{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:39:35Z","timestamp":1790073575022,"version":"4.0.1"},"reference-count":24,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2023,7,15]],"date-time":"2023-07-15T00:00:00Z","timestamp":1689379200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2023,7,15]],"date-time":"2023-07-15T00:00:00Z","timestamp":1689379200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100012161","name":"Faculty of Medicine, University of British Columbia","doi-asserted-by":"publisher","award":["Summer Student Research Funding"],"award-info":[{"award-number":["Summer Student Research Funding"]}],"id":[{"id":"10.13039\/100012161","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Hand (New York, N,Y.)"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>For children with upper brachial plexus birth injury (BPBI; C5, C6, \u00b1C7 roots), most clinics first recommend nonsurgical treatment followed by primary and\/or secondary surgical interventions in selected patients. Since 2008, we have used an infant shoulder repositioning protocol (supination-external rotation [Sup-ER]) designed to prevent shoulder internal rotation contracture and its potential effects on the shoulder joint. This study characterizes our clinic\u2019s current choice, number, and timing of primary and secondary procedural interventions (including Botox) and compares Sup-ER protocol patients with those of our historical controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The records of all patients with upper BPBI who underwent procedures from 2001 to 2018 were retrospectively reviewed and grouped into a historical (2001-2007, n = 20) and recent (2008-2018, n = 23) cohort. Patient demographics, procedure types and timing, and functional outcomes were collected and analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Since the 2008 institution of the Sup-ER protocol, fewer brachial plexus exploration and grafting (BPEG) surgeries were performed and none in later infancy, where nerve transfers were preferred. There were more and earlier Botox injections. There were fewer tendon transfers, and the preoperative indications were from a higher level of function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>We now see fewer indications for BPEG surgeries overall. After the 3-month-age group, more direct nerve transfers are indicated instead of the BPEG surgery if nerve surgery is required at all. Shoulder tendon transfer rates have decreased. Humeral osteotomies are not seen in our recent group. Glenoid osteotomies within tendon transfers are rare in both groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15589447231184896","type":"journal-article","created":{"date-parts":[[2023,7,15]],"date-time":"2023-07-15T03:13:46Z","timestamp":1689390826000},"page":"1195-1205","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["How Institution of the Sup-ER Protocol in a Clinic Changed Procedure Patterns in Upper Brachial Plexus (Erb\u2019s Type) Birth Injuries"],"prefix":"10.1177","volume":"19","author":[{"given":"Vanessa Choi Yin","family":"Wong","sequence":"first","affiliation":[{"name":"University of British Columbia, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darius","family":"Balumuka","sequence":"additional","affiliation":[{"name":"British Columbia Children\u2019s Hospital, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Ji","family":"Tuen","sequence":"additional","affiliation":[{"name":"University of British Columbia, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marija","family":"Bucevska","sequence":"additional","affiliation":[{"name":"University of British Columbia, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Courtemanche","sequence":"additional","affiliation":[{"name":"University of British Columbia, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Durlacher","sequence":"additional","affiliation":[{"name":"British Columbia Children\u2019s Hospital, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doria","family":"Bellows","sequence":"additional","affiliation":[{"name":"British Columbia Children\u2019s Hospital, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Hynes","sequence":"additional","affiliation":[{"name":"University of British Columbia, Vancouver, Canada"},{"name":"British Columbia Children\u2019s Hospital, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8284-1975","authenticated-orcid":false,"given":"Cynthia","family":"Verchere","sequence":"additional","affiliation":[{"name":"University of British Columbia, Vancouver, Canada"},{"name":"British Columbia Children\u2019s Hospital, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,7,15]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.3171\/2015.6.PEDS14703"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-323-53091-0.00011-7"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cppeds.2017.06.003"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2009.11.026"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-014141"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpn.2018.06.006"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.3171\/2008.12.PEDS0885"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2015.05.008"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/1558944720937365"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/1558944718760038"},{"issue":"11","key":"e_1_3_2_12_2","first-page":"17","article-title":"A review of brachial plexus birth palsy: injury and rehabilitation","volume":"100","author":"Raducha JE","year":"2017","unstructured":"Raducha JE, Cohen B, Blood T, et al. 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