Our Summary

The research paper discusses elbow flexion paralysis, a major problem affecting the arm, often caused by injury to the brachial plexus (a group of nerves that control arm muscles) or nerve trunk. The study suggests that early nerve surgery or moving muscles from other parts of the body should be part of the treatment plan to recover elbow flexion (ability to bend the elbow).

For cases where the paralysis has been present for a long time, if a person is not a good candidate for nerve surgery, or if nerve surgery doesn’t provide sufficient results, a muscle or tendon transfer may be recommended. This involves moving a muscle from one part of the body to another. If a strong muscle donor is available, it is preferred. This could be muscles like the pectoralis major and minor (chest muscles), triceps brachii (back of the upper arm), or latissimus dorsi (large back muscle).

If the patient has only partial recovery of elbow bending, a weaker muscle may be transferred. This could be the pectoralis minor, a muscle near the elbow (using a technique called Steindler), or the biceps brachii tendon on the forearm.

If no donor muscle is available, a free muscle transfer (removing a muscle from one part of the body and transplanting it in the affected area with reconnection of nerves and blood vessels) may be done if the person is young and has favourable nerve regeneration conditions.

FAQs

  1. What is elbow flexion paralysis and how is it treated?
  2. What are some of the methods used in tendon transfers for treating elbow flexion paralysis?
  3. When is a free reinnervated muscle transfer indicated in the treatment of elbow flexion paralysis?

Doctor’s Tip

A helpful tip a doctor might tell a patient about elbow surgery is to follow the post-operative rehabilitation plan carefully. This may include physical therapy exercises to help regain strength and range of motion in the elbow. It is important to be patient and consistent with the exercises to ensure optimal recovery and function of the elbow. Additionally, it is important to communicate any concerns or changes in symptoms to the doctor to ensure proper healing and recovery.

Suitable For

Patients who are typically recommended for elbow surgery include those with elbow flexion paralysis, particularly those with brachial plexus palsy or nerve trunk lesions. Surgery may be recommended in cases where early nerve surgery or palliative transfers are needed for restoration of elbow flexion. Tendon transfers may also be indicated in long-standing palsies, in patients who are not good candidates for nerve surgery, or when the results of nerve surgery are inadequate. In cases where a regional pedicled muscle transfer is performed, a “strong” donor muscle such as the pectoralis major with pectoralis minor transfer, triceps brachii to biceps brachii transfer, or bipolar latissimus dorsi transfer may be preferred. For patients with incomplete recovery of elbow flexion, a “weak” transfer such as an isolated pectoralis minor transfer, medial epicondylar muscle transfer according to the Steindler technique, or advancement of the biceps brachii tendon on the forearm may be recommended. In cases where no donor muscle is available, a free reinnervated muscle transfer may be indicated if age and nerve regeneration conditions are favorable.

Timeline

Before Elbow Surgery:

  • Patient may have experienced trauma or injury to the elbow
  • Patient may have undergone diagnostic tests such as X-rays or MRI to assess the extent of the injury
  • Patient may have tried non-surgical treatments such as physical therapy or medication to manage symptoms
  • Patient may have consulted with a surgeon to discuss surgical options and risks

After Elbow Surgery:

  • Patient will undergo the surgical procedure to repair the elbow injury
  • Patient will be monitored in the hospital for a period of time post-surgery
  • Patient will begin physical therapy and rehabilitation to regain strength and mobility in the elbow
  • Patient will have follow-up appointments with the surgeon to assess healing and progress
  • Patient may need to continue with physical therapy and rehabilitation for several weeks or months to fully recover from surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about elbow surgery may include:

  1. What is the specific reason for the elbow surgery?
  2. What are the potential risks and complications associated with the surgery?
  3. What is the expected recovery time and rehabilitation process after the surgery?
  4. Will I need physical therapy after the surgery, and if so, for how long?
  5. Are there any alternative treatments or procedures that could be considered instead of surgery?
  6. What type of anesthesia will be used during the surgery?
  7. How long will I need to stay in the hospital after the surgery?
  8. What are the success rates of this type of surgery for my condition?
  9. What are the long-term outcomes and expectations for my elbow function after the surgery?
  10. Are there any restrictions or limitations on activities that I should be aware of after the surgery?

Reference

Authors: Cambon-Binder A, Chammas M, Coulet B, Lazerges C, Thaury MN. Journal: Hand Surg Rehabil. 2022 Feb;41S:S76-S82. doi: 10.1016/j.hansur.2020.09.015. Epub 2021 Jun 17. PMID: 34146744