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van der Laan TMJ, Postema SG, van Bodegom JM, Postema K, Dijkstra PU, van der Sluis CK. Prevalence and factors associated with musculoskeletal complaints and disability in individuals with brachial plexus injury: a cross-sectional study. Disabil Rehabil 2023; 45:2936-2945. [PMID: 36149019 DOI: 10.1080/09638288.2022.2117426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE (1) To determine the prevalence of musculoskeletal complaints (MSCs) in the non-affected bodily structures in individuals with brachial plexus injury (BPI) and (2) to analyse factors associated with MSCs and disability. METHODS Survey among individuals with BPI and a control group. Multivariable logistic and linear regression analyses were used to identify factors associated with MSCs or disability. RESULTS Forty-nine percent of individuals (34/70) with BPI experienced MSC, which was not significantly different from controls (35%, n = 40/113). Complaints were most often located in high back (OR = 3.6) or non-affected limb (OR = 2.2) or neck (OR = 2.1). Greater disability was associated with the presence of MSC in individuals with BPI (OR = 1.1, 95% confidence interval (95% CI) = 1.0; 1.1). Those with no or a low level of education (B = -10.2, 95% CI = -19.6; -1.4), a history of nerve surgery (B = 11.1, 95% CI = -0.2; 20.9), and moderately affected active range of motion (AROM) of the affected limb (B = 20.7, 95% CI = 8.8; 31.0) experienced most disability. Individuals with severely affected AROM showed a wide range of experienced disability. CONCLUSIONS Clinicians should be aware that almost half of individuals with BPI have MSCs in the non-affected bodily structures, which was associated with increased disability.Implications for rehabilitationMusculoskeletal complaints of the non-affected limb, back and neck are common among individuals with brachial plexus injury, and are associated with more disability.Disability was associated with loss of active range of motion (AROM) in the affected limb, although there was a wide variation in experienced disability among individuals with no or a very limited AROM.
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Affiliation(s)
- Tallie M J van der Laan
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sietke G Postema
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jeroen M van Bodegom
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Klaas Postema
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Corry K van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Restoration of Grasp after Single-Stage Free Functioning Gracilis Muscle Transfer in Traumatic Adult Pan-Brachial Plexus Injury. Plast Reconstr Surg 2023; 151:133-142. [PMID: 36219863 DOI: 10.1097/prs.0000000000009787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND A variety of approaches have been described to obtain rudimentary grasp after traumatic pan-brachial plexus injury in adults. The aim of this study is to evaluate hand prehension after a gracilis single-stage free functioning muscle transfer. METHODS Twenty-seven patients who underwent gracilis single-stage free functioning muscle transfer for elbow flexion and hand prehension after a pan-plexus injury were included. All patients presented with a minimum of 2 years of follow-up. Postoperative finger flexion, elbow flexion strength, preoperative and postoperative Disability of the Arm, Shoulder, and Hand questionnaire scores, secondary hand procedures, complications, and demographic characteristics were analyzed. RESULTS Twenty patients (74%) demonstrated active finger pull-through. Only six patients (25%) considered their hand function useful for daily activities. Disability of the Arm, Shoulder, and Hand score improved by 13.1 ± 13.7 ( P < 0.005). All patients were expected to require one secondary procedure (wrist fusion, thumb carpometacarpal fusion, and/or thumb interphalangeal fusion) because no extensor reconstruction was performed. These were performed in 89%, 78%, and 74% of patients, respectively. Four postoperative complications (hematoma, seroma, wound dehiscence, and skin paddle loss) occurred. No flap loss occurred. CONCLUSIONS In pan-plexus injuries, the use of a gracilis single-stage free functioning muscle transfer is an alternative to the double free functioning muscle transfer procedure and contralateral C7 transfer, especially for patients who are unable to undergo two to three important operations in a short period of time. Further research and studies are required to improve hand function in these patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Shin AY, Bishop AT, Loosbroch MF, Spinner RJ. A multidisciplinary approach to the management of brachial plexus injuries: experience from the Mayo Clinic over 100 years. J Hand Surg Eur Vol 2022; 47:1103-1113. [PMID: 35833214 DOI: 10.1177/17531934221110733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A multidisciplinary brachial plexus clinic has been a relatively new concept, offering different surgical speciality perspectives on the treatment of brachial plexus injuries. The resulting collaborative effort has proven to be greater than the sum of its parts. In this review, the history, philosophy of care, development/implementation and impact of a creation of a multidisciplinary brachial plexus team at the Mayo Clinic are detailed.
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Affiliation(s)
- Alexander Y Shin
- Department of Orthopedic Surgery, Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Allen T Bishop
- Department of Orthopedic Surgery, Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle F Loosbroch
- Department of Orthopedic Surgery, Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert J Spinner
- Department of Orthopedic Surgery, Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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Lustosa L, Silva AEL, Carvalho RDP, Vargas CD. Upper limb joint coordination preserves hand kinematics after a traumatic brachial plexus injury. Front Hum Neurosci 2022; 16:944638. [PMID: 36277047 PMCID: PMC9583840 DOI: 10.3389/fnhum.2022.944638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTraumatic brachial plexus injury (TBPI) causes a sensorimotor deficit in upper limb (UL) movements.ObjectiveOur aim was to investigate the arm–forearm coordination of both the injured and uninjured UL of TBPI subjects.MethodsTBPI participants (n = 13) and controls (n = 10) matched in age, gender, and anthropometric characteristics were recruited. Kinematics from the shoulder, elbow, wrist, and index finger markers were collected, while upstanding participants transported a cup to their mouth and returned the UL to a starting position. The UL coordination was measured through the relative phase (RP) between arm and forearm phase angles and analyzed as a function of the hand kinematics.ResultsFor all participants, the hand transport had a shorter time to peak velocity (p < 0.01) compared to the return. Also, for the control and the uninjured TBPI UL, the RP showed a coordination pattern that favored forearm movements in the peak velocity of the transport phase (p < 0.001). TBPI participants' injured UL showed a longer movement duration in comparison to controls (p < 0.05), but no differences in peak velocity, time to peak velocity, and trajectory length, indicating preserved hand kinematics. The RP of the injured UL revealed altered coordination in favor of arm movements compared to controls and the uninjured UL (p < 0.001). Finally, TBPI participants' uninjured UL showed altered control of arm and forearm phase angles during the deceleration of hand movements compared to controls (p < 0.05).ConclusionThese results suggest that UL coordination is reorganized after a TBPI so as to preserve hand kinematics.
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Affiliation(s)
- Luiggi Lustosa
- Laboratório de Neurobiologia do Movimento, Instituto de Biofísica Carlos Chagas Filho – Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Núcleo de Pesquisa em Neurociências e Reabilitação, Instituto de Neurologia Deolindo Couto – Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Elisa Lemos Silva
- Núcleo de Pesquisa em Neurociências e Reabilitação, Instituto de Neurologia Deolindo Couto – Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raquel de Paula Carvalho
- Departamento de Ciências do Movimento Humano, Instituto Saúde e Sociedade, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Claudia D. Vargas
- Laboratório de Neurobiologia do Movimento, Instituto de Biofísica Carlos Chagas Filho – Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Núcleo de Pesquisa em Neurociências e Reabilitação, Instituto de Neurologia Deolindo Couto – Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- *Correspondence: Claudia D. Vargas
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Souza L, Lustosa L, Silva AEL, Martins JV, Pozzo T, Vargas CD. Kinematic Changes in the Uninjured Limb After a Traumatic Brachial Plexus Injury. Front Hum Neurosci 2021; 15:777776. [PMID: 34955793 PMCID: PMC8696281 DOI: 10.3389/fnhum.2021.777776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/18/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Traumatic brachial plexus injury (TBPI) typically causes sensory, motor and autonomic deficits of the affected upper limb. Recent studies have suggested that a unilateral TBPI can also affect the cortical representations associated to the uninjured limb. Objective: To investigate the kinematic features of the uninjured upper limb in participants with TBPI. Methods: Eleven participants with unilateral TBPI and twelve healthy controls matched in gender, age and anthropometric characteristics were recruited. Kinematic parameters collected from the index finger marker were measured while participants performed a free-endpoint whole-body reaching task and a cup-to-mouth task with the uninjured upper limb in a standing position. Results: For the whole-body reaching task, lower time to peak velocity (p = 0.01), lower peak of velocity (p = 0.003), greater movement duration (p = 0.04) and shorter trajectory length (p = 0.01) were observed in the TBPI group compared to the control group. For the cup-to-mouth task, only a lower time to peak velocity was found for the TBPI group compared to the control group (p = 0.02). Interestingly, no differences between groups were observed for the finger endpoint height parameter in either of the tasks. Taken together, these results suggest that TBPI leads to a higher cost for motor planning when it comes to movements of the uninjured limb as compared to healthy participants. This cost is even higher in a task with a greater postural balance challenge. Conclusion: This study expands the current knowledge on bilateral sensorimotor alterations after unilateral TBPI and should guide rehabilitation after a peripheral injury.
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Affiliation(s)
- Lidiane Souza
- Laboratório de Neurobiologia do Movimento, Instituto de Biofísica Carlos Chagas Filho - Universidade Federal Rio de Janeiro, Rio de Janeiro, Brazil.,Núcleo de Pesquisa em Neurociências e Reabilitação, Instituto de Neurologia Deolindo Couto - Universidade Federal Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luiggi Lustosa
- Laboratório de Neurobiologia do Movimento, Instituto de Biofísica Carlos Chagas Filho - Universidade Federal Rio de Janeiro, Rio de Janeiro, Brazil.,Núcleo de Pesquisa em Neurociências e Reabilitação, Instituto de Neurologia Deolindo Couto - Universidade Federal Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Elisa Lemos Silva
- Núcleo de Pesquisa em Neurociências e Reabilitação, Instituto de Neurologia Deolindo Couto - Universidade Federal Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Vicente Martins
- Núcleo de Pesquisa em Neurociências e Reabilitação, Instituto de Neurologia Deolindo Couto - Universidade Federal Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thierry Pozzo
- INSERM UMR 1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon, France
| | - Claudia D Vargas
- Laboratório de Neurobiologia do Movimento, Instituto de Biofísica Carlos Chagas Filho - Universidade Federal Rio de Janeiro, Rio de Janeiro, Brazil.,Núcleo de Pesquisa em Neurociências e Reabilitação, Instituto de Neurologia Deolindo Couto - Universidade Federal Rio de Janeiro, Rio de Janeiro, Brazil
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Gonçalves DHM, de Oliveira AS, Freire LC, Silva ABM, Garbelotti SA, Lucareli PRG. Three-dimensional kinematic analysis of upper limb movements between individuals with and without subacromial shoulder pain exploring the statistical parametric mapping. J Biomech 2021; 129:110806. [PMID: 34666249 DOI: 10.1016/j.jbiomech.2021.110806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/27/2022]
Abstract
Subacromial shoulder pain (SSP) accounts for 44-65% of all cases of shoulder pain. Kinematic alterations in the upper limbs have been observed in individuals with SSP, although there is no consensus on such alterations in the literature. Therefore, the present study aimed to compare the three-dimensional kinematics of the scapula, trunk, and arm during shoulder flexion-extension and abduction-adduction movements in individuals with SSP and a control group using statistical parametric mapping (SPM). We evaluated 117 participants [61 with SSP and 56 in the control group (CG)]. The three-dimensional kinematic analysis was performed starting from arm extension/adduction (0%), moving to flexion/abduction, and ending returning to extension/adduction, respectively (100%) in both groups. SSP group flexed more their trunk (0-100%, p < 0.001) and rotated scapula internally (0-20%, p < 0.001 and 75-100%, p < 0.001); rotated upwards (17-32%, p < 0.005 and 58-87%, p < 0.003) and posteriorly tilted (28-79%,p < 0.001 and 81-95%,p < 0.006) less than CG group during arm abduction-adduction. Through arm flexion-extension, the SSP group flexed (38-82% p < 0.009) less their trunk, rotated upwards (5-10% p = 0.021) less their scapula, and posteriorly tilted scapula (0-100% p < 0.001) more than CG. Combining conventional variables used to describe motion in individuals with SSP, such as minimum and maximum values, range of motion, and results provided by SPM can furnish a detailed description of the compensations and limitations of the patient, enabling a better understanding of the function of the scapular girdle as well as improvements in the evaluation process and clinical decision making.
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Affiliation(s)
| | | | - Lucas Cruz Freire
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Ana Beatriz Marcelo Silva
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | | | - Paulo Roberto Garcia Lucareli
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil.
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