Long-Term Outcome Of Hand And Shoulder Function In Children Following Early Surgical Intervention For Upper Brachial Plexus Birth Injury
Rachel Aber, BA1, Leslie A. Grossman, MPH2, Aaron J. Berger, MD, PhD2, Israel Alfonso, MD2, Andrew Price, MD2, John AI Grossman, MD3.
1Sackler School of Medicine, Tel Aviv, Israel, 2Nicklaus Children's Hospital, Miami, FL, USA, 3Nicklaus Children's Hospital, Miami, FL, USA.
PURPOSE: To describe the long-term (15-year) outcome of shoulder and hand function in patients with a history of upper brachial plexus birth injury (BPBI).
METHODS: Retrospective review was performed of patients who underwent primary nerve surgery for BPBI between 2000-2005.
Of 131 patients, 55 of were classified as upper BPBI; 32/55 were available for long-term follow-up. Evaluation at an average age of 15years ± 2y2mo included hand function assessment with 9-hole peg test (9-HPT).
Shoulder function was evaluated using the Miami Shoulder Scale.
Statistical analysis included comparison of 9-HPT time against normative data using the student's t-test.
RESULTS: The cohort includes 22 right-hand-dominant and 10 left-hand-dominant patients. Mean age at surgery: 10 months; mean age at follow‐up:15years ± 2y2mo.
Cumulative shoulder function was 'good' or 'excellent' (Miami score) in 23 patients; 4 patients had 'poor' shoulder scores.
For 9‐HPT, 27/32 patients required significantly longer time using the involved hand; mean time difference 2.9 seconds (expected difference 0.68 seconds; p= 0.00035). Among 7 patients with hand dominance on the affected side, two demonstrated significantly worse times for the involved hand, and mean time difference for the remaining 5 patients was 2.7 seconds.
Three patients displayed no time difference between involved and uninvolved hands.
CONCLUSIONS: Long term follow-up in patients with upper BPBI demonstrates that the majority of patients have detectable differences in hand function, contrary to the accepted 'normal' hand function in this patient population. Under-recognized deficits in hand function may play a role in residual functional disability in these patients.
Back to 2022 Posters