Our Summary

This research paper is about a condition known as elbow extension palsy, which is an inability to extend or straighten the arm at the elbow. The condition is usually okay because gravity helps when a person is standing up. However, if the person has other types of paralysis, like trunk paralysis or brachial plexus palsy, then being able to extend the elbow becomes more important for activities like cycling or even just positioning the hand above the shoulder.

In certain cases, if the condition is treated early enough, surgery can be done to re-connect the nerves to the muscle that controls elbow extension (the triceps brachii). However, if the muscle has already deteriorated too much, surgery won’t be possible.

There are also cases where the person’s other arm is healthy. In these situations, elbow extension won’t be restored if nerve re-connection isn’t possible. For people with tetraplegia (paralysis of all four limbs) who use a wheelchair, being able to extend the elbow is crucial for positioning the hand and activating other muscles that control the hand.

Currently, there are two main techniques to restore elbow extension: transferring the posterior deltoid muscle (at the back of the shoulder) and the biceps brachii muscle (in the upper arm). The first one works well but requires that the shoulder be stabilized by another muscle, the pectoralis major. The second technique can be used in more cases, especially when the elbow is contracted and the shoulder can’t be stabilized.

Overall, the paper emphasizes that these treatments should be part of a comprehensive plan for upper limb surgery that takes into account the patient’s specific situation and needs.

FAQs

  1. What is elbow extension palsy and why is it important to treat?
  2. What surgical techniques are currently available to restore elbow extension?
  3. How does the condition of the patient’s other arm or additional paralysis affect the possibility of restoring elbow extension?

Doctor’s Tip

A helpful tip a doctor might tell a patient about elbow surgery is to follow all post-operative instructions carefully, including completing any physical therapy or rehabilitation exercises recommended by their healthcare team. This will help to optimize recovery and regain function in the affected arm. It is also important to communicate any concerns or difficulties experienced during the recovery process with their healthcare provider to ensure the best possible outcome.

Suitable For

Typically, patients who are recommended for elbow surgery are those with conditions such as elbow extension palsy, brachial plexus palsy, or tetraplegia. These patients may have difficulty extending their elbow due to nerve damage or muscle deterioration, impacting their ability to perform daily activities and use their upper limb effectively. Surgery may be an option for those who have the potential for nerve re-connection or muscle transfer to restore elbow extension. It is important for patients to work with a multidisciplinary team to develop a personalized treatment plan that addresses their individual needs and goals.

Timeline

  • Before surgery: The patient may have difficulty extending their elbow, leading to limitations in daily activities. They may undergo various tests and consultations with medical professionals to determine the best course of treatment. Physical therapy and other non-surgical interventions may be attempted first.

  • Day of surgery: The patient undergoes the surgical procedure to restore elbow extension. This may involve nerve re-connection or muscle transfer techniques.

  • Immediately after surgery: The patient will likely experience pain and swelling at the surgical site. They may be given pain medication and instructions for wound care.

  • Post-surgery recovery: The patient will undergo a period of rehabilitation and physical therapy to regain strength and range of motion in the affected arm. This may involve exercises to strengthen the muscles and improve coordination.

  • Long-term recovery: The patient continues to work on improving function and mobility in the affected arm. They may need ongoing therapy and follow-up appointments with their healthcare provider.

Overall, the timeline for a patient before and after elbow surgery involves a period of preparation, the surgical procedure itself, immediate post-operative care, and long-term recovery and rehabilitation to regain function in the affected arm.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with elbow surgery for elbow extension palsy?
  2. What is the success rate of the surgery in restoring elbow extension in cases like mine?
  3. How long is the recovery process after elbow surgery and what can I expect in terms of pain and limitations during this time?
  4. Will physical therapy be necessary after the surgery and if so, what will the rehabilitation process entail?
  5. Are there any alternative treatments or therapies that could be considered before opting for surgery?
  6. What are the long-term outcomes of elbow surgery for elbow extension palsy and how likely is it that the condition will recur in the future?
  7. How experienced are you in performing this type of surgery and what is your success rate with similar cases?
  8. Are there any lifestyle changes or modifications that I will need to make after the surgery to ensure the best possible outcome?
  9. Will I need additional surgeries or treatments in the future to maintain or improve the function of my elbow?
  10. Are there any specific pre-operative preparations or guidelines that I should follow leading up to the surgery?

Reference

Authors: Coulet B, Chammas M. Journal: Hand Surg Rehabil. 2022 Feb;41S:S83-S89. doi: 10.1016/j.hansur.2020.09.017. Epub 2021 Aug 21. PMID: 34428569