gms | German Medical Science

Objectives/Interrogation: Restoration of elbow extension in patients with birth brachial plexus palsy has received much less attention in the literature. Restoration of elbow flexion is considered as a prime aim and recovery of elbow extension is relied on assistance by gravity. However, in absence of elbow extension, the capacity of the child to reach for objects especially above the shoulder level is greatly limited which henceforth dramatically limits the use of the hand. Lack of elbow extension causes the elbow (with the hand) to fall into flexion when the child abducts the shoulder overhead, again limiting the reach to the objects.

Methods: The techniques described for restoration of elbow extension include the posterior deltoid-to-triceps transfer and lower trapezius to deltoid transfer. In our experience, the posterior deltoid to triceps transfer gave good results but it was possible only when the function of posterior deltoid is normal. Most of the children with birth brachial plexus palsy have limited deltoid function. We have performed the described lower trapezius to triceps in four patients. Two of them achieved grade 2 triceps function but other two could not perform any active extension of the elbow. This operation has not given good results as reported for adults.

So we modified the technique and used the upper trapezius to triceps transfer in six patients. The upper trapezius was extended with the fascia lata and connected to the triceps to restore elbow extension. In last two years, we have performed six cases of upper trapezius to triceps transfer (with fascia lata graft).

Results and Conclusions: All the six patients could actively perform elbow extension against gravity (grade 3). They reported that their ability to reach for objects has improved and overall function of the limb as well. Since the transfer also transversed the shoulder it also improved the shoulder abduction.