguimiento
2.
Artículo en Inglés | MEDLINE | ID: mdl-39151671

RESUMEN

BACKGROUND: Tendon transfers are often utilized to improve shoulder external rotation and abduction in children with brachial plexus birth injuries and are designed to improve glenohumeral (GH) joint motion. However, changes in scapulothoracic (ST) and glenohumeral (GH) joint function after tendon transfer are not well defined. The purpose of this study was to quantify changes in GH, ST, and humerothoracic (HT) joint function before and after tendon transfer, and we hypothesized that tendon transfers would reorient the arc of motion into more external rotation and abduction, but not increase GH motion. METHODS: Motion analysis was performed in 15 children (ages 3-16) before and after transfer of teres major and/or latissimus dorsi. Scapulothoracic, GH, and HT joint angles were measured in a neutral, resting position and each of the modified Mallet positions. Joint angular displacements from the neutral position and the total arc of internal-external rotation for each joint were also calculated. Relevant joint angles, joint angular displacements, and internal-external rotation arcs were compared using multivariate analyses of variance with repeated measures and univariate post-hoc analyses. RESULTS: Glenohumeral and HT external rotation were significantly increased in all positions postoperatively. The arc of GH internal-external rotation was unchanged, but oriented in more external rotation after surgery. Only 6 patients gained active external rotation. Glenohumeral and HT internal rotation were significantly decreased after surgery, but ST internal rotation was significantly increased. Two patients had loss of midline function. In the abduction position, GH elevation joint angles were unchanged, but ST and HT elevation increased. DISCUSSION: Only four patients gained active GH external rotation and maintained their internal rotation. Each of those patients underwent isolated tendon transfer without concomitant joint release. Seven patients maintained their preoperative internal rotation, which was attributed to increased ST internal rotation. The other half of patients lost internal rotation and gained external rotation through reorientation of the arc of rotation. Nine patients gained HT elevation, with three attributed to increased ST upward rotation, five attributed to a combination of increased ST upward rotation and increased GH elevation, and one attributed to increased GH abduction contracture. These findings challenge the dogma that teres major/latissimus dorsi tendon transfers augment GH motion and highlight the importance of ST function for outcome determination.

3.
J Hand Surg Am ; 2024 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-39066760

RESUMEN

PURPOSE: Lack of shoulder external rotation is common in children with brachial plexus birth injuries. Development of glenohumeral (GH) dysplasia is associated with progressive loss of passive external rotation. Some authors recommend measuring external rotation with the arm adducted, whereas others recommend measurement with the arm in 90° of abduction. The purpose of this study was to compare active and passive external rotation and internal rotation measured in adduction versus abduction. METHODS: Fifteen children with brachial plexus birth injuries held their affected arms in maximal external and internal rotation with the arm adducted and the arm at approximately 90° of abduction. Active and passive rotations were measured with three-dimensional motion capture. Scapulothoracic (ST) internal/external rotation and GH internal/external rotation joint angles were calculated and compared using multivariable, one-way repeated measures analyses of variance. RESULTS: There were no significant differences for active or passive ST rotation in external rotation in adduction versus abduction. Glenohumeral external rotation was significantly increased with the arm in abduction compared with adduction both actively and passively. There were no differences in ST rotation in active versus passive conditions, but all GH rotations were significantly greater passively. CONCLUSIONS: Shoulder internal/external rotation in abduction and adduction is not interchangeable. Comprehensive assessment of shoulder external and internal rotation should include both adduction and abduction. CLINICAL RELEVANCE: For children with brachial plexus birth injuries, both active and passive GH external rotations were greater in abduction. Therefore, early GH joint dysplasia may be missed if GH external rotation is measured in abduction. Additionally, consistency in arm position is important for comparison over time. The entire ST rotation capacity was used to perform maximal internal and external rotation, but the entire passive GH range of motion was not actively used. This highlights an area for potential surgical intervention to improve motion.

4.
J Pediatr Orthop ; 2024 Jul 22.
Artículo en Inglés | MEDLINE | ID: mdl-39034600

RESUMEN

BACKGROUND: Brachial plexus birth injuries (BPBI) occur in up 0.4 to 4.6 per 1000 live births. Weakness about the shoulder and development of glenohumeral joint contractures are common sequalae of BPBI. Shoulder function in children with BPBI is frequently assessed using the modified Mallet classification to evaluate upper extremity motion deficits. The purpose of this study was to assess the accuracy of the abduction, external rotation, and hand-to-mouth Mallet classification scores in children with BPBI using motion capture. METHODS: A retrospective study of 107 children with BPBI who underwent motion capture assessment and Mallet scores on the same date were reviewed. Motion capture measurements were used to calculate humerothoracic elevation and external rotation joint angles in the abduction/hand-to-mouth and external rotation positions, respectively. The humerothoracic joint angles were converted to the corresponding Mallet scores. Discrepancies between the Mallet scores determined by clinicians and those determined by motion capture were assessed. RESULTS: For abduction, 24.3% of Mallet scores were misclassified during clinical examination. Of the misclassified scores, 22 were overestimated by 1 point and 4 were underestimated by 1 point compared with motion capture. For external rotation, 72.9% of Mallet scores were misclassified during clinical examination. Only 5 patients had an HT elevation that was less than 40 degrees, with 4 of them (80%) having a Mallet hand-to-mouth score of 4. There were no differences in proportion of patients with HT elevation less than 40 degrees who had a Mallet score of 4 or a Mallet score less than 4. CONCLUSIONS: There was better agreement in global abduction Mallet scores compared with external rotation and hand-to-mouth Mallet scores. This difference was likely due to the complex compensatory strategies that patients employ while performing external rotation and hand-to-mouth positions. The inaccuracy of the clinically determined Mallet scores is alarming given that they are frequently utilized to assist with surgical indications and are commonly used as outcome measures. LEVEL OF EVIDENCE: Level IV Case series.

5.
J Hand Surg Eur Vol ; 49(5): 645-648, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38488628

RESUMEN

The management of brachial plexus birth injuries (BPBI) remains controversial and ever evolving. In this article, studies are examined to provide further insight into the ongoing controversies and debates surrounding BPBI. The articles are diverse and examine the topics of aetiology, demographics, reliability versus accuracy of measurements and surgical management. The management of BPBI may differ depending on resources. Outcome measures may also vary depending on geography. Future research should focus on developing consensus-validated measures and reproducible surgical techniques. These can then guide further population-based research and provide guidelines to minimize the incidence of BPBI.


Asunto(s)
Traumatismos del Nacimiento , Plexo Braquial , Humanos , Plexo Braquial/lesiones , Recién Nacido , Neuropatías del Plexo Braquial/cirugía , Neuropatías del Plexo Braquial/etiología , Parálisis Neonatal del Plexo Braquial/cirugía
6.
J Hand Surg Am ; 49(2): 141-149, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38099877

RESUMEN

PURPOSE: Brachial plexus birth injury (BPBI) results in upper extremity (UE) movement limitations. Current assessments of UE function used to inform clinical decision-making only evaluate a limited set of static postures and/or movements and have been criticized for being insensitive to certain meaningful differences in function. Reachable workspace provides a numeric and visual assessment of global UE movement ability by quantifying the regions in space that patients can reach with their hands, and it can be collected using real-time feedback to elicit a best-effort acquisition of function. This study evaluated the ability of a real-time feedback reachable workspace tool to assess UE movement in BPBI. METHODS: Twenty-two children with BPBI participated. Reachable workspace data were collected with three-dimensional motion capture using real-time visual feedback to measure UE reaching ability in all regions surrounding the body. All outer, far-from-body points reached by the hand were recorded and analyzed by region. A two-way, within-subjects analysis of variance was used to assess interlimb differences in percentage workspace reached and median reach distance for each of the six regions. RESULTS: The affected limb had significantly less percentage workspace reached than the unaffected limb for all six regions (mean interlimb differences by region, 5.7%-38.6%). The affected limb had significantly less median reach distance than the unaffected limb for all six regions (mean interlimb differences by region, 3.1%-36.8%). CONCLUSIONS: The workspace approach was capable of detecting UE movement impairments of the BPBI-affected limb. The reported deficits in workspace on the affected limb correspond to common movement impairments in BPBI, such as limitations in shoulder elevation, external rotation, extension, and elbow extension. CLINICAL RELEVANCE: The real-time feedback reachable workspace tool is sufficiently robust for assessing UE movement impairments in children with BPBI.


Asunto(s)
Traumatismos del Nacimiento , Extremidad Superior , Niño , Humanos , Rango del Movimiento Articular , Mano , Movimiento
7.
J Hand Surg Eur Vol ; 48(11): 1116-1125, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37572317

RESUMEN

Madelung deformity remains a fascinating yet unresolved challenge. There is an increasing awareness for early diagnosis by healthcare providers with improvement in diagnostic modalities, however, the exact mechanisms for the development of the deformity have still to be clarified. While some corrective procedures have been described to effectively address an established deformity, the existing literature lacks clear and evidence-based treatment guidelines on how to proceed in daily practice. This review article aims to summarize the current best evidence on this topic, including particular areas of controversy and areas with need for future research.


Asunto(s)
Trastornos del Crecimiento , Osteocondrodisplasias , Humanos , Osteotomía/métodos , Ácido Dioctil Sulfosuccínico , Radio (Anatomía)
8.
Semin Plast Surg ; 37(2): 84, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-37503526
9.
Semin Plast Surg ; 37(2): 143-154, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-37503530

RESUMEN

The care of children with brachial plexus birth injuries (BPBI) is a complex multidisciplinary endeavor. At the Shriners Hospital for Children in Philadelphia, we have sought to elevate the quality of care delivered to patients through outcomes research and collaboration with colleagues around the world. Our approach to the management of this challenging pathology has evolved time and again. Here, we describe our current approach to patient assessment and operative management in patients with BPBI and its many sequelae.

10.
J Am Acad Orthop Surg ; 31(5): 221-228, 2023 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-36745692

RESUMEN

Individuals with C5 or C6 spinal cord injury (SCI) have paralysis of the triceps brachii, and the subsequent loss of elbow extension makes it impossible to reliably use their hands above shoulder level because of the inability to hold the elbow extended against gravity. For persons with cervical SCI, elbow extension can be restored with both tendon and nerve transfers. Elbow extension is necessary for dressing, eating, wheelchair locomotion, pressure relief maneuvers, independent transfers, and reaching objects above shoulder level. Deltoid-to-triceps and biceps-to-triceps tendon transfers have established efficacy and a longer history of use. Transfer of motor branches from the axillary nerve to triceps motor branches is new with no current published prospective studies but shows early promise. This review aims to highlight the amazing potential these procedures can have on the independence and quality of life for people with quadriplegia. Despite the immense benefit possible, fewer than 14% of eligible people with cervical SCI in the United States receive upper limb reconstructive surgery. Surgical timing is critical. A broader understanding and raised awareness of reconstructive options for elbow extension in people with quadriplegia will increase recognition of eligible patients and speed referral time to the appropriate practitioner.


Asunto(s)
Articulación del Codo , Traumatismos de la Médula Espinal , Humanos , Codo , Estudios Prospectivos , Calidad de Vida , Articulación del Codo/cirugía , Cuadriplejía/cirugía , Traumatismos de la Médula Espinal/complicaciones
11.
J Hand Surg Am ; 2023 Feb 09.
Artículo en Inglés | MEDLINE | ID: mdl-36774321

RESUMEN

PURPOSE: Surgical treatment of Madelung deformity can present challenges due to a need for multiplanar correction. Developing customized cutting guides for osteotomies may improve surgical outcomes by enhancing the surgeon's understanding and surgical correction. METHODS: All patients who underwent forearm osteotomies for Madelung deformity using computed tomography planning with 3-dimensional-printed customized cutting guides were retrospectively reviewed (n = 8). Seven patients underwent a double osteotomy of the radius, and 1 underwent a single osteotomy. RESULTS: Ulnar tilt was improved in all cases. Correction of deformity was significant on anteroposterior but not on lateral views. The mean preoperative and postoperative radial bow was measured in 2 planes, with an average preoperative bow of 32° (± 21°) on anteroposterior radiographs and 36° (± 17°) on lateral radiographs, and an average bow of 10° (± 6°) on anteroposterior radiographs and 7° (± 6°) on lateral films after surgery. The predicted radial bow was calculated to be 9.1° (± 8°). CONCLUSIONS: Three-dimensional planning allows predictable deformity correction across multiple but not all parameters. Future studies comparing clinical and radiographic outcomes of guided versus nonguided osteotomies are required to justify the additional expense and preoperative planning efforts. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.

12.
J Hand Surg Am ; 47(12): 1172-1179, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-36253198

RESUMEN

PURPOSE: We compared robotic-assisted scaphoid screw fixation to conventional technique in terms of accuracy, surgical times, radiation exposure, and clinical outcomes, including range of motion, grip strength, functional score, and complications. METHODS: This study was a registered, prospective, randomized, controlled trial. From May 2019 to December 2019, 1 surgeon performed 18 robotic-assisted and 18 conventional scaphoid screw fixations and these patients were eligible for participation in this study. Surgical time, including the time of the overall procedure, set-up time, and time for ideal guidewire placement, was recorded. The number of guidewire attempts also was recorded. All patients were evaluated clinically and radiographically at follow-up with respect to the severity of pain, wrist motion, grip strength, complications, and Mayo modified wrist score. RESULTS: The average set-up time and overall time of the procedure were longer in the robotic-assisted than in the conventional groups, while the mean guidewire insertion time and the mean guidewire attempts was less in the robotic-assisted group than that of the conventional group. The overall radiation exposure was lower in the robotic group. CONCLUSIONS: Robotic-assisted technique provided a useful tool to improve implantation accuracy and shorten radiation exposure. Additional cost and prolonged duration of surgery without evidence of improved clinical scores may limit widespread acceptance of this technique. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.


Asunto(s)
Fracturas Óseas , Traumatismos de la Mano , Procedimientos Quirúrgicos Robotizados , Hueso Escafoides , Traumatismos de la Muñeca , Humanos , Hueso Escafoides/diagnóstico por imagen , Hueso Escafoides/cirugía , Hueso Escafoides/lesiones , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Estudios Prospectivos , Tornillos Óseos , Traumatismos de la Muñeca/diagnóstico por imagen , Traumatismos de la Muñeca/cirugía , Fijación Interna de Fracturas/métodos
13.
J Hand Surg Am ; 47(11): 1108-1114, 2022 11.
Artículo en Inglés | MEDLINE | ID: mdl-36207227

RESUMEN

Adolescence is a difficult time, both physically and emotionally. Rapid growth coupled with physical changes in the background of high levels of activity can be overwhelming. Meanwhile, unfamiliar life stressors coupled with undeveloped compensatory mechanisms can lead to overwhelming anxiety and emotional distress. Emotional factors can make injuries and overuse syndromes feel more catastrophic. Occasionally, an adolescent's emotional distress can manifest physically, without antecedent injury or physiologic cause. Understanding the psychological milieu is as important as understanding the disease processes that can affect adolescents if one hopes to manage these patients effectively.


Asunto(s)
Trastornos de Traumas Acumulados , Muñeca , Adolescente , Humanos , Ansiedad , Artralgia
14.
Pediatr Neurol ; 136: 35-42, 2022 11.
Artículo en Inglés | MEDLINE | ID: mdl-36084421

RESUMEN

BACKGROUND: Publications regarding the epidemiology and management of brachial plexus birth injury (BPBI) were evaluated to investigate treatment guidelines for children with BPBI. METHODS: A search of neurology literature from 1990 to 2019 was performed using PubMed, Scopus, and Medline. Data including incidence, risk factors, spontaneous recovery rates, imaging studies, treatment recommendations, and indications and timing for surgery were collected. RESULTS: A total of 46 total studies were reviewed. Reported incidence rates for BPBI ranged from 0.3 to 3 per 1000 births. Spontaneous recovery rates had an average reported range from 66% to 75%. Physical and occupational therapy were recommended in 37% of articles. Computed tomographic myelogram and magnetic resonance imaging of the brachial plexus were the most commonly recommended imaging studies for BPBI. Timelines for surgical interventions ranged from age three to nine months. Early referral was recommended in 28% of the articles included in the review. CONCLUSIONS: Given the inconsistencies in spontaneous recovery rates, imaging recommendations, and timing of referral, establishing consistent clinical guidelines for patients with BPBI is crucial for management. Early referral to specialists for evaluation and treatment may improve outcomes in children with BPBI.


Asunto(s)
Traumatismos del Nacimiento , Neuropatías del Plexo Braquial , Plexo Braquial , Neurología , Traumatismos del Nacimiento/diagnóstico por imagen , Traumatismos del Nacimiento/epidemiología , Plexo Braquial/diagnóstico por imagen , Neuropatías del Plexo Braquial/diagnóstico , Neuropatías del Plexo Braquial/epidemiología , Neuropatías del Plexo Braquial/etiología , Niño , Humanos , Incidencia , Lactante
15.
Gait Posture ; 98: 17-23, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-36030706

RESUMEN

BACKGROUND: Challenges in measuring dynamic scapular orientation limit assessment of scapulothoracic and glenohumeral contributions to shoulder function in children with brachial plexus birth injury (BPBI). Double calibration acromion marker cluster (D-AMC) and linear model approaches have been validated to estimate scapular motion in healthy adults, but neither has been evaluated in BPBI. RESEARCH QUESTION: Are the linear model and D-AMC approaches able to accurately estimate scapular orientation in children with BPBI at functional arm postures? METHODS: Seventeen children with BPBI positioned their affected limbs in 11 static positions while their segment orientations were measured with motion capture. Linear model and D-AMC estimates of scapular orientation were compared against palpation at six of the static positions with functional relevance to BPBI using a three-way repeat measures ANOVA and a comparison of root mean square errors (RMSE) against literature AMC values for healthy adults. RESULTS: The D-AMC was similar to palpation across all positions and scapular axes while the linear model differed from palpation in a few instances. RMSEs of the D-AMC (3.7-14.8°) and particularly the linear model (4.6-24.8°) were generally at or beyond the upper range of past AMC analyses on healthy adults (1.6-14.2°), especially for more complex, multiplanar arm postures. Despite the D-AMC outperforming the linear model, this approach still produced clinically meaningful (>10°) errors for roughly (12.7-22.5%) of subjects. SIGNIFICANCE: Current methods for estimating dynamic scapular orientation remain less than ideal for BPBI. Use of the D-AMC may be appropriate to gain broad insights into general dynamic scapulothoracic and glenohumeral function; however, given their potential for producing clinically meaningful errors, the D-AMC and linear model are not recommended for diagnostic purposes or outcomes assessment on an individual patient basis unless their patient-specific accuracy has been evaluated and confirmed prior to use.


Asunto(s)
Traumatismos del Nacimiento , Plexo Braquial , Articulación del Hombro , Niño , Adulto , Humanos , Rango del Movimiento Articular , Fenómenos Biomecánicos , Escápula , Plexo Braquial/lesiones , Traumatismos del Nacimiento/complicaciones , Traumatismos del Nacimiento/diagnóstico
16.
J Pediatr Orthop ; 42(8): 443-450, 2022 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-35878417

RESUMEN

BACKGROUND: Brachial plexus birth injuries (BPBI) can result in lasting impairments of external rotation and cross-body adduction (CBA) that disrupt functional activities such as dressing, grooming, or throwing a ball. The purpose of this study was to compare the quantification of shoulder humerothoracic (HT) external rotation (ER), and glenohumeral (GH) CBA by 3 methods - physician visual estimate, goniometer measurement by an occupational therapist, and motion capture. METHODS: Twenty-six patients with BPBI (average age of 9.9±3.2 y) participated in this study. Mallet scores and visual estimates of passive HT ER and GH CBA were recorded by a physician. The passive measures were repeated by an occupational therapist using a goniometer while motion capture measures were simultaneously collected. Active HT ER was also measured by motion capture. The passive measures were compared with analyses of variance with repeated measures, intraclass correlations, and Bland-Altman plots. External rotation Mallet scores determined by motion capture and by the physician were compared. RESULTS: The measures of GH CBA were not statistically different and demonstrated good agreement, but substantial variation. For HT ER, all measures were significantly different and demonstrated poor agreement and substantial variation. When the joint angles measured by motion capture were used to determine the Mallet score, 79% of external rotation Mallet scores assigned by the physician were incorrectly categorized, with the physician always scoring the participant higher than predicted motion capture Mallet score. CONCLUSIONS: Both GH CBA and HT ER measures demonstrated substantial variability between measurement types, but only HT ER joint angles were significantly different. In addition, more than three-quarters of external rotation Mallet scores were misclassified by the physician. Motion capture measurements offer the benefit of less susceptibility to patients' compensatory and/or out-of-plane movements and should be considered for clinical assessment of shoulder range of motion in children with BPBI. If motion capture is unavailable, the use of a goniometer provides more accurate clinical measures of shoulder motion than visual estimates and care should be taken to minimize and account for compensatory movement strategies. LEVEL OF EVIDENCE: Level IV Case series.


Asunto(s)
Neuropatías del Plexo Braquial , Plexo Braquial , Articulación del Hombro , Adolescente , Plexo Braquial/lesiones , Niño , Humanos , Rango del Movimiento Articular , Hombro
17.
J Biomech ; 132: 110939, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-34998183

RESUMEN

Clinical upper extremity (UE) functional assessments and motion capture measures are limited to a set of postures and/or motions that may provide an incomplete evaluation of UE functionality. Reachable workspace analysis offers a more global assessment of UE function, but is reliant on patient compliance with instructions and may result in underestimates of a patient's true UE function. This study evaluated a clinical tool that incorporates real-time visual feedback with motion capture to provide an innovative means of engaging patients to ensure a 'best effort' quantification of their available UE workspace. Reachable workspace for 10 children with brachial plexus birth injury was collected with and without real-time feedback on the affected and unaffected limbs. Real-time feedback consisted of subjects reaching for virtual targets surrounding their physical space using a virtual cursor controlled by the real-time location of their hand. Real-time feedback resulted in significantly greater workspace in multiple regions on both the affected (3/6 octants; mean differences 10.8%-20.0%) and unaffected (6/6 octants; mean differences 24.3%-40.0%) limbs. Use of real-time feedback also yielded significant interlimb differences in workspace across more regions (4/6 octants; mean differences 29.0%-39.9% vs. 1/6 octants; mean difference 17%). Finally, real-time feedback resulted in significant interlimb differences in median reach distance across more regions (4/6 octants; mean differences 7.5%-44.8% vs. 1/6 octants; mean difference 11.2%). A reachable workspace tool with real-time feedback results in more workspace and UE function recorded and offers a highly visual and intuitive depiction of a patient's UE abilities.


Asunto(s)
Traumatismos del Nacimiento , Plexo Braquial , Niño , Retroalimentación , Humanos , Rango del Movimiento Articular , Extremidad Superior
18.
Hand (N Y) ; 17(1): 55-59, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-32188298

RESUMEN

Background: Tendon transfers are commonly performed in patients with brachial plexus birth palsy (BPBP) to improve function. Transferring 2 tendons in patients with C5-7 injury has the potential complication of loss of midline function. The purpose of this study was to investigate whether a single tendon transfer (1TT) as opposed to the traditional double tendon transfer (2TT) resulted in any differences in functional outcomes in patients with C5-7 BPBP. Methods: A retrospective review of all patients with C5-7 BPBP who underwent tendon transfers to improve shoulder external rotation over a 5-year period was performed at 2 institutions. Outcomes were assessed using the modified Mallet (MM) classification scores. Results: Twenty-two C5-7 patients had complete records of preoperative and postoperative MM scores, including 11 sex-matched patients in both the 1TT and 2TT groups. When comparing preoperative and postoperative MM categories, there were significant improvements in both the 1TT and 2TT groups for global abduction (P < .05 and P < .01, respectively) and external rotation (P < .00001 for both). Modified Mallet (MM) hand to neck scores were significantly improved in the 2TT group (P < .05) but not in the 1TT group (P = .053). Internal rotation scores significantly decreased in both groups (P < .001). Both groups demonstrated significant increases in total scores from the preoperative MM scores (P < .01). Conclusion: The 1TT and 2TT procedures result in substantial gains in upper extremity functions for patients with C5-7 BPBP as measured by the MM score, specifically within the global abduction and external rotation subcategories. However, a significant loss occurs in internal rotation for both groups.


Asunto(s)
Traumatismos del Nacimiento , Plexo Braquial , Articulación del Hombro , Traumatismos del Nacimiento/complicaciones , Plexo Braquial/lesiones , Humanos , Parálisis , Rango del Movimiento Articular , Hombro , Articulación del Hombro/cirugía , Transferencia Tendinosa/métodos
19.
J Hand Ther ; 35(1): 51-57, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-33308927

RESUMEN

INTRODUCTION: This study aims to assess the relationship between the modified Mallet classification and the Brachial Plexus Profile activity short form (BP-PRO activity SF). The therapist or surgeon classifies upper extremity movement for the modified Mallet classification, while the BP-PRO assesses parents' perceptions of difficulty performing activities. PURPOSE: To provide a deeper understanding of the relationship of functional and perceived outcome measurements. STUDY DESIGN: Prospective, correlational design. METHODS: Eighty children with brachial plexus birth injuries were evaluated using the modified Mallet classification, while parents simultaneously answered the BP-PRO activity SF questions. All patients had undergone one of three surgical interventions to improve shoulder function. The relationship between the two measures, patient injury levels, and surgical histories were assessed. RESULTS: The average modified Mallet scores and BP-PRO activity SF scores weakly correlated (r = 0.312, P = .005) and both measures differentiated between C5-6 and C5-7 injury levels (P = .03 and P = .02, respectively). Conversely, the modified Mallet scores could differentiate between the three surgical groups (F = 8.2, P < .001), while the BP-PRO activity SF could not (P = .54). CONCLUSION: The results suggest that these tools measure different aspects of patient outcomes. The Mallet classification may be more focused on shoulder motion than the BP-PRO activity SF. Additional questions that specifically require shoulder function could be incorporated into the BP-PRO activity SF to improve understanding of patient/parent perceptions of shoulder function for children with brachial plexus injuries. Clinicians should be aware of the strengths, weaknesses, and limitations of each outcome assessment tool for appropriate use and interpretation of results.


Asunto(s)
Traumatismos del Nacimiento , Neuropatías del Plexo Braquial , Plexo Braquial , Articulación del Hombro , Plexo Braquial/lesiones , Neuropatías del Plexo Braquial/cirugía , Niño , Humanos , Estudios Prospectivos , Rango del Movimiento Articular , Resultado del Tratamiento
20.
J Hand Ther ; 35(4): 670-677, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-33947614

RESUMEN

BACKGROUND: Holt-Oram syndrome (HOS) is a rare, genetic condition characterized by the combination of congenital heart defect and hypoplasia in one or both upper extremities. Children with HOS commonly present with varied joint and limb involvement including radial longitudinal deficiency impacting hand function. Evidence-based guidelines regarding orthotic wear and therapeutic techniques are lacking. PURPOSE: The aim of this case report was to present the results of a long-term occupational therapy program for a patient with HOS pre and postpollicization. STUDY DESIGN: Case report. METHODS: A 4-month-old patient with bilateral radial longitudinal deficiencies began outpatient occupational therapy for custom orthosis fabrication and treatment which included long term clinic and home-based intervention. Techniques included passive range of motion, orthosis wear, therapeutic taping, and modified constraint induced movement therapy. Longitudinal assessment of musculoskeletal alignment and functional hand use was performed using goniometry for passive and active range of motion, the Assisting Hand Assessment (AHA), and The Thumb Grasp and Pinch Assessment (T-GAP). RESULTS: Improvement in passive and active range of motion was achieved as well as improved activity level function as measured by the AHA and T-GAP postpollicization and intervention. CONCLUSIONS: A combined clinic and home-based therapeutic approach can be effective for children with HOS to improve alignment and function pre and postpollicization to further enhance hand function. Comprehensive, long-term assessment is necessary to fully evaluate and communicate improvement.


Asunto(s)
Anomalías Múltiples , Cardiopatías Congénitas , Defectos del Tabique Interatrial , Deformidades Congénitas de las Extremidades Superiores , Humanos , Niño , Lactante , Defectos del Tabique Interatrial/genética , Cardiopatías Congénitas/genética , Deformidades Congénitas de las Extremidades Superiores/terapia
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