A case of congenital bilateral absence of elbow flexor muscles: review of differential diagnosis and treatment.
A 1-year-old boy presented to us with congenital inability to flex his elbow. He had bilaterally absent biceps brachii and brachialis muscles, a rare condition. We performed pedicle latissimus dorsi musculocutaneous flaps to the left and right volar upper arm at 21 and 24 months of age, respectively, to create elbow flexors. By 4 years of age, he had excellent elbow flexion bilaterally with strength grade in excess of 4.5. In addition to discussing our patient's treatment options, we discuss other potential causes of weak elbow flexion when faced with this clinical dilemma.
Netscher
David T
DT
Division of Plastic Surgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA. dnetscher@bcm.tmc.edu
Aliu
Oluseyi
O
Samra
Saleh
S
Lewis
Eric
E
J Neurol Sci. 1983 Jan;58(1):89-102
6842261
J Neurol Sci. 1973 Apr;18(4):373-9
4699429
J Hand Surg Am. 1993 Mar;18(2):285-91
8463596
Am J Med Genet. 1983 Aug;15(4):571-90
6614047
J Bone Joint Surg Am. 1954 Jul;36-A(4):775-89; passim
13174607
Clin Orthop Relat Res. 1985 Apr;(194):30-43
3978931
Neuromuscul Disord. 2004 Oct;14(10):635-49
15351421
Pediatr Neurol. 1995 Apr;12(3):237-41
7619191
Pediatr Neurol. 1997 Oct;17(3):249-51
9390702
J Clin Invest. 1996 Nov 15;98(10):2358-63
8941654
Microsurgery. 1991;12(5):346-51
1770864
Brain Dev. 1998 Oct;20(7):507-11
9840670
Eur J Obstet Gynecol Reprod Biol. 2003 Aug 15;109(2):160-5
12860334
Am J Phys Med Rehabil. 1996 May-Jun;75(3):227-31
8663931
Am J Dis Child. 1993 Aug;147(8):907-8
8352229
J Neurol Neurosurg Psychiatry. 1976 Sep;39(9):890-9
993811
J Hand Surg Br. 2002 Oct;27(5):484-6
12367550
Surg Gynecol Obstet. 1952 Dec;95(6):685-8
13005342
Hand Clin. 1988 May;4(2):297-307
3294249
Neurology. 1968 Sep;18(9):926-30
4176659
Pediatr Pathol. 1994 Mar-Apr;14(2):277-85
8008690
J Hand Surg Am. 1998 Nov;23(6):1063-70
9848560
Am J Obstet Gynecol. 1998 Mar;178(3):423-7
9539501
Am J Obstet Gynecol. 1992 Jun;166(6 Pt 1):1673-6; discussion 1676-7
1309174
J Bone Joint Surg Am. 1973 Sep;55(6):1265-75
4758039
Clin Neuropathol. 1988 Nov-Dec;7(6):285-93
3224470
Am J Phys Med Rehabil. 2001 Oct;80(10):759-61
11562558
Clin Orthop Relat Res. 1994 Dec;(309):201-7
7994962
Brain Dev. 2004 Jan;26(1):47-52
14729415
Lancet. 1950 Jan 21;1(6595):99-103
15400661
J Bone Joint Surg Br. 1976 Nov;58-B(4):488-91
1018037
Plast Reconstr Surg. 2000 Dec;106(7):1582-5
11129190
J Bone Joint Surg Am. 1976 Jan;58(1):52-8
175070
Clin Orthop Relat Res. 1977 Jun;(125):36-9
880776
Neuropediatrics. 2001 Dec;32(6):330-4
11870590
Dev Med Child Neurol. 1980 Jun;22(3):371-4
6446471
J Bone Joint Surg Am. 1955 Dec;37-A(6):1129-39; discussion, 1139-40
13271460
J Bone Joint Surg Am. 1988 Apr;70(4):526-35
3356719
Arch Phys Med Rehabil. 1978 Jun;59(6):290-3
666561
J Med Genet. 1973 Sep;10(3):260-5
4774536
J Neurol Neurosurg Psychiatry. 1974 Mar;37(3):316-23
4364274
Brain. 1957 Sep;80(3):319-34
13471804
J Hand Surg Am. 1979 Nov;4(6):501-7
512308
Acta Neurol Scand. 1994 Oct;90(4):232-40
7839807
Lancet. 1980 Apr 26;1(8174):919-22
6103267
Arch Dis Child. 1959 Dec;34:505-10
13824224
Arch Phys Med Rehabil. 1979 Mar;60(3):130-3
485803
J Neurol Neurosurg Psychiatry. 1993 Apr;56(4):365-8
8482956
J Bone Joint Surg Br. 1981 Feb;63-B(1):98-101
7204481
N Engl J Med. 1972 Sep 7;287(10):487-9
4340236
Ann Chir Main. 1989;8(2):110-23
2802838
J Bone Joint Surg Am. 1967 Jun;49(4):785-92
6026011
Ann N Y Acad Sci. 1974 Mar 22;228(0):121-44
4152235
Med J Aust. 1986 Aug 4-18;145(3-4):153-4
3016490
Neurology. 1977 Nov;27(11):1049-52
563000
Burns. 2005 Feb;31(1):113-5
15639376
Muscle Nerve. 1982 Mar;5(3):256
7088024