Conclusion our study suggests that in patients with c5c6c7 palsy where the wrist and finger extensors are paralyzed or weaked, the flexorpronators muscles of the forearm are strong but the triceps is not available for transfer. Pdf restoration of elbow flexion by modified steindler flexorplasty. Restoration of elbow flexion by modified steindler. Steindler flexorplasty to restore elbow flexion in c5c6c7 brachial plexus palsy type by ricardo monreal topics. Modified steindler procedure for the treatment of brachial. In the patients requiring stabilization of the shoulder and flexorplasty, the pectoralis major tendon transfer was at least equivalent to the modified steindler. All patients had sustained upper trunk brachial plexus injuries and were adults o. A modified steindler flexorplasty was used to restore elbow flexion in 8 patients with posttraumatic flail elbow.
Steindler flexorplasty first reported in 1918 1, is still preferred by many surgeons. A fixation technique for the steindler flexorplasty. Most commonly, the latissimus dorsi or the steindler flexorplasty is used. Read modified steindler procedure for the treatment of brachial plexus injuries, archives of orthopaedic and trauma surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. The passive pronation moment was reduced slightly 4% in the simulation with a 1 cm lateral displacement of the attachment, which is consistent with the stated goals of the mayer and green modification of the steindler flexorplasty. At steindler orthopedic clinic, our commitment is to keep you moving by providing excellence in orthopedic care continues through our services. Steindler flexorplasty definition of steindler flexorplasty. Abstract a modified steindler flexorplasty was used to. Matime from the department of hand and microsurgery, garankuwa hospital and the medical university of southern africa the latissimus dorsi transfer and the steindler flexorplasty were compared to restore elbow flexion in seven cases.
Preliminary results of double nerve transfer to restore. The muscular branches arising from the median nerve did not seem to limit the mobilization of the medial epicondyle when performing steindlers transfer. Steindler procedure is preferred to a pedicled latissimus dorsi ld transfer or free functioning muscle transfer, if the patient has good function of the wrist and finger flexors. Steindler arthrodesis definition of steindler arthrodesis. Flexorplasty definition of flexorplasty by medical dictionary.
Steindler release definition of steindler release by. Biomechanics of the steindler flexorplasty surgery neuromuscular. The latissimus dorsi transfer and the steindler flexorplasty were compared to restore elbow flexion in seven cases. If you would like a large, unwatermarked image for your web page or blog, please purchase the appropriate license. Journal of brachial plexus and peripheral nerve injury. You may not embed one of our images on your web page without a link back to our site.
In the series, 8 of 9 patients achieved at least 90 degrees of active antigravity m3 or greater elbow flexion. Triceps to biceps transfer for restoration of elbow flexion following. In both patients these symptoms subsided without further surgery. The results of steindler flexorplasty in nine patients with obstetric brachial plexus palsy are reported. This 52yearold man had a residual left brachial plexus injury from a shotgun wound. We studied these branches before and after steindlers procedure in 20 fresh cadavers and observed a considerable variation in the origin of the branches. Many transfers are well known for restoration of elbow flexion. Restoration of elbow flexion by modified steindler flexorplasty. Flexorplasty definition of flexorplasty by medical. The muscular branches arising from the median nerve did not seem to limit the mobilization of the medial epicondyle when.
In 5 patients there was associated loss of wrist and finger extension, which was treated by tendon transfer and in 2 patients an associated. The authors stress the importance of understanding the anatomy of the pectoral branches, especially at their origin. The steindler flexorplasty for the arthrogrypotic elbow. Pdf steindler flexorplasty to restore elbow flexion in c5. Preliminary results of double nerve transfer to restore elbow. Steindler flexorplasty to restore elbow flexion in c5c6c7 brachial. Steindler flexorplasty was the usual secondary procedure performed to restore elbow flexion. He had a flail shoulder that was fused and a contracture of his forearm in full supination, which was relieved by a distal ulnar ostectomy. Patient resources thank you for choosing steindler orthopedic clinic for your orthopedic care.
If you would like a large, unwatermarked image for your web page or. There were 5 girls and 4 boys with a mean age of 6 range 2 years. Elbow flexion reconstruction by steindler flexorplasty in obstetric brachial plexus palsy. Request pdf biomechanics of the steindler flexorplasty surgery. Most of the failures occurred in the earlier cases, and when reexploration was performed, distraction of the repair site was found. A computer simulation study our goal was to investigate the capacity of a steindler flexorplasty to restore elbow flexion to. Transfer of pectoral nerves to the musculocutaneous nerve. Jul 11, 2007 there are various methods to restore elbow flexion which are well documented in the medical literature but the most known and used is steindler flexorplasty.
Modified steindler flexorplasty is a simple, effective and reliable procedure for the restoration of elbow flexion. Our goal was to investigate the capacity of a steindler. Clinical studies on steindler flexorplasty at the elbow. Pdf steindler flexorplasty to restore elbow flexion in c5c6c7.
Functional muscle transfers come next to the sophisticated types of nerve surgery in this area. In 5 patients there was associated loss of wrist and finger extension, which was. Lag screw fixation for steindler flexorplasty springerlink. Steindler flexorplasty to restore elbow flexion in c5c6. Looking for online definition of steindler flexorplasty in the medical dictionary. Purposeour goal was to investigate the capacity of a steindler flexorplasty to restore elbow flexion to persons with c5c6 brachial plexus palsy. This helps to maintain continuity of care when doctors are unavailable. Tendon transfer tendon transfers are useful in restoring upper extremity function after bpi. Steindler procedure is preferred to a pedicled latissimus dorsi ld transfer or free functioning muscle transfer, if the patient. Schematic representation of the surgical technique for a free reverse gracilis combined with steindler flexorplasty for elbow flexion reconstruction.
Effect of the steindler procedure on the median nerve. The results were not compromised in patients whose flexor tendons had been transferred for wrist. Seventeen elbows in 10 patients with an average age of 7 years were treated surgically with the steindler flexorplasty procedure. The steindler flexorplasty was performed at our hospital to treat a lack of active elbow flexion in patients with arthrogryposis. We describe interdisciplinary postoperative care programs for augmentation of the deltoid muscle with trapezius transfer, arthrodesis of the glenohumeral joint, biceps augmentation with the latissimus dorsi transfer, steindler flexorplasty and augmentation of flexorsextensors muscles in the hand. Physician assistants can treat patients and write prescriptions when their supervising doctors are away. Looking for online definition of steindler arthrodesis in the medical dictionary.
Steindler flexorplasty at the elbow was performed on seven patients of plexus brachialis injury and one patient of arthogryposis multiplex congenita. Two cases of elbow flexorplasty following traumatic brachial plexus injuries. Elbow flexion reconstruction by steindler flexorplasty in. We understand that patients can sometimes feel overwhelmed when it comes to seeking medical care, so in this section youll find links to a wide range of our online resources, such as patient forms, billing and insurance information, and patient. Surgical options for brachial plexus injury in adults. Free reverse gracilis muscle combined with steindler. In the longterm followup, the modified steindler procedure maintained good results in 67% of the cases in our series, and this percentage raised by 82% when the wrist extensor was present or restored before the steindler procedure. A fixation technique for the steindler flexorplasty a technique for fixation o f the. Email article add to my reading list export citation create citation alert cited by in scopus. Background loss of elbow flexion due to traumatic palsy of the brachial plexus represents a major functional handicap.
Steindler operation definition of steindler operation by. After reconstruction surgery for elbow flexion via the modified steindler. In 5 patients there was associated loss of wrist and finger extension, which was treated by tendon transfer and in 2 patients an associated flail shoulder was treated by arthrodesis. They also report a retrospective case series of patients from 2007 to 2017 who underwent a steindler flexorplasty at their institution to restore elbow flexion. Flexorplasty, elbow eg, steindler type advancement cpt code information is available to subscribers and includes the cpt code number, short description, long description, guidelines and more. Green6 modified the steindler flexorplasty by mov ing the muscle. Selection criteria for the procedure included strong at least m4 grip strength and wrist and elbow extension, as well as the presence of the steindler effect.
A retrospective followup study was completed on ten patients who suffered from a brachial plexus injury that was treated with a modified steindler procedure. Followup research after the operation extended from six months to seven years and six months three years and one month on the average. Steindler flexorplasty to restore elbow flexion in c5c6c7. The nerve to the gracilis is coaptated to a median nerve motor branch. Steindler flexorplasty to restore elbow flexion in c5c6c7 brachial plexus palsy type. A fixation technique for the steindler flexorplasty journal of hand.
A pedicled ld transfer or free functioning muscle transfer can be considered if the wrist flexors are weak. Journal of brachial plexus and peripheral nerve injury biomed. Steindler orthopedic clinic utilizes physician assistants pas who practice as part of the medical team in all areas of orthopedics. Pdf restoration of elbow flexion by modified steindler. Steindler orthopedic offers free sports injury clinics for high school athletes iowa city, ia august 29, 2019 student athletes around eastern iowa are gearing up for fall sports and steindler orthopedic, as it has for over 20 years, will treat high school sports injuries afterhours at its saturday sports injury clinics now through october 26. Transfer of forearm muscles according to steindler to restore elbow. The modified steindler procedurea reconstructive surgery used to restore elbow flexion following upper brachial plexus injuriesinvolves shifting the origins of the muscle groups responsible for wrist flexion and forearm pronation originating from the medial epicondyle to the proximal direction to be used as flexors of the elbow. Biomechanics of the steindler flexorplasty surgery. There are various methods to restore elbow flexion which are well documented in the medical literature but the most known and used is steindler flexorplasty.