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Oberlin partial ulnar nerve transfer for restoration in obstetric brachial plexus palsy of a newborn: case report.

Shigematsu K, Yajima H, Kobata Y, Kawamura K, Maegawa N, Takakura Y - J Brachial Plex Peripher Nerve Inj (2006)

Bottom Line: An 8 month old male infant with Erb's birth palsy was treated with two peripheral nerve transfers.Forty months after surgery, elbow flexion reached M5 without functional loss of the ulnar nerve.However, at this time partial ulnar nerve transfer for Erb's birth palsy is an optional procedure; a larger number of cases will need to be studied for it to be widely accepted as a standard procedure for Erb's palsy at birth.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan. shigema2@naramed-u.ac.jp

ABSTRACT
An 8 month old male infant with Erb's birth palsy was treated with two peripheral nerve transfers. Except for rapid motor reinnervations, elbow flexion was obtained by an Oberlin's partial ulnar nerve transfer, while shoulder abduction was restored by an accessory-to-suprascapular nerve transfer. The initial contraction of the biceps muscle occurred two months after surgery. Forty months after surgery, elbow flexion reached M5 without functional loss of the ulnar nerve. This case demonstrates an excellent result of an Oberlin's nerve transfer for restoration of flexion of the elbow joint in Erb's birth palsy. However, at this time partial ulnar nerve transfer for Erb's birth palsy is an optional procedure; a larger number of cases will need to be studied for it to be widely accepted as a standard procedure for Erb's palsy at birth.

No MeSH data available.


Related in: MedlinePlus

Intraoperative view of the partial ulnar nerve transfer to the musculocutaneous branch of the biceps muscle. The forceps indicate one fascicle of the ulnar nerve. UN; ulnar nerve. MB; motor branch of the musculocutaneous nerve. BM; biceps muscle.
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Figure 2: Intraoperative view of the partial ulnar nerve transfer to the musculocutaneous branch of the biceps muscle. The forceps indicate one fascicle of the ulnar nerve. UN; ulnar nerve. MB; motor branch of the musculocutaneous nerve. BM; biceps muscle.

Mentions: Under general anesthesia, an operation was performed in the supine position. The brachial artery and the median, ulnar, and a branch of the musculocutaneous nerve supplying the biceps muscle were identified at a level approximately 7.0 cm distal from the acromion. One fascicle of the ulnar nerve was separated at the same level as the branch of the biceps muscle. We confirmed a fascicle corresponding to the motor fascicle of the ulnar nerve by microelectronic stimulation, and we then transferred this fascicle to the motor branch of the biceps muscle [1,2]. End-to-end nerve repair, at a level approximately 1.0 cm proximal from the insertion to the biceps muscle, was then performed using 10-0 sutures (Fig. 2). After resection of the omohyoid muscle, the upper trunks appeared. The spinal accessory nerve and the suprascapular nerve were identified, and the spinal accessory nerve was then transferred to the suprascapular nerve. The duration of these procedures was two hours and forty minutes. After surgery, the upper arm of the operative site was set free with no cast immobilization. No specific motor re-education program was used post-operatively.


Oberlin partial ulnar nerve transfer for restoration in obstetric brachial plexus palsy of a newborn: case report.

Shigematsu K, Yajima H, Kobata Y, Kawamura K, Maegawa N, Takakura Y - J Brachial Plex Peripher Nerve Inj (2006)

Intraoperative view of the partial ulnar nerve transfer to the musculocutaneous branch of the biceps muscle. The forceps indicate one fascicle of the ulnar nerve. UN; ulnar nerve. MB; motor branch of the musculocutaneous nerve. BM; biceps muscle.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1636634&req=5

Figure 2: Intraoperative view of the partial ulnar nerve transfer to the musculocutaneous branch of the biceps muscle. The forceps indicate one fascicle of the ulnar nerve. UN; ulnar nerve. MB; motor branch of the musculocutaneous nerve. BM; biceps muscle.
Mentions: Under general anesthesia, an operation was performed in the supine position. The brachial artery and the median, ulnar, and a branch of the musculocutaneous nerve supplying the biceps muscle were identified at a level approximately 7.0 cm distal from the acromion. One fascicle of the ulnar nerve was separated at the same level as the branch of the biceps muscle. We confirmed a fascicle corresponding to the motor fascicle of the ulnar nerve by microelectronic stimulation, and we then transferred this fascicle to the motor branch of the biceps muscle [1,2]. End-to-end nerve repair, at a level approximately 1.0 cm proximal from the insertion to the biceps muscle, was then performed using 10-0 sutures (Fig. 2). After resection of the omohyoid muscle, the upper trunks appeared. The spinal accessory nerve and the suprascapular nerve were identified, and the spinal accessory nerve was then transferred to the suprascapular nerve. The duration of these procedures was two hours and forty minutes. After surgery, the upper arm of the operative site was set free with no cast immobilization. No specific motor re-education program was used post-operatively.

Bottom Line: An 8 month old male infant with Erb's birth palsy was treated with two peripheral nerve transfers.Forty months after surgery, elbow flexion reached M5 without functional loss of the ulnar nerve.However, at this time partial ulnar nerve transfer for Erb's birth palsy is an optional procedure; a larger number of cases will need to be studied for it to be widely accepted as a standard procedure for Erb's palsy at birth.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan. shigema2@naramed-u.ac.jp

ABSTRACT
An 8 month old male infant with Erb's birth palsy was treated with two peripheral nerve transfers. Except for rapid motor reinnervations, elbow flexion was obtained by an Oberlin's partial ulnar nerve transfer, while shoulder abduction was restored by an accessory-to-suprascapular nerve transfer. The initial contraction of the biceps muscle occurred two months after surgery. Forty months after surgery, elbow flexion reached M5 without functional loss of the ulnar nerve. This case demonstrates an excellent result of an Oberlin's nerve transfer for restoration of flexion of the elbow joint in Erb's birth palsy. However, at this time partial ulnar nerve transfer for Erb's birth palsy is an optional procedure; a larger number of cases will need to be studied for it to be widely accepted as a standard procedure for Erb's palsy at birth.

No MeSH data available.


Related in: MedlinePlus