Correlation between the elbow flexion and the hand and wrist flexion after neurotization of the fascicles of the ulnar nerve to the motor branch to the biceps

• Published in: Revista brasileira de ortopedia 2017-05, Vol.52 (3), p.309-314
• Main Authors: Escudero, Ricardo Boso, Rezende, Marcelo Rosa de, Wataya, Erick Yoshio, Pontes, Fernando Vicente de, Cho, Álvaro Baik, Pisani, Marina Justi
• Format: Article
• Language: English
• Subjects: Brachial plexus neuropathies/etiology; Brachial plexus neuropathies/surgery; Brachial plexus/injuries; Brachial plexus/surgery; Nerve transfer; Neuropatias do plexo braquial/cirurgia; Neuropatias do plexo braquial/etiologia; Original; ORTHOPEDICS; Plexo braquial/cirurgia; Plexo braquial/lesões; Reabilitação; Rehabilitation; Transferência de nervo
• ISSN: 2255-4971; 1982-4378; 2255-4971
• DOI: 10.1016/j.rboe.2017.04.006

Gain in elbow flexion in patients with brachial plexus injury is extremely important. The transfer of a fascicle from the ulnar nerve to the motor branch of the musculocutaneous nerve (Oberlin surgery) is a treatment option. However, in some patients, gain in elbow flexion is associated with wrist and finger flexion. This study aimed to assess the frequency of this association and the functional behavior of the limb. Case–control study of 18 patients who underwent the Oberlin surgery. Group 1 included patients without disassociation of range of elbow flexion and that of the fingers and wrist; Group 2 included patients in whom this disassociation was present. In the functional evaluation, the Sollerman and DASH tests were used. It was observed that 38.89% of the patients did not present disassociation of elbow flexion with flexion of the wrist and fingers. Despite the existence of a favorable difference in the group with disassociation of the movement, when the Sollerman protocol was applied to the comparison between both groups, this difference was not statistically significant. With the DASH test, however, there was a statistically significant difference in favor of the group of patients who managed to disassociate the movement. The association of elbow flexion with flexion of the wrist and fingers, in the group studied, was shown to be a frequent event, which influenced the functional result of the affected limb. O ganho da flexão do cotovelo em pacientes com lesão no plexo braquial é de suma importância. A cirurgia de transferência de fascículo do nervo ulnar para ramo motor do nervo musculocutâneo (cirurgia de Oberlin) é uma opção de tratamento. Contudo, o ganho da flexão do cotovelo, em alguns pacientes, vem associado à flexão do punho e dos dedos. O objetivo deste trabalho é avaliar a frequência dessa associação e o comprometimento funcional do membro. Estudo tipo caso-controle de 18 pacientes submetidos à cirurgia de Oberlin. No Grupo 1 foram incluídos os pacientes que não apresentavam dissociação do ganho da flexão do cotovelo com a dos dedos e do punho; no Grupo 2, os pacientes em que havia dissociação. Os testes de Sollerman e Disabilities of the Arm, Shoulder and Hand (Dash) foram usados na avaliação funcional. Observou-se que 38,89% dos pacientes não dissociavam flexão de cotovelo de flexão de punho e dos dedos. Apesar de existir uma diferença favorável ao grupo que dissociava o movimento quando aplicado o protocolo de Sollerman na comparação e