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Megerle K, Bahm J. [Peripheral Nerve Surgery]. HANDCHIR MIKROCHIR P 2024; 56:6. [PMID: 38508201 DOI: 10.1055/a-2168-2239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
In den letzten dreißig Jahren hat sich die Chirurgie an peripheren Nerven vermehrt zu
einem Schwerpunkt entwickelt, der Kolleginnen und Kollegen aus der Neurochirurgie,
Orthopädie, Plastischen und Handchirurgie anspricht. Die Interaktion der
chirurgischen Fächer mit Neurologen, Neuropathologen und Neuroradiologen ist dabei
sehr wichtig.
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2
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Schäfer B, Beier JP, Bahm J. [Nerve Transfers in Children with Non-traumatic Amyoplasia]. HANDCHIR MIKROCHIR P 2024; 56:55-64. [PMID: 38508206 DOI: 10.1055/a-2240-4781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The treatment of obstetric brachial plexus palsy through primary reconstruction and nerve transfers has been established in the past decades. In the case of non-traumatic diseases that lead to flaccid paralysis and the inability to move the extremities, such as transverse myelitis (TM) or arthrogryposis multiplex congenita (AMC), which can have a wide variety of causes, the focus has been on rehabilitative therapy so far, while surgical interventions have been used to a lesser extent, e. g., in the form of osteotomies or muscle transfers. Our aim is to establish nerve transfers as a surgical option to improve mobility in non-traumatic amyoplasia. PATIENTS This work presents the needs-adapted treatment of a total of 23 patients (aged 4 months to 64 months, 18 with AMC and 5 with TM) using nerve transfers on the upper extremity. RESULTS We were able to show that early nerve transfers in the upper extremity enabled the reanimation of muscles in both AMC and TM. CONCLUSION This work shows that the treatment of non-traumatic amyoplasia in children with selective nerve grafts is a successful method. Nerve transfers allow patients to gain or regain important functions for managing independent everyday life. The surgical methods have been established in the treatment of traumatic nerve injuries. They are well-known and can be carried out safely. We believe that this is an important treatment option for paediatric patients with paralysis associated with TM or AMC, which should also be known to the treating physicians.
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Affiliation(s)
- Benedikt Schäfer
- Department of Plastic Surgery, Hand Surgery - Burn Center, Division for Plexus Surgery, University Hospital RWTH Aachen, Germany
- Department of Plastic Surgery, Hand Surgery - Burn Center, Division for Plexus Surgery, University Hospital RWTH Aachen, Germany
| | - Justus P Beier
- Department of Plastic Surgery, Hand Surgery - Burn Center, Division for Plexus Surgery, University Hospital RWTH Aachen, Germany
| | - Jörg Bahm
- Department of Plastic Surgery, Hand Surgery - Burn Center, Division for Plexus Surgery, University Hospital RWTH Aachen, Germany
- Department of Plastic Surgery, Hand Surgery - Burn Center, Division for Plexus Surgery, University Hospital RWTH Aachen, Germany
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3
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Wachenfeld-Teschner V, Schäfer B, Beier JP, Bahm J. [Anatomical variants of the median and musculocutaneous nerve - a case report]. HANDCHIR MIKROCHIR P 2024; 56:106-107. [PMID: 38508209 DOI: 10.1055/a-2244-7642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
EinleitungTraumatische Schädigungen des Plexus brachialis resultieren häufig in einer
eingeschränkten oder aufgehobenen Flexionsbewegung des Ellenbogens. Die
Wiederherstellung dieser Bewegung ist ein wichtiges Ziel der chirurgischen Therapie
1
2. Maßgeblich für die Flexionsbewegung und Innervation der Zielmuskeln
ist der N. musculocutaneus (MSC). Dieser bildet einen der beiden Endäste des
Fasciculus lateralis des Plexus brachialis (C5-C7). In den meisten Fällen verläuft
er an der ventralen Oberarmseite, in der Flexorenloge, zwischen dem M. brachialis
und M. biceps brachii nach distal und gibt Äste zur motorischen Innervation der
beiden Muskeln ab. Er verläuft anschließend durch den Sulcus bicipitalis lateralis
und durchbricht die Fascia brachii in der Ellenbeuge 3 um als Nervus cutaneus antebrachii
lateralis, sensibel den Unterarm zu versorgen. Variable Verläufe des Plexus
brachialis in Zusammenschau mit dem N. musculocutaneus sind beschrieben und können
auf vielseitige Art und Weisen imponieren 4
5. So kann der N.
musculocutaneus direkte Verbindungen zum N.medianus aufweisen, oder diesen als
direkter dritter Zuschuss anteilweise bilden. Der N. medianus kann also sowohl Äste
an den N. musculocutaneus abgeben als auch solche von diesem erhalten. Vorliegende
Kadaverstudien zeigen in über 50+% der Fälle Verbindungen zwischen dem N.
musculocutaneus und dem N. medianus, wobei ein Großteil solcher Verbindungen
proximal des Eintrittes des N. musculocutaneus in den M. coracobrachialis liegt
6. Trotzdem sind diese Variationen im
klinischen Alltag meist Zufallsbefunde bei chirurgischen Interventionen 7.
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Affiliation(s)
- Victoria Wachenfeld-Teschner
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Universitätsklinikum RWTH Aachen, Aachen, Germany
| | - Benedikt Schäfer
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Universitätsklinikum RWTH Aachen, Aachen, Germany
| | - Justus P Beier
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Universitätsklinikum RWTH Aachen, Aachen, Germany
| | - Jörg Bahm
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Universitätsklinikum RWTH Aachen, Aachen, Germany
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Bahm J, Beier JP, Schäfer B. [Contralateral C7 Nerve Transfer]. HANDCHIR MIKROCHIR P 2024; 56:74-83. [PMID: 38408481 DOI: 10.1055/a-2246-1704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
Complex brachial plexus injuries with multiple or complete root avulsions make intraplexic reconstruction impossible in some cases. Such cases necessitate the use of extraplexic nerve donors such as the spinal accessory nerve or intercostal nerves. The contralateral C7 root represents a donor with a high axon count and can be used as an axon source in such cases. We summarise current indications, surgical technique and functional results after a contralateral C7 transfer in cases of brachial plexus injury, describing some of our own cases and including a selective literature review.
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Affiliation(s)
- Jörg Bahm
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Sektion für Plexuschirurgie, Universitätsklinikum Aachen, Aachen, Germany
| | - Justus P Beier
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Uniklinik RWTH Aachen, Aachen, Germany
| | - Benedikt Schäfer
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Sektion für Plexuschirurgie, Universitätsklinikum Aachen, Aachen, Germany
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Assmus H, Antoniadis G, Heinen C, Kneser U, Bahm J. ["Nerve Surgery" In German-Speaking Countries - Starting With The Nerve Club Up To A Certificate]. HANDCHIR MIKROCHIR P 2024; 56:7-10. [PMID: 38508202 DOI: 10.1055/a-2241-2809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
We present the Nerve Club, a community of colleagues originating from german-speaking countries and dedicated to those working in or outside surgery with interest in the peripheral nerve. This article reviews the club´s history and specific characteristics and activities, and highlights the concept of a certificate in nerve surgery. We have annual club meetings and organize every two years a plexus symposium. Also exists a scientific publication award and cooperation with an online based journal dedicated to medical publications in the field of nerve surgery.
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Affiliation(s)
| | | | - Christian Heinen
- Medizinisches Versorgungszentrum am Christlichen Krankenhaus Fachbereich Neurochirurgie, Quakenbrück
| | - Ulrich Kneser
- Hand-, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwigshafen
| | - Jörg Bahm
- Klinik für Plastische, Hand und Verbrennungschirurgie am Universitätsklinikum der RWTH Aachen, Aachen
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Schäfer B, Bahm J, Beier JP. Nerve Transfers Using a Dedicated Microsurgical Robotic System. Plast Reconstr Surg Glob Open 2023; 11:e5192. [PMID: 37583397 PMCID: PMC10424892 DOI: 10.1097/gox.0000000000005192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/29/2023] [Indexed: 08/17/2023]
Abstract
Microsurgical demands in peripheral nerve surgery are increasing. Because of the development of multiple simultaneous selective nerve transfers, the transposition of very small nerves and even single fascicles has evolved. Coaptation of these increasingly smaller structures require high skills in microsurgical techniques. In addition, the surgical situs often has very limited access and is difficult to reach with conventional microsurgical options. Robot technology, the Symani Surgical System (Medical Microinstruments, S.p.A, Calci, Pisa, Italy), was used for epineural coaptation of three donor nerves (intercostal nerves 4-6) to the long thoracic nerve and the thoracodorsal nerve as recipient nerves in a patient with brachial plexus palsy. The coaptations could be carried out successfully with the microsurgical robot technology. In combination with a high-magnification (up to 26×) 3D-exoscope, the epineural sutures could be placed very precisely and accurately. Using this new microsurgical robotic system, successful coaptation of very small nerve structures is possible. This opens possibilities for the microsurgeon to carry out even finer, more targeted and more complex nerve transfers, including procedures in anatomical regions that are difficult to reach.
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Affiliation(s)
- Benedikt Schäfer
- From the Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany
- Division for Plexus Surgery,University Hospital RWTH Aachen, Aachen, Germany
| | - Jörg Bahm
- From the Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany
- Division for Plexus Surgery,University Hospital RWTH Aachen, Aachen, Germany
| | - Justus P Beier
- From the Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany
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Bahm J. Additions Required. Dtsch Arztebl Int 2023; 120:485. [PMID: 37661320 PMCID: PMC10487678 DOI: 10.3238/arztebl.m2023.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Jörg Bahm
- *Klinik für Plastische, Hand- und Verbrennungschirurgie am Universitätsklinikum Aachen
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8
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Bahm J, Schäfer B. Microsurgical reconstruction of obstetric brachial plexus palsy: ongoing challenges and future directions. J Hand Surg Eur Vol 2023; 48:368-372. [PMID: 36601858 DOI: 10.1177/17531934221146860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Jörg Bahm
- Division for Plexus Surgery, Department for Plastic, Hand and Burn Surgery, RWTH University Hospital, Aachen Germany
| | - Benedikt Schäfer
- Division for Plexus Surgery, Department for Plastic, Hand and Burn Surgery, RWTH University Hospital, Aachen Germany
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Gatskiy AA, Tretyak IB, Bahm J, Tsymbaliuk VI, Tsymbaliuk YV. Redefining the Inclusion Criteria for Successful Steindler Flexorplasty Based on the Outcomes of a Case Series in Eight Patients. J Brachial Plex Peripher Nerve Inj 2023; 18:e32-e41. [PMID: 37829766 PMCID: PMC10567141 DOI: 10.1055/s-0043-1767672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 02/03/2023] [Indexed: 10/14/2023] Open
Abstract
Background (rationale) Steindler flexorplasty (SF) is aimed at restoring independent elbow flexion in the late stages of dysfunction of the primary elbow flexors. Selection criteria for successful SF have been defined. Objectives The purpose of this study was to redefine the inclusion criteria for successful SF based on functional outcomes. Methods Eight patients received SF after an average of 50.8 months after injury or dysfunction. Three patients (37.5%) met all five Al-Qattan inclusion criteria (AQIC), and another five patients (62.5%) met four or less AQIC. Patients were followed up for at least 9 months, and the maximum range of active elbow flexion (REF) was measured. Functional results of SF were assessed using the Al-Qattan scale (in accordance with Al-Qattan's scale). Results The mean maximum REF was 100 degrees (70 to 140 degrees). Five patients reached REF greater than 100 degrees. One patient had a poor outcome, two patients (25%) had a fair outcome, three patients (37.5%) had a good outcome, and two patients (25%) had an excellent outcome of SF on the Al-Qattan scale. The impact of each AQIC on functional outcome has been critically reviewed from a biomechanical point of view. Conclusions The sufficient number of inclusion criteria required for successful SF can be reduced from five (according to AQIC) to two; Normal or near-normal function (M4 or greater on the MRC scale) of the muscles of the flexor-pronator mass should be considered an obligatory inclusion criterion, while primary wrist extensors may be considered an optional inclusion criterion.
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Affiliation(s)
- Alexander A. Gatskiy
- Restorative Neurosurgery Department, Romodanov Neurosurgery Institute, Kyiv, Ukraine
| | - Ihor B. Tretyak
- Restorative Neurosurgery Department, Romodanov Neurosurgery Institute, Kyiv, Ukraine
| | - Jörg Bahm
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Sektion Plexuschirurgie in der Uniklinik RWTH Aachen, Aachen, Deutschland
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10
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Schäfer B, Freund G, Bohn B, Bahm J. [Case report of a congenital thoracic outlet syndrome]. HANDCHIR MIKROCHIR P 2022; 54:522-524. [PMID: 35998674 DOI: 10.1055/a-1889-5662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Benedikt Schäfer
- Department of Plastic Surgery, Hand Surgery - Burn Center, Division for Plexus Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Gerrit Freund
- Department of Plastic Surgery, Hand Surgery - Burn Center, Division for Plexus Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Benjamin Bohn
- Chirurgische Gemeinschaftspraxis am Langwahn 31, Chirurgische Gemeinschaftspraxis, Eschweiler, Germany
| | - Jörg Bahm
- Department of Plastic Surgery, Hand Surgery - Burn Center, Division for Plexus Surgery, University Hospital RWTH Aachen, Aachen, Germany
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11
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Bahm J. Looking through different lenses at neonatal brachial plexus injuries. Dev Med Child Neurol 2022; 64:1186-1187. [PMID: 35451053 DOI: 10.1111/dmcn.15250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Jörg Bahm
- RWTH University Hospital Aachen - Department for Plastic, Hand and Burn Surgery, Division for Plexus Surgery, Aachen, Germany
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12
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Bahm J. Re: Hems T. Questions regarding natural history and management of obstetric brachial plexus injury. J Hand Surg Eur. 2021, 46: 796-9. J Hand Surg Eur Vol 2022; 47:335-337. [PMID: 34816746 DOI: 10.1177/17531934211059019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Jörg Bahm
- Division of Plexus Surgery, RWTH University Hospital, Aachen, Germany
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13
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Bahm J. Re: Oberlin C. Rethinking surgical strategy in the management of obstetrical palsy. J Hand Surg Eur. 2021, 46: 705-7. J Hand Surg Eur Vol 2022; 47:333. [PMID: 34816767 DOI: 10.1177/17531934211059020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Jörg Bahm
- Division of Plexus Surgery, RWTH University Hospital, Aachen, Germany
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14
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Bahm J. Re: Pondaag W and Malessy MJA. Evidence that nerve surgery improves functional outcome for obstetric brachial plexus injury. J Hand Surg Eur. 2021, 46: 229-36 Re: Hems T. Commentary on 'Evidence that nerve surgery improves functional outcome for obstetric brachial plexus injury'. J Hand Surg Eur. 2021, 46: 237-8. J Hand Surg Eur Vol 2022; 47:222-224. [PMID: 35098780 DOI: 10.1177/17531934211021729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Jörg Bahm
- Division of Plexus Surgery, Clinic for Plastic, Hand and Burn Surgery, University Hospital Aachen Germany, Aachen, Germany
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15
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Bahm J, Gohritz A. [Nerve transposition (nerve transfer): development and principles]. Oper Orthop Traumatol 2021; 33:377-383. [PMID: 34515807 DOI: 10.1007/s00064-021-00735-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 12/01/2022]
Abstract
This review article presents the history, indications and techniques for the usual nerve transpositions in the upper extremities. By means of nerve transposition paralyzed muscles are reinnervated using dispensable donor motor axons. Many standard operations on the upper extremities are attributable to concepts of German-speaking surgeons and orthopedists. The reliable return of function by the short-range and selective motor reinnervation using nerve transfer results in a renaissance of these techniques. The spectrum of applications has been substantially extended in recent years. In order to achieve an optimal result, a subtle microsurgical technique is necessary. In this way excellent results can be achieved even for complex proximal nerve injuries.
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Affiliation(s)
- Jörg Bahm
- Sektion Plexuschirurgie, Klinik für Plastische, Hand- und Verbrennungschirurgie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - Andreas Gohritz
- Klinik für Plastische Chirurgie, Universitätsklinikum Basel (CH), Basel, Schweiz
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Freund G, Dafotakis M, Bahm J, Beier JP. Treatment of Peripheral Nerve Compression Syndromes of the Upper Extremities: a Systematic Review. Z Orthop Unfall 2021; 161:182-194. [PMID: 34261169 DOI: 10.1055/a-1498-3197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Nerve compression syndromes are referred to as chronic irritation or pressure palsies of peripheral nerves in areas of preformed anatomical constriction. Carpal tunnel syndrome is the most common nerve compression syndrome, followed by cubital tunnel syndrome. In addition, less frequent nerve compression syndromes of the upper extremities that affect the median, ulnar or radial nerves have been described. This review provides an overview of current treatment options for nerve compression syndromes of the upper extremities. STUDY DESIGN Systematic overview. METHODS Based on established national (AWMF) and international guidelines as well as the Cochrane Library, we performed a systematic literature search on PubMed (NLM), focusing on randomised controlled trials. RESULTS Over the research period (2012 - 2020), there were 43 randomised trials that investigated surgical carpal tunnel release methods, 68 that compared different conservative therapies and 12 that compared surgical versus conservative treatments. Furthermore, eight studies analysed surgical techniques and four analysed conservative techniques for cubital tunnel syndrome. No randomised trials were conducted on the less common peripheral nerve compression syndromes, but case reports and observational studies were conducted. CONCLUSION For carpal and cubital tunnel syndromes, there are evidence-based diagnostic methods as well as therapeutic recommendations based on randomised and controlled trials. When diagnosis is made after clinical examination and supported by radiological and electrophysiological evaluation, surgical treatment is considered superior to conservative treatment. In particular, excellent long-term results can be achieved by surgery for carpal and cubital tunnel syndromes. More controlled studies are needed to establish evidence-based therapeutic recommendations for the less common nerve compression syndromes, which are somewhat controversially and inconsistently defined.
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Affiliation(s)
- Gerrit Freund
- Department of Plastic, Hand and Burns Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Manuel Dafotakis
- Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany
| | - Jörg Bahm
- Department of Plastic, Hand and Burns Surgery, Section for Brachial Plexus Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Justus P Beier
- Department of Plastic, Hand and Burns Surgery, RWTH Aachen University Hospital, Aachen, Germany
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Bahm J, Bouslama S, Hagert EM, Andersson JK. Ulnar Wrist Deviation in Children With Obstetric Brachial Plexus Palsy: A Descriptive Study of Clinical and Radiological Findings of Impaired Ulnar Growth and Associated Incongruence of the Distal Radioulnar Joint. Hand (N Y) 2020; 15:615-619. [PMID: 30819026 PMCID: PMC7543203 DOI: 10.1177/1558944719831243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Backround: Some children with obstetric brachial plexus palsy (OBPP) present later on with an ulnarly deviated wrist. The aim of this study was to present a retrospective analysis of a subgroup of OBPP children with ulnarly deviated wrists and to describe their morphologic wrist deformity in terms of clinical and radiological appearance. Methods: We present a retrospective analysis of the records of 27 children with an ulnarly deviated wrist as a consequence of OBPP. Radiographs of the affected wrist were performed when the ulnar deformity became clinically manifest and merited investigation, at a mean age of 15 (range: 6.5-27) years. Available clinical and radiological data were analyzed and categorized. Results: The ulnar-deviated position was associated with impaired active and passive pronosupination in all patients. Fifteen fixed supination deformities and 3 anterior radial head dislocations were noted clinically. Plain radiographs were completed in 24 patients and could be analyzed in 18, showing variations in ulnar variance (7 neutral, 7 ulna minus, and 4 ulna plus) along with 6 subluxations of the distal radioulnar joint (DRUJ). Of the patients treated surgically (n = 7), only the 2 patients treated with wrist fusion had an actual improvement in ulnar wrist deformity. Conclusion: Radiologically visible ulnar head hypoplasia, overgrowth of the distal ulna, or a shortened ulnar diaphysis and an incongruent DRUJ were present in all examined OBPP patients with a clinically evident ulnarly deviated wrists. The radiological findings highlight the morphologic adaptation behind this clinical condition and could allow further investigation into suitable treatment strategies.
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Affiliation(s)
| | | | - Elisabet M. Hagert
- Karolinska Institute, Stockholm, Sweden,ARCADEMY Stockholm, Sophiahemmet Hospital, Stockholm, Sweden
| | - Jonny K. Andersson
- SportsMed, Carlanderska Hospital, Göteborg, Sweden,Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden,Jonny K. Andersson, SportsMed, Carlanderska Hospital, Göteborg SE-405 45, Sweden.
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18
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Bahm J. Diffusion Weighted and Diffusion Tensor Imaging: A Clinical Guide. J Brachial Plex Peripher Nerve Inj 2018. [PMCID: PMC6089799 DOI: 10.1055/s-0038-1669394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- J. Bahm
- Euregio Reconstructive Microsurgery Unit, Franziskus Hospital, Aachen, Germany
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19
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Bahm J. Neurosurgical Operative Atlas: Spine and Peripheral Nerves. J Brachial Plex Peripher Nerve Inj 2018. [PMCID: PMC6089797 DOI: 10.1055/s-0038-1669395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J. Bahm
- Euregio Reconstructive Microsurgery Unit, Franziskus Hospital, Aachen, Germany
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Bahm J. Manual of Peripheral Nerve Surgery. J Brachial Plex Peripher Nerve Inj 2018. [PMCID: PMC6089796 DOI: 10.1055/s-0038-1669393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- J. Bahm
- Euregio Reconstructive Microsurgery Unit, Franziskus Hospital, Aachen, Germany
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Affiliation(s)
- J. Bahm
- Euregio Reconstructive Microsurgery Unit, Franziskus Hospital, Aachen, Germany
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Bahm J, Gkotsi A, Bouslama S, El-Kazzi W, Schuind F. Direct Nerve Sutures in (Extended) Upper Obstetric Brachial Plexus Repair. J Brachial Plex Peripher Nerve Inj 2017; 12:e17-e20. [PMID: 29134042 PMCID: PMC5680045 DOI: 10.1055/s-0037-1608624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 09/15/2017] [Indexed: 11/25/2022] Open
Abstract
Background
In rare, selected cases of severe (extended) upper obstetric brachial plexus palsy (OBPP), after supraclavicular exposure and distal mobilization of the traumatized trunks and careful neuroma excision, we decided to perform direct nerve coaptation with tolerable tension and immobilized the affected arm positioned in adduction and 90-degree elbow flexion for three weeks.
Objectives
We present our surgical technique and preliminary results in a prospective open patient series, including 22 patients (14 right and 8 left side affected) between 2009 and 2016, operated at a mean age of 8.4 months.
Methods
Analysis of functional results after a minimum of 18 months was conducted using the British Medical Research Council (BMRC) scale.
Results
All children reached 60–90° of elbow flexion and 75° of shoulder abduction at already six months after surgery. For those patients having already passed one year post surgery, the mean active shoulder abduction reached 92°, and for those who past the 18 months 124°. We discuss the actual knowledge about nerve coaptation under “reasonable” tension including its advantages and drawbacks.
Conclusion
This technique may be indicated in preoperatively selected cases of (extended) upper OBPP and may give good functional results.
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Affiliation(s)
- J Bahm
- Euregio Reconstructive Microsurgery Unit, Franziskushospital Aachen, Aachen, Germany
| | - A Gkotsi
- Department of Orthopaedics and Traumatology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, Belgium
| | - S Bouslama
- Euregio Reconstructive Microsurgery Unit, Franziskushospital Aachen, Aachen, Germany
| | - W El-Kazzi
- Department of Orthopaedics and Traumatology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, Belgium
| | - F Schuind
- Department of Orthopaedics and Traumatology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, Belgium
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Fonseca LCS, Nelke AK, Bahm J, Disselhorst-Klug C. Assessment of upper extremity movement performance of patients with obstetric brachial plexus palsy. Current Directions in Biomedical Engineering 2017. [DOI: 10.1515/cdbme-2017-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract:Coping strategies of patients with obstetric brachial plexus palsy (OBPP) are highly individual. Up to now, individual movement performance is assessed by visual observations of physicians or therapists - a procedure, which is highly subjective and lacks objective data. However, objective data about the individual movement performance are the key to evidence-based and individualized treatment. In this paper, a new approach is presented, which provides objective information about the upper extremity movement performance of patients with OBPP. The approach is based on the use of accelerometers in combination with a classification procedure. The movement performance of 10 healthy volunteers and 41 patients with OBPP has been evaluated by experienced physiotherapists and has been assigned to one of 4 categories representing the Mallet Scale (MS) IV to I. Three triaxial-accelerometers were placed at chest, upper arm and wrist of the affected side of the patient. Acceleration signals have been recorded during repetitive movements with relevance regarding daily life. Here, especially the results from the “hand to mouth” task are presented. From the 9 recorded acceleration signals 13 relevant features were extracted. For each of the 13 features 4 thresholds have been determined distinguishing best between the 4 patient categories of the MS and the healthy subjects. With respect to the thresholds each feature value has been assigned to the discrete numbers 0, 1, 2, 3 or 4. Afterwards, each discrete number has been weighted by a factor regarding the correlation between the feature’s value and the MS score. The resulting weighted discrete numbers of all 13 features have been added resulting in a score, which quantifies the individual upper extremity movement performance. Based on this score the movement performance of each patient has been assigned to the classes “very good”, “good”, “regular” and “bad”. All movements of the 10 healthy volunteers were classified as “very good”. The movement performance of two patients MS IV were classified as “very good” as well and the movements of the other 16 patients as “good”. The movements of the entire group of MS III patients fell into the class “regular”. Just one MS II patient was assigned to the class “regular” while the others were classified as “bad”. It was not possible to classify the movements of MS I patients. This was mainly due to the fact that none of these patients MS I was able to complete the task successfully. The developed approach demonstrated its ability to quantify the movement performance of upper extremity movements based on accelerometers. This provides an easy to use tool to assess patient’s movement strategies during daily tasks for diagnosis and rehabilitation.
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Affiliation(s)
- Ligia C. S. Fonseca
- 1Department of Rehabilitation & Prevention Engineering, Institute of Applied Medical Engineering, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen Germany
| | - Annika K. Nelke
- 1Department of Rehabilitation & Prevention Engineering, Institute of Applied Medical Engineering, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen Germany
| | - Jörg Bahm
- 2Reconstructive Surgery Unit, St. Franziskus Hospital, Morillenhang 27, 52074 Aachen Germany
| | - Catherine Disselhorst-Klug
- 1Department of Rehabilitation & Prevention Engineering, Institute of Applied Medical Engineering, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen Germany
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Bahm J. The Surgical Strategy to Correct the Rotational Imbalance of the Glenohumeral Joint after Brachial Plexus Birth Injury. J Brachial Plex Peripher Nerve Inj 2017; 11:e10-e17. [PMID: 28077955 DOI: 10.1055/s-0036-1579763] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 01/22/2016] [Indexed: 10/22/2022] Open
Abstract
In upper brachial plexus birth injury, rotational balance of the glenohumeral joint is frequently affected and contracture in medial rotation of the arm develops, due to a severe palsy or insufficient recovery of the lateral rotators. Some of these children present with a severe glenohumeral joint contracture in the first months, although regular physiotherapy has been provided, a condition associated with a posteriorly subdislocated or dislocated humeral head. These conditions should be screened early by a pediatrician or specialized physiotherapist. Both aspects of muscular weakness affecting the lateral rotators and the initial or progressive glenohumeral deformity and/or subdislocation must be identified and treated accordingly, focusing on the reestablishment of joint congruence and strengthening of the lateral rotators to improve rotational balance, thus working against joint dysplasia and loss of motor function of the shoulder in a growing child. Our treatment strategy adapted over the last 20 years to results from retrospective studies, including biomechanical aspects on muscular imbalance and tendon transfers. With this review, we confront our actual concept to recent literature.
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Affiliation(s)
- J Bahm
- Euregio Reconstructive Microsurgery Unit, Franziskushospital, Aachen (D), Germany
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Bahm J. Journal of Brachial Plexus and Peripheral Nerve Injury. J Brachial Plex Peripher Nerve Inj 2016; 10:e1. [PMID: 27917232 DOI: 10.1055/s-0035-1570130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Jörg Bahm
- Chief Surgeon in the Reconstructive Microsurgery Unit of the Franziskushospital, Aachen, Germany; Consultant for Peripheral Nerves in the Orthopedic Department of the Erasme University Hospital, Brussels, Belgium
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Aljabab S, Vellayappan B, Vandervoort E, Bahm J, Zohr R, Sinclair J, Caudrelier J, Szanto J, Malone S. Dosimetric Comparison of 3 Techniques for Spine Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bahm J. Editorial on participating in the Journal of Brachial Plexus and Peripheral Nerve Injury. J Brachial Plex Peripher Nerve Inj 2014; 2:8. [PMID: 17374160 PMCID: PMC1847432 DOI: 10.1186/1749-7221-2-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Accepted: 03/20/2007] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jörg Bahm
- Reconstructive Microsurgery Unit, Franziskushospital, Aachen, Germany
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Maricq C, Jeunehomme M, Mouraux D, Rémy P, Brassinne E, Bahm J, Schuind F. Objective evaluation of elbow flexion strength and fatigability after nerve transfer in adult traumatic upper brachial plexus injuries. ACTA ACUST UNITED AC 2014; 19:335-41. [PMID: 25121938 DOI: 10.1142/s0218810414500245] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nerve transfers Oberlin-type are currently used in upper brachial plexus lesions to recover elbow flexion. Is the regained active motion sufficient to resume heavy manual activities? Five adult patients (mean age 37 years) operated of a nerve transfer to recover elbow flexion (transfer of a motor fascicle of the ulnar nerve to the motor branch of the biceps; in three patients, additional transfer from the median to the motor nerve of the brachialis) were clinically and isokinetically evaluated, after a mean follow-up of 47 months. The median Constant-Murley score was 22/100, the DASH 56/100 and the MEPI 60/100. For isokinetic tests the most significant finding was a severe deficit of elbow strength, of about 80%. No patient was able to maintain an isometric contraction during sufficient time to evaluate fatigability. This preliminary study suggests that major functional impairments persist despite early recovery of elbow flexion. These results should be confirmed in a study on a larger group of patients.
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Affiliation(s)
- Céline Maricq
- Haute Ecole Libre de Bruxelles - Ilya Prigogine, Belgium
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Abstract
Thirty three per cent of children with obstetrical brachial plexus palsy with incomplete neurological recovery develop shoulder internal contracture associated with osseous deformity. Some of the older children are treated by humeral derotational osteotomy. The classical technique of open approach to the humeral diaphysis and plate fixation imposes a longitudinal scar and carries significant risks (nonunion, nerve palsy); a secondary procedure for plate removal is necessary in a significant proportion of patients. The authors report a new technique of percutaneous humeral osteotomy with osteosynthesis by Hoffmann external fixator. In six cases bone healing was obtained at an average of 45 days, without adverse complication. The postoperative results showed improved shoulder function. This new technique is simple and safe; it represents a new option for the treatment of sequelae of obstetrical brachial plexus palsy.
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Affiliation(s)
- A Aly
- Department of Orthopaedics and Traumatology, Erasme University Hospital, Brussels, Belgium
| | - J Bahm
- Department of Orthopaedics and Traumatology, Erasme University Hospital, Brussels, Belgium
| | - F Schuind
- Department of Orthopaedics and Traumatology, Erasme University Hospital, Brussels, Belgium
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Abstract
Wrist arthrodesis is exceptionally performed in children. The main indication is severe wrist flexion contracture resulting from Volkmann's ischaemia or spasticity. In such cases, a proximal row carpectomy is usually necessary to allow the wrist to be positioned in neutral position. In young children, it is essential to preserve the distal radius growth plate, to prevent physeal closure. In these very particular indications, with high stresses along the stretched palmar soft-tissues, Kirschner wire fixation provides poor stability, and plate fixation is contra-indicated. Radio-metacarpal external fixation is an excellent alternative, preserving the distal radius growth plate and offering sufficient stability. This technique was used in a seven-year-old girl suffering from Volkmann's ischaemic contracture, treated by first carpal bone resection and subsequent arthrodesis with radio-metacarpal external fixation. Bone healing was achieved in three months, with a five years follow-up preservation of the distal radius growth plate.
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Affiliation(s)
- Wissam El-Kazzi
- Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium
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Bahm J. FESSH and European Accreditation in Hand Surgery. J Hand Surg Eur Vol 2013; 38:1014-5. [PMID: 24158710 DOI: 10.1177/1753193413506358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- J Bahm
- Erasme ULB University Hospital Brussels (Belgium), Chairman European Accreditation of Hand Surgery Committee, FESSH Council
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Kleiber T, Popovic N, Bahm J, Disselhorst-Klug C. A modeling approach to compute modification of net joint forces caused by coping movements in obstetric brachial plexus palsy. J Brachial Plex Peripher Nerve Inj 2013; 8:10. [PMID: 24139445 PMCID: PMC3816998 DOI: 10.1186/1749-7221-8-10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 10/16/2013] [Indexed: 11/28/2022] Open
Abstract
Background Many disorders of the musculoskeletal system are caused by modified net joint forces resulting from individual coping movement strategies of patients suffering from neuromuscular diseases. Purpose of this work is to introduce a personalized biomechanical model which allows the calculation of individual net joint forces via inverse dynamics based on anthropometry and kinematics of the upper extremity measured by 3D optoelectronical motion analysis. Methods The determined resulting net joint forces in the anatomical axis of movement may be used to explain the reason for possible malfunction of the musculoskeletal system, especially joint malformation. For example the resulting net joint forces in the humerothoracic joint from simulations are compared to a sample of children presenting obstetric brachial plexus palsy showing an internal shoulder rotation position and a sample of healthy children. Results The results presented from the simulation show that an increased internal shoulder rotation position leads to increased net joint forces in the humerothoracic joint. A similar behavior is presented for the subjects suffering from brachial plexus palsy with an internal shoulder rotation position. Conclusions The increased net joint forces are a possible reason for joint malformation in the humerothoracic joint caused by coping movements resulting from neuromuscular dysfunction as stated in literature.
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Affiliation(s)
- Tim Kleiber
- Department of Rehabilitation and Prevention Engineering, Institute of Applied Medical Engineering, RWTH Aachen University, Aachen, Germany.
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Abstract
We present two children with a diagnosis of upper limb arthrogryposis and report on findings about brachial plexus exploration and a nerve transfer procedure to reanimate elbow flexion. Although the etiology of arthrogryposis multiplex congenita remains unknown and multifactorial, it can be worthful to explore the brachial plexus in the affected upper limb and to perform selective motor nerve transfers on morphologically well developed but not sufficiently innervated target muscles, like the biceps brachialis, brachialis, deltoid and supra-/infraspinatus muscles. This strategy may reduce the necessity of later muscle transfers and improves the overall functional status of the affected limb(s).
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Affiliation(s)
- Jörg Bahm
- Euregio Reconstructive Microsurgery Unit, Franziskus hospital, Morillenhang 27, D 52074, Aachen, Germany.
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Bahm J. [Comment on the manuscript "A hand surgeon's advanced experience with thoracic outlet compression syndrome", by Erdogan Atasoy]. HANDCHIR MIKROCHIR P 2013; 45:151. [PMID: 23860699 DOI: 10.1055/s-0033-1349103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- J Bahm
- Franziskushospital, Plastische und Handchirurgie, Aachen.
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Angers C, Studinski R, La Russa D, Bahm J, Renaud J, Clark BG. Poster - Thur Eve - 19: Risk assessment of clinical radiation processes using failure modes and effect analysis. Med Phys 2012; 39:4628. [DOI: 10.1118/1.4740127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Bahm J, El Kazzi W, Schuind F. [Nerve transfers]. Rev Med Brux 2011; 32:S54-S57. [PMID: 22458058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Nerve transfers are recent surgical techniques where an unaffected nerve or part of its fascicules is transferred onto another nerve and co-apted end-to-end, or sometimes end-to-side, in order to "reanimate", sensitive or motor deficits. The technique is indicated when the proximal nerve stump has been destroyed or is of bad histological quality (brachial plexus root avulsion, or stump hidden in an extended scar), far from the target (important loss of substance), or difficult to access. Nerve transfers may be indicated for the microsurgical repair of brachial or lumbo-sacral plexus lesions, and in specific upper and lower limb peripheral nerve injuries : rupture of the axillary nerve in the quadrilateral space, irreversible lesion of the upper trunk of the brachial plexus, and in facial nerve surgery.
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Affiliation(s)
- J Bahm
- Service d'Orthopédie-Traumatologie, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Bruxelles.
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Alhussain H, Caudrelier J, Malone S, Agboola O, Nguyen T, Belec J, Carty K, Bahm J, Montgomery L. Prospective Study of Accelerated Radiation Therapy using Tomotherapy Simultaneous Integrated Boost with Concurrent and Adjuvant Temozolomide Chemotherapy in the Treatment of Glioblastoma Multiforme: Dosimetric Data. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bahm J, Rath W. [Paediatric brachial plexus injury--an interdisciplinary challenge to obstetricians, neonatologists and plexus surgeons]. Z Geburtshilfe Neonatol 2009; 213:176-9. [PMID: 19856239 DOI: 10.1055/s-0029-1224187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Brachial plexus injuries are an interdisciplinary challenge to obstetricians, neonatologists and plexus surgeons. The incidence of brachial plexus injuries is 1-4/1,000 live births, and the incidence of permanent lesions has been estimated to be 1/10,000 live births. Shoulder dystocia is associated with a 75-100-fold increase in plexus injuries. The antenatal (intrauterine) development of brachial plexus injuries is still a matter of controversial debate. The early recognition of antenatal risk factors of shoulder dystocia and its proper management by experienced obstetricians are mandatory; 90% of brachial plexus injuries recover without clinical sequelae for the newborn, however, 10% of the cases may lead to severe pareses requiring surgical intervention. Microsurgical nerve reconstruction should be performed in these cases within the first three months after birth. In this context, the intraoperative findings are of high prognostic relevance. The pathophysiology of birth-associated plexus brachialis injuries has been investigated in recently published experimental studies. An open dialogue between the specialists involved may be a great support for the parents of newborns suffering from plexus brachialis injuries. Medico-legal conflicts lasting for years should be avoided, and appropriate plexus surgical treatment by an experienced surgeon should be offered in good time after a careful diagnosis.
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Affiliation(s)
- J Bahm
- Arbeitsbereich Plastische und Handchirurgie, Franziskushospital, Aachen.
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Bahm J, Ocampo-Pavez C. Monopolar teres major muscle transposition to improve shoulder abduction and flexion in children with sequelae of obstetric brachial plexus palsy. J Brachial Plex Peripher Nerve Inj 2009; 4:20. [PMID: 19857253 PMCID: PMC2772838 DOI: 10.1186/1749-7221-4-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2009] [Accepted: 10/26/2009] [Indexed: 12/03/2022] Open
Abstract
We present a new surgical technique for a pedicled teres major muscle transfer to improve shoulder abduction and flexion in children with sequelae of obstetric brachial plexus palsy. In addition, we provide the clinical outcome in the first 17 operated children.
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Affiliation(s)
- Jörg Bahm
- Euregio Reconstructive Microsurgery Unit, Franziskushospital, Aachen, Germany.
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Schaakxs D, Bahm J, Sellhaus B, Weis J. Clinical and neuropathological study about the neurotization of the suprascapular nerve in obstetric brachial plexus lesions. J Brachial Plex Peripher Nerve Inj 2009; 4:15. [PMID: 19744351 PMCID: PMC2753616 DOI: 10.1186/1749-7221-4-15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Accepted: 09/11/2009] [Indexed: 11/12/2022] Open
Abstract
Background The lack of recovery of active external rotation of the shoulder is an important problem in children suffering from brachial plexus lesions involving the suprascapular nerve. The accessory nerve neurotization to the suprascapular nerve is a standard procedure, performed to improve shoulder motion in patients with brachial plexus palsy. Methods We operated on 65 patients with obstetric brachial plexus palsy (OBPP), aged 5-35 months (average: 19 months). We assessed the recovery of passive and active external rotation with the arm in abduction and in adduction. We also looked at the influence of the restoration of the muscular balance between the internal and the external rotators on the development of a gleno-humeral joint dysplasia. Intraoperatively, suprascapular nerve samples were taken from 13 patients and were analyzed histologically. Results Most patients (71.5%) showed good recovery of the active external rotation in abduction (60°-90°). Better results were obtained for the external rotation with the arm in abduction compared to adduction, and for patients having only undergone the neurotization procedure compared to patients having had complete plexus reconstruction. The neurotization operation has a positive influence on the glenohumeral joint: 7 patients with clinical signs of dysplasia before the reconstructive operation did not show any sign of dysplasia in the postoperative follow-up. Conclusion The neurotization procedure helps to recover the active external rotation in the shoulder joint and has a good prevention influence on the dysplasia in our sample. The nerve quality measured using histopathology also seems to have a positive impact on the clinical results.
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Bahm J, Ocampo-Pavez C, Disselhorst-Klug C, Sellhaus B, Weis J. Obstetric brachial plexus palsy: treatment strategy, long-term results, and prognosis. Dtsch Arztebl Int 2009; 106:83-90. [PMID: 19562016 PMCID: PMC2695299 DOI: 10.3238/arztebl.2009.0083] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 09/01/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND Obstetric brachial plexus palsy is rare, but the limb impairments are manifold and often long-lasting. Physiotherapy, microsurgical nerve reconstruction, secondary joint corrections, and muscle transpositions are employed with success. The role of conservative and operative treatment options should be regularly reviewed. METHODS Selective literature review (evidence levels 3 and 4) and analysis of personal clinical operative and scientific experience over the past 15 years. RESULTS Children with upper and total plexus palsy displaying nerve root avulsions and/or -ruptures are treated today by early primary nerve reconstruction in the first few months of life followed by secondary corrections, with good functional results. The late complications, with muscle weakness, impaired motion patterns, and joint dysplasia, are often underrated. CONCLUSIONS The potential for scientific analysis is limited, due to the rarity and interindividual variability of the lesions and the varying effects on function and growth. Expectations and compliance are different in every patient. Surgical techniques are not yet standardized. Knowledge of the consequences for joint growth and congruence is inadequate. Today, functional improvement can be achieved by surgery in most clinical manifestations of obstetric brachial plexus palsy, within the framework of an interdisciplinary treatment concept.
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Affiliation(s)
- Jörg Bahm
- Arbeitsbereich Plastische und Handchirurgie, Franziskushospital Aachen, Aachen, Germany.
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Bahm J, Ocampo-Pavez C. Free functional gracilis muscle transfer in children with severe sequelae from obstetric brachial plexus palsy. J Brachial Plex Peripher Nerve Inj 2008; 3:23. [PMID: 18973657 PMCID: PMC2584626 DOI: 10.1186/1749-7221-3-23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 10/30/2008] [Indexed: 11/12/2022] Open
Abstract
We present 4 children between 6 and 13 years suffering from severe sequelae after a total obstetric brachial plexus lesion resulting in a hand without functional active long finger flexion. They had successfully reanimated long finger flexion using a free functional gracilis muscle transfer. These children initially presented a total obstetric brachial plexus palsy without neurotisation of the lower trunk in an early microsurgical nerve reconstruction procedure. We describe our indications for this complex microsurgical procedure, the surgical technique and the outcome.
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Affiliation(s)
- Jörg Bahm
- Euregio Reconstructive Microsurgery Unit, Franziskushospital, Aachen, Germany.
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Bahm J, Wein B, Alhares G, Dogan C, Radermacher K, Schuind F. Assessment and treatment of glenohumeral joint deformities in children suffering from upper obstetric brachial plexus palsy. J Pediatr Orthop B 2007; 16:243-51. [PMID: 17527100 DOI: 10.1097/bpb.0b013e3280925681] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
We present our approach to gleno-humeral joint deformities as sequelae from severe upper obstetric brachial plexus palsy. In 50 consecutive children with severe medial rotation contracture of the shoulder after obstetric brachial plexus palsy, we used magnetic resonance imaging to evaluate joint incongruence and dysplasia; showing frequently various deformities of the glenoid, the humeral head and pathologic changes in their relationship. The most severe deformity is true glenohumeral dysplasia. These diagnostic findings might influence our choice and technical details within surgical procedures. We actually evaluate image processing tools (segmentation software) for a better understanding of changes in anatomical structures responsible for this multifactorial joint deformity, limiting lateral and/or medial rotation of the glenohumeral joint in children with obstetric brachial plexus palsy.
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Affiliation(s)
- Jörg Bahm
- Euregio Reconstructive Microsurgery Unit, Franziskushospital, Aachen, Germany.
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Bahm J, Ocampo-Pavez C, Noaman H. Microsurgical technique in obstetric brachial plexus repair: a personal experience in 200 cases over 10 years. J Brachial Plex Peripher Nerve Inj 2007; 2:1. [PMID: 17214900 PMCID: PMC1781450 DOI: 10.1186/1749-7221-2-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Accepted: 01/10/2007] [Indexed: 11/20/2022] Open
Abstract
We present our personal operative technique in exposing and repairing obstetric brachial plexus (obp) lesions. This technical description of the operative procedure and the strategic choice for the neurotisations are analysed with special regards on the follow-up of these patients (always performed by the surgeon), the histological quality of the proximal root stumps used for cable grafting, and the general reconstruction principles established in international workshops. We would like to encourage debate on these detailed considerations wherever they could affect the functional outcome.
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Affiliation(s)
- Jörg Bahm
- Euregio Reconstructive Microsurgery Unit, Franziskushospital Aachen, Germany
| | | | - Hassan Noaman
- Euregio Reconstructive Microsurgery Unit, Franziskushospital Aachen, Germany
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Abstract
Based on actual references from international well-known surgical colleagues with large experience, this article summarises the clinical and surgical strategy when treating thoracic outlet syndrome.
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Affiliation(s)
- J Bahm
- Bereich Plastische Wiederherstellungschirurgie, Franziskushospital Aachen.
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Bahm J. Frühe mikrochirurgische Rekonstruktion nach schwerer kindlicher Plexuslähmung. Monatsschr Kinderheilkd 2006. [DOI: 10.1007/s00112-004-1077-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Heinze F, Meinecke L, Bahm J, Rau G, Schmitz-Rode T, Disselhorst-Klug C. Upper extremity movement and muscular co-ordination in children with plexus lesion. J Biomech 2006. [DOI: 10.1016/s0021-9290(06)83191-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bahm J. Neurovaskuläre Dekompression an der oberen Thoraxapertur: Anatomische Besonderheiten und klinische Beispiele. HANDCHIR MIKROCHIR P 2005. [DOI: 10.1055/s-2004-862438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Bahm J, Noaman H, Becker M. The dorsal approach to the suprascapular nerve in neuromuscular reanimation for obstetric brachial plexus lesions. Plast Reconstr Surg 2005; 115:240-4. [PMID: 15622257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Jörg Bahm
- Reconstructive Microsurgery Unit, St. Franziskus Hospital, Aachen, Germany.
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