reza sh. kamrani m.d. orthopaedic hand surgeon tums, shariati hospital isfehan ums annual meeting...
TRANSCRIPT
![Page 1: Reza Sh. Kamrani M.D. Orthopaedic Hand Surgeon TUMS, Shariati Hospital Isfehan UMS Annual Meeting 2-4 / 12 / 1391](https://reader035.vdocument.in/reader035/viewer/2022062301/5697c02f1a28abf838cda64a/html5/thumbnails/1.jpg)
Reza Sh. Kamrani M.D.Orthopaedic Hand Surgeon
TUMS, Shariati HospitalIsfehan UMS Annual Meeting
2-4 / 12 / 1391
![Page 2: Reza Sh. Kamrani M.D. Orthopaedic Hand Surgeon TUMS, Shariati Hospital Isfehan UMS Annual Meeting 2-4 / 12 / 1391](https://reader035.vdocument.in/reader035/viewer/2022062301/5697c02f1a28abf838cda64a/html5/thumbnails/2.jpg)
Neon. 1-3 m 3-6 m 6-12 m 6-12 m 1-3 y 3-6 y 6-12 y Adoles.
Physical therapyPT/Release
TTOsteotomy
Osteotomy
![Page 3: Reza Sh. Kamrani M.D. Orthopaedic Hand Surgeon TUMS, Shariati Hospital Isfehan UMS Annual Meeting 2-4 / 12 / 1391](https://reader035.vdocument.in/reader035/viewer/2022062301/5697c02f1a28abf838cda64a/html5/thumbnails/3.jpg)
Neon. 1-3 m 3-6 m 6-12 m 6-12 m 1-3 y 3-6 y 6-12 y Adoles.
Close observationPT
MicrosurgicalBP repair
NeurolysisNerve repairNerve graft
Nerve transfer
MicrosurgicalBP repair
Conservative treatment
PT
OT
Butolonium Toxin
Surgical release ???
Arthroscopic releaseOpen releaseOpen reductionGlenoid osteotomy
(Gleno-Humeral anatomy)
CT-MR
(Gleno-Humeral anatomy)CT-MR
Release
TT
Humeral Osteotomy
Release
TTHumeral Osteotomy+/_
Arthroscopic releaseOpen releaseOpen reductionGlenoid osteotomy
Upper, Midd, Low
Ant, Med
Latismus Dorsi+/_
Teres maj
Shoulder
Elbow
Forearm
Hand
![Page 4: Reza Sh. Kamrani M.D. Orthopaedic Hand Surgeon TUMS, Shariati Hospital Isfehan UMS Annual Meeting 2-4 / 12 / 1391](https://reader035.vdocument.in/reader035/viewer/2022062301/5697c02f1a28abf838cda64a/html5/thumbnails/4.jpg)
Neon. 1-3 m 3-6 m 6-12 m 6-12 m 1-3 y 3-6 y 6-12 y Adoles.
Close observationPT
MicrosurgicalBP repair
NeurolysisNerve repairNerve graft
Nerve transfer
MicrosurgicalBP repair
Conservative treatment
PT
OT
Butolonium Toxin
Surgical release ???
Arthroscopic releaseOpen releaseOpen reductionGlenoid osteotomy
(Gleno-Humeral anatomy)
CT-MR
(Gleno-Humeral anatomy)CT-MR
Release
TT
Humeral Osteotomy
Release
TTHumeral Osteotomy+/_
Arthroscopic releaseOpen releaseOpen reductionGlenoid osteotomy
Upper, Midd, Low
Ant, Med
Latismus Dorsi+/_
Teres maj
Shoulder
Elbow
Forearm
Hand
![Page 5: Reza Sh. Kamrani M.D. Orthopaedic Hand Surgeon TUMS, Shariati Hospital Isfehan UMS Annual Meeting 2-4 / 12 / 1391](https://reader035.vdocument.in/reader035/viewer/2022062301/5697c02f1a28abf838cda64a/html5/thumbnails/5.jpg)
Neon. 1-3 m 3-6 m 6-12 m 6-12 m 1-3 y 3-6 y 6-12 y Adoles.
Close observationPT
MicrosurgicalBP repair
NeurolysisNerve repairNerve graft
Nerve transfer
MicrosurgicalBP repair
Conservative treatment
PT
OT
Butolonium Toxin
Surgical release ???
(Gleno-Humeral anatomy)
CT-MR
(Gleno-Humeral anatomy)CT-MR
Release
TT
Humeral Osteotomy
TTHumeral Osteotomy+/_
Arthroscopic releaseOpen releaseOpen reductionGlenoid osteotomy
Upper, Midd, Low
Ant, Med
Latismus Dorsi+/_
Teres maj
Shoulder
Elbow
Forearm
Hand
![Page 6: Reza Sh. Kamrani M.D. Orthopaedic Hand Surgeon TUMS, Shariati Hospital Isfehan UMS Annual Meeting 2-4 / 12 / 1391](https://reader035.vdocument.in/reader035/viewer/2022062301/5697c02f1a28abf838cda64a/html5/thumbnails/6.jpg)
Neon. 1-3 m 3-6 m 6-12 m 6-12 m 1-3 y 3-6 y 6-12 y Adoles.
Close observationPT
MicrosurgicalBP repair
NeurolysisNerve repairNerve graft
Nerve transfer
MicrosurgicalBP repair
Conservative treatment
PT
OT
Butolonium Toxin
Surgical release ???
(Gleno-Humeral anatomy)
CT-MR
(Gleno-Humeral anatomy)CT-MR
Release
TT
Humeral Osteotomy
Arthroscopic releaseOpen releaseOpen reductionGlenoid osteotomy
Upper, Midd, Low
Ant, Med
Latismus Dorsi+/_
Teres maj
Shoulder
Elbow
Forearm
Hand
![Page 7: Reza Sh. Kamrani M.D. Orthopaedic Hand Surgeon TUMS, Shariati Hospital Isfehan UMS Annual Meeting 2-4 / 12 / 1391](https://reader035.vdocument.in/reader035/viewer/2022062301/5697c02f1a28abf838cda64a/html5/thumbnails/7.jpg)
Neon. 1-3 m 3-6 m 6-12 m 6-12 m 1-3 y 3-6 y 6-12 y Adoles.
Close observationPT
MicrosurgicalBP repair
NeurolysisNerve repairNerve graft
Nerve transfer
MicrosurgicalBP repair
Conservative treatment
PT
OT
Butolonium Toxin
Surgical release ???
(Gleno-Humeral anatomy)
CT-MR
(Gleno-Humeral anatomy)CT-MR
Release
TT
Humeral Osteotomy
Arthroscopic releaseOpen releaseOpen reductionGlenoid osteotomy
Upper, Midd, Low
Ant, Med
Latismus Dorsi+/_
Teres maj
Shoulder
![Page 8: Reza Sh. Kamrani M.D. Orthopaedic Hand Surgeon TUMS, Shariati Hospital Isfehan UMS Annual Meeting 2-4 / 12 / 1391](https://reader035.vdocument.in/reader035/viewer/2022062301/5697c02f1a28abf838cda64a/html5/thumbnails/8.jpg)
Neon. 1-3 m 3-6 m 6-12 m 6-12 m 1-3 y 3-6 y 6-12 y Adoles.
Close observationPT
MicrosurgicalBP repair
NeurolysisNerve repairNerve graft
Nerve transfer
MicrosurgicalBP repair
Conservative treatment
PT
OT
Butolonium Toxin
Surgical release ???
(Gleno-Humeral anatomy)
CT-MR
![Page 9: Reza Sh. Kamrani M.D. Orthopaedic Hand Surgeon TUMS, Shariati Hospital Isfehan UMS Annual Meeting 2-4 / 12 / 1391](https://reader035.vdocument.in/reader035/viewer/2022062301/5697c02f1a28abf838cda64a/html5/thumbnails/9.jpg)
Neon. 1-3 m 3-6 m 6-12 m 6-12 m 1-3 y
Close observationPT
MicrosurgicalBP repair
NeurolysisNerve repairNerve graft
Nerve transfer
MicrosurgicalBP repair
Conservative treatment
PT
OT
Butolonium Toxin
Surgical release ???
(Gleno-Humeral anatomy)
CT-MR
Indication
Time of surgery
Kind of surgery
![Page 10: Reza Sh. Kamrani M.D. Orthopaedic Hand Surgeon TUMS, Shariati Hospital Isfehan UMS Annual Meeting 2-4 / 12 / 1391](https://reader035.vdocument.in/reader035/viewer/2022062301/5697c02f1a28abf838cda64a/html5/thumbnails/10.jpg)
Alain Gilbert Howard Clarke
Biceps < 3/5 in 3m. Coockey sign in 9m.
spectrum
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Alain Gilbert Howard Clarke
Biceps < 3/5 in 3m. Coockey sign in 9m.
spectrum
![Page 12: Reza Sh. Kamrani M.D. Orthopaedic Hand Surgeon TUMS, Shariati Hospital Isfehan UMS Annual Meeting 2-4 / 12 / 1391](https://reader035.vdocument.in/reader035/viewer/2022062301/5697c02f1a28abf838cda64a/html5/thumbnails/12.jpg)
Alain Gilbert Howard Clarke
Biceps < 3/5 in 3m. Coockey sign in 9m.
spectrum
![Page 13: Reza Sh. Kamrani M.D. Orthopaedic Hand Surgeon TUMS, Shariati Hospital Isfehan UMS Annual Meeting 2-4 / 12 / 1391](https://reader035.vdocument.in/reader035/viewer/2022062301/5697c02f1a28abf838cda64a/html5/thumbnails/13.jpg)
White zone
Poor biceps + Impaired hand in 3m. Poor biceps 6m.
Gray zone Poor biceps 3-6m
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Neurolysis Nerve repair Nerve graft Nerve transfer
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ADULT BP INJ. OBSTETRIC BP INJ.
Adult Infant Shorter regeneration
distance Stronger potential for
regeneration Greater capacity for
brain adaptation
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ADULT BP INJ. OBSTETRIC BP INJ.
Classic nerve transfer .Intra plexus
Avulsion is more common
.
Classic nerve transfer .Intra plexus
Avulsion is less common
.
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ADULT BP INJ. OBSTETRIC BP INJ.
Goal Goal
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ADULT BP INJ. OBSTETRIC BP INJ.
Goal Elbow flexion Shoulder stability
Goal Elbow flexion Shoulder reanimation
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ADULT BP INJ. OBSTETRIC BP INJ.
Goal Elbow flexion Shoulder stability Medial border
sensation Wrist and finger
function
Intrinsic function
Goal Hand function Elbow flexion Shoulder reanimation
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Classic nerve graft is currently the most common approchroach for BPBP
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But new nerve transfers is more and more popularised
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ADULT BP INJ. OBSTETRIC BP INJ.
New nerve transfers Becomes standard
approach
New nerve transfer Becomes more and
more popularised Acc. To Sup. Scap may
be the most common
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Neon. 1-3 m 3-6 m 6-12 m 6-12 m 1-3 y
Close observationPT
MicrosurgicalBP repair
NeurolysisNerve repairNerve graft
Nerve transfer
MicrosurgicalBP repair
Conservative treatment
PT
OT
Butolonium Toxin
Surgical release ???
(Gleno-Humeral anatomy)
CT-MR
Indication
Time of surgery
Kind of surgery
![Page 28: Reza Sh. Kamrani M.D. Orthopaedic Hand Surgeon TUMS, Shariati Hospital Isfehan UMS Annual Meeting 2-4 / 12 / 1391](https://reader035.vdocument.in/reader035/viewer/2022062301/5697c02f1a28abf838cda64a/html5/thumbnails/28.jpg)
23 months old boy BPBP Under observation from 5 months old
Shoulder Passive ROM is gradually reduced in spite of physical/occupational therapy
Shoulder plain X-ray is almost normal
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What is the treatment?
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Use Dysport
Dry vial = 500IU Dilution with normal saline Total dose 20-25 U/kg 1cc/location Price = 5,000,000R./1,200,000R.F Painful injection Nervelocator guided injectin
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New bornSlingPT/OT
1-3 y
3-6 m Under-observation good Prog.
Passive should. ROM
Active elbow flexion
PT/OTAggress. PT/OT
3-6 m visit6 w visit
Br Plex microsurgery
goodbad
Soft tissue release
Passive Should. ROM Dysport injection
goodbad
6 w visitgoodbad
goodbad
Passive Should. ROM goodbad Humerus osteotomy?
Should. CT/MR
OR,Glenoid osteotomy,Arthroscopic release
3-6 m visit
3-6 m visit
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