Neuroma-in-continuity resection: early outcome in obstetrical brachial plexus palsy.
The short-term effect of neuroma-in-continuity resection in obstetrical brachial plexus palsy was evaluated to test the hypothesis that the neuroma does not contribute to useful limb function. Twenty-six patients with obstetrical brachial plexus palsy underwent resection of the neuroma-in-continuity and interpositional nerve grafting, and 17 patients underwent neurolysis only. The preoperative and postoperative active movement scores were recorded using an eight-point scale for 15 joint motions in each patient. Data analysis examined the change in total limb motion scores over time within patients undergoing neuroma-in-continuity resection and a comparison with those patients undergoing neurolysis. Compared with preoperative assessment, limb motion scores after neuroma resection were significantly decreased at 6 weeks, not significantly different by 3 months, and significantly improved at 12 months postoperatively. In comparison to patients undergoing neurolysis only, limb motion scores after neuroma resection were not significantly different at 3, 6, and 12 months postoperatively. These findings are unlikely to be accounted for by axonal regeneration across interpositional nerve grafts. Nerve regeneration or recovery in the nongrafted segment of the plexus must be sufficient to reproduce preoperative motion. Resection of the neuromas-in-continuity in obstetrical brachial plexus palsy does not significantly diminish motor activity.
Division of Plastic Surgery at The Hospital for Sick Children, University of Toronto, Canada.
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L
Capek
H M
HM
Clarke
C G
CG
Curtis
D001917:Brachial Plexus / Q000293:injuries*; D004551:Elbow Joint / Q000503:physiopathology; D005260:Female; D005384:Finger Joint / Q000503:physiopathology; D005542:Forearm / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D009119:Muscle Contraction; D009416:Nerve Regeneration; D016067:Nerve Transfer; D009463:Neuroma / Q000503:physiopathology / Q000601:surgery*; D010246:Paralysis, Obstetric / Q000601:surgery*; D010524:Peripheral Nervous System Neoplasms / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000503:physiopathology; D016896:Treatment Outcome; D014955:Wrist Joint / Q000503:physiopathology