Clinical and Functional Outcome of Modified Quad Surgery in Adult Obstetric Brachial Plexus Injury Patients: Case Reports

Figures

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  Figure 1.. A series of images of a 46-year-old woman with obstetric brachial plexus injury. Follows pre- (upper panel) and postoperative movement (lower panel), 4 months after mod Quad surgery. Upper panel: (A) limited hand to spine movement; (B) limited ability to raise arms above head; (C) difficulty in hand to mouth movement; (D) difficulty in placing hands to the neck; (E) supination with an angled forearm. Lower panel: (F, G, H, I, J) Postoperative images of same patient 4 months after mod Quad surgery relating to same movement as that directly above it. Total Mallet score increased significantly from 15 to 21. Her hand to neck movement increased significantly, from Mallet score 2 to 4.

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  Figure 2.. A series of images of a 23-year-old woman with obstetric brachial plexus injury. Follows pre- (upper panel) and postoperative movement (lower panel) - 9 months apart (exception: 3 months apart for first column). Upper panel: (A) difficulty in moving hands to spine; (B) limited ability to raise arms above head; (C) easy and relatively symmetrical hand to mouth movement; (D) difficulty in placing hands to neck symmetrically; (E) supination, angled hand. Lower panel: (F, G, H, I, J) Postoperative images of the same patient after mod Quad procedure relating to same motion as that directly above it. Total Mallet score increased from 18 to 21.

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  Figure 3.. A series of images of a 21-year-old woman with obstetric brachial plexus injury. Follows pre- (upper panel) and postoperative movement (lower panel) -1 month apart. Upper panel: (A) limited abduction movement; (B) difficulty in hand to mouth movement, 90° angle; (C) inability to place hands to the neck; (D) supination, unable to place hand face up. Lower panel: (E, F, G, H) Postoperative images of the same patient following mod Quad surgery relating to same motion as that directly above. There were noticeable improvements in the patient’s range of motion; apparent improvement in her shoulder abduction.