Sensibility of the hand in children with conservatively or surgically treated upper neonatal brachial plexus lesion

Publication date: Available online 11 May 2018
Source:Pediatric Neurology
Author(s): Sonja M. Buitenhuis, Willem Pondaag, Ron Wolterbeek, Martijn J.A. Malessy
AimThe aim of this study was to assess the sensibility of the hand in children with a neonatal brachial plexus palsy (NBPP) involving the upper nerves C5 and C6, and to correlate the results with dexterity.MethodFifty children with NBPP (mean age 9.8 y) and 25 healthy controls (mean age 9.6 y) were investigated. In the NBPP group, nerve surgery had been performed in 30 children and 20 children had been treated conservatively. Sensibility was assessed with two-point discrimination (2PD) and Semmes-Weinstein (SW) monofilaments. Dexterity was evaluated with a single item from the Movement Assessment Battery for Children-2. We compared the affected side of the NBPP group with the non-dominant hand of the control group.ResultsThe sensibility in the first and second fingers was significantly lower in the NBPP group than in the control group for both the 2PD (p=0.005 and p=0.014 respectively) and the SW monofilament test (p<0.001). Dexterity was significantly lower in the NBPP group than in controls, corrected for age (p=0.023). There was a significant difference toward decreasing hand function with decreasing sensibility according to the SW test for the thumb (Jonckheere-Terpstra non-parametric trend test, p= 0.036)InterpretationThe sensibility of the thumb and index finger in children with an upper plexus lesion (either surgically or conservatively treated) is diminished. The decreased sensibility has a negative impact on hand function. Appreciation of diminished hand function in patients with NBPP involving C5-C6 is important to optimize treatment.



https://ift.tt/2I8yTSj