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Early and Simultaneous Nerve Repair and Tendon transfer: A Paradigm Shift in the treatment of Obstetrical Brachial Plexus Palsy
Chilando M. Mulenga, BS1; Jeffrey N. Gross, MD3; Collin Young, DO2 ; Khoa Tran MPH3; Mary H. Benecke MS, OTR/L, BCP2;Francisco J. Angulo Parker, MD2;Joshua M. Adkinson, MD3; Gregory H. Borschel, MD3
Indiana University School of Medicine
2025-01-10
Presenter: Chilando Mulenga
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: William Wooden, MD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand
Introduction: Obstetrical brachial plexus palsy (OBPP) arises from forceful displacement of the infant's head during birth, leading to motor deficits and glenohumeral joint dysplasia (GJD) due to incomplete neurological recovery. Traditionally, staged primary nerve repair and latissimus dorsi/teres major tendon transfer (LTT) have been used, but managing internal rotation contractures remains challenging. This study compares outcomes between concurrent primary nerve repair with muscle transfer and the staged approach, emphasizing improved upper extremity function.
Methods: A retrospective review included patients under 18 at Riley Children's Hospital who underwent LTT between 2021–2023. The Active Movement Scale (AMS) was used to evaluate upper extremity function, with scores ranging from 0 (no contraction) to 7 (full function against gravity).
Results: Nineteen patients underwent LTT: nine had concurrent surgery (median age 0.5 years), and ten had staged surgery (median age 1.8 years). MRI revealed GJD in nine patients-eight from the staged group and one from the concurrent group. Preoperative AMS scores for both groups showed reduced shoulder external rotation, shoulder abduction, shoulder flexion, elbow flexion, forearm supination, wrist extension, and thumb extension. Postoperatively (approx. 2 months), at 6, 12, and 24 months , both groups improved in these movements (Figure 1). Preoperative scores for antagonistic movements were 5 or higher (Figure 2).
Conclusion: Both groups showed functional improvement, but the concurrent group achieved comparable outcomes to the staged group at a younger age (2.5 vs. 3.8 years) without requiring a second surgery. Early concurrent surgery may reduce the risk of GJD and repeated anesthesia exposure.
