Muscle changes in BPBI with elbow flexion contracture - PowerPoint PPT Presentation
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Muscle changes in BPBI with elbow flexion contracture
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P yhi T, Koivikko M, Peltonen J, Kirjavainen M, Lamminen A, Nietosvaara Y ... D=delta, BB=biceps brachii, B=brachial, BR=brachioradial, S=supinator, PT ... – PowerPoint PPT presentation
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Title: Muscle changes in BPBI with elbow flexion contracture
1
Muscle changes in BPBI with elbow flexion
contracture
- Pöyhiä T, Koivikko M, Peltonen J, Kirjavainen M,
Lamminen A, Nietosvaara Y - Childrens Hospital, Helsinki, Finland
2
patients
- 15 consecutive BPBI patients with
- extension deficit of the elbow ( gt 9)
- mean age 11 years (range 3-18)
- extent of the injury
- C5-6 6 patients
- C5-7 5 patients
- C5-T1 4 patients
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methods
- clinical examination
- joint stability and range of motion
- MR imaging (1.5-T)
- both arms, elbows, forearms
- surface coil with 3 mm slice thickness
- interpretition
- two musculoskeletal radiologists
- blinded to clinical history and findings
- congruency of the elbow
- degree of muscle atrophy
- amount of fatty infiltration (4 point scale)
- reduction in size (3 point scale)
4
methods MR imaging
- fatty infiltration
- F0 normal muscle signal
- F1 hyperintense, patchy but not confluent
- F2 hyperintense, patchy and confluent (lt50)
- F3 homogeneosly hyperintense (gt50)
- size reduction
- SR0 normal pattern
- SR1 moderate atrophy (lt 50)
- SR2 severe atrophy (gt50)
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results clinical examination
- median subluxation of elbow 1/15
- subluxation of RHJ 2/15
- mean elbow extension deficit 31 (10-90)
- mean elbow TAM 113 (50 -140)
- mean pronation 57 (5-90)
- mean supination 34 (0-80)
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results MRI
- elbow incongruency
- humeroulnar 1
- radiohumeral 2
- muscle atrophy
- supinator
- brachial
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grade F 0, SR 0
grade F1, SR1
grade F 2, SR 2
grade F 3, SR 2
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Ddelta, BBbiceps brachii, Bbrachial,
BRbrachioradial, Ssupinator, PTpronator
teres, Aanconeus, Ttriceps, Eextensors,
Fflexors
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results correlations
- TAM positive negative
- elbow TAM forearm brachioradialis
- flexors
- patient age
- forearm TAM elbow extent of BPBI
- pronator teres
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conclusions
- significant extension deficit (gt30) is mainly
caused by permanent muscle changes in the
brachial muscle. - extension deficit has a tendency to increase with
time. - supinator is affected in most patients with
permanent palsy. - significant reduction of prosupination is caused
if also pronator teres is affected.
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