A case of congenital bilateral absence of elbow flexor muscles: review of differential diagnosis and treatment

Abstract

A 1-year-old boy presented to us with congenital inability to flex his elbow. He had bilaterally absent biceps brachii and brachialis muscles, a rare condition. We performed pedicle latissimus dorsi musculocutaneous flaps to the left and right volar upper arm at 21 and 24 months of age, respectively, to create elbow flexors. By 4 years of age, he had excellent elbow flexion bilaterally with strength grade in excess of 4.5. In addition to discussing our patient's treatment options, we discuss other potential causes of weak elbow flexion when faced with this clinical dilemma.

Figure 1

a Intraoperative view of the volar forearm compartment showing absence of biceps brachii and brachialis muscles. D shows deltoid insertion on the humerus. b Musculocutaneous latissimus dorsi muscle flap prior to tubing and insetting as a functional muscle transfer.

Figure 2

Pedicle transfer of the musculocutaneous latissimus dorsi flap. Bone anchors facilitate proximal and distal bone attachments to coracoid process and ulna, respectively.

Figure 3

Postoperative pictures after bilateral neo-biceps reconstruction show a good strength, b ability to reach behind the head for personal hygiene, and c performance of daily activities such as donning a shirt.