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In obstetric brachial plexus lesions with avulsion injury, nerve grafting for biceps muscle re-innervation may not be possible owing to the unavailability of a proximal stump. In such cases, the intercostal nerves or medial pectoral nerve can serve as donor nerves in an end-to-end transfer to the musculocutaneous nerve. The present study reports the results of both techniques from a single institution in a consecutive series of 42 patients between 1995 and 2008. From 1995 to 2000 we always used the intercostal nerve transfer, and from 2001 to 2008 both techniques were used. Biceps muscle force ≥Medical Research Council Grade 3 was achieved in 37 of 42 patients after a mean follow-up of 44 months. There was no statistical difference in the results in the medial pectoral nerve transfer group (n = 25) and the intercostal nerve transfer group (n = 17). [ABSTRACT FROM PUBLISHER]

Introduction: We developed the parent-rated Hand-Use-at-Home questionnaire (HUH) to assess the amount of spontaneous use of the affected arm/hand in daily-life activities in children with unilateral paresis, aged 3–10 years. This study describes its development and examination of the internal structure, unidimensionality, validity and test–retest reliability. Patients: Children with Unilateral Cerebral Palsy (UCP) or Neonatal Brachial Plexus Palsy (NBPP) and Typically Developing children (TD) participated. Method: Rasch-analysis was used to examine the rating scale and internal structure of the item-set. Test–retest reliability and construct validity was established. Intra class correlation (ICC), standard error of measurement (SEM) and smallest detectable change (SDC) were calculated. Construct validity was determined by comparing HUH scores between groups (UCP/NBPP/TD), within levels of lesion-extent in NBPP and Manual Ability Classification System (MACS) levels in UCP. Results: The development-cohort consisted of 322 children (mean age 6.7 years, UCP: n = 131/NBPP: n = 191) and the validation-cohort of 315 children (mean age 6.8 years, UCP: n = 79/NBPP: n = 181/TD: n = 55). Eighteen hierarchically ordered bimanual items fitted a unidimensional model. HUH scores ranged from −4.69 to 5.17 logits. Test–retest reliability was excellent (ICC = 0.89). Agreement was high with a SEM = 0.60 and SDC = 1.66 logits. The HUH discriminated between groups (TD/NBPP/UCP): H(2) = 118.985, p < 0.001, supporting construct validity. HUH scores decreased with greater lesion-extent (r = −0.5) and higher MACS-levels (r = −0.4). Discussion/conclusion: The HUH questionnaire has good psychometric properties and validly quantifies the amount of spontaneous use of the affected arm/hand in children with unilateral paresis, aged 3–10 years. Clinical message: The HUH questionnaire is a valuable addition to the current assessment of children with unilateral upper-limb paresis and provides clinicians with more insight in daily-life upper limb performance. [ABSTRACT FROM AUTHOR]

Purpose: Brachial plexus birth injuries (BPBI) can have lifelong effects on the development and functional use of the upper extremity. Currently there is no agreement with regards to what patient-reported outcome (PRO) measures should be used. Therefore, the ability to compare the effects of treatment between individuals and institutions is challenging. This study aimed to achieve consensus among clinicians on the use of PRO measures within this patient group to allow for improved comparison of treatments and outcomes in the future., Materials and Methods: Online, a 3 round Delphi survey was completed by 35 international multi-disciplinary specialist centers., Results: All respondents (100%) agreed that PRO measures are useful for clinical evaluation and patient treatment. None of the outcome measures scored >75% agreement for ability to assess responsiveness and current state in children with BPBI as most outcome measures were judged as not specific for BPBI. Additionally, participant centers were asked their perspective on the best available PRO option for each of the 3 categories: functional use of the upper limb, quality of life and pain. This resulted in endorsement by the participant centers of the Brachial Plexus Outcome Measure - Self-Evaluation, the Pediatric Quality of Life Inventory, and Visual Analogue Scale/Brief Pain Inventory respectively., Conclusion: International specialists in BPBI agree that PRO measures are important to use both clinically and in research in children aged 5 years and above.

Objective: Common peroneal (fibular) neuropathy is the most common mononeuropathy of the lower extremity. Despite this, there are surprisingly few studies on the topic, and a knowledge gap remains in the literature. As one attempts to address this knowledge gap, a core outcome set (COS) is needed to guide the planning phases of future studies to allow synthesis and comparability of these studies. The objective of this study was to develop the COS-common peroneal neuropathy (CoPe) using a modified Delphi approach., Methods: A 5-stage approach was used to develop the COS-CoPe: 1) stage 1, consortium development; 2) stage 2, a literature review to identify potential outcome measures; 3) stage 3, a Delphi survey to develop consensus on outcomes for inclusion; 4) stage 4, a Delphi survey to develop definitions; and 5) stage 5, a consensus meeting to finalize COS and definitions. The study followed the COS-STAndards for Development (COS-STAD) recommendations., Results: The Core Outcomes in Nerve Surgery (COINS) Consortium comprised 23 participants, all neurological surgeons, representing 13 countries. The final COS-CoPe consisted of 31 data points/outcomes covering domains of demographics, diagnostics, patient-reported outcomes, motor/sensory outcomes, and complications. Appropriate instruments, methods of testing, and definitions were set. The consensus minimum duration of follow-up was 12 months. The consensus optimal time points for assessment were preoperatively and 3, 6, 12, and 24 months postoperatively., Conclusions: The COINS Consortium developed a consensus COS and provided definitions, methods of implementation, and time points for assessment. The COS-CoPe should serve as a minimum set of data that should be collected in all future neurosurgical studies on common peroneal neuropathy. Incorporation of this COS should help improve consistency in reporting, data synthesis, and comparability, and should minimize outcome reporting bias.

While there is considerable spontaneous recovery in most cases of brachial plexus birth injury, many children are left with significant problems that may lead to lifelong functional limitations, loss of work and social isolation. Detailed treatment with the right strategy can provide very valuable improvement in function. Over the past few years, the clinical approach to brachial plexus birth palsy has entered a new era in both diagnostic and surgical treatment methods. This article reviews four areas of management, the role of imaging in defining the severity of the injury, the optimal timing of for nerve exploration and reconstruction in appropriate cases, the advantages and potential complications of nerve transfers, and the role of physiotherapy. Available evidence is considered. Although it is difficult to make clear and precise inferences on a subject where there are many variables and considerable uncertainties, some currently accepted views will be summarized. Level of evidence: V., Competing Interests: Declaration of conflicting interestsThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.