Restoration of elbow flexion by a new operative technique

Steindler flexorplasty to restore elbow flexion in C5-C6-C7 brachial plexus palsy type

Background

Loss of elbow flexion due to traumatic palsy of the brachial plexus represents a major functional handicap.

Then, the first goal in the treatment of the flail arm is to restore the elbow flexion by primary direct nerve surgery or secondary reconstructive surgery.

There are various methods to restore elbow flexion which are well documented in the medical literature but the most known and used is Steindler flexorplasty.

This review is intended to detail the author's experience with Steindler flexorplasty to restore elbow flexion in patients with brachial plexus palsy C5-C6-C7 where wrist extensors are paralyzed or weakened.

Methods

We conducted a retrospective follow-up study of 12 patients with absent or extremely weak elbow flexion (motor grade 2 or less), wrist/finger extensor and triceps palsy associated; who had undergone surgical reconstruction of the flail upper limb by tendon transfer (Steindler flexorplasty) and wrist arthrodesis to restore elbow flexion. The aetiology of elbow weakness was in all patients brachial plexus palsy (C5-C6-C7 deficit). Data were collected from medical records and from the information obtained during follow-up visits.

Age, sex, preoperative strength (rated on a 0 to 5 scale for the flexors of the elbow, wrist flexors, pronator and triceps), previous surgery, length of follow-up, other associated operative procedures, results and complications were recorded.

Results

The results are the follows: Eleven patients were found to have very good or good function of the transferred muscles. One patient had mild active flexion of the elbow despite the reconstructive procedure.

There were no major intraoperative complications. Two patients experienced transient, intermittent nocturnal ulnar paresthesias postoperatively. In both patients these symptoms subsided without further surgery.

Conclusion

Our study suggests that in patients with C5-C6-C7 palsy where the wrist and finger extensors are paralyzed or weaked, the flexor-pronators muscles of the forearm are strong but the triceps is not available for transfer; Steindler flexorplasty to restore elbow flexion should be complemented with wrist arthrodesis.

Muscle transpositions in the shoulder and upper arm for sequelae of brachial plexus palsy

Permanent deficiency in abduction and external rotation of the arm seen after brachial plexus injury may be corrected by a levator scapulae transposition onto the supraspinatus, while the teres major, associated or not with latissimus dorsi, is transferred onto the infraspinatus muscle. Transposed in a bipolar manner, the latissimus may compensate the deltoid muscle. Associated measures have to be carried out in children with deformities caused by obstetrical palsy. A paralysed serratus anterior is best compensated by a transfer of the pectoralis major together with pectoralis minor muscle.