Elbow Flexion and Forearm Rotation Profile in OBPI
Research type
Research Study
Full title
Elbow Flexion and Forearm Rotation Profile in Obstetric Brachial Plexus Injury
IRAS ID
231769
Contact name
Timothy Hems
Contact email
Sponsor organisation
Clinical Research & Development, NHS GGC
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
Summary of Research
The brachial plexus is a network of nerves in the neck and shoulder which controls movement and provides sensation in the upper limb. The brachial plexus may be injured as a result of stretching during birth, a condition known as obstetric brachial plexus injury (OBPI), causing partial or occasionally complete paralysis of the upper limb. In most cases there is improvement with complete or partial recovery. In children with incomplete recovery the most common deficits are shoulder movement, flexion contracture of the elbow (elbow doesn’t fully straighten), and limitation of forearm rotation.
This project involves analysing information recorded on the brachial plexus service database for clinical reasons, in order to establish the natural history of flexion contracture of the elbow and limitation of forearm rotation in children with OBPI. Linked anomymised data will be used. The incidence and age of onset of elbow and forearm deformity will be calculated together with degree of fixed flexion of the elbow, range of forearm pronation, and range of forearm supination, at each age. This will give information on how the condition progresses with age. We will also identify any correlation with initial severity of the obstetric brachial plexus injury.
It is hoped that the new information will enable us to develop methods for identifying children likely to develop more severe contracture, who may benefit from treatment at an early stage.Summary of Results
Abstract from published results:
A prospective database study was undertaken to investigate the severity and progression of elbow and forearm contractures in patients with obstetric brachial plexus injury. One-hundred and fifty-nine patients, who had not undergone nerve repair (mean age 12 years at last follow-up) (56 Narakas Group 1, 66 Group 2,
27 Group 3, 10 Group 4) were studied. Mean fixed flexion of the elbow at last follow-up was 13 degrees for Group 1, 15 degrees for Group 2, 19 degrees for Group 3 and 24 degrees for Group 4. Severe contracture of 30 or more developed in 31 children (mean age 118 months), with poorer active shoulder abduction being a significant risk factor. Onset of contracture was before the age of 5 years but did not increase substantially beyond 12 years. Active and passive pronation and supination tended to decrease with increasing injury severity. Seventeen children developed severe restriction of passive pronation (supination contracture) (mean age 69 months), and 12 developed severe restriction of passive supination at a mean of 137 months.Implications:
The results of this study give information on severity and rate of progression of flexion contracture of the elbow (inability to straighten the elbow) and limitation of forearm rotation. This will help to inform management of elbow and forearm contractures in patients with obstetric brachial plexus injury.REC name
East of Scotland Research Ethics Service REC 2
REC reference
18/ES/0104
Date of REC Opinion
22 Aug 2018
REC opinion
Favourable Opinion