Tendon Lengthening Surgery for Elbow Flexion Contractures in Brachial Plexus Birth Palsy

Purpose Flexion contracture of the elbow is a common deformity associated with brachial plexus birth palsy and is often managed with preventive night orthoses. For severe cases, however, surgical interventions may become necessary. This study evaluated the effectiveness of surgically releasing elbow...

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Autores: Gutierrez-Pereira, J, Garcia-Lopez, A
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
Repositorio:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
OAI Identifier:oai:isabial.fundanetsuite.com:p11397
Acceso en línea:https://isabial.portalinvestigacion.com/publicaciones11397
https://doi.org/10.1016/j.jhsa.2024.07.026
Access Level:acceso abierto
Palabra clave:Biceps brachii
brachialis
brachial plexus birth palsy
elbow flexion contracture
tendon lengthening
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spelling Tendon Lengthening Surgery for Elbow Flexion Contractures in Brachial Plexus Birth PalsyGutierrez-Pereira, JGarcia-Lopez, ABiceps brachiibrachialisbrachial plexus birth palsyelbow flexion contracturetendon lengtheningPurpose Flexion contracture of the elbow is a common deformity associated with brachial plexus birth palsy and is often managed with preventive night orthoses. For severe cases, however, surgical interventions may become necessary. This study evaluated the effectiveness of surgically releasing elbow flexion contractures exceeding 30 degrees through partial tenotomy of the brachialis and biceps brachii muscles, along with a division of the lacertus fibrosus. Methods We performed 36 anterior elbow releases on patients with injury to the upper trunk (C5-C6) of the brachial plexus and elbow flexion contractures between 30 degrees and 80 degrees. All releases involved lacertus fibrosus section and partial lengthening of the distal portion of the brachialis tendon. In severe cases, biceps brachii tenotomy was also performed. All participants had a minimum follow-up of 12 months and preoperative elbow flexion strength of at least grade 4 on the British Medical Research Council scale, with no deformities in the shape of the ulnohumeral joint or radial head subluxation. Results Following a mean follow-up of 41 months, the average extension gain was 31 degrees (range, 10 degrees-50 degrees). All patients maintained their flexion strength. Except for two participants with weaker triceps, the mean elbow extension gain was sustained throughout the follow-up period. There were no major or minor complications or reinterventions in the study. Conclusions Partial tenotomy of the brachialis and biceps brachii muscles, coupled with lacertus fibrosus section, is an effective treatment for elbow contractures exceeding 30 degrees flexion. This method is successful in individuals with a functioning triceps brachii and elbow extension strength of at least grade 3 on the British Medical Research Council scale. (J Hand Surg Am. 2025;50(8):1012.e1-e8. Copyright (c) 2025 by the American Society for Surgery of the Hand. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).)W B SAUNDERS CO-ELSEVIER INC2025info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://isabial.portalinvestigacion.com/publicaciones11397https://doi.org/10.1016/j.jhsa.2024.07.026JOURNAL OF HAND SURGERY-AMERICAN VOLUMEISSN: 03635023ISSNe: 15316564reponame:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicanteinstname:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)Inglésinfo:eu-repo/semantics/openAccessoai:isabial.fundanetsuite.com:p113972026-06-12T10:20:37Z
dc.title.none.fl_str_mv Tendon Lengthening Surgery for Elbow Flexion Contractures in Brachial Plexus Birth Palsy
title Tendon Lengthening Surgery for Elbow Flexion Contractures in Brachial Plexus Birth Palsy
spellingShingle Tendon Lengthening Surgery for Elbow Flexion Contractures in Brachial Plexus Birth Palsy
Gutierrez-Pereira, J
Biceps brachii
brachialis
brachial plexus birth palsy
elbow flexion contracture
tendon lengthening
title_short Tendon Lengthening Surgery for Elbow Flexion Contractures in Brachial Plexus Birth Palsy
title_full Tendon Lengthening Surgery for Elbow Flexion Contractures in Brachial Plexus Birth Palsy
title_fullStr Tendon Lengthening Surgery for Elbow Flexion Contractures in Brachial Plexus Birth Palsy
title_full_unstemmed Tendon Lengthening Surgery for Elbow Flexion Contractures in Brachial Plexus Birth Palsy
title_sort Tendon Lengthening Surgery for Elbow Flexion Contractures in Brachial Plexus Birth Palsy
dc.creator.none.fl_str_mv Gutierrez-Pereira, J
Garcia-Lopez, A
author Gutierrez-Pereira, J
author_facet Gutierrez-Pereira, J
Garcia-Lopez, A
author_role author
author2 Garcia-Lopez, A
author2_role author
dc.subject.none.fl_str_mv Biceps brachii
brachialis
brachial plexus birth palsy
elbow flexion contracture
tendon lengthening
topic Biceps brachii
brachialis
brachial plexus birth palsy
elbow flexion contracture
tendon lengthening
description Purpose Flexion contracture of the elbow is a common deformity associated with brachial plexus birth palsy and is often managed with preventive night orthoses. For severe cases, however, surgical interventions may become necessary. This study evaluated the effectiveness of surgically releasing elbow flexion contractures exceeding 30 degrees through partial tenotomy of the brachialis and biceps brachii muscles, along with a division of the lacertus fibrosus. Methods We performed 36 anterior elbow releases on patients with injury to the upper trunk (C5-C6) of the brachial plexus and elbow flexion contractures between 30 degrees and 80 degrees. All releases involved lacertus fibrosus section and partial lengthening of the distal portion of the brachialis tendon. In severe cases, biceps brachii tenotomy was also performed. All participants had a minimum follow-up of 12 months and preoperative elbow flexion strength of at least grade 4 on the British Medical Research Council scale, with no deformities in the shape of the ulnohumeral joint or radial head subluxation. Results Following a mean follow-up of 41 months, the average extension gain was 31 degrees (range, 10 degrees-50 degrees). All patients maintained their flexion strength. Except for two participants with weaker triceps, the mean elbow extension gain was sustained throughout the follow-up period. There were no major or minor complications or reinterventions in the study. Conclusions Partial tenotomy of the brachialis and biceps brachii muscles, coupled with lacertus fibrosus section, is an effective treatment for elbow contractures exceeding 30 degrees flexion. This method is successful in individuals with a functioning triceps brachii and elbow extension strength of at least grade 3 on the British Medical Research Council scale. (J Hand Surg Am. 2025;50(8):1012.e1-e8. Copyright (c) 2025 by the American Society for Surgery of the Hand. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).)
publishDate 2025
dc.date.none.fl_str_mv 2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://isabial.portalinvestigacion.com/publicaciones11397
https://doi.org/10.1016/j.jhsa.2024.07.026
url https://isabial.portalinvestigacion.com/publicaciones11397
https://doi.org/10.1016/j.jhsa.2024.07.026
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv W B SAUNDERS CO-ELSEVIER INC
publisher.none.fl_str_mv W B SAUNDERS CO-ELSEVIER INC
dc.source.none.fl_str_mv JOURNAL OF HAND SURGERY-AMERICAN VOLUME
ISSN: 03635023
ISSNe: 15316564
reponame:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
instname:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
instname_str Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
reponame_str r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
collection r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
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