Challenges in restoring prehension after severe panplexus brachial plexus injury
DOI:
https://doi.org/10.57922/mec.2468Abstract
Severe brachial plexus injury is an uncommon but devastating injury suffered predominantly by young working age men involving motor cycles or cars. In those requiring surgical reconstruction, half have panplexus injuries, 30-40% have upper plexus injuries, and a small minority have lower plexus injuries (1,2). A myriad of surgical techniques are used to attempt to restore function to the arm - decompression and repair, nerve transfers, free functional muscle transfers, tendon transfers, joint arthrodesis, and targeted muscle reinnervation (Aszman). Multidisciplinary Rehabilitation is essential to maintain joint range of motion, protect the flail limb from secondary injury, keep a functional focus, address pain management, provide psychological support, teach personal care independence, and provide vocational support to return to their existing employment or retrain. The surgical options are complex and the recovery times e.g. after nerve transfers, can be much longer than patients anticipate, leading to a loss of engagement, and uncertainty about achievable outcomes. In the past prehension was addressed through body powered(BP) or externally powered(EP) orthoses or transhumeral amputation (THA) and BP or EP prostheses. In Australia these approaches have fallen entirely out of favour. The surgical units however, have a reliable expectation of providing a stable shoulder with limited abduction/flexion and good biceps function following nerve and or tendon transfers +/- humeral rotation osteotomy. What patients lack is prehension. I was inspired by Aszman's innovative work combining TMR and Trans Radial Amputation(TRA) and have since developed an approach which involves a patient centred choice between TRA and prosthetic fitting or exoskeleton both of which can be activated by auxiliary switching technology in the absence of sEMG signals in the arm. I will present examples of each in a series of cases which we have treated at The Prince of Wales Hospital in Sydney Australia.
Downloads
Published
2024-08-15
How to Cite
[1]
G. Bowring and M. Leong, “Challenges in restoring prehension after severe panplexus brachial plexus injury”, MEC Symposium, Aug. 2024.
Conference Proceedings Volume
Section
Clinical Practice
