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Glenohumeral Arthrodesis Leads to Improved Elbow Flexion in Traumatic Adult Brachial Plexus Injury Patients
Lauren E Dittman, MD
1; Robert J. Spinner, MD
2; Allen T Bishop, MD
3; Alexander Y Shin, MD
11Mayo Clinic, Rochester, MN; 2Orthopedics, Mayo Clinic, Rochester, MN; 3Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
Introduction: Brachial plexus injuries (BPI) are devastating injuries that can lead to tremendous upper extremity dysfunction. Restoration of elbow flexion is the first priority in the treatment of BPI and can be accomplished by nerve transfers, tendon transfers, or free-functioning muscle transfers. While the goal is anti-gravity elbow flexion strength (modified British Medical Research Council grade (mBMRC) >3), occasionally, this strength is not obtained, especially with a flail, subluxated glenohumeral (GH) joint. We hypothesize that with GH stabilization, elbow flexion would be improved, as there is no longer the need to waste elbow flexion excursion to reduce the GH joint prior to obtaining elbow flexion. energy through an unstable shoulder girdle. The purpose of this study was to compare elbow flexion strength before and after glenohumeral arthrodesis (GHA) in patients with BPI who had both loss of elbow flexion and shoulder function.
Materials & Methods: A retrospective review of all patients who underwent GHA after a previous failed procedure to restore elbow flexion was undertaken at a multidisciplinary brachial plexus clinic. Patient demographics, including level of BPI, type of elbow flexion restoration surgery and time from injury to GHA were collected. Primary outcome was pre- to postoperative change in mBMRC. Secondary outcomes were pre- and postoperative elbow flexion, extension and total arc of motion. A t-test was utilized to analyze the changes in pre- to post-operative outcomes.
Results: A total of 13 patients met inclusion criteria, with an average age of 41 years (range: 20-70). Mean follow-up was 63 weeks (range: 6-187). Six patients (46%) underwent a previous nerve grafting or transfer surgery, and six patients (46%) underwent a previous free functioning muscle transfer for restoration of elbow flexion. Eight patients (62%) sustained pan-plexus injuries, while the remaining 5 (38%) sustained upper trunk injuries. Mean time from injury to GHA was 7 years (range: 1.2-61.8). There was a significant improvement postoperatively in both mean elbow flexion, from an average of 68 degrees to 114 degrees (
p=0.010), as well as in mBRMC grade, from an average of 2- to 4- (
p<0.001).
Conclusions: Glenohumeral arthrodesis led to improvement in degrees of elbow flexion as well as elbow flexion strength in BPI patients who had undergone previous failed surgery to restore elbow flexion. In patients with flail shoulders or failed shoulder reconstructions and inadequate elbow flexion strength after reconstruction, glenohumeral arthrodesis should be considered to improve elbow flexion strength.
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