Pleksopatilerin Yönetiminde Güncel Fiziksel Tıp ve Rehabilitasyon Uygulamaları
Özet
Pleksopatilerin yönetiminde güncel fiziksel tıp ve rehabilitasyon uygulamalarını ele alan metin, brakiyal pleksopatilerin en sık travmatik nedenlerle gençlerde, lumbosakral pleksopatilerin ise diyabete bağlı geliştiğini belirtmektedir. Tedavinin temel amacı; rejenerasyon tam olsa bile fonksiyonel iyileşmeyi engelleyebilen eklem sertliği, kontraktür, kas atrofisi, ödem ve nöropatik ağrı gibi komplikasyonları önlemek ve yönetmektir. Bu doğrultuda pozisyonlama, pasif-aktif eklem hareket açıklığı egzersizleri, elektrik stimülasyonu, EMG-biyofeedback ve ortez uygulamalarından yararlanılır. Yenidoğandaki obstetrik pleksopatilerde erişkinlerden farklı olarak nöropatik ağrı görülmez, kas atrofisi için elektrik stimülasyonu kullanılmaz ve tedavisinde botulinum toksini, zorunlu kullanım tedavisi ile iş-uğraş terapisi gibi özel yaklaşımlar uygulanır. Lumbosakral pleksopatilerde ise öncelikle alt yatan etiyolojik nedene (diyabetik amyotrofi, tümör, enfeksiyon vb.) yönelik tedaviler ön plandadır; rehabilitasyonda etkilenen nöroanatomik bölgeye göre kalça-diz çevresi güçlendirme egzersizleri ile düşük ayak için ayak-ayak bileği ortezleri tercih edilir. Sonuç olarak pleksopatilerde başarı, lezyonun şiddetine, yerine ve etiyolojisine göre değişen multidisipliner bir ekip çalışmasını zorunlu kılmaktadır.
Plexopathy management covers current physical medicine and rehabilitation practices, noting that brachial plexopathies mostly occur due to traumatic etiologies in young populations, whereas the most common cause of lumbosacral plexopathies is diabetes. The primary goals of treatment are to enhance functional recovery and prevent complications such as joint stiffness, contracture, muscle atrophy, edema, and neuropathic pain, which can hinder recovery even if regeneration is complete. For this purpose, methods including positioning, range of motion exercises, electrical stimulation, EMG-biofeedback, and orthotics are utilized. In neonatal obstetric plexopathies, unlike in adults, neuropathic pain is not observed, electrical stimulation is not used for muscle atrophy, and specific approaches such as botulinum toxin, constraint-induced movement therapy, and occupational therapy are implemented. In lumbosacral plexopathies, treatments targeted at the underlying etiology (diabetic amyotrophy, tumor, infection, etc.) are prioritized; during rehabilitation, hip-knee strengthening exercises and foot drop orthoses are utilized based on the affected neuroanatomical region. Consequently, plexopathy management requires a multidisciplinary team approach that varies according to the location, severity, and underlying cause of the lesion.
Referanslar
Moghekar, A.R., et al., Brachial plexopathies: etiology, frequency, and electrodiagnostic localization. Journal of clinical neuromuscular disease, 2007. 9(1): p. 243-247.
Rubin, D.I., Brachial and lumbosacral plexopathies: A review. Clinical Neurophysiology Practice, 2020.
Ferrante, M.A., Brachial plexopathies: classification, causes, and consequences. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine, 2004. 30(5): p. 547-568.
Sunderland, S.S., The anatomy and physiology of nerve injury. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine, 1990. 13(9): p. 771-784.
Kinlaw, D., Pre-/postoperative therapy for adult plexus injury. Hand clinics, 2005. 21(1): p. 103-8, vii.
Akyüz M. Beyazova M, G.K.Y., Brakial pleksus yaralanmalari. 2016, Güneş Kitabevi: Ankara. p. 2465–2475.
Schnick, U., et al., Traumatic lesions of the brachial plexus: clinical symptoms, diagnostics and treatment. Der Unfallchirurg, 2018. 121(6): p. 483-496.
Smania, N., et al., Rehabilitation of brachial plexus injuries in adults and children. Eur J Phys Rehabil Med, 2012. 48(3): p. 483-506.
Ashley, Z., et al., Therapeutic stimulation of denervated muscles: the influence of pattern. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine, 2008. 38(1): p. 875-886.
Bertelli, J.A., M.F. Ghizoni, and D.P. Loure Iro Chaves, Sensory disturbances and pain complaints after brachial plexus root injury: a prospective study involving 150 adult patients. Microsurgery, 2011. 31(2): p. 93-97.
Cruccu, G. and A. Truini, A review of neuropathic pain: from guidelines to clinical practice. Pain and therapy, 2017. 6(1): p. 35-42.
Kim, D.H., et al., Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana State University Health Sciences Center. Journal of neurosurgery, 2003. 98(5): p. 1005-1016.
Bertelli, J.A., M.F. Ghizoni, and F. Soldado, Patterns of brachial plexus stretch palsy in a prospective series of 565 surgically treated patients. The Journal of hand surgery, 2017. 42(6): p. 443-446. e2.
Kline, D.G., Timing for brachial plexus injury: a personal experience. Neurosurgery clinics of North America, 2009. 20(1): p. 24-26.
Terzis, J.K., M.D. Vekris, and P.N. Soucacos, Outcomes of brachial plexus reconstruction in 204 patients with devastating paralysis. Plastic and reconstructive surgery, 1999. 104(5): p. 1221-1240.
Gilbert, A. and J. Tassin, Surgical repair of the brachial plexus in obstetric paralysis. Chirurgie; memoires de l'Academie de chirurgie, 1984. 110(1): p. 70-75.
Yang, L.J.-S. Neonatal brachial plexus palsy—management and prognostic factors. in Seminars in perinatology. 2014. Elsevier.
Van der Looven, R., et al., Early electrodiagnosis in the management of neonatal brachial plexus palsy: A systematic review. Muscle & nerve, 2020. 61(5): p. 557-566.
Borschel, G.H. and H.M. Clarke, Obstetrical brachial plexus palsy. Plastic and reconstructive surgery, 2009. 124(1): p. 144e-155e.
Norton, E., Developmental muscular torticollis and brachial plexus injury. Physical Therapy for Children. 2nd ed. Philadelphia: WB Saunders, 2000: p. 282-301.
Gobets, D., et al., Indications and effects of botulinum toxin A for obstetric brachial plexus injury: a systematic literature review. Developmental Medicine & Child Neurology, 2010. 52(6): p. 517-528.
DeMatteo, C., et al., Botulinum toxin as an adjunct to motor learning therapy and surgery for obstetrical brachial plexus injury. Developmental Medicine & Child Neurology, 2006. 48(4): p. 245-252.
Santamato, A., et al., Effect of botulinum toxin type A and modified constraint-induced movement therapy on motor function of upper limb in children with obstetrical brachial plexus palsy. Child's Nervous System, 2011. 27(12): p. 2187-2192.
Hoeksma, A.F., et al., Shoulder contracture and osseous deformity in obstetrical brachial plexus injuries. JBJS, 2003. 85(2): p. 316-322.
Uysal, H., et al., Extremity shortness in obstetric brachial plexus lesion and its relationship to root avulsion. Journal of child neurology, 2007. 22(12): p. 1377-1383.
Planner, A., M. Donaghy, and N. Moore, Causes of lumbosacral plexopathy. Clinical radiology, 2006. 61(12): p. 987-995.
Dyck, P.J.B., J.E. Norell, and P.J. Dyck, Microvasculitis and ischemia in diabetic lumbosacral radiculoplexus neuropathy. Neurology, 1999. 53(9): p. 2113-2113.
Dyck, P.J.B. and A.J. Windebank, Diabetic and nondiabetic lumbosacral radiculoplexus neuropathies: new insights into pathophysiology and treatment. Muscle & nerve, 2002. 25(4): p. 477-491.
Evans, B.A., J.C. Stevens, and P.J. Dyck, Lumbosacral plexus neuropathy. Neurology, 1981. 31(10): p. 1327-1327.
Laughlin, R.S. and P.J.B. Dyck, Diabetic radiculoplexus neuropathies. Handbook of clinical neurology, 2014. 126: p. 45-52.
Dyck, P.J.B., J.E. Norell, and P.J. Dyck, Non-diabetic lumbosacral radiculoplexus neuropathy: natural history, outcome and comparison with the diabetic variety. Brain, 2001. 124(6): p. 1197-1207.
Chan, Y.C., Y.L. Lo, and E.S. Chan, Immunotherapy for diabetic amyotrophy. Cochrane Database of Systematic Reviews, 2017(7).
Kutsy, R.L., L.R. Robinson, and M.L. Routt Jr, Lumbosacral plexopathy in pelvic trauma. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine, 2000. 23(11): p. 1757-1760.
