Poliomyelitis-like Paralysis of the Upper Extremity – Surgical Strategy and Literature Review

Poliomyelitis-like paralysis concerns acute flaccid limb paralysis following some virus infections. The surgical approaches to the disease have not yet been discussed in the literature. This study was the first report describing the clinical course and proposing surgical management of disabilities related to this paralysis.

Between 1982 and 2004, 17 patients (11 males, 6 females) with acute flaccid limb paralysis were retrospectively reviewed. The average patient age at the onset of disease was 2 years. All patients had shoulder abduction and/or elbow flexion disability. Of 17 patients, 10 received reconstructive surgery.

Stage V shoulder abduction according to Gilbert's classification was regained in 5 patients who received early nerve transfer within 1 year. However, in one patient who was treated by nerve transfer 3 years after the onset of paralysis, the result was unsatisfactory with stage of abduction. In two patients, the pedicled functional muscle transfer was performed for the shoulder abduction disability, which resulted only in a stage 1 abduction. In five patients, the functioning free muscle transfer for elbow flexion regained functional muscle strength M4. Of 7 cases in the non-operated group, two patients had complete recovery within 1 year and 5 patients had permanent limb paralysis at a mean follow-up of 3 years.

Surgical strategies including nerve transfers for shoulder abduction and functioning free muscle transfers for elbow flexion should be considered with the clinical course of the disease. The timing of the surgical approach is crucial, especially for nerve transfers which can promise satisfactory results.