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Koshinski JL, Russo SA, Zlotolow DA. Brachial Plexus Birth Injury: A Review of Neurology Literature Assessing Variability and Current Recommendations. Pediatr Neurol 2022; 136:35-42. [PMID: 36084421 DOI: 10.1016/j.pediatrneurol.2022.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 10/31/2022]
Abstract
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.
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Affiliation(s)
| | - Stephanie A Russo
- Department of Orthopaedic Surgery, Akron Children's Hospital, Akron, Ohio.
| | - Dan A Zlotolow
- Department of Orthopaedic Surgery, Shriners Hospital for Children, Philadelphia, Pennsylvania; The Hospital for Special Surgery, New York, New York
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González-Mantilla P, Abril A, Bedoya MA. Brachial Plexus Birth Palsy: Practical Concepts for Radiologists. Semin Musculoskelet Radiol 2022; 26:182-193. [PMID: 35609579 DOI: 10.1055/s-0042-1742392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Brachial plexus birth palsy (BPBP) is classified as a preganglionic or postganglionic injury based on the site of injury. Most patients recover spontaneously and are followed up with clinical evaluation; however, permanent sequelae are not uncommon. For patients with persistent neurologic deficits, clinical and radiologic evaluation is crucial. Untreated BPBP can progress to significant sequelae, such as muscle contractures and glenohumeral dysplasia (GHD). Timely characterization of these entities based on different imaging modalities is a high priority for optimal patient outcomes. We describe the anatomy and pathogenesis, as well as the different imaging modalities involved in the evaluation and classification of BPBP and GHD.
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Affiliation(s)
| | - Angela Abril
- Geisinger Autism & Developmental Medicine Institute, Lewisburg, Pennsylvania
| | - Maria Alejandra Bedoya
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Cooper DM, Girolami GL, Kepes B, Stehli A, Lucas CT, Haddad F, Zalidvar F, Dror N, Ahmad I, Soliman A, Radom-Aizik S. Body composition and neuromotor development in the year after NICU discharge in premature infants. Pediatr Res 2020; 88:459-465. [PMID: 31926484 PMCID: PMC7351612 DOI: 10.1038/s41390-020-0756-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/27/2019] [Accepted: 01/01/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hypothesis: neuromotor development correlates to body composition over the first year of life in prematurely born infants and can be influenced by enhancing motor activity. METHODS Forty-six female and 53 male infants [27 ± 1.8 (sd) weeks] randomized to comparison or exercise group (caregiver provided 15-20 min daily of developmentally appropriate motor activities) completed the year-long study. Body composition [lean body and fat mass (LBM, FM)], growth/inflammation predictive biomarkers, and Alberta Infant Motor Scale (AIMS) were assessed. RESULTS AIMS at 1 year correlated with LBM (r = 0.32, p < 0.001) in the whole cohort. However, there was no effect of the intervention. LBM increased by ~3685 g (p < 0.001)); insulin-like growth factor-1 (IGF-1) was correlated with LBM (r = 0.36, p = 0.002). IL-1RA (an inflammatory biomarker) decreased (-75%, p < 0.0125). LBM and bone mineral density were significantly lower and IGF-1 higher in the females at 1 year. CONCLUSIONS We found an association between neuromotor development and LBM suggesting that motor activity may influence LBM. Our particular intervention was ineffective. Whether activities provided largely by caregivers to enhance motor activity in prematurely born infants can affect the interrelated (1) balance of growth and inflammation mediators, (2) neuromotor development, (3) sexual dimorphism, and/or (4) body composition early in life remains unknown.
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Affiliation(s)
- Dan M Cooper
- Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA, USA.
| | - Gay L Girolami
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Brenda Kepes
- Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA, USA
| | - Annamarie Stehli
- Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA, USA
| | - Candice Taylor Lucas
- Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA, USA
| | - Fadia Haddad
- Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA, USA
| | - Frank Zalidvar
- Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA, USA
| | - Nitzan Dror
- Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA, USA
| | - Irfan Ahmad
- Children's Hospital of Orange County, Orange, CA, USA
| | | | - Shlomit Radom-Aizik
- Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA, USA
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Hokkoku K, Matsukura K, Uchida Y, Kuwabara M, Furukawa Y, Tsukamoto H, Hatanaka Y, Sonoo M. Quantitative muscle ultrasound is useful for evaluating secondary axonal degeneration in chronic inflammatory demyelinating polyneuropathy. Brain Behav 2017; 7:e00812. [PMID: 29075571 PMCID: PMC5651395 DOI: 10.1002/brb3.812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/11/2017] [Accepted: 07/23/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION In chronic inflammatory demyelinating polyneuropathy (CIDP), exclusion of secondary axonal degeneration is challenging with conventional methods such as nerve conduction study (NCS), needle electromyography, and nerve biopsy. Increased echo intensity (EI) and decreased muscle thickness (MT) identified on muscle ultrasound (MUS) examination represent muscle denervation due to axonal degeneration in neurogenic disorders, suggesting MUS as a new tool to detect secondary axonal degeneration in patients with CIDP. METHODS EI and MT of abductor pollicis brevis, abductor digiti minimi, and first dorsal interosseous muscles were measured in 16 CIDP patients. Raw values were converted into z-scores using data from 60 normal controls (NCs). RESULTS Six of 45 muscles showed abnormally high EI and low MT, suggesting denervation following secondary axonal degeneration. These six muscles belonged to two patients with long disease history, unresponsiveness to treatment, and long interval from onset to initial therapy. There were no significant differences in EI and MT (p = .23 and .67, respectively) between the CIDP and NC groups, although NCS results revealed obvious demyelinating abnormalities in all CIDP patients, suggesting the fact that muscle structures will be preserved, and EI and MT will not change unless secondary axonal degeneration occurs in CIDP. CONCLUSION MUS is a promising tool for evaluating secondary axonal degeneration in patients with CIDP.
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Affiliation(s)
- Keiichi Hokkoku
- Department of Neurology Teikyo University School of Medicine Itabashi-ku Tokyo Japan
| | - Kiyoshi Matsukura
- Department of Neurology Teikyo University School of Medicine Itabashi-ku Tokyo Japan
| | - Yudai Uchida
- Department of Neurology Teikyo University School of Medicine Itabashi-ku Tokyo Japan
| | - Midori Kuwabara
- Department of Neurology Teikyo University School of Medicine Itabashi-ku Tokyo Japan
| | - Yuichi Furukawa
- Department of Neurology Teikyo University School of Medicine Itabashi-ku Tokyo Japan
| | - Hiroshi Tsukamoto
- Department of Neurology Teikyo University School of Medicine Itabashi-ku Tokyo Japan
| | - Yuki Hatanaka
- Department of Neurology Teikyo University School of Medicine Itabashi-ku Tokyo Japan
| | - Masahiro Sonoo
- Department of Neurology Teikyo University School of Medicine Itabashi-ku Tokyo Japan
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Willsey M, Wilson TJ, Henning PT, Yang LJS. Intraoperative Ultrasound for Peripheral Nerve Applications. Neurosurg Clin N Am 2017; 28:623-632. [PMID: 28917290 DOI: 10.1016/j.nec.2017.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Offering real-time, high-resolution images via intraoperative ultrasound is advantageous for a variety of peripheral nerve applications. To highlight the advantages of ultrasound, its extraoperative uses are reviewed. The current intraoperative uses, including nerve localization, real-time evaluation of peripheral nerve tumors, and implantation of leads for peripheral nerve stimulation, are reviewed. Although intraoperative peripheral nerve localization has been performed previously using guide wires and surgical dyes, the authors' approach using ultrasound-guided instrument clamps helps guide surgical dissection to the target nerve, which could lead to more timely operations and shorter incisions.
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Affiliation(s)
- Matthew Willsey
- Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive #2, Ann Arbor, MI 48109, USA
| | - Thomas J Wilson
- Department of Neurosurgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Phillip Troy Henning
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 East Eisenhower Parkway, Suite 100, Ann Arbor, MI 48108, USA.
| | - Lynda J-S Yang
- Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive #2, Ann Arbor, MI 48109, USA
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Somashekar DK, Wilson TJ, DiPietro MA, Joseph JR, Ibrahim M, Yang LJS, Parmar HA. The current role of diagnostic imaging in the preoperative workup for refractory neonatal brachial plexus palsy. Childs Nerv Syst 2016; 32:1393-7. [PMID: 27179536 DOI: 10.1007/s00381-016-3106-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 05/02/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Despite recent improvements in perinatal care, the incidence of neonatal brachial plexus palsy (NBPP) remains relatively common. CT myelography is currently considered to be the optimal imaging modality for evaluating nerve root integrity. Recent improvements in MRI techniques have made it an attractive alternative to evaluate nerve root avulsions (preganglionic injuries). AIM We demonstrate the utility of MRI for the evaluation of normal and avulsed spinal nerve roots. We also show the utility of ultrasound in providing useful preoperative evaluation of the postganglionic brachial plexus in patients with NBPP.
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Affiliation(s)
- Deepak K Somashekar
- Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Room B1-132A TC, Ann Arbor, MI, 48109-5302, USA
| | - Thomas J Wilson
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, 48109-5302, USA
| | - Michael A DiPietro
- Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Room B1-132A TC, Ann Arbor, MI, 48109-5302, USA
| | - Jacob R Joseph
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, 48109-5302, USA
| | - Mohannad Ibrahim
- Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Room B1-132A TC, Ann Arbor, MI, 48109-5302, USA
| | - Lynda J-S Yang
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, 48109-5302, USA
| | - Hemant A Parmar
- Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Room B1-132A TC, Ann Arbor, MI, 48109-5302, USA.
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Somashekar DK, Di Pietro MA, Joseph JR, Yang LJS, Parmar HA. Utility of ultrasound in noninvasive preoperative workup of neonatal brachial plexus palsy. Pediatr Radiol 2016; 46:695-703. [PMID: 26718200 DOI: 10.1007/s00247-015-3524-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ultrasound has been utilized in the evaluation of compressive and traumatic peripheral nerve pathology. OBJECTIVE To determine whether US can provide comprehensive evaluation of the post-ganglionic brachial plexus in the setting of neonatal brachial plexus palsy and whether this information can be used to guide preoperative nerve reconstruction strategies. MATERIALS AND METHODS In this retrospective cohort study, preoperative brachial plexus ultrasonography was performed in 52 children with neonatal brachial plexus palsy who were being considered for surgery. The 33 children who had surgery compose the patient cohort. The presence and location of post-ganglionic neuromas were evaluated by US and compared to the surgical findings. US evaluation of shoulder muscle atrophy was conducted as an indirect way to assess the integrity of nerves. Finally, we correlated glenohumeral joint laxity to surgical and clinical management. RESULTS Ultrasound correctly identified 21 of 25 cases of upper trunk and middle trunk neuroma involvement (84% sensitivity for each). It was 68% sensitive and 40% specific in detection of lower trunk involvement. US identified shoulder muscle atrophy in 11 of 21 children evaluated; 8 of these 11 went on to nerve transfer procedures based upon the imaging findings. US identified 3 cases of shoulder joint laxity of the 13 children evaluated. All 3 cases were referred for orthopedic evaluation, with 1 child undergoing shoulder surgery and another requiring casting. CONCLUSION Ultrasound can provide useful preoperative evaluation of the post-ganglionic brachial plexus in children with neonatal brachial plexus palsy.
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Affiliation(s)
- Deepak K Somashekar
- Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Department of Radiology, Section of Neuroradiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Michael A Di Pietro
- Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Jacob R Joseph
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Lynda J-S Yang
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Hemant A Parmar
- Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
- Department of Radiology, Section of Neuroradiology, University of Michigan Health System, Ann Arbor, MI, USA.
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Joseph JR, DiPietro MA, Somashekar D, Parmar HA, Yang LJS. Ultrasonography for neonatal brachial plexus palsy. J Neurosurg Pediatr 2014; 14:527-31. [PMID: 25216291 DOI: 10.3171/2014.7.peds14108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Ultrasonography has previously been reported for use in the evaluation of compressive or traumatic peripheral nerve pathology and for its utility in preoperative mapping. However, these studies were not performed in infants, and they were not focused on the brachial plexus. The authors report a case in which ultrasonography was used to improve operative management of neonatal brachial plexus palsy (NBPP). An infant boy was born at term, complicated by right-sided shoulder dystocia. Initial clinical evaluation revealed proximal arm weakness consistent with an upper trunk injury. Unlike MRI or CT myelography that focus on proximal nerve roots, ultrasonography of the brachial plexus in the supraclavicular fossa was able to demonstrate a small neuroma involving the upper trunk (C-5 and C-6) and no asymmetry in movement of the diaphragm or in the appearance of the rhomboid muscle when compared with the unaffected side. However, the supra- and infraspinatus muscles were significantly asymmetrical and atrophied on the affected side. Importantly, ultrasound examination of the shoulder revealed posterior glenohumeral laxity. Instead of pursuing the primary nerve reconstruction first, timely treatment of the shoulder subluxation prevented formation of joint dysplasia and formation of a false glenoid, which is a common sequela of this condition. Because the muscles innervated by proximal branches of the cervical nerve roots/trunks were radiographically normal, subsequent nerve transfers were performed and good functional results were achieved. The authors believe this to be the first report describing the utility of ultrasonography in the surgical treatment planning in a case of NBPP. Noninvasive imaging, in addition to thorough history and physical examination, reduces the intraoperative time required to determine the extent and severity of nerve injury by allowing improved preoperative planning of the surgical strategy. Inclusion of ultrasonography as a preoperative modality may yield improved outcomes for children with NBPP.
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