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Safety of Shoulder Spica Casting After Brachial Plexus Birth Injury Repair
Christina R Kuhrau, BA; Tamara Al-Muhtaseb, MS; Kevin Little, MD; Ann Schwentker, MD
University of Cincinnati
2025-01-10
Presenter: Christina Kuhrau
Affidavit:
Christina Kuhrau
Director Name: Dr. Ann Schwentker
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction: Brachial plexus birth injury can result in infantile glenohumeral joint dysplasia. Traditionally, nerve and shoulder surgery are performed separately and require opposing postoperative immobilization. We show that shoulder spica casting in abduction and external rotation protects both repairs.
Methods: Retrospective chart review was completed for patients who had combined shoulder and nerve surgery. Shoulder procedures included Botox, closed reduction, arthroscopic release, and tendon transfer. Sural nerve grafting with or without spinal accessory (SAN) to suprascapular nerve (SSN) transfer was performed. Mallet and Active Movement Scale (AMS) scores were collected. Shoulder external rotation was a marker for SAN recovery, shoulder abduction/flexion and elbow extension for posterior division of upper trunk (PDUT), elbow flexion for anterior division of upper trunk (ADUT), and hand function for lower trunk (LT). Active motion confirmed nerve graft continuity.
Results: 14 patients were identified. Surgery was performed at 5.9 months on average. Follow-up was 5.5 years. Ten patients had SAN-SSN transfers; the SSN was grafted in three. Every patient required PDUT and ADUT grafting. Three required C8 reconstruction, and four lower trunk. Secondary shoulder procedures were done for six. At latest follow-up, Mallet & AMS scores indicated complete or ongoing recovery of all grafted nerves. One patient had no external rotation at 1.5 years after SAN transfer, and recovery of hand function was variable as is typical for LT repair.
Conclusions: Recovery of reconstructed nerves in our cohort indicates that casting in abduction and external rotation can be implemented safely after combined shoulder and nerve repair.
