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Sample records for brachial cutaneous nerve

  1. Cutaneous nerve entrapment syndrome

    DongFuhui

    2004-01-01

    The cutaneous nerve entrapment syndrome is named that, the cutaneous nerve's functional disorder caused by some chronic entrapment, moreover appears a series of nerve's feeling obstacle,vegetative nerve function obstacle, nutrition obstacle, even motor function obstacle in various degree.

  2. Nerve Transfers for Adult Traumatic Brachial Plexus Palsy (Brachial Plexus Nerve Transfer)

    Rohde, Rachel S.; Wolfe, Scott W.

    2006-01-01

    Adult traumatic brachial plexus injuries can have devastating effects on upper extremity function. Although neurolysis, nerve repair, and nerve grafting have been used to treat injuries to the plexus, nerve transfer makes use of an undamaged nerve to supply motor input over a relatively short distance to reinnervate a denervated muscle. A review of several recent innovations in nerve transfer surgery for brachial plexus injuries is illustrated with surgical cases performed at this institution.

  3. Phrenic nerve transfer to the musculocutaneous nerve for the repair of brachial plexus injury: electrophysiological characteristics

    Ying Liu

    2015-01-01

    Full Text Available Phrenic nerve transfer is a major dynamic treatment used to repair brachial plexus root avulsion. We analyzed 72 relevant articles on phrenic nerve transfer to repair injured brachial plexus that were indexed by Science Citation Index. The keywords searched were brachial plexus injury, phrenic nerve, repair, surgery, protection, nerve transfer, and nerve graft. In addition, we performed neurophysiological analysis of the preoperative condition and prognosis of 10 patients undergoing ipsilateral phrenic nerve transfer to the musculocutaneous nerve in our hospital from 2008 to 201 3 and observed the electromyograms of the biceps brachii and motor conduction function of the musculocutaneous nerve. Clinically, approximately 28% of patients had brachial plexus injury combined with phrenic nerve injury, and injured phrenic nerve cannot be used as a nerve graft. After phrenic nerve transfer to the musculocutaneous nerve, the regenerated potentials first appeared at 3 months. Recovery of motor unit action potential occurred 6 months later and became more apparent at 12 months. The percent of patients recovering ′excellent′ and ′good′ muscle strength in the biceps brachii was 80% after 18 months. At 12 months after surgery, motor nerve conduction potential appeared in the musculocutaneous nerve in seven cases. These data suggest that preoperative evaluation of phrenic nerve function may help identify the most appropriate nerve graft in patients with an injured brachial plexus. The functional recovery of a transplanted nerve can be dynamically observed after the surgery.

  4. Modified Quad surgery significantly improves the median nerve conduction and functional outcomes in obstetric brachial plexus nerve injury

    Nath, Rahul K; Kumar, Nirupuma; Somasundaram, Chandra

    2013-01-01

    Background Nerve conduction studies or somatosensory evoked potentials (SSEPs) have become an important tool in the investigation of peripheral nerve lesions, and is sensitive in detecting brachial plexus nerve injury, and other nerve injuries. To investigate whether the modified Quad surgical procedure improves nerve conductivity and functional outcomes in obstetric brachial plexus nerve injury (OBPI) patients. Methods All nerves were tested with direct functional electrical stimulation. A P...

  5. Surgical outcomes following nerve transfers in upper brachial plexus injuries

    Bhandari P

    2009-01-01

    Full Text Available Background: Brachial plexus injuries represent devastating injuries with a poor prognosis. Neurolysis, nerve repair, nerve grafts, nerve transfer, functioning free-muscle transfer and pedicle muscle transfer are the main surgical procedures for treating these injuries. Among these, nerve transfer or neurotization is mainly indicated in root avulsion injury. Materials and Methods: We analysed the results of various neurotization techniques in 20 patients (age group 20-41 years, mean 25.7 years in terms of denervation time, recovery time and functional results. The inclusion criteria for the study included irreparable injuries to the upper roots of brachial plexus (C5, C6 and C7 roots in various combinations, surgery within 10 months of injury and a minimum follow-up period of 18 months. The average denervation period was 4.2 months. Shoulder functions were restored by transfer of spinal accessory nerve to suprascapular nerve (19 patients, and phrenic nerve to suprascapular nerve (1 patient. In 11 patients, axillary nerve was also neurotized using different donors - radial nerve branch to the long head triceps (7 patients, intercostal nerves (2 patients, and phrenic nerve with nerve graft (2 patients. Elbow flexion was restored by transfer of ulnar nerve motor fascicle to the motor branch of biceps (4 patients, both ulnar and median nerve motor fascicles to the biceps and brachialis motor nerves (10 patients, spinal accessory nerve to musculocutaneous nerve with an intervening sural nerve graft (1 patient, intercostal nerves (3rd, 4th and 5th to musculocutaneous nerve (4 patients and phrenic nerve to musculocutaneous nerve with an intervening graft (1 patient. Results: Motor and sensory recovery was assessed according to Medical Research Council (MRC Scoring system. In shoulder abduction, five patients scored M4 and three patients M3+. Fair results were obtained in remaining 12 patients. The achieved abduction averaged 95 degrees (range, 50 - 170

  6. Correspondence in relation to the case report "Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note." published in May issue of Journal of Brachial Plexus and Peripheral Nerve Injury

    Bhakta Pradipta

    2008-01-01

    Abstract Comment on 'Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note' Bhagat H, Agarwal A, Sharma MS Journal of Brachial Plexus and Peripheral Nerve Injury 2008, 3:14 (22 May 2008)

  7. Granular Cell Tumor of Brachial Plexus Mimicking Nerve Sheath Tumor: A Case Report

    Kim, Young-Im; Lee, Chul-kyu; Cho, Ki Hong; Kim, Sang-Hyun

    2012-01-01

    Primary tumors of the brachial plexus region are rare and granular cell tumors arising from the brachial plexus region is an extremely rare disease. We present a case of granular cell tumor arising from of the brachial plexus which appeared to be a usual presentation of nerve sheath tumor before the pathological confirmation. We report a granular cell tumor of the brachial plexus with literature review. Total resection is important for good clinical outcome and prognosis in the treatment of g...

  8. Nerve Transfers in Birth Related Brachial Plexus Injuries: Where Do We Stand?

    Davidge, Kristen M; Clarke, Howard M; Borschel, Gregory H

    2016-05-01

    This article reviews the assessment and management of obstetrical brachial plexus palsy. The potential role of distal nerve transfers in the treatment of infants with Erb's palsy is discussed. Current evidence for motor outcomes after traditional reconstruction via interpositional nerve grafting and extraplexal nerve transfers is reviewed and compared with the recent literature on intraplexal distal nerve transfers in obstetrical brachial plexus injury. PMID:27094890

  9. Formation of median nerve without the medial root of medial cord and associated variations of the brachial plexus

    Bhanu SP

    2010-02-01

    Full Text Available The anatomical variations in the formation, course and termination of brachial plexus are well documented and have clinical significance to surgeons, neurologists and anatomists. The present case report describes the unusual origin of median nerve, arising directly from the lateral cord without the union of lateral and medial roots of brachial plexus. A communicating branch existed between the ulnar nerve and anterior division of middle trunk. The lateral pectoral nerve was arising from anterior divisions of upper and middle trunks as two separate branches instead from lateral cord. The branches then joined together to form the lateral pectoral nerve. The medial cord instead of its five terminal branches, had only three branches, the ulnar nerve, medial pectoral nerve and a single trunk for the medial cutaneous nerve of arm and forearm which got separated at the middle of the arm. The variations of the lateral cord and its branches make it a complicated clinical and surgical approach which is discussed with the developmental background.

  10. Human amniotic epithelial cell transplantation for the repair of injured brachial plexus nerve: evaluation of nerve viscoelastic properties

    Hua Jin; Qi Yang; Feng Ji; Ya-jie Zhang; Yan Zhao; Min Luo

    2015-01-01

    The transplantation of embryonic stem cells can effectively improve the creeping strength of nerves near an injury site in animals. Amniotic epithelial cells have similar biological properties as embryonic stem cells; therefore, we hypothesized that transplantation of amniotic epithelial cells can repair peripheral nerve injury and recover the creeping strength of the brachial plexus nerve. In the present study, a brachial plexus injury model was established in rabbits using the C 6 root avul...

  11. Human amniotic epithelial cell transplantation for the repair of injured brachial plexus nerve: evaluation of nerve viscoelastic properties

    Hua Jin

    2015-01-01

    Full Text Available The transplantation of embryonic stem cells can effectively improve the creeping strength of nerves near an injury site in animals. Amniotic epithelial cells have similar biological properties as embryonic stem cells; therefore, we hypothesized that transplantation of amniotic epithelial cells can repair peripheral nerve injury and recover the creeping strength of the brachial plexus nerve. In the present study, a brachial plexus injury model was established in rabbits using the C 6 root avulsion method. A suspension of human amniotic epithelial cells was repeatedly injected over an area 4.0 mm lateral to the cephal and caudal ends of the C 6 brachial plexus injury site (1 × 10 6 cells/mL, 3 μL/injection, 25 injections immediately after the injury. The results showed that the decrease in stress and increase in strain at 7,200 seconds in the injured rabbit C 6 brachial plexus nerve were mitigated by the cell transplantation, restoring the viscoelastic stress relaxation and creep properties of the brachial plexus nerve. The forepaw functions were also significantly improved at 26 weeks after injury. These data indicate that transplantation of human amniotic epithelial cells can effectively restore the mechanical properties of the brachial plexus nerve after injury in rabbits and that viscoelasticity may be an important index for the evaluation of brachial plexus injury in animals.

  12. Human amniotic epithelial cell transplantation for the repair of injured brachial plexus nerve:evaluation of nerve viscoelastic properties

    Hua Jin; Qi Yang; Feng Ji; Ya-jie Zhang; Yan Zhao; Min Luo

    2015-01-01

    The transplantation of embryonic stem cells can effectively improve the creeping strength of nerves near an injury site in animals. Amniotic epithelial cells have similar biological properties as em-bryonic stem cells; therefore, we hypothesized that transplantation of amniotic epithelial cells can repair peripheral nerve injury and recover the creeping strength of the brachial plexus nerve. In the present study, a brachial plexus injury model was established in rabbits using the C6root avulsion method. A suspension of human amniotic epithelial cells was repeatedly injected over an area 4.0 mm lateral to the cephal and caudal ends of the C6 brachial plexus injury site (1 × 106 cells/mL, 3μL/injection, 25 injections) immediately after the injury. The results showed that the decrease in stress and increase in strain at 7,200 seconds in the injured rabbit C6 brachial plexus nerve were mitigated by the cell transplantation, restoring the viscoelastic stress relaxation and creep properties of the brachial plexus nerve. The forepaw functions were also signiifcantly improved at 26 weeks after injury. These data indicate that transplantation of human amniotic epithelial cells can effec-tively restore the mechanical properties of the brachial plexus nerve after injury in rabbits and that viscoelasticity may be an important index for the evaluation of brachial plexus injury in animals.

  13. Intercostal Nerve Neurotization for the Treatment of Obstetrical Brachial Plexus Palsy Patients

    Terzis, Julia K.; Kostas, Ioannis

    2005-01-01

    In severe obstetrical brachial plexus palsy with proximal nerve root involvement, there is an insufficient number of motor axons to reconstruct the entire plexus, and neurotization procedures are the only possibility to achieve useful upper extremity function. One of the most useful neurotization procedures is intercostal nerve transfer. In our practice, intercostal nerve transfer was used for direct neurotization of primary nerve targets or for neurotization of transferred muscles. The best ...

  14. Comparision of nerve stimulator and ultrasonography as the techniques applied for brachial plexus anesthesia

    2011-01-01

    Background Brachial plexus block is useful for upper extremity surgery, and many techniques are available. The aim of our study was to compare the efficacy of axillary brachial plexus block using an ultrasound technique to the peripheral nerve stimulation technique. Methods 60 patients scheduled for surgery of the forearm or hand were randomly allocated into two groups (n = 30 per group). For Group 1; US, and for Group 2 PNS was applied. The quality and the onset of the sensorial and motor bl...

  15. Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note

    Agarwal Anil; Bhagat Hemant; Sharma Manish S

    2008-01-01

    Abstract Background To determine whether monitoring end- tidal Carbon Dioxide (capnography) can be used to reliably identify the phrenic nerve during the supraclavicular exploration for brachial plexus injury. Methods Three consecutive patients with traction pan-brachial plexus injuries scheduled for neurotization were evaluated under an anesthetic protocol to allow intraoperative electrophysiology. Muscle relaxants were avoided, anaesthesia was induced with propofol and fentanyl and the airw...

  16. Correspondence in relation to the case report "Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note." published in May issue of Journal of Brachial Plexus and Peripheral Nerve Injury

    Bhakta Pradipta

    2008-10-01

    Full Text Available Abstract Comment on 'Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note' Bhagat H, Agarwal A, Sharma MS Journal of Brachial Plexus and Peripheral Nerve Injury 2008, 3:14 (22 May 2008

  17. Response to comments on "Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note"

    Agarwa Anil

    2008-10-01

    Full Text Available Abstract Response to comments on 'Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note' Bhagat H, Agarwal A, Sharma MS Journal of Brachial Plexus and Peripheral Nerve Injury 2008, 3:14 (22 May 2008

  18. Response to comments on "Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note"

    Agarwa Anil; Bhagat Hemant; Sharma Manish S

    2008-01-01

    Abstract Response to comments on 'Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note' Bhagat H, Agarwal A, Sharma MS Journal of Brachial Plexus and Peripheral Nerve Injury 2008, 3:14 (22 May 2008)

  19. Aberrant Dual Origin of the Dorsal Scapular Nerve and Its Communication with Long Thoracic Nerve: An Unusual Variation of the Brachial Plexus

    Shilal, Poonam; Sarda, Rohit Kumar; Chhetri, Kalpana; Lama, Polly; Tamang, Binod Kumar

    2015-01-01

    Pre and post-fixed variations at roots of the brachial plexus have been well documented, however little is known about the variations that exist in the branches which arise from the brachial plexus. In this paper, we describe about one such rare variation related to the dorsal scapular and the long thoracic nerve, which are the branches arising from the roots of the brachial plexus. The variation was found during routine dissection. The dorsal scapular nerve, which routinely arises from the f...

  20. Dual Nerve Transfers for Restoration of Shoulder Function After Brachial Plexus Avulsion Injury.

    Chu, Bin; Wang, Huan; Chen, Liang; Gu, Yudong; Hu, Shaonan

    2016-06-01

    The purpose of this study was to investigate the effectiveness of shoulder function restoration by dual nerve transfers, spinal accessory nerve to the suprascapular nerve and 2 intercostal nerves to the anterior branch of the axillary nerve, in patients with shoulder paralysis that resulted from brachial plexus avulsion injury. It was a retrospective analysis to assess the impact of a variety of factors on reanimation of shoulder functions with dual nerve transfers. A total of 19 patients were included in this study. Most of these patients sustained avulsions of C5, C6, and C7 nerve roots (16 patients). Three of them had avulsions of C5 and C6 roots only. Through a posterior approach, direct coaptation of the intercostal nerves and the anterior branch of the axillary nerve was performed, along with accessory nerve transfer to the suprascapular nerve. Satisfactory shoulder function recovery (93.83° of shoulder abduction and 54.00° of external rotation on average) was achieved after a 62-month follow-up. This dual nerve transfer procedure provided us with a reliable and effective method for shoulder function reconstruction after brachial plexus root avulsion, especially C5/C6/C7 avulsion. The level of evidence is therapeutic IV. PMID:26835823

  1. The Diagnostic Value of Nerve Ultrasound in an Atypical Palmar Cutaneous Nerve Lesion.

    Zanette, Giampietro; Tamburin, Stefano

    2016-07-01

    Detailed knowledge of the fascicular anatomy of peripheral nerves is important for microsurgical repair and functional electrostimulation.We report a patient with a lesion on the left palmar cutaneous branch of the median nerve (PCBMN) and sensory signs expanding outside the PCBMN cutaneous innervation territory. Nerve conduction study showed the absence of left PCBMN sensory nerve action potential, but apparently, no median nerve (MN) involvement. Nerve ultrasound documented a neuroma of the left PCBMN and a coexistent lateral neuroma of the left MN in the carpal tunnel after the PCBMN left the main nerve trunk.Nerve ultrasound may offer important information in patients with peripheral nerve lesions and atypical clinical and/or nerve conduction study findings. The present case may shed some light on the somatotopy of MN fascicles at the wrist. PMID:26945219

  2. The usefulness of MR myelography for evaluation of nerve root avulsion in brachial plexus injury

    Nishiura, Yasumasa; Ochiai, Naoyuki; Miyauchi, Yukio; Niitsu, Mamoru [Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine

    2002-10-01

    Myelography has been the most popular and reliable method for evaluation of nerve root avulsion in brachial plexus injury. However, it is invasive because it requires the use of contrast medium, dural puncture and exposure to radiation. In addition, it has a fault. When a nerve rootlet is not filled with contrast medium, it is impossible to evaluate it. It has sometimes been a problem in the injury to upper roots. Recently, MRI also has been used for diagnosis of brachial plexus injury. But it was not until recently that it has had a high resolution to detect affected nerve rootlets. We have used MR myelography with high resolution for diagnosis of brachial plexus injury. The purpose of this study is to investigate the usefulness of it. MR myelography was preoperatively performed in 14 cases, consisting of 13 traumatic brachial plexus injuries and an obstetrical palsy. In them, 12 cases had root avulsion injuries and 2 cases had infraclavicular injuries. A 1.5 Tesla MR system (Philips) and a cervical coil were used. Coronal sections with 2 mm-overcontiguous thickness were obtained by heavily T2-weighted sequence fast spin echo (TR/TE=3000/450). The fat signal was suppressed by a presaturation inversion-pulse. The scanning time was about five minutes. The three-dimensional image was reconstructed by using maximum intensity projection (MIP) method. MIP images and individual coronal images were used for evaluation for root avulsion. In evaluation the shape of a nerve sleeve and nerve rootlets was compared on both sides. The abnormal shape of a nerve sleeve or the defect of nerve rootlets was diagnosed as root avulsion. The brachial plexus lesions were exposed operatively and examined with electrophysiologic methods (SEP and/or ESCP) in all cases. Operative findings were compared with MR myelography. Twenty-four roots had been diagnosed as normal and 46 roots had been diagnosed as root avulsion with MR myelography preoperatively. In the former only one root was

  3. The usefulness of MR myelography for evaluation of nerve root avulsion in brachial plexus injury

    Myelography has been the most popular and reliable method for evaluation of nerve root avulsion in brachial plexus injury. However, it is invasive because it requires the use of contrast medium, dural puncture and exposure to radiation. In addition, it has a fault. When a nerve rootlet is not filled with contrast medium, it is impossible to evaluate it. It has sometimes been a problem in the injury to upper roots. Recently, MRI also has been used for diagnosis of brachial plexus injury. But it was not until recently that it has had a high resolution to detect affected nerve rootlets. We have used MR myelography with high resolution for diagnosis of brachial plexus injury. The purpose of this study is to investigate the usefulness of it. MR myelography was preoperatively performed in 14 cases, consisting of 13 traumatic brachial plexus injuries and an obstetrical palsy. In them, 12 cases had root avulsion injuries and 2 cases had infraclavicular injuries. A 1.5 Tesla MR system (Philips) and a cervical coil were used. Coronal sections with 2 mm-overcontiguous thickness were obtained by heavily T2-weighted sequence fast spin echo (TR/TE=3000/450). The fat signal was suppressed by a presaturation inversion-pulse. The scanning time was about five minutes. The three-dimensional image was reconstructed by using maximum intensity projection (MIP) method. MIP images and individual coronal images were used for evaluation for root avulsion. In evaluation the shape of a nerve sleeve and nerve rootlets was compared on both sides. The abnormal shape of a nerve sleeve or the defect of nerve rootlets was diagnosed as root avulsion. The brachial plexus lesions were exposed operatively and examined with electrophysiologic methods (SEP and/or ESCP) in all cases. Operative findings were compared with MR myelography. Twenty-four roots had been diagnosed as normal and 46 roots had been diagnosed as root avulsion with MR myelography preoperatively. In the former only one root was

  4. Natural history of sensory nerve recovery after cutaneous nerve injury following foot and ankle surgery

    Bai, Lu; Han, Yan-ni; Zhang, Wen-tao; Huang, Wei; Zhang, Hong-lei

    2015-01-01

    Cutaneous nerve injury is the most common complication following foot and ankle surgery. However, clinical studies including long-term follow-up data after cutaneous nerve injury of the foot and ankle are lacking. In the current retrospective study, we analyzed the clinical data of 279 patients who underwent foot and ankle surgery. Subjects who suffered from apparent paresthesia in the cutaneous sensory nerve area after surgery were included in the study. Patients received oral vitamin B12 and methylcobalamin. We examined final follow-up data of 17 patients, including seven with sural nerve injury, five with superficial peroneal nerve injury, and five with plantar medial cutaneous nerve injury. We assessed nerve sensory function using the Medical Research Council Scale. Follow-up immediately, at 6 weeks, 3, 6 and 9 months, and 1 year after surgery demonstrated that sensory function was gradually restored in most patients within 6 months. However, recovery was slow at 9 months. There was no significant difference in sensory function between 9 months and 1 year after surgery. Painful neuromas occurred in four patients at 9 months to 1 year. The results demonstrated that the recovery of sensory function in patients with various cutaneous nerve injuries after foot and ankle surgery required at least 6 months. PMID:25788928

  5. Natural history of sensory nerve recovery after cutaneous nerve injury following foot and ankle surgery

    Lu Bai

    2015-01-01

    Full Text Available Cutaneous nerve injury is the most common complication following foot and ankle surgery. However, clinical studies including long-term follow-up data after cutaneous nerve injury of the foot and ankle are lacking. In the current retrospective study, we analyzed the clinical data of 279 patients who underwent foot and ankle surgery. Subjects who suffered from apparent paresthesia in the cutaneous sensory nerve area after surgery were included in the study. Patients received oral vitamin B 12 and methylcobalamin. We examined final follow-up data of 17 patients, including seven with sural nerve injury, five with superficial peroneal nerve injury, and five with plantar medial cutaneous nerve injury. We assessed nerve sensory function using the Medical Research Council Scale. Follow-up immediately, at 6 weeks, 3, 6 and 9 months, and 1 year after surgery demonstrated that sensory function was gradually restored in most patients within 6 months. However, recovery was slow at 9 months. There was no significant difference in sensory function between 9 months and 1 year after surgery. Painful neuromas occurred in four patients at 9 months to 1 year. The results demonstrated that the recovery of sensory function in patients with various cutaneous nerve injuries after foot and ankle surgery required at least 6 months

  6. Natural history of sensory nerve recovery after cutaneous nerve injury following foot and ankle surgery

    Lu Bai; Yan-ni Han; Wen-tao Zhang; Wei Huang; Hong-lei Zhang

    2015-01-01

    Cutaneous nerve injury is the most common complication following foot and ankle surgery. However, clinical studies including long-term follow-up data after cutaneous nerve injury of the foot and ankle are lacking. In the current retrospective study, we analyzed the clinical data of 279 patients who underwent foot and ankle surgery. Subjects who suffered from apparent paresthesia in the cutaneous sensory nerve area after surgery were included in the study. Pa-tients received oral vitamin B12 and methylcobalamin. We examined ifnal follow-up data of 17 patients, including seven with sural nerve injury, ifve with superifcial peroneal nerve injury, and ifve with plantar medial cutaneous nerve injury. We assessed nerve sensory function using the Medical Research Council Scale. Follow-up immediately, at 6 weeks, 3, 6 and 9 months, and 1 year after surgery demonstrated that sensory function was gradually restored in most patients within 6 months. However, recovery was slow at 9 months. There was no signiifcant difference in sensory function between 9 months and 1 year after surgery. Painful neuromas occurred in four patients at 9 months to 1 year. The results demonstrated that the recovery of sensory func-tion in patients with various cutaneous nerve injuries after foot and ankle surgery required at least 6 months.

  7. Remote therapeutic effect of early nerve transposition in treatment of obstetric al brachial plexus palsy

    2001-01-01

    Objective: To report a method and remote therape utic effect of early nerve transposition in treatment of obstetrical brachial pl exus palsy.   Methods: From May 1995 to August 1996, 12 patients who had no r ecovery of biceps 3 months after birth were treated with nerve transposition. Ei ght had neuroma at the upper trunk and 4 had rupture or avulsion of the upper tr unk. Mallet test was used to evaluate the results.   Results: The follow-up of 40-52 months showed that excellent and good recovery in functions was found in 75% of the patients and the excellen t rate of phrenic nerve and accessory nerve transposition was 83.3% and 6 6.7% respectively. A complete recovery in shoulder and elbow joint function wa s in 3 patients and Mallet Ⅳ was in 6 patients.   Conclusions: Satisfactory outcome can be obtained by using earl y nerve transposition in treating obstetrical brachial plexus.Paralysis, obstetric; Peripheral nerves; Nerve trans position

  8. Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note

    Agarwal Anil

    2008-05-01

    Full Text Available Abstract Background To determine whether monitoring end- tidal Carbon Dioxide (capnography can be used to reliably identify the phrenic nerve during the supraclavicular exploration for brachial plexus injury. Methods Three consecutive patients with traction pan-brachial plexus injuries scheduled for neurotization were evaluated under an anesthetic protocol to allow intraoperative electrophysiology. Muscle relaxants were avoided, anaesthesia was induced with propofol and fentanyl and the airway was secured with an appropriate sized laryngeal mask airway. Routine monitoring included heart rate, noninvasive blood pressure, pulse oximetry and time capnography. The phrenic nerve was identified after blind bipolar electrical stimulation using a handheld bipolar nerve stimulator set at 2–4 mA. The capnographic wave form was observed by the neuroanesthetist and simultaneous diaphragmatic contraction was assessed by the surgical assistant. Both observers were blinded as to when the bipolar stimulating electrode was actually in use. Results In all patients, the capnographic wave form revealed a notch at a stimulating amplitude of about 2–4 mA. This became progressively jagged with increasing current till diaphragmatic contraction could be palpated by the blinded surgical assistant at about 6–7 mA. Conclusion Capnography is a sensitive intraoperative test for localizing the phrenic nerve during the supraclavicular approach to the brachial plexus.

  9. Effect of Collateral Sprouting on Donor Nerve Function After Nerve Coaptation: A Study of the Brachial Plexus

    Reichert, Paweł; Kiełbowicz, Zdzisław; Dzięgiel, Piotr; Puła, Bartosz; Wrzosek, Marcin; Bocheńska, Aneta; Gosk, Jerzy

    2016-01-01

    Background The aim of the present study was to evaluate the donor nerve from the C7 spinal nerve of the rabbit brachial plexus after a coaptation procedure. Assessment was performed of avulsion of the C5 and C6 spinal nerves treated by coaptation of these nerves to the C7 spinal nerve. Material/Methods After nerve injury, fourteen rabbits were treated by end-to-side coaptation (ETS), and fourteen animals were treated by side-to-side coaptation (STS) on the right brachial plexus. Electrophysiological and histomorphometric analyses and the skin pinch test were used to evaluate the outcomes. Results There was no statistically significant difference in the G-ratio proximal and distal to the coaptation in the ETS group, but the differences in the axon, myelin sheath and fiber diameters were statistically significant. The comparison of the ETS and STS groups distal to the coaptation with the controls demonstrated statistically significant differences in the fiber, axon, and myelin sheath diameters. With respect to the G-ratio, the ETS group exhibited no significant differences relative to the control, whereas the G-ratio in the STS group and the controls differed significantly. In the electrophysiological study, the ETS and STS groups exhibited major changes in the biceps and subscapularis muscles. Conclusions The coaptation procedure affects the histological structure of the nerve donor, but it does not translate into changes in nerve conduction or the sensory function of the limb. The donor nerve lesion in the ETS group is transient and has minimal clinical relevance. PMID:26848925

  10. Brachial Neuritis With Phrenic Nerve Involvement in a Patient With a Possible Connective Tissue Disease

    Subash, Meera; Patel, Gaurav; Welker, John; Nugent, Kenneth

    2014-01-01

    Background. Brachial neuritis (BN) is a rare inflammatory condition of peripheral nerves, usually involving the cervicobrachial plexus. These patients present with sudden onset of shoulder and arm pain that evolves into muscle weakness and atrophy.. Case Report. A 33-year-old woman presented with a 1-month history of diffuse pain in her thorax. She had no trauma or inciting incident prior to the onset of this pain and was initially treated for muscle spasms. The patient was seen in the emerge...

  11. Nerve transfer for treatment of brachial plexus injury: comparison study between the transfer of partial median and ulnar nerves and that of phrenic and spinal accessary nerves

    侯之启; 徐中和

    2002-01-01

    Objective: To compare the effect of using partial median and ulnar nerves for treatment of C5-6 or C5-7 avulsion of the brachial plexus with that of using phrenic and spinal accessary nerves.Methods: The patients were divided into 2 groups randomly according to different surgical procedures. Twelve cases were involved in the first group. The phrenic nerve was transferred to the musculocutaneous nerve or through a sural nerve graft, and the spinal accessary nerve was to the suprascapular nerve. Eleven cases were classified into the second group. A part of the fascicles of median nerve was transferred to be coapted with the motor fascicle of musculocutaneous nerve and a part of fascicles of ulnar nerve was transferred to the axillary nerve. The cases were followed up from 1 to 3 years and the clinical outcome was compared between the two groups. Results: There were 2 cases (16.6%) who got the recovery of M4 strength of biceps muscle in the first group but 7 cases (63.6%) in the second group, and the difference was statistically significant (P<0.025). However, it was not statistically different in the recovery of shoulder function between the two groups. Conclusions: Partial median and ulnar nerve transfer, phrenic and spinal accessary nerve transfer were all effective for the reconstruction of elbow or shoulder function in brachial plexus injury, but the neurotization using a part of median nerve could obtain more powerful biceps muscle strength than that of phrenic nerve transfer procedure.

  12. Brachial plexus

    The brachial plexus is a group of nerves that run from the lower neck through the upper shoulder area. These ... Damage to the brachial plexus nerves can cause muscle and sensation problems that are often associated with pain in the same area. Symptoms may ...

  13. Origin of Medial and Lateral Pectoral Nerves from the Supraclavicular Part of Brachial Plexus and its Clinical Importance – A Case Report

    Shetty, Prakashchandra; Nayak, Satheesha B.; KUMAR, NAVEEN; Thangarajan, Rajesh; D’Souza, Melanie Rose

    2014-01-01

    Knowledge of normal and anomalous formation of brachial plexus and its branches is of utmost importance to anatomists, clinicians, anesthesiologists and surgeons. Possibility of variations in the origin, course and distribution of branches of brachial plexus must be kept in mind during anesthetizing the brachial plexus, mastectomy and plastic surgery procedures. In the current case, the medial pectoral nerve arose directly from the middle trunk of the brachial plexus and the lateral pectoral ...

  14. Isolated Unilateral Brachial Neuritis of the Phrenic Nerve (Parsonage-Turner Syndrome) in a Marathon Runner With Exertional Dyspnea

    Weng, Modern; Fidel, Constance

    2010-01-01

    Parsonage-Turner syndrome, or acute brachial neuritis/plexitis, is a rare condition that should be included in the differential diagnosis of any athlete who presents with antecedent flulike symptoms, with progression to significant neuropathic pain, followed by profound weakness in the affected upper extremity. In rare cases, the main presenting symptom of this condition may be dyspnea on exertion secondary to an isolated unilateral brachial neuritis of the phrenic nerve.

  15. Median nerve's loop in the arm penetrated by a superficial brachial artery: case report and neurosurgical considerations

    George K. Paraskevas

    2015-08-01

    Full Text Available Median nerve is commonly formed by the union of the lateral and medial cord of the brachial plexus, which embrace the third part of the axillary artery. Formation of a median nerve's loop is a very rare condition. We present a cadaveric case, in which the right median nerve was found at the upper arm forming a fusiform neural loop penetrated by a superficial brachial artery, which continued over the forearm as the radial artery. The literature concerning nerve loops and traversing arteries is discussed, as well as the relevant embryology. We consider that such nerve loops constitute vulnerable sites of the nerve trunk since it is compressed by the pulsation of the abnormal traversing artery. Moreover, neurosurgeons should keep in mind that in case of existing arterial variation, variation of the associated neural structures may co-exist. [Int J Res Med Sci 2015; 3(8.000: 2123-2125

  16. Unusual Communications between the Cutaneous Branches of Ulnar Nerve in the Palm

    Sirasanagandla, Srinivasa Rao; Padavinangady, Abhinitha; Nayak, Satheesha B.; Jetti, Raghu

    2015-01-01

    Variations of dorsal and volar digital cutaneous branches of ulnar nerve are of tremendous clinical importance for successful regional nerve blocks, skin flaps, carpal tunnel release and placement of electrodes for electrophysiological studies. With the aforementioned clinical implications it is worth to report the variations of cutaneous branches of ulnar nerve. In the current case, we have encountered a rare variation (Kaplan`s anastomosis) of ulnar nerve, in the right upper limb. We have n...

  17. A Need for Logical and Consistent Anatomical Nomenclature for Cutaneous Nerves of the Limbs

    Gest, Thomas R.; Burkel, William E.; Cortright, Gerald W.

    2009-01-01

    The system of anatomical nomenclature needs to be logical and consistent. However, variations in translation to English of the Latin and Greek terminology used in Nomina Anatomica and Terminologia Anatomica have led to some inconsistency in the nomenclature of cutaneous nerves in the limbs. An historical review of cutaneous nerve nomenclature…

  18. Diagnosis of nerve root avulsion injuries in adults with traumatic brachial plexopathies: MRI compared with CT myelography

    Ewoudt van der Linde

    2015-03-01

    Full Text Available Background: Computed tomography myelography (CTM has been broadly adopted as the ‘gold standard’ imaging technique in the diagnosis of nerve root avulsion injuries in traumatic brachial plexopathies. CTM has the distinct advantage of better spatial resolution than magnetic resonance imaging (MRI; however, this technique is invasive and can result in significant patient discomfort. MRI, therefore, seems relatively more advantageous as it is less invasive (requires no lumbar puncture, lacks radiation exposure, has no adverse reactions related to intrathecal contrast agents and confers excellent soft-tissue contrast. Objectives: To compare the sensitivity and specificity of MRI with CTM in the diagnosis of preganglionic nerve root avulsion injuries in adults with traumatic brachial plexopathies at the Inkosi Albert Luthuli Central Hospital.Method: A retrospective comparative analysis was performed on 16 adult patients with traumatic preganglionic brachial plexopathies who underwent both MRI and CTM at Inkosi Albert Luthuli Central Hospital. Radiologists experienced in both CTM and MRI interpreted the data and a comparison was made using CTM as the gold standard. Results: The sensitivity and specificity for MRI detecting preganglionic nerve root avulsion injuries and pseudomeningoceles was 82% and 100% respectively. The interobserver agreement between CTM and MRI for the detection of preganglionic nerve root avulsion injuries was 81.25% (Kappa = 0.77 and 87.5% (Kappa = 0.84 for the detection of pseudomeningoceles. Conclusion: MRI was as sensitive as CTM at detecting preganglionic nerve root avulsion injuries and pseudomeningoceles of spinal nerve roots C7–T1 of the brachial plexus. Some mild discrepancies existed at the C5 and C6 nerve root levels. Owing to the invasiveness of the procedure and resultant patient discomfort, CTM should be reserved for complicated cases or for patients with contraindications to MRI.

  19. Sensory cutaneous nerve fine-needle aspiration in Hansen's disease: A retrospective analysis of our experience

    Prasoon, Dev; Mandal, Swapan Kumar; Agrawal, Parimal

    2015-01-01

    Background: Leprosy affects peripheral nerves. As Mycobacterium leprae has unique tropism for Schwann cells, thickened sensory cutaneous nerves provide an easy target for the detection of lepra bacilli and other changes associated with the disease. Materials and Methods: The data of patients with sensory cutaneous nerve involvement were retrieved from our record for the period January 2006 to December 2014. The hematoxylin and eosin (H and E)- and May-Grünwald-Giemsa (MGG)-stained slides were...

  20. Magnetic resonance imaging of the cervical nerve root avulsion in brachial plexus injuries. New imaging technique and classification

    The Author describes a new magnetic resonance (MR) imaging technique of the cervical nerve roots in traumatic brachial plexus injury. The overlapping coronal-oblique slice MR imaging procedure of the cervical nerve root was performed in 35 patients with traumatic brachial plexus injury. The results were retrospectively evaluated and classified into four major categories (normal rootlet, rootlet partial injuries, avulsion, and meningocele), after diagnosis by surgical exploration. In this study, the sensitivity of detection of the cervical nerve root avulsion in MR imaging was the same (92.9%) as that of myelography and CT myelography. The reliability and reproducibility of the MR imaging classification was prospectively in 10 patients with traumatic brachial plexus injury, assessed by eight independent observers, and its diagnostic accuracy was compared with that of myelography and CT myelography. In this study, interobserver reliability and intraobserver reproducibility showed that there were no statistically significant difference between both modalities. This new MR imaging technique is a reliable and reproducible method for detecting nerve root avulsion, and the MR imaging information provided valiable data for helping to decide whether to proceed with exploration, nerve repair, primary reconstruction, or other imaging modalities. (author)

  1. Unusual Communications between the Cutaneous Branches of Ulnar Nerve in the Palm

    Sirasanagandla, Srinivasa Rao; Nayak, Satheesha B.; Jetti, Raghu

    2015-01-01

    Variations of dorsal and volar digital cutaneous branches of ulnar nerve are of tremendous clinical importance for successful regional nerve blocks, skin flaps, carpal tunnel release and placement of electrodes for electrophysiological studies. With the aforementioned clinical implications it is worth to report the variations of cutaneous branches of ulnar nerve. In the current case, we have encountered a rare variation (Kaplan`s anastomosis) of ulnar nerve, in the right upper limb. We have noticed that the dorsal cutaneous branch of ulnar nerve divided into three branches, the lateral two branches supplied the skin of the medial one and half fingers of the dorsum of hand. The medial branch established communications with the superficial branches of ulnar nerve and distributed to the skin of the one and half fingers of the volar aspect of hand. The possible outcome of this communications is discussed. Course and distribution of ulnar nerve on the contralateral side was found to be normal. PMID:25954612

  2. Comparison of the Supraclavicular, Infraclavicular and Axillary Approaches for Ultrasound-Guided Brachial Plexus Block for Surgical Anesthesia

    Stav, Anatoli; Reytman, Leonid; Stav, Michael-Yohay; Portnoy, Isaak; Kantarovsky, Alexander; Galili, Offer; Luboshitz, Shmuel; Sevi, Roger; Sternberg, Ahud

    2016-01-01

    Objective We hypothesized that ultrasound (US)-guided technique of the supra- and infraclavicular and axillary approaches of brachial plexus block (BPB) will produce a high quality of surgical anesthesia for operations below the shoulder independently of the approach and body mass index (BMI). Intercostobrachial and medial brachial cutaneous nerves will be blocked separately because they are not a part of the brachial plexus. Methods This is a prospective randomized observer-blinded study. Th...

  3. Comparison of the Supraclavicular, Infraclavicular and Axillary Approaches for Ultrasound-Guided Brachial Plexus Block for Surgical Anesthesia

    Anatoli Stav; Leonid Reytman; Michael-Yohay Stav; Isaak Portnoy; Alexander Kantarovsky; Offer Galili; Shmuel Luboshitz; Roger Sevi; Ahud Sternberg

    2016-01-01

    Objective We hypothesized that ultrasound (US)-guided technique of the supra- and infraclavicular and axillary approaches of brachial plexus block (BPB) will produce a high quality of surgical anesthesia for operations below the shoulder independently of the approach and body mass index (BMI). Intercostobrachial and medial brachial cutaneous nerves will be blocked separately because they are not a part of the brachial plexus. Methods This is a prospective randomized observer-blinded ...

  4. Brachial plexus (image)

    The brachial plexus is a group of nerves that originate from the neck region and branch off to give rise ... movement in the upper limb. Injuries to the brachial plexus are common and can be debilitating. If the ...

  5. Brachial Neuritis With Phrenic Nerve Involvement in a Patient With a Possible Connective Tissue Disease.

    Subash, Meera; Patel, Gaurav; Welker, John; Nugent, Kenneth

    2014-01-01

    Background. Brachial neuritis (BN) is a rare inflammatory condition of peripheral nerves, usually involving the cervicobrachial plexus. These patients present with sudden onset of shoulder and arm pain that evolves into muscle weakness and atrophy.. Case Report. A 33-year-old woman presented with a 1-month history of diffuse pain in her thorax. She had no trauma or inciting incident prior to the onset of this pain and was initially treated for muscle spasms. The patient was seen in the emergency room multiple times and was treated with several courses of antibiotics for pneumonia on the basis of clinical symptoms and abnormal x-rays. The pleuritic chest pain persisted for at least 4 months, and the patient was eventually admitted for worsening pain and dyspnea. On physical examination, crackles were heard at both lung bases, and chest inspection revealed increased expansion in the upper thorax but poor expansion of the lower thorax and mild paradoxical respiration. "Sniff" test revealed no motion of the left hemidiaphragm and reduced motion on the right hemidiaphragm. Her computed tomography scan revealed bilateral atelectasis, more severe at the left base. She reported no symptoms involving her joints or skin or abdomen. Her presentation and clinical course are best explained by BN with a bilateral diaphragmatic weakness. However, she had a positive ANA, RF, anti-RNP antibody, and anti SS-A. Conclusion. Patients with BN can present with diffuse thoracic pain, pleuritic chest pain, and diaphragmatic weakness. Our patient may represent a case of connective tissue disease presenting with brachial plexus neuritis. PMID:26425609

  6. Origin, distribution, and insertion of the brachial plexus nerves in Blue-and-yellow Macaws (Ara ararauna, Linnaeus, 1758

    Kamal Achôa Filho

    2014-09-01

    Full Text Available Brazil has about 80 species of parrots cataloged, and five of them are identified as Macaws. As the vast majority of birds, Macaws use flight as their primary means of locomotion. However, the strength and power generated during the cycle of beating wings require a mechanism of active neuromuscular control and specialized adaptations of muscles responsible for flight, which are innervated by the brachial plexus. This study aims to describe the origin and distribution of peripheral nerves that make up the brachial plexus in Blue-and-yellow Macaw (Ara ararauna, Linnaeus, 1758, in order to aid the veterinarian to recognize and locate neuromuscular lesions in this species. We used five dead bodies, obtained from the Screening Center for Wild Animals in Paraíba, Brazil, in which the nerves were identified by direct dissection. Four nerve roots were viewed, originating three nerve trunks, which stem from the intervertebral spaces between the tenth cervical vertebra and the second thoracic vertebra. Nerves from the dorsal cord innervated extensor muscles, while ventral cord nerves innervated flexor muscles of the wing, in addition to the pectoral branches, responsible to innervate the superficial thoracic and shoulder muscles.

  7. Facial nerve paralysis and partial brachial plexopathy after epidural blood patch: a case report and review of the literature

    Radi Shahien

    2011-02-01

    Full Text Available Radi Shahien, Abdalla BowirratDepartment of Neurology, Ziv Medical Center, Zfat, IsraelAbstract: We report a complication related to epidural analgesia for delivery in a 24-year-old woman who was admitted with mild pre-eclampsia and for induction of labor. At the first postpartum day she developed a postdural puncture headache, which was unresponsive to conservative measures. On the fifth day an epidural blood patch was done, and her headache subsided. Sixteen hours later she developed paralysis of the right facial nerve, which was treated with prednisone. Seven days later she complained of pain in the left arm and the posterior region of the shoulder. She was later admitted and diagnosed with partial brachial plexopathy.Keywords: facial nerve paralysis, partial brachial plexopathy, epidural blood patch

  8. Origin, distribution, and insertion of the brachial plexus nerves in Blue-and-yellow Macaws (Ara ararauna, Linnaeus, 1758)

    Kamal Achôa Filho; Marcio Nogueira Rodrigues; Erika Toledo da Fonseca; Rafael Magdanelo Leandro; Vanessa Bertagia Pasqualetti; Maria Angélica Miglino

    2014-01-01

    Brazil has about 80 species of parrots cataloged, and five of them are identified as Macaws. As the vast majority of birds, Macaws use flight as their primary means of locomotion. However, the strength and power generated during the cycle of beating wings require a mechanism of active neuromuscular control and specialized adaptations of muscles responsible for flight, which are innervated by the brachial plexus. This study aims to describe the origin and distribution of peripheral nerves that...

  9. Results of spinal accessory to suprascapular nerve transfer in 110 patients with complete palsy of the brachial plexus.

    Bertelli, Jayme Augusto; Ghizoni, Marcos Flávio

    2016-06-01

    OBJECTIVE Transfer of the spinal accessory nerve to the suprascapular nerve is a common procedure, performed to reestablish shoulder motion in patients with total brachial plexus palsy. However, the results of this procedure remain largely unknown. METHODS Over an 11-year period (2002-2012), 257 patients with total brachial plexus palsy were operated upon in the authors' department by a single surgeon and had the spinal accessory nerve transferred to the suprascapular nerve. Among these, 110 had adequate follow-up and were included in this study. Their average age was 26 years (SD 8.4 years), and the mean interval between their injury and surgery was 5.2 months (SD 2.4 months). Prior to 2005, the suprascapular and spinal accessory nerves were dissected through a classic supraclavicular L-shape incision (n = 29). Afterward (n = 81), the spinal accessory and suprascapular nerves were dissected via an oblique incision, extending from the point at which the plexus crossed the clavicle to the anterior border of the trapezius muscle. In 17 of these patients, because of clavicle fractures or dislocation, scapular fractures or retroclavicular scarring, the incision was extended by detaching the trapezius from the clavicle to expose the suprascapular nerve at the suprascapular fossa. In all patients, the brachial plexus was explored and elbow flexion reconstructed by root grafting (n = 95), root grafting and phrenic nerve transfer (n = 6), phrenic nerve transfer (n = 1), or third, fourth, and fifth intercostal nerve transfer. Postoperatively, patients were followed for an average of 40 months (SD 13.7 months). RESULTS Failed recovery, meaning less than 30° abduction, was observed in 10 (9%) of the 110 patients. The failure rate was 25% between 2002 and 2004, but dropped to 5% after the staged/extended approach was introduced. The mean overall range of abduction recovery was 58.5° (SD 26°). Comparing before and after distal suprascapular nerve exploration (2005-2012), the

  10. The investigation of traumatic lesions of the brachial plexus by electromyography and short latency somatosensory potentials evoked by stimulation of multiple peripheral nerves.

    Yiannikas, C; Shahani, B T; Young, R. R.

    1983-01-01

    A study of 10 patients with brachial plexus trauma was performed to determine whether the diagnostic accuracy of sensory evoked potentials (SEPs) may be improved by using stimulation of multiple peripheral nerves (median, radial, musculocutaneous and ulnar). In addition, the relative advantages of SEPs and peripheral electrophysiological studies were considered. SEP patterns following most common brachial plexus lesions were predictable. Injuries to the upper trunk affected the musculocutaneo...

  11. Anatomical Variations in the Emergence of the Cutaneous Nerves from the Nerve Point in the Neck and Identification of the Landmarks to Locate the Nerve Point with Its Clinical Implications: A Cadaveric Study on South Indian Human Foetuses

    Gupta, Chandni; D’Souza, Antony Sylvan; Raythe, Biswabswabina

    2013-01-01

    Objective: The cutaneous nerves from the cervical plexuses are anaesthetized by using local anaesthetics for pain relief or when minor surgical operations are performed. Knowing the variations in these nerves is important for anaestheticists to administer an effective anaesthesia to a particular nerve. So, the aim of this study was to look for the variations in the emerging patterns of the cervical cutaneous nerves in the neck and to locate the nerve point in the neck by using the superficial...

  12. Computed tomography myelography with coronal and oblique coronal views for diagnosis of nerve root avulsion in brachial plexus injury

    We describe a new computed tomography (CT) myelography technique with coronal and oblique coronal views to demonstrate the status of the cervical nerve rootlets that are involved in brachial plexus injury. We discuss the usefulness of this technique for the diagnosis of nerve root avulsion compared with that of CT myelography with axial view. CT myelography was performed with enhancement of the cervical subarachnoid space by using a contrast medium. Subsequently, coronal and oblique coronal reconstructions were created. The results of CT myelography were evaluated and classified in the presence of pseudomeningocele, intradural ventral nerve rootlets, and intradural dorsal nerve rootlets. The diagnosis was based on the findings of extraspinal surgical exploration with or without spinal evoked potential measurements and choline acetyltransferase activity measurement in 25 patients and recovery by a natural course in 3 patients. The diagnostic accuracies of CT myelography with coronal and oblique coronal views and that with axial view were compared and correlated with the surgical findings or natural course in 57 cervical roots in 28 patients. Coronal and oblique coronal views were superior to axial views in the visualization of the rootlets and orientation of the exact level of the root. They showed 100% sensitivity, 96% specificity, and 98% diagnostic accuracy (26 true-positive findings, 27 true-negative findings, none false-positive findings, and one false-negative findings) for diagnosing root avulsion. No statistically significant difference was observed between the coronal and oblique coronal views and the axial views. The information obtained using coronal and oblique coronal slice CT myelography enabled the assessment of the rootlets of the brachial plexus and provided valuable data for deciding the appropriate treatment strategy, namely, exploration, nerve repair, or primary reconstruction. (author)

  13. Cutaneous lesions sensory impairment recovery and nerve regeneration in leprosy patients

    Ximena Illarramendi

    2012-12-01

    Full Text Available It is important to understand the mechanisms that enable peripheral neurons to regenerate after nerve injury in order to identify methods of improving this regeneration. Therefore, we studied nerve regeneration and sensory impairment recovery in the cutaneous lesions of leprosy patients (LPs before and after treatment with multidrug therapy (MDT. The skin lesion sensory test results were compared to the histopathological and immunohistochemical protein gene product (PGP 9.5 and the p75 nerve growth factor receptors (NGFr findings. The cutaneous neural occupation ratio (CNOR was evaluated for both neural markers. Thermal and pain sensations were the most frequently affected functions at the first visit and the most frequently recovered functions after MDT. The presence of a high cutaneous nerve damage index did not prevent the recovery of any type of sensory function. The CNOR was calculated for each biopsy, according to the presence of PGP and NGFr-immunostained fibres and it was not significantly different before or after the MDT. We observed a variable influence of MDT in the recovery from sensory impairment in the cutaneous lesions of LPs. Nociception and cold thermosensation were the most recovered sensations. The recovery of sensation in the skin lesions appeared to be associated with subsiding inflammation rather than with the regenerative activity of nerve fibres.

  14. Ultrasound guidance for brachial plexus block decreases the incidence of complete hemi-diaphragmatic paresis or vascular punctures and improves success rate of brachial plexus nerve block compared with peripheral nerve stimulator in adults

    YUAN Jia-min; YANG Xiao-hu; FU Shu-kun; YUAN Chao-qun; CHEN Kai; LI Jia-yi; LI Quan

    2012-01-01

    Background The use of traditional techniques (such as landmark techniques,paresthesia and peripheral nerve stimulator) for upper-limb anesthesia has often been restricted to the expert or enthusiast,which was blind.Recently,ultrasound (US) has been applied to differ blood vessel,pleura and nerve,thus may reduce the risk of complications while have a high rate of success.The aim of this study was to determine if the use of ultrasound guidance (vs.peripheral nerve stimulator,(PNS)) decreases risk of vascular puncture,risk of hemi-diaphragmatic paresis and risk of Horner syndrome and improves the success rate of nerve block.Methods A search strategy was developed to identify randomized control trials (RCTs) reporting on complications of US and PNS guidance for upper-extremity peripheral nerve blocks (brachial plexus) in adults available through PubMed databases,the Cochrane Central Register of Controlled Trials,Embase databases,SinoMed databases and Wanfang data (date up to 2011-12-20).Two independent reviewers appraised eligible studies and extracted data.Risk ratios (OR)were calculated for each outcome and presented with 95% confidence intervals (CI) with the software of ReviewManager 5.1.0 System (Cochrane Library).Results Sixteen trials involving 1321 adults met our criteria were included for analysis.Blocks performed using US guidance were more likely to be successful (risk ratio (RR) for block success 0.36,95% CI 0.23-0.56,P <0.00001),decreased incidence of vascular puncture during block performance (RR 0.13,95% CI 0.06-0.27,P <0.00001),decreased the risk of complete hemi-diaphragmatic paresis (RR 0.09,95% CI 0.03-0.52,,P=0.0001).Conclusions US decreases risks of complete hemi-diaphragmatic paresis or vascular puncture and improves success rate of brachial plexus nerve block compared with techniques that utilize PNS for nerve localization.Larger studies are needed to determine whether or not the use of US can decrease risk of neurologic complications.

  15. Surgical trainees neuropraxia? An unusual case of compression of the lateral cutaneous nerve of the forearm.

    Seoighe, D M

    2010-09-01

    Compression of the lateral cutaneous nerve of the forearm is an uncommon diagnosis but has been associated with strenuous upper limb activity. We report the unique case of a 32-year-old male orthopaedic trainee who suffered this nerve palsy as a result of prolonged elbow extension and forearm pronation while the single assistant during a hip resurfacing procedure. Conservative measures were sufficient for sensory recovery to be clinically detectable after 12 weeks.

  16. Sensory cutaneous nerve fine-needle aspiration in Hansen′s disease: A retrospective analysis of our experience

    Dev Prasoon; Swapan Kumar Mandal; Parimal Agrawal

    2015-01-01

    Background: Leprosy affects peripheral nerves. As Mycobacterium leprae has unique tropism for Schwann cells, thickened sensory cutaneous nerves provide an easy target for the detection of lepra bacilli and other changes associated with the disease. Materials and Methods: The data of patients with sensory cutaneous nerve involvement were retrieved from our record for the period January 2006 to December 2014. The hematoxylin and eosin (H and E)- and May-Grünwald-Giemsa (MGG)-stained slides ...

  17. High-resolution sonography of the palmar cutaneous branch of the median nerve

    A. Tagliafico (Alberto); F. Pugliese (Francesca); S. Bianchi (Stefano); G. Bodner (Gerd); L. Padua (Luca); M. Rubino (Maurizio); C. Martinoli (Carlo)

    2008-01-01

    textabstractOBJECTIVE. The aim of this study was to describe the potential value of high-resolution sonography for evaluation of the palmar cutaneous branch of the median nerve (MN). SUBJECTS AND METHODS. The volar wrists of 12 healthy volunteers and 22 consecutive patients with sensory deficit in t

  18. Schwannoma of Brachial Plexus

    Kumar, Ameet; Akhtar, Saeed

    2010-01-01

    Brachial plexus tumours are a rare entity. Schwannomas are benign nerve sheath tumours and only about 5% arise from the brachial plexus. Due to its rarity and complex anatomical location they can pose a formidable challenge to surgeons. We present a case of a young patient who presented with an axillary swelling three months after a lymph node biopsy from the same axilla, which turned out to be a Schwannoma arising for the medial cord of the brachial plexus.

  19. Electrical nerve stimulation as an aid to the placement of a brachial plexus block : clinical communication

    K.E. Joubert

    2002-07-01

    Full Text Available Most local anaesthetic blocks are placed blindly, based on a sound knowledge of anatomy. Very often the relationship between the site of deposition of local anaesthetic and the nerve to be blocked is unknown. Large motor neurons may be stimulated with the aid of an electrical current. By observing for muscle twitches, through electrical stimulation of the nerve, a needle can be positioned extremely close to the nerve. The accuracy of local anaesthetic blocks can be improved by this technique. By using the lowest possible current a needle could be positioned within 2-5mm of a nerve. The correct duration of stimulation ensures that stimulation of sensory nerves does not occur. The use of electrical nerve stimulation in veterinary medicine is a novel technique that requires further evaluation.

  20. Mechanical sensitization of cutaneous sensory fibers in the spared nerve injury mouse model

    Smith, Amanda K.; O’Hara, Crystal L; Cheryl L Stucky

    2013-01-01

    Background The spared nerve injury (SNI) model of neuropathic pain produces robust and reproducible behavioral mechanical hypersensitivity. Although this rodent model of neuropathic pain has been well established and widely used, peripheral mechanisms underlying this phenotype remain incompletely understood. Here we investigated the role of cutaneous sensory fibers in the maintenance of mechanical hyperalgesia in mice post-SNI. Findings SNI produced robust, long-lasting behavioral mechanical ...

  1. Cutaneous sensory nerve as a substitute for auditory nerve in solving deaf-mutes’ hearing problem: an innovation in multi-channel-array skin-hearing technology

    Li, Jianwen; Li, Yan; Zhang, Ming; Ma, Weifang; Ma, Xuezong

    2014-01-01

    The current use of hearing aids and artificial cochleas for deaf-mute individuals depends on their auditory nerve. Skin-hearing technology, a patented system developed by our group, uses a cutaneous sensory nerve to substitute for the auditory nerve to help deaf-mutes to hear sound. This paper introduces a new solution, multi-channel-array skin-hearing technology, to solve the problem of speech discrimination. Based on the filtering principle of hair cells, external voice signals at different...

  2. The brain plasticity in patients with brachial plexus root avulsion after contralateral C7 nerve-root transfer: a FDG-PET study

    Objectives: To study FDG-PET for imaging the brain plasticity in patients with brachial plexus root avulsion after contralateral C7 nerve-root transfer. Methods: One male patient with left brachial plexus root avulsion underwent a two-stage procedure (first phase: C7 root → ulnar nerve; second phase: ulnar nerve → recipient nerve) 4 years ago; Another with right brachial plexus root avulsion also underwent a two-stage procedure 3 years ago. First two patients underwent basic FDG-PET imaging, the next day FDG-PET scans were performed after initiative or passive limb movement. Using ROI and MPI tools to evaluate the images. The ratios of sensorimotor frontal cingulated Thalami to white matter were used as the semiquantitive index. Results: Whether brain plasticity had occurred was determined by whether the affected limb can perform initiative movement. The increases in glucose metabolism of left sensorimotor frontal cingulated Thalami in patient with left brachial plexus root avulsion were 40.1%, 37.9%, 48.3%, 31.9% after initiative movement, the right corresponding brain regions were 39.4%, 34.3%, 48.5%,35.4% respectively. However, the increases in glucose metabolism of left sensorimotor frontal cingulated Thalami in patient with right brachial plexus root avulsion were increased by 12.6%, 9.6%, 10.7%, 5.3% after passive movement, the right corresponding brain regions were respectively 17.9%, 12.9%, 15.4%, 10.1%. It was founded that the metabolism of bilateral sensorimotor frontal cingulated Thalami increased after initiative movement, while the metabolism of right sensorimotor frontal cingulated Thalami increased more obviously than that of the left brain regions when using MPI tool to substract the images before and after the affected limb movement. Conclusions: Sensorimotor frontal cingulated Thalami were necessary to the initiative movement. After being activated by movement, the metabolisms of plasticised brain regions increased obviously. However, the

  3. A Tool for Teaching Three-Dimensional Dermatomes Combined with Distribution of Cutaneous Nerves on the Limbs

    Kooloos, Jan G. M.; Vorstenbosch, Marc A. T. M.

    2013-01-01

    A teaching tool that facilitates student understanding of a three-dimensional (3D) integration of dermatomes with peripheral cutaneous nerve field distributions is described. This model is inspired by the confusion in novice learners between dermatome maps and nerve field distribution maps. This confusion leads to the misconception that these two…

  4. Dorsal cutaneous branch of ulnar nerve: an appraisal on the anatomy, injuries and application of conduction velocity studies in diagnosis

    GARIBALDI SOLANGE G

    2000-01-01

    Full Text Available Classical textbooks and recent publications about the anatomy of the dorsal cutaneous branch of the ulnar nerve are revisited and correlated with methods of measurement of its conduction velocity, in order to evaluate the indications and limitations of the procedure. Etiology and pathogenesis of isolated lesions of this nerve branch are discussed.

  5. Transfer of the radial branch of the superficial radial nerve to the sensory branch of the ulnar nerve for sensory restoration after C7-T1 brachial plexus injury.

    Xu, Bin; Dong, Zhen; Zhang, Cheng-Gang; Gu, Yu-Dong

    2016-03-01

    Previously, we have reconstructed the motor function of patients with C7-T1 brachial plexus palsies through combined nerve and tendon transfers. However, these patients lose not only the motor function of the hand but also the sensation on the ulnar side of the hand. Without sensory recovery, the injured hand may be further damaged, particularly by burns in this contact zone. Therefore, we described a technique to restore the sensation at the ulnar aspect of the hand by performing a transfer of the radial branch of the superficial radial nerve to the sensory branch of the ulnar nerve. PMID:26626199

  6. Dorsal cutaneous branch of the ulnar nerve: a light and electron microscopy histometric study.

    Oliveira, Adriana L C R D; Fazan, Valéria P S; Marques, Wilson; Barreira, Amilton A

    2011-06-01

    This study describes the normal morphology and morphometry of the dorsal cutaneous branch of the ulnar nerve (DCBU) in humans. Fourteen nerves of eight donors were prepared by conventional techniques for paraffin and epoxy resin embedding. Semiautomatic morphometric analysis was performed by means of specific computer software. Histograms of the myelinated and unmyelinated fiber population and the G-ratio distribution of fibers were plotted. Myelinated fiber density per nerve varied from 5,910 to 10,166 fibers/mm(2) , with an average of 8,170 ± 393 fibers/mm(2) . The distribution was bimodal with peaks at 4.0 and 9.5 µm. Unmyelinated fiber density per nerve varied from 50,985 to 127,108, with an average of 78,474 ± 6,610 fibers/mm(2) , with a unimodal distribution displaying a peak at 0.8 µm. This study thus adds information about the fascicles and myelinated and unmyelinated fibers of DCBU nerves in normal people, which may be useful in further studies concerning ulnar nerve neuropathies, mainly leprosy neuropathy. PMID:21692907

  7. Somatosensory evoked potential monitoring of the brachial plexus to predict nerve injury during internal mammary artery harvest: intraoperative comparisons of the Rultract and Pittman sternal retractors.

    Jellish, W S; Martucci, J; Blakeman, B; Hudson, E

    1994-08-01

    Brachial plexus injury after coronary artery bypass grafting (CABG) continues to be a common problem postoperatively. With the use of somatosensory evoked potential monitoring (SSEP), neurologic integrity of the brachial plexus during internal mammary artery (IMA) harvest was assessed and the Rultract and Pittman sternal retractors were compared to determine what effect they had on SSEP characteristics. Results showed that the Rultract and Pittman retractors caused large decreases in SSEP amplitudes after insertion, (1.25 +/- 0.14 versus 0.72 +/- 0.09, P < 0.05; and 1.64 +/- 0.27 versus 0.91 +/- 0.14, P < 0.05) respectively. This decrease was noted in 85% of Rultract and 68.75% of Pittman patients, respectively. Amplitudes increased after retractor removal but never returned to baseline values. Cooley retractor placement in the patients not undergoing IMA harvest (control) produced only mild decreases in amplitude. Waveform latency increased in all groups after retractor placement, but these increases were thought to be clinically insignificant. Postoperatively, three patients in each of the IMA retractor groups had brachial plexus symptoms (18%), whereas only one patient in the control group had symptoms. Somatosensory evoked potential monitoring seems to be a sensitive intraoperative monitor for assessing brachial plexus injury during CABG. The nerve plexus seems to be most at risk for pathologic injury during retraction of the sternum for IMA harvest. Though the Rultract retractor caused greater changes in SSEP characteristics than the Pittman, no clinical outcome differences between the two could be ascertained. Using SSEP monitoring may reduce brachial plexus injury during IMA harvest by allowing early detection of nerve compromise and therapeutic interventions to alleviate the insult while under general anesthesia. PMID:7948794

  8. Neuroma of medial dorsal cutaneous nerve of superficial peroneal nerve after ankle arthroscopy.

    Shim, Jae Sun; Lee, Ji Hyun; Han, Soo Hong; Kim, MinYoung; Lee, Hang Jae; Min, Kyunghoon

    2014-09-01

    Superficial peroneal neuropathy is a known complication of foot and ankle arthroscopy. A 27-year-old man developed pain and paresthesia on the medial side of the dorsum of his left foot after ankle arthroscopy. An electrodiagnostic study revealed conduction abnormality in the medial branch of superficial peroneal nerve, in which neuroma-in-continuity was subsequently detected by ultrasonography. After neuroma excision and nerve graft, the subject's neuropathic pain was substantially improved. PMID:24486918

  9. BILATERAL MULTIPLE VARIATIONS IN THE FORMATION OF THE BRACHIAL PLEXUS AND ITS TERMINAL NERVES: A CASE REPORT

    Flora M Fabian; Hortensia G Nondoli; Gabriel J. Mchonde

    2013-01-01

    Variations in formation of brachial plexus roots, trunks, divisions and cords are not uncommon and maybe of important in regional anaesthesia involving the upper limb. However, in the present case we are reporting a rare bilateral multiple variations observed during routine dissection on a 77-years-old embalmed male cadaver on left and right brachial plexus. Understanding the anatomical variations involving brachial plexus is important and might benefit the physicians, surgeons, anaesthesiolo...

  10. Brachial plexus variation involving the formation and branches of the cords

    Fabian-Taylor FM

    2010-11-01

    Full Text Available This case report is aimed at reporting a rare variation of brachial plexus involving the cords and its branches in the right upper limb. The musculocutaneous nerve was missing. The whole medial cord continued as a medial root of median nerve. The lateral cord gave off the lateral root of median nerve and an additional root joined with posterior cord to form a short common trunk. The short common trunk divided into two roots: one joined the median nerve; and the second one continued down as ulnar nerve. Median nerve supplied biceps brachii and brachialis muscles. The coracobrachialis muscle was supplied by radial nerve. The cutaneous innervation to the upper limb was derived from radial and ulnar nerves.

  11. Brachial plexus myoclonus.

    Banks, G.; Nielsen, V K; Short, M P; Kowal, C D

    1985-01-01

    Rhythmic myoclonus in an arm began abruptly following an injury and persisted continuously for six years. Topographical EMG showed abnormal activity confined to muscles innervated by the axillary and radial nerves from the posterior cord of the brachial plexus. Abduction of the arm above horizontal level stopped myoclonus and EMG discharges. EEG was normal. It is suggested that the myoclonus was caused by mechanical irritation of the posterior cord of the brachial plexus.

  12. MRI of brachial plexopathies

    Sureka, J. [Department of Radiology, Christian Medical College, Vellore (India)], E-mail: drjyoticmch@rediffmail.com; Cherian, R.A.; Alexander, M.; Thomas, B.P. [Department of Radiology, Christian Medical College, Vellore (India)

    2009-02-15

    Magnetic resonance imaging (MRI) has become the primary imaging technique in the evaluation of brachial plexus pathology, and plays an important role in the identification, localization, and characterization of the cause. Improvements in MRI technique have helped in detecting changes in the signal intensity of nerves, subtle enhancement, and in detecting perineural pathology, thereby refining the differential diagnosis. The present review of the visualization of brachial plexus abnormalities using MRI is based on a review of 26 cases. The causes include trauma and a spectrum of non-traumatic causes, such as acute idiopathic/viral plexitis, metastases, immune-mediated plexitis, and mass lesions compressing the brachial plexus.

  13. BILATERAL MULTIPLE VARIATIONS IN THE FORMATION OF THE BRACHIAL PLEXUS AND ITS TERMINAL NERVES: A CASE REPORT

    Flora M Fabian

    2013-09-01

    Full Text Available Variations in formation of brachial plexus roots, trunks, divisions and cords are not uncommon and maybe of important in regional anaesthesia involving the upper limb. However, in the present case we are reporting a rare bilateral multiple variations observed during routine dissection on a 77-years-old embalmed male cadaver on left and right brachial plexus. Understanding the anatomical variations involving brachial plexus is important and might benefit the physicians, surgeons, anaesthesiologists and neuroanatomists during their routine procedures involving the cervical, axillary and the upper limb regions.

  14. Obstetrical brachial plexus palsy: Can excision of upper trunk neuroma and nerve grafting improve function in babies with adequate elbow flexion at nine months of age?

    Argenta, Anne E; Brooker, Jack; MacIssac, Zoe; Natali, Megan; Greene, Stephanie; Stanger, Meg; Grunwaldt, Lorelei

    2016-05-01

    Accepted indications for exploration in obstetrical brachial plexus palsy (OBPP) vary by center. Most agree that full elbow flexion against gravity at nine months of age implies high chance of spontaneous recovery and thus excludes a baby from surgical intervention. However, there are certain movements of the shoulder and forearm that may not be used frequently by the infant, but are extremely important functionally as they grow. These movements are difficult to assess in a baby and may lead to some clinicians to recommend conservative treatment, when this cohort of infants may in fact benefit substantially from surgery. A retrospective review was conducted on all infants managed surgically at the Brachial Plexus Center of a major children's hospital from 2009 to 2014. Further analysis identified five patients who had near-normal AMS scores for elbow flexion but who had weakness of shoulder abduction, flexion, external rotation, and/or forearm supination. In contrast to standard conservative management, this cohort underwent exploration, C5-6 neuroma excision, and sural nerve grafting. Data analysis was performed on this group to look for overall improvement in function. During an average follow-up period of 29 months, all patients made substantial gains in motor function of the shoulder and forearm, without loss of elbow flexion or extension, or worsening of overall outcome. In select infants with brachial plexus injuries but near-normal AMS scores for elbow flexion, surgical intervention may be indicated to achieve the best functional outcome. PMID:26806089

  15. The role of sensory nerve conduction study of the palmar cutaneous nerve in the diagnosis of carpal tunnel syndrome in patients with polyneuropathy

    Ayse Tokcaer

    2007-01-01

    Full Text Available Background: Conventional methods in the diagnosis of carpal tunnel syndrome (CTS in patients with polyneuropathy (PNP are insufficient. Aims: We suggest that the comparison of the conduction of the median nerve with that of the neighboring peripheral nerves may be more beneficial in the diagnosis of entrapment neuropathy. Setting and Design: The median nerve sensory conduction in healthy volunteers, in cases of CTS, PNP cases without CTS and in cases of PNP in whom clinical findings point to CTS, were compared by palmar cutaneous nerve (PCN sensory conduction. Materials and Methods: Comparative parameters were difference of PCN-1st digits′ nerve conduction velocities (NCV, PCN/1st digit NCVs ratio, difference of 5th-2nd digits′ NCVs and 5th/2nd digits′ NCVs ratio. Statistical Analysis: The statistical analysis was performed by the SPSS package for statistics. Student t test and receiver operating characteristic were used. Results: Although the ratio of PCN-1st digit did not differ significantly between the control group and the polyneuropathy group, there was a significant difference between CTS and PNP+CTS groups and the control group ( P < 0.001 and P < 0.001, respectively. The ratio of PCN-1st digit nerve conduction velocity was also significantly different between polyneuropathy and PNP+CTS groups ( P < 0.001. Conclusion: To diagnose CTS on a background of polyneuropathy in mild cases in which sensory conduction is preserved, the ratio of sensory nerve conduction velocities of the palmar cutaneous nerve and the median nerve 1st digit-wrist segment may be a criterion.

  16. MR neurography of the brachial plexus

    Magnetic resonance neurography was used to directly image the brachial plexus in patients with clinically suspected brachial plexus neuritis. The authors obtained spectral presaturation with inversion recovery and short T1 inversion recovery images parallel to the long axis of nerves using neurovascular array coils in 17 patients. In seven patients, the images revealed nerve swelling and hyperintensity in the the brachial plexus. In three patients with zoster paresis of the shoulder or upper extremity the images revealed marked hyperintensity in the roots. Direct nerve imaging may prove to be helpful in evaluating patients with brachial plexus neuritis. (author)

  17. Medial antebrachial cutaneous nerve measurements to diagnose neurogenic thoracic outlet syndrome.

    Machanic, Bennett I; Sanders, Richard J

    2008-03-01

    A reliable objective test is still needed to confirm the diagnosis of neurogenic thoracic outlet syndrome (NTOS). Over the past 20 years, it has been suggested that responses to medial antebrachial cutaneous nerve (MAC) and C8 nerve root stimulation could be used for this purpose. Herein, we explore this thesis. A clinical diagnosis of NTOS was established in 41 patients, all of whom underwent surgical decompression. Preoperatively, all patients were studied with MAC sensory neural action potential (SNAP) determinations and C8 nerve root stimulation. Controls were 19 asymptomatic, healthy volunteers. MAC sensory latency on 79 control sides was 1.5-2.4 msec, while latency in 41 symptomatic patients ranged 2.2-2.8 msec. Latency of 2.5 or greater was noted in 30 patients (specificity 99%, sensitivity 73%), confirming a diagnosis of NTOS, while the remaining 11 (27%) fell into the borderline zone of 2.2-2.4 msec. The latency difference between right and left sides in controls was 0-0.2 msec in 17 (89%), while in NTOS patients 31 had a difference of 0.3 msec or more (sensitivity 89%, specificity 63%). Amplitudes of 10 muV or more occurred in 77 of 79 control sides, whereas the amplitude was under 10 muV in 28 patients (specificity 97%, sensitivity 68%). Amplitude ratios between right and left sides in controls were 1.7 or less. Ratios of 2.0 or more were measured in 25 patients (specificity 100%, sensitivity 61%). Using the four diagnostic criteria (latency over 2.4 msec, latency difference between sides of 0.3 or more, amplitude under 10 muV, and amplitude ratios of 2.0 or more), 40 of the 41 patients had at least one of the four diagnostic criteria, 23 patients (56%) had three or four positive criteria, and 12 (29%) had two. C8 nerve root stimulation responses were below normal (56 M/sec) in 54%. MAC measurement is a fairly reliable technique for confirming the diagnosis of NTOS. Latency determination appeared to be a slightly more consistent measurement in this study

  18. Operative treatment with nerve repair can restore function in patients with traction injuries in the brachial plexus

    Stiasny, Jerzy; Birkeland, Peter

    2015-01-01

    INTRODUCTION: Brachial plexus injuries are usually a result of road traffic accidents and a cause of severe disability that typically affects young adult males. In 2010, a national centre was established for referral of these cases from Danish trauma centres. In this paper, we report on our...

  19. Avulsão do plexo braquial em cães - 2: biópsia fascicular e histologia dos nervos radial, mediano, ulnar e musculocutâneo Brachial plexus avulsion in dogs - 2: fascicular biopsy and histology of the radial, median, ulnar and musculocutaneous nerves

    Mônica Vicky Bahr Arias

    1997-03-01

    Full Text Available O objetivo deste trabalho foi demonstrar os aspectos clínicos e neurológicos relevantes para o diagnóstico da avulsão do plexo braquial em cães, relacionando estes achados com os resultados da histologia dos nervos radiais, medianos, ulnar e músculo cutânea. A biópsia fascicular destes nervos foi realizada após abordagem cirúrgica às faces lateral e medial do braço afetado. Todos os fascículos submetidos ao exame histológico apresentaram alterações como tumefação axonal, degeneração walleriana e infiltrado inflamatório em graus variados, havendo principalmente nos nervos radial, mediano e ulnar a proliferação de colagem endoneural. A associação destes resultados com as alterações neurológicas e da eletroneuroestimulação (relatados na parte 1 e 3 deste trabalho respectivamente sugeriu envolvimento quase que total das raízes do plexo braquial em todos os casos.The main purposes of this work were the neurological evaluation of dogs with brachial plexus avulsion and correlation of these findings with the results of histology of the radial, median, and ulnar and muscle cutaneous nerves. Fascicular nerve biopsy was performed after surgical approach of medial and lateral aspect of the arm. Ali the submitted fascicles presented histologic alterations compatible with wallerian degeneration, axonal swelling, and inflammatory infiltrate ranging from mild to pronounced, with endoneural collagen proliferation mainly in radial, median and ulnar nerves. The association of these results with neurological and electroneurostimulation exams (respectively described in part 1 and 3 of this work suggested in all cases an almost total involvement of brachial plexus roots.

  20. Oberlin partial ulnar nerve transfer for restoration in obstetric brachial plexus palsy of a newborn: case report

    Kawamura Kenji; Kobata Yasunori; Yajima Hiroshi; Shigematsu Koji; Maegawa Naoki; Takakura Yoshinori

    2006-01-01

    Abstract An 8 month old male infant with Erb's birth palsy was treated with two peripheral nerve transfers. Except for rapid motor reinnervations, elbow flexion was obtained by an Oberlin's partial ulnar nerve transfer, while shoulder abduction was restored by an accessory-to-suprascapular nerve transfer. The initial contraction of the biceps muscle occurred two months after surgery. Forty months after surgery, elbow flexion reached M5 without functional loss of the ulnar nerve. This case dem...

  1. Cutaneous and Mixed Nerve Silent Period Recordings in Symptomatic Paroxysmal Kinesigenic Dyskinesia

    Cogez, Julien; Etard, Olivier; Derache, Nathalie; Defer, Gilles

    2016-01-01

    Objective: The underlying neurophysiologic mechanism responsible for secondary paroxysmal kinesigenic dyskinesia (PKD) is still unclear. Here, we study the pathogenesis of PKD in two patients with a demyelinating lesion in the spinal cord. Methods: Electromyogram recordings from affected arms of two patients with spinal cord lesions presenting PKD were compared with our laboratory standards. The cutaneous silent period (CuSP), mixed nerve silent period (MnSP) and coincidence period (CiP), defined as the common period between the CuSP and MnSP, were recorded. Results: A large decrease in the MnSP and disappearance of the CiP were observed in our patients, which was secondary to simultaneous extinction of the third portion of the MnSP, while the CuSP was normal. The MnSP and CiP were normal after recovery. Conclusions: Our results demonstrate that the third portion of the MnSP and the CuSP do not correspond to the same physiologic process. These findings suggest that PKD patients have abnormal spinal interneuron integration. PMID:27330574

  2. Transcriptional Profiling of Cutaneous MRGPRD Free Nerve Endings and C-LTMRs

    Ana Reynders

    2015-02-01

    Full Text Available Cutaneous C-unmyelinated MRGPRD+ free nerve endings and C-LTMRs innervating hair follicles convey two opposite aspects of touch sensation: a sensation of pain and a sensation of pleasant touch. The molecular mechanisms underlying these diametrically opposite functions are unknown. Here, we used a mouse model that genetically marks C-LTMRs and MRGPRD+ neurons in combination with fluorescent cell surface labeling, flow cytometry, and RNA deep-sequencing technology (RNA-seq. Cluster analysis of RNA-seq profiles of the purified neuronal subsets revealed 486 and 549 genes differentially expressed in MRGPRD-expressing neurons and C-LTMRs, respectively. We validated 48 MRGPD- and 68 C-LTMRs-enriched genes using a triple-staining approach, and the Cav3.3 channel, found to be exclusively expressed in C-LTMRs, was validated using electrophysiology. Our study greatly expands the molecular characterization of C-LTMRs and suggests that this particular population of neurons shares some molecular features with Aβ and Aδ low-threshold mechanoreceptors.

  3. Comparison of the Supraclavicular, Infraclavicular and Axillary Approaches for Ultrasound-Guided Brachial Plexus Block for Surgical Anesthesia

    Anatoli Stav

    2016-04-01

    Full Text Available Objective We hypothesized that ultrasound (US-guided technique of the supra- and infraclavicular and axillary approaches of brachial plexus block (BPB will produce a high quality of surgical anesthesia for operations below the shoulder independently of the approach and body mass index (BMI. Intercostobrachial and medial brachial cutaneous nerves will be blocked separately because they are not a part of the brachial plexus. Methods This is a prospective randomized observer-blinded study. The three approaches of the US-guided BPB without neurostimulation were compared for quality, performance time, and correlation between performance time and BMI. Intercostobrachial and medial brachial cutaneous nerve blocks were used in all patients. Results A total of 101 patients were randomized into three groups: SCL (supraclavicular, ICL (infraclavicular, and AX (axillary. Seven patients were excluded due to various factors. All three groups were similar in demographic data, M:F proportion, preoperative diagnosis and type of surgery, anesthesiologists who performed the block, and surgical staff that performed the surgical intervention. The time between the end of the block performance and the start of the operation was also similar. The quality of the surgical anesthesia and discomfort during the operation were identical following comparison between groups. No direct positive correlation was observed between BMI and the block performance time. The time for the axillary block was slightly longer than the time for the supra- and infraclavicular approaches, but it had no practical clinical significance. Transient Horner syndrome was observed in three patients in the SCL group. No other adverse effects or complications were observed. Conclusions All three approaches can be used for US-guided BPB with similar quality of surgical anesthesia for operations of below the shoulder. A block of the intercostobrachial and medial brachial cutaneous nerves is recommended

  4. Comparison of the Supraclavicular, Infraclavicular and Axillary Approaches for Ultrasound-Guided Brachial Plexus Block for Surgical Anesthesia

    Stav, Anatoli; Reytman, Leonid; Stav, Michael-Yohay; Portnoy, Isaak; Kantarovsky, Alexander; Galili, Offer; Luboshitz, Shmuel; Sevi, Roger; Sternberg, Ahud

    2016-01-01

    Objective We hypothesized that ultrasound (US)-guided technique of the supra- and infraclavicular and axillary approaches of brachial plexus block (BPB) will produce a high quality of surgical anesthesia for operations below the shoulder independently of the approach and body mass index (BMI). Intercostobrachial and medial brachial cutaneous nerves will be blocked separately because they are not a part of the brachial plexus. Methods This is a prospective randomized observer-blinded study. The three approaches of the US-guided BPB without neurostimulation were compared for quality, performance time, and correlation between performance time and BMI. Intercostobrachial and medial brachial cutaneous nerve blocks were used in all patients. Results A total of 101 patients were randomized into three groups: SCL (supraclavicular), ICL (infraclavicular), and AX (axillary). Seven patients were excluded due to various factors. All three groups were similar in demographic data, M:F proportion, preoperative diagnosis and type of surgery, anesthesiologists who performed the block, and surgical staff that performed the surgical intervention. The time between the end of the block performance and the start of the operation was also similar. The quality of the surgical anesthesia and discomfort during the operation were identical following comparison between groups. No direct positive correlation was observed between BMI and the block performance time. The time for the axillary block was slightly longer than the time for the supra- and infraclavicular approaches, but it had no practical clinical significance. Transient Horner syndrome was observed in three patients in the SCL group. No other adverse effects or complications were observed. Conclusions All three approaches can be used for US-guided BPB with similar quality of surgical anesthesia for operations of below the shoulder. A block of the intercostobrachial and medial brachial cutaneous nerves is recommended. Obesity is not

  5. Oberlin partial ulnar nerve transfer for restoration in obstetric brachial plexus palsy of a newborn: case report

    Kawamura Kenji

    2006-09-01

    Full Text Available Abstract An 8 month old male infant with Erb's birth palsy was treated with two peripheral nerve transfers. Except for rapid motor reinnervations, elbow flexion was obtained by an Oberlin's partial ulnar nerve transfer, while shoulder abduction was restored by an accessory-to-suprascapular nerve transfer. The initial contraction of the biceps muscle occurred two months after surgery. Forty months after surgery, elbow flexion reached M5 without functional loss of the ulnar nerve. This case demonstrates an excellent result of an Oberlin's nerve transfer for restoration of flexion of the elbow joint in Erb's birth palsy. However, at this time partial ulnar nerve transfer for Erb's birth palsy is an optional procedure; a larger number of cases will need to be studied for it to be widely accepted as a standard procedure for Erb's palsy at birth.

  6. Functional reconstruction following brachial plexus root avulsion

    Guixin Sun; Cunyi Fan; Yudong Gu

    2007-01-01

    OBJECTIVE: To sum up the treatment of brachial plexus root avulsion and the progress in functional reconstruction and rehabilitation following brachial plexus root avulsion.DATA SOURCES: A search of Medline was performed to select functional reconstruction and rehabilitation following brachial plexus injury-related English articles published between January 1990 and July 2006, with key words of "brachial plexus injury, reconstruction and rehabilitation". Meanwhile, a computer-based search of CBM was carried out to select the similar Chinese articles published between January 1998 and July 2006,with key words of "brachial plexus injury, reconstruction and rehabilitation".STUDY SELECTION: The materials were checked primarily, and the literatures of functional reconstruction and rehabilitation of brachial plexus injury were selected and the full texts were retrieved.Inclusive criteria: ① Functional reconstruction following brachial plexus injury. ② Rehabilitation method of brachial plexus injury. Exclusive criteria: Reviews, repetitive study, and Meta analytical papers.DATA EXTRACTION: Forty-six literatures about functional reconstruction following brachial plexus injury were collected, and 36 of them met the inclusive criteria.DATA SYNTHESIS: Brachial plexus injury causes the complete or incomplete palsy of muscle of upper extremity. The treatment of brachial plexus is to displace not very important nerves to the distal end of very important nerve, called nerve transfer, which is an important method to treat brachial plexus injury.Postoperative rehabilitations consist of sensory training and motor functional training. It is very important to keep the initiativeness of exercise. Besides recovering peripheral nerve continuity by operation, combined treatment and accelerating neural regeneration, active motors of cerebral cortex is also the important factor to reconstruct peripheral nerve function.CONCLUSION: Consciously and actively strengthening functional

  7. Ulnar nerve damage (image)

    The ulnar nerve originates from the brachial plexus and travels down arm. The nerve is commonly injured at the elbow because of elbow fracture or dislocation. The ulnar nerve is near the surface of the body where ...

  8. Brachial plexopathy

    Khadilkar, Satish V; Snehaldatta S Khade

    2013-01-01

    Brachial plexus injury can occur as a result of trauma, inflammation or malignancies, and associated complications. The current topic is concerned with various forms of brachial plexopathy, its clinical features, pathophysiology, imaging findings, and management. Idiopathic brachial neuritis (IBN), often preceded with antecedent events such as infection, commonly present with abruptonset painful asymmetric upper limb weakness with associated wasting around the shoulder girdle and arm muscles....

  9. Musculocutaneous nerve substituting for the distal part of radial nerve: A case report and its embryological basis

    A S Yogesh

    2011-01-01

    Full Text Available In the present case, we have reported a unilateral variation of the radial and musculocutaneous nerves on the left side in a 64-year-old male cadaver. The radial nerve supplied all the heads of the triceps brachii muscle and gave cutaneous branches such as lower lateral cutaneous nerve of the arm and posterior cutaneous nerve of forearm. The radial nerve ended without continuing further. The musculocutaneous nerve supplied the brachioradialis, extensor carpi radialis longus and extensor carpi radialis brevis muscles. The musculocutaneous nerve divided terminally into two branches, superficial and deep. The deep branch of musculocutaneous nerve corresponded to usual deep branch of the radial nerve while the superficial branch of musculocutaneous nerve corresponded to usual superficial branch of the radial nerve. The dissection was continued to expose the entire brachial plexus from its origin and it was found to be normal. The structures on the right upper limb were found to be normal. Surgeons should keep such variations in mind while performing the surgeries of the upper limb.

  10. From the brachial plexus to the hand, multiple connections between the median and ulnar nerves may serve as bypass routes for nerve fibres.

    Yang, H; Gil, Y; Kim, S; Bang, J; Choi, H; Lee, H Y

    2016-07-01

    Axons from the median and ulnar nerves can pass to each other through aberrant connections between them. Multiple interconnections between the nerves may provide a detour route for nerve fibres going to the hand. We investigated the incidence of variations and the associations between them in 90 cadaveric upper limbs. In 91% of upper limbs, one to five variations were found, with several statistically significant associations. The contribution of the C8 nerve to the lateral cord was positively associated with an accessory contribution of the lateral cord to the ulnar nerve. The latter variation showed positive association with the occurrence of any of the variations in the hand itself. Ulnar innervation of the superficial head of the flexor pollicis brevis was positively associated with the Riche-Cannieu communication. The co-existence of the variations and their associations may be the explanation for unusual clinical findings related to median and ulnar conduction, which appear contrary to anatomical knowledge. PMID:26763269

  11. Twenty-eight Cases of Neuritis of Lateral Cutaneous Nerve of Thigh Treated by Acupuncture and Point-Injection

    廖明扬

    2001-01-01

    @@Neuritis of lateral cutaneous nerve of thigh, also called meralgia paresthetica, is a commonly encountered disease in clinical practice. The author has treated 28 cases of meralgia paresthetica since 1996 by acupuncture plus point-injection with satisfactory results. A report follows. Clinical Data Among the 28 cases, 13 were male and 15 female. Their age ranged from 24 to 72 years, most of the patients being 35 to 50 years; the duration of illness varied from one month to ten years and 6 cases were affected on left side, 8 cases on right side and 14 cases on both sides.

  12. Selective bilateral activation of leg muscles after cutaneous nerve stimulation during backward walking

    Hoogkamer, W.; Massaad, F.; Jansen, K.; Bruijn, S.M.; Duysens, J.E.J.

    2012-01-01

    During human locomotion, cutaneous reflexes have been suggested to function to preserve balance. Specifically, cutaneous reflexes in the contralateral leg's muscles (with respect to the stimulus) were suggested to play an important role in maintaining stability during locomotor tasks where stability

  13. Augmentation of partially regenerated nerves by end-to-side side-to-side grafting neurotization: experience based on eight late obstetric brachial plexus cases

    Moharram Ashraf N

    2006-12-01

    Full Text Available Abstract Objective The effect of end-to-side neurotization of partially regenerated recipient nerves on improving motor power in late obstetric brachial plexus lesions, so-called nerve augmentation, was investigated. Methods Eight cases aged 3 – 7 years were operated upon and followed up for 4 years (C5,6 rupture C7,8T1 avulsion: 5; C5,6,7,8 rupture T1 avulsion:1; C5,6,8T1 rupture C7 avulsion:1; C5,6,7 ruptureC8 T1 compression: one 3 year presentation after former neurotization at 3 months. Grade 1–3 muscles were neurotized. Grade0 muscles were neurotized, if the electromyogram showed scattered motor unit action potentials on voluntary contraction without interference pattern. Donor nerves included: the phrenic, accessory, descending and ascending loops of the ansa cervicalis, 3rd and 4th intercostals and contralateral C7. Results Superior proximal to distal regeneration was observed firstly. Differential regeneration of muscles supplied by the same nerve was observed secondly (superior supraspinatus to infraspinatus regeneration. Differential regeneration of antagonistic muscles was observed thirdly (superior biceps to triceps and pronator teres to supinator recovery. Differential regeneration of fibres within the same muscle was observed fourthly (superior anterior and middle to posterior deltoid regeneration. Differential regeneration of muscles having different preoperative motor powers was noted fifthly; improvement to Grade 3 or more occurred more in Grade2 than in Grade0 or Grade1 muscles. Improvements of cocontractions and of shoulder, forearm and wrist deformities were noted sixthly. The shoulder, elbow and hand scores improved in 4 cases. Limitations The sample size is small. Controls are necessary to rule out any natural improvement of the lesion. There is intra- and interobserver variability in testing muscle power and cocontractions. Conclusion Nerve augmentation improves cocontractions and muscle power in the biceps, pectoral

  14. The expression of NGFr and PGP 9.5 in leprosy reactional cutaneous lesions: an assessment of the nerve fiber status using immunostaining

    Antunes Sérgio Luiz Gomes; Liang Yong; Neri José Augusto da Costa; Haak-Frendscho Mary; Johansson Olle

    2003-01-01

    The effects of reactional episodes on the cutaneous nerve fibers of leprosy patients was assessed in six patients (three with reversal reactions and three with erythema nodosum leprosum). Cryosections of cutaneous biopsy of reactional lesions taken during the episode and of another sample during the remission period were immunostained with anti-NGFr and anti-PGP 9.5 (indirect immunofluorescence). We found no significant statistical difference in the number of NGFr- and PGP 9.5-positive fibers...

  15. Brachial plexopathy.

    Khadilkar, Satish V; Khade, Snehaldatta S

    2013-01-01

    Brachial plexus injury can occur as a result of trauma, inflammation or malignancies, and associated complications. The current topic is concerned with various forms of brachial plexopathy, its clinical features, pathophysiology, imaging findings, and management. Idiopathic brachial neuritis (IBN), often preceded with antecedent events such as infection, commonly present with abruptonset painful asymmetric upper limb weakness with associated wasting around the shoulder girdle and arm muscles. Idiopathic hypertrophic brachial neuritis, a rare condition, is usually painless to begin with, unlike IBN. Hereditary neuralgic amyotrophy is an autosomal-dominant disorder characterized by repeated episodes of paralysis and sensory disturbances in an affected limb, which is preceded by severe pain. While the frequency of the episodes tends to decrease with age, affected individuals suffer from residual deficits. Neurogenic thoracic outlet syndrome affects the lower trunk of the brachial plexus. It is diagnosed on the basis of electrophysiology and is amenable to surgical intervention. Cancer-related brachial plexopathy may occur secondary to metastatic infiltration or radiation therapy. Traumatic brachial plexus injury is commonly encountered in neurology, orthopedic, and plastic surgery set-ups. Trauma may be a direct blow or traction or stretch injury. The prognosis depends on the extent and site of injury as well as the surgical expertise. PMID:23661957

  16. Brachial plexopathy

    Satish V Khadilkar

    2013-01-01

    Full Text Available Brachial plexus injury can occur as a result of trauma, inflammation or malignancies, and associated complications. The current topic is concerned with various forms of brachial plexopathy, its clinical features, pathophysiology, imaging findings, and management. Idiopathic brachial neuritis (IBN, often preceded with antecedent events such as infection, commonly present with abruptonset painful asymmetric upper limb weakness with associated wasting around the shoulder girdle and arm muscles. Idiopathic hypertrophic brachial neuritis, a rare condition, is usually painless to begin with, unlike IBN. Hereditary neuralgic amyotrophy is an autosomal-dominant disorder characterized by repeated episodes of paralysis and sensory disturbances in an affected limb, which is preceded by severe pain. While the frequency of the episodes tends to decrease with age, affected individuals suffer from residual deficits. Neurogenic thoracic outlet syndrome affects the lower trunk of the brachial plexus. It is diagnosed on the basis of electrophysiology and is amenable to surgical intervention. Cancer-related brachial plexopathy may occur secondary to metastatic infiltration or radiation therapy. Traumatic brachial plexus injury is commonly encountered in neurology, orthopedic, and plastic surgery set-ups. Trauma may be a direct blow or traction or stretch injury. The prognosis depends on the extent and site of injury as well as the surgical expertise.

  17. Neurinomas of the brachial plexus: case report.

    Forte, A; Gallinaro, L S; Bertagni, A; Montesano, G; Prece, V; Illuminati, G

    1999-01-01

    Neurinomas, also referred to as neurilemmomas and schwannomas, are rare benign tumours of the peripheral nerves, a low proportion of which arise from the brachial plexus. Authors report a case of an ancient schwannoma arising from the brachial plexus. The tumour, usually asymptomatic, may cause sensory radicular symptoms, or rarely motor deficits in the involved arm. Enucleation of the tumour from the nerve without damage to any of the fascicles is the correct treatment. PMID:10710825

  18. Brachial plexopathy

    Jepsen, Jørgen Riis

    2015-01-01

    Background Work-related upper limb disorders constitute a diagnostic challenge. However, patterns of neurological abnormalities that reflect brachial plexus dysfunction are frequent in limbs with pain, weakness and/or numbness/tingling. There is limited evidence about the association between...... occupational physical exposures and brachial plexopathy. Methods 80 patients with brachial plexopathy according to defined criteria and 65 controls of similar age and sex without upper limb complaints were recruited by general practitioners. Patients and controls completed a questionnaire on physical and....... The identified psychosocial relations were limited to measures reflecting physical exposures. Conclusions While the identified risk indicators have previously been associated to upper limb symptoms as well as to diagnosed disorders other than brachial plexopathy, this study indicates an association...

  19. Obstetric brachial plexus injury

    Mukund R Thatte

    2011-01-01

    Full Text Available Obstetric brachial plexus injury (OBPI, also known as birth brachial plexus injury (BBPI, is unfortunately a rather common injury in newborn children. Incidence varies between 0.15 and 3 per 1000 live births in various series and countries. Although spontaneous recovery is known, there is a large subset which does not recover and needs primary or secondary surgical intervention. An extensive review of peer-reviewed publications has been done in this study, including clinical papers, review articles and systematic review of the subject. In addition, the authors′ experience of several hundred cases over the last 15 years has been added and has influenced the ultimate text. Causes of OBPI, indications of primary nerve surgery and secondary reconstruction of shoulder, etc. are discussed in detail. Although all affected children do not require surgery in infancy, a substantial proportion of them, however, require it and are better off for it. Secondary surgery is needed for shoulder elbow and hand problems. Results of nerve surgery are very encouraging. Children with OBPI should be seen early by a hand surgeon dealing with brachial plexus injuries. Good results are possible with early and appropriate intervention even in severe cases.

  20. Brachial neuritis following a corticosteroid injection.

    Robinson, Matthew; Fulcher, Mark

    2014-01-01

    This report presents a case of brachial neuritis following a subacromial corticosteroid injection. The patient developed an anterior interosseous neuropathy shortly after the injection, with no other trigger being identified. This neuropathy has unfortunately not shown any sign of recovery at 2 years. The authors propose that corticosteroid injection be added to the list of possible triggering events of brachial neuritis and highlight the frequent use of oral corticosteroids in its treatment. (1) The injection of local anaesthetic and corticosteroid should be considered as a potential trigger for brachial neuritis. (2) Brachial neuritis should be considered in the differential diagnosis for patients presenting with severe arm pain and weakness. (3) The nerves originating from the upper trunk of the brachial plexus are most commonly affected. (4) The anterior interosseous nerve is involved in one-third of cases. PMID:24596414

  1. Magnetic resonance neurography of the brachial plexus

    Vaishali Upadhyaya

    2015-01-01

    Full Text Available Magnetic Resonance Imaging (MRI is being increasingly recognised all over the world as the imaging modality of choice for brachial plexus and peripheral nerve lesions. Recent refinements in MRI protocols have helped in imaging nerve tissue with greater clarity thereby helping in the identification, localisation and classification of nerve lesions with greater confidence than was possible till now. This article on Magnetic Resonance Neurography (MRN is based on the authors′ experience of imaging the brachial plexus and peripheral nerves using these protocols over the last several years.

  2. Functional outcome of nerve transfer for restoration of shoulder and elbow function in upper brachial plexus injury

    Faruquee Sajedur

    2008-05-01

    Full Text Available Abstract Background Purpose of this study was to evaluate the functional outcome of spinal accessory to suprascapular nerve transfer (XI-SSN done for restoration of shoulder function and partial transfer of ulnar nerve to the motor branch to the biceps muscle for the recovery of elbow flexion (Oberlin transfer. Methods This is a prospective study involving 15 consecutive cases of upper plexus injury seen between January 2004 and December 2005. The average age of patients was 35.6 yrs (15–52 yrs. The injury-surgery interval was between 2–6 months. All underwent XI-SSN and Oberlin nerve transfer. The coaptation was done close to the biceps muscle to ensure early recovery. The average follow up was 15 months (range 12–36 months. The functional outcome was assessed by measuring range of movements and also on the grading scale proposed by Narakas for shoulder function and Waikakul for elbow function. Results Good/Excellent results were seen in 13/15 patients with respect to elbow function and 8/15 for shoulder function. The time required for the first sign of clinical reinnervation of biceps was 3 months 9 days (range 1 month 25 days to 4 months and for the recovery of antigravity elbow flexion was 5 months (range 3 1/2 months to 8 months. 13 had M4 and two M3 power. On evaluating shoulder function 8/15 regained active abduction, five had M3 and three M4 shoulder abduction. The average range of abduction in these eight patients was 66 degrees (range 45–90. Eight had recovered active external rotation, average 44 degrees (range 15–95. The motor recovery of external rotation was M3 in 5 and M4 in 3. 7/15 had no active abduction/external rotation, but they felt that their shoulder was more stable. Comparable results were observed in both below and above 40 age groups and those with injury to surgery interval less than 3 or 3–6 months. Conclusion Transfer of ulnar nerve fascicle to the motor branch of biceps close to the muscle consistently

  3. Morphological description of the brachial plexus in ocelot (Leopardus pardalis)

    Kylma Lorena Saldanha Chagas; Lara Cochete Moura Fé; Luiza Correa Pereira; Érika Branco; Ana Rita de Lima

    2014-01-01

    The brachial plexus is formed by the ventral roots of the spinal nerves, which unite to form the nerve trunks. It is usually formed by contributions of the last three cervical nerves and the first two thoracic nerves. Due to the scarcity of information on neuroanatomy, this study aimed to determine the macroscopic morphology of the brachial plexus of the ocelot (Leopardus pardalis). In this work, we used two ocelot specimens from the area of the Paragominas Bauxite Mine, P...

  4. Resultado da neurotização do nervo ulnar para o músculo bíceps braquial na lesão do plexo braquial Results of ulnar nerve neurotization to brachial biceps muscle in brachial plexus injury

    Marcelo Rosa de Rezende

    2012-12-01

    Full Text Available OBJETIVO: Avaliar de forma crítica os fatores que influenciam os resultados da neurotização do nervo ulnar no ramo motor do músculo bíceps braquial, visando a restauração da flexão do cotovelo em pacientes com lesão do plexo braquial. MÉTODOS: 19 pacientes, 18 homens e uma mulher, com idade média de 28,7 anos foram avaliados entre fevereiro de 2003 e maio de 2007. Oito pacientes apresentavam lesão das raízes C5-C6 e 11, das raízes C5-C6-C7. O intervalo de tempo médio entre a injúria e o tratamento cirúrgico foi 7,5 meses. Quatro pacientes apresentavam fraturas cervicais associadas à lesão do plexo braquial. O seguimento pós-operatório foi de 15,7 meses. RESULTADO: Oito pacientes recuperaram força de flexão do cotovelo MRC grau 4; dois, MRC grau 3 e nove, MRC OBJECTIVE: To evaluate the factors influencing the results of ulnar nerve neurotization at the motor branch of the brachial biceps muscle, aiming at the restoration of elbow flexion in patients with brachial plexus injury. METHODS: 19 patients, with 18 men and 1 woman, mean age 28.7 years. Eight patients had injury to roots C5-C6 and 11, to roots C5-C6-C7. The average time interval between injury and surgery was 7.5 months. Four patients had cervical fractures associated with brachial plexus injury. The postoperative follow-up was 15.7 months. RESULTS: Eight patients recovered elbow flexion strength MRC grade 4; two, MRC grade 3 and nine, MRC <3. There was no impairment of the previous ulnar nerve function. CONCLUSION: The surgical results of ulnar nerve neurotization at the motor branch of brachial biceps muscle are dependent on the interval between brachial plexus injury and surgical treatment, the presence of associated fractures of the cervical spine and occipital condyle, residual function of the C8-T1 roots after the injury and the involvement of the C7 root. Signs of reinnervation manifested up to 3 months after surgery showed better results in the long term

  5. Magnetic resonance imaging in brachial plexus injury.

    Caranci, F; Briganti, F; La Porta, M; Antinolfi, G; Cesarano, E; Fonio, P; Brunese, L; Coppolino, F

    2013-08-01

    Brachial plexus injury represents the most severe nerve injury of the extremities. While obstetric brachial plexus injury has showed a reduction in the number of cases due to the improvements in obstetric care, brachial plexus injury in the adult is an increasingly common clinical problem. The therapeutic measures depend on the pathologic condition and the location of the injury: Preganglionic avulsions are usually not amenable to surgical repair; function of some denervated muscles can be restored with nerve transfers from intercostals or accessory nerves and contralateral C7 transfer. Postganglionic avulsions are repaired with excision of the damaged segment and nerve autograft between nerve ends or followed up conservatively. Magnetic resonance imaging is the modality of choice for depicting the anatomy and pathology of the brachial plexus: It demonstrates the location of the nerve damage (crucial for optimal treatment planning), depicts the nerve continuity (with or without neuroma formation), or may show a completely disrupted/avulsed nerve, thereby aiding in nerve-injury grading for preoperative planning. Computed tomography myelography has the advantage of a higher spatial resolution in demonstration of nerve roots compared with MR myelography; however, it is invasive and shows some difficulties in the depiction of some pseudomeningoceles with little or no communication with the dural sac. PMID:23949940

  6. MR imaging of brachial plexus

    The brachial plexus is a difficult region to evaluate with radiological techniques. MR imaging has great potentials for the depiction of the various anatomical structures of the branchial plexus - i.e., spinal ganglion, ventral nerve rami root exit of the neural foramina, trunks an cordes. Moreover, MR imaging, thanks to its direct multiplanarity, to its excellent soft-tissue contrast, and to its lack of motion artifacts, allows good evaluation of pathologic conditions in the branchial plexus, especially traumas and cancers. On the contrary CT, in spite of its high spatial resolution and good contrast, cannot demonstrate the anatomical structures of the brachial plexus. US detects superficials structures, and conventional radiographs depict only indirect changes in the adjacent lung apex and skeletal structures. From November 1989 to May 1990, 20 normal volunteers (15 males and 5 females; average age: 35 years) were studied with MR imaging. Multisection technique was employed with a dedicated coil and a primary coil. The anatomical structures of the brachial plexus were clearly demonstrated by T1-weighted sequences on the sagittal and axial planes. T2-weighted pulse sequences on the coronal plane were useful for the anatomical definition of the brachial plexus and for eventual tissue characterization. The correct representation of the anatomical structures of the brachial plexus allowed by MR imaging with author's standard technique makes MR imaging the most appropriate exam for the diagnosis of pathologic conditions in the brachial plexus, although its use must be suggested by specific clinical questions

  7. Regeneration of putative sensory and sympathetic cutaneous nerve endings in the rat foot after sciatic nerve injury.

    Stankovic, N; Johansson, O; Hildebrand, C

    1996-01-01

    The present study examines the occurrence of calcitonin gene-related peptide-, substance P- and tyrosine hydroxylase-like immunoreactive profiles in glabrous and hairy foot skin from normal and nerve-injured rats. After neurotomy/suture, glabrous skin samples contain few calcitonin gene-related peptide-, substance P- and tyrosine hydroxylase-like immunoreactive profies. The number of calcitonin gene-related peptide- and substance P-like immunoreacive profiles in the epidermis is significantly subnormal. Hairy skin from these rats does also contain few calcitonin gene-related peptide-, substance P- and tyrosine hydroxylase-like immunoreactive profiles. In addition, the presence of epidermal calcitonin gene-related peptide-like imunoreactive profiles in glabrous skin is subnormal on the contralateral side. After nerve crush injury, the occurrence of calcitonin gene-related peptide-like, but not substance P-like, immunoreactive profiles in th epidermis of the glabrous skin is significantly subnormal. The occurrence of tyrosine hylase-like immnunoreactive fibres in relation to the digital artery is also subnormal. The occurrence in hairy skin of calcitonin gene-related peptide-like immunoreactive, substance P-like immunoreactive and tyrosine hydroxylase-like immunoreactive profiles is subnormal. In both skin types, the contralateral occurrence of such profiles is subjectively normal. These results show that the occurrence of calcitonin gene-related peptide-, substance P-, and tyrosine hydroxylase-like immunoreactive profiles in glabrous and hairy foot skin is clearly subnormal after neurotomy and suture and less abnormal after nerve crush. After neurotomy and suture the contralateral side is also affected. PMID:10970110

  8. Idiopathic brachial neuritis in a child: A case report and review of the literature

    Shikha Jain; Girish Chandra Bhatt; Nirendra Rai; Bhavna Dhingra Bhan

    2014-01-01

    Brachial neuritis is a rare disease in children, affecting mainly the lower motor neurons of the brachial plexus and/or individual nerves or nerve branches. We report a case of idiopathic brachial plexus neuritis in a 2³-year-old female child admitted with acute respiratory distress and given antibiotic therapy following which she developed weakness of the left hand. She was diagnosed as a case of idiopathic brachial plexus neuritis and was given supportive care. Although, the association wit...

  9. GABAA-Receptor-Mediated Conductance and Action Potential Waveform in Cutaneous and Muscle Afferent Neurons of the Adult Rat: Differential Expression and Response to Nerve Injury

    OYELESE, ADETOKUNBO A.; Kocsis, Jeffery D.

    1996-01-01

    Whole cell patch-clamp recordings were obtained from identified cutaneous and muscle afferent neurons (33-60 μm diam) in dissociated L4 and L5 dorsal root ganglia (DRGs) from normal rats and from rats 2-3 wk after sciatic nerve ligation or crush injury. γ-Aminobutyric acid (GABA)-induced conductance was compared in normal and injured neurons from both functional classes of sensory neurons.Control cutaneous afferent neurons had a peak GABA-mediated conductance of 287 ± 27 (SE) nS compared with...

  10. Anatomical study of the dorsal cutaneous branch of the ulnar nerve (DCBUN) and its clinical relevance in TFCC repair.

    Poublon, A R; Kraan, G; Lau, S P; Kerver, A L A; Kleinrensink, G-J

    2016-07-01

    The aim of this study was to define a detailed description of the dorsal cutaneous branch of the ulnar nerve (DCBUN) in particular in relevance to triangular fibrocartilage complex (TFCC) repairs. In 20 formalin-embalmed arms, the DCBUN was dissected, and the course in each arm was mapped and categorized. Furthermore, the point of origin of the DCBUN, that is, from the ulnar nerve in association with the ulnar styloid process, was defined. Finally, the distance between the ulnar styloid process and the branching of the radial-ulnar communicating branch (RUCB) and the first branch of DCBUN was measured. The distance between the origin of the DCBUN in relation to the ulnar styloid process ranges from 55 to 111 mm (mean 87 mm; STD 14 mm). The distance between the ulnar styloid process and the RUCB ranges from 1 to 54 mm (mean 19 mm; STD 12 mm). Finally, the distance between the ulnar styloid process and the lateral distal branch shows a range of -6 to 28 mm (mean 10 mm; STD 9 mm). In general, three dorsal digital nerves (medial, intermediate, and lateral branch), run at the dorsal ulnar aspect of the hand. The RUCB is often less abundant and shows a large amount of variation. No complete safe zone could be identified; the course of the DCBUN suggests a longitudinal incision for the 6R portal. In fact, a more dorsal incision also prevents damage to the main branches of the DCBUN. PMID:26997325

  11. Ultrasound guided lateral femoral cutaneous nerve block in meralgia paresthesia; review of 25 cases

    Sameh Khodair; Rasha Elshafey

    2014-01-01

    Aim: To evaluate the feasibility and efficacy of ultrasound guidance technique for the treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy). Methods: 25 patients (10 males and 15 females); age 17–68 years; with meralgia paresthetica are diagnosed clinically by electromyography. A needle was inserted targeting the LFCN with ultrasound guidance, treatment with perineural injection of 2 mL of methylprednisolone acetate (40 mg/mL) and 8 mL of mepivacaine, 2%, under ultraso...

  12. Regionally distinct cutaneous afferent populations contribute to reflex modulation evoked by stimulation of the tibial nerve during walking.

    Nakajima, Tsuyoshi; Suzuki, Shinya; Futatsubashi, Genki; Ohtsuska, Hiroyuki; Mezzarane, Rinaldo A; Barss, Trevor S; Klarner, Taryn; Zehr, E Paul; Komiyama, Tomoyoshi

    2016-07-01

    During walking, cutaneous reflexes in ankle flexor muscle [tibialis anterior (TA)] evoked by tibial nerve (TIB) stimulation are predominantly facilitatory at early swing phase but reverse to suppression at late swing phase. Although the TIB innervates a large portion of the skin of the foot sole, the extent to which specific foot-sole regions contribute to the reflex reversals during walking remains unclear. Therefore, we investigated regional cutaneous contributions from discrete portions of the foot sole on reflex reversal in TA following TIB stimulation during walking. Summation effects on reflex amplitudes, when applying combined stimulation from foot-sole regions with TIB, were examined. Middle latency responses (MLRs; 70-120 ms) after TIB stimulation were strongly facilitated during the late stance to mid-swing phases and reversed to suppression just before heel (HL) strike. Both forefoot-medial (f-M) and forefoot-lateral stimulation in the foot sole induced facilitation during stance-to-swing transition phases, but HL stimulation evoked suppression during the late stance to the end of swing phases. At the stance-to-swing transition, a summation of MLR amplitude occurred only for combined f-M&TIB stimulation. However, the same was not true for the combined HL&TIB stimulation. At the swing-to-stance transition, there was a suppressive reflex summation only for HL&TIB stimulation. In contrast, this summation was not observed for the f-M&TIB stimulation. Our results suggest that reflex reversals evoked by TIB stimulation arise from distinct reflex pathways to TA produced by separate afferent populations innervating specific regions of the foot sole. PMID:27075541

  13. High origin of dorsal branch of the ulnar nerve and variations in its branching pattern and distribution: a case report

    Lama, Polly; Potu, Bhagath K.; Bhat, Kumar MR

    2009-01-01

    Introduction Ulnar nerve is a branch of the brachial plexus. In the front of the forearm, normally near the wrist joint, it gives a dorsal cutaneous branch which supplies the skin of the dorsum of the hand. Case presentation The present case reports a very rare finding, the dorsal branch of the ulnar nerve along with the main nerve trunk originated between the two heads of the flexor carpi ulnaris muscle, after descending along the medial border of the forearm extensor surface, on the dorsal ...

  14. Brachial Plexus Anatomy: Normal and Variant

    Orebaugh, Steven L.; Williams, Brian A.

    2009-01-01

    Effective brachial plexus blockade requires a thorough understanding of the anatomy of the plexus, as well as an appreciation of anatomic variations that may occur. This review summarizes relevant anatomy of the plexus, along with variations and anomalies that may affect nerve blocks conducted at these levels. The Medline, Cochrane Library, and PubMed electronic databases were searched in order to compile reports related to the anatomy of the brachial plexus using the following free terms: "b...

  15. The expression of NGFr and PGP 9.5 in leprosy reactional cutaneous lesions: an assessment of the nerve fiber status using immunostaining

    Antunes Sérgio Luiz Gomes

    2003-01-01

    Full Text Available The effects of reactional episodes on the cutaneous nerve fibers of leprosy patients was assessed in six patients (three with reversal reactions and three with erythema nodosum leprosum. Cryosections of cutaneous biopsy of reactional lesions taken during the episode and of another sample during the remission period were immunostained with anti-NGFr and anti-PGP 9.5 (indirect immunofluorescence. We found no significant statistical difference in the number of NGFr- and PGP 9.5-positive fibers between the reactional and post-reactional groups. A significant difference was detected between the number of NGFr and PGP 9.5-stained fibers inside of the reactional group of biopsy cryosections but this difference was ascribed to the distinct aspects of the nerve fibers displayed whether stained with anti-NGFr or with anti-PGP 9.5; NGFr-positive branches looked larger and so interpreted as containing more fibers. In addition, a substantial number NGFr-positive fibers were PGP 9.5-negative. No differences in the number of stained fibers among the distinct cutaneous regions examined (epidermis + upper dermis, mid and deep dermis was detected. In conclusion, the number of PGP- and NGFr-positive fibers were not significantly different in the reactional and post-reactional biopsies in the present study. NGFr-staining of the nerve fibers is different from their PGP-imunoreactivity and the evaluation of the nerve fiber status on an innervated target organ should be carried out choosing markers for both components of nerve fibers (Schwann cells and axons.

  16. Brachial Plexus Injuries in Adults: Evaluation and Diagnostic Approach

    Sakellariou, Vasileios I.; Badilas, Nikolaos K.; Mazis, George A.; Stavropoulos, Nikolaos A; Kotoulas, Helias K.; Stamatios Kyriakopoulos; Ioannis Tagkalegkas; Sofianos, Ioannis P.

    2014-01-01

    The increased incidence of motor vehicle accidents during the past century has been associated with a significant increase in brachial plexus injuries. New imaging studies are currently available for the evaluation of brachial plexus injuries. Myelography, CT myelography, and magnetic resonance imaging (MRI) are indicated in the evaluation of brachial plexus. Moreover, a series of specialized electrodiagnostic and nerve conduction studies in association with the clinical findings during the n...

  17. A comparison of two approaches to brachial plexus anaesthesia

    Rajib Hazarika; Tejwant Rajkhowa; Mridu Paban Nath; Samit Parua

    2016-01-01

    Background: A prospective, double blind study was performed to compare the clinical effect of vertical infraclavicular and supraclavicular brachial plexus block using a nerve stimulation technique for upper limb surgery. Methods: Eighty patients undergoing upper limb surgery under infraclavicular or supraclavicular brachial plexus block were enrolled into this study. The infraclavicular brachial plexus block was performed using the vertical technique (group I; N=40). The supraclavicular b...

  18. Malignant brachial plexopathy: A pictorial essay of MRI findings

    For imaging, the brachial plexus is a technically and anatomically challenging region of the peripheral nervous system. MRI has a central role in the identification and accurate characterization of malignant lesions arising here, as also in defining their extent and the status of the adjacent structures. The purpose of this pictorial essay is to describe the MRI features of primary and secondary malignant brachial plexopathies and radiation-induced brachial nerve damage

  19. Peripheral communications of intercostobrachial nerve Peripheral communications of the intercostobrachial nerve in relation to the alar thoracic artery

    Shaifaly Madan Rustagi

    2015-01-01

    Full Text Available The intercostobrachial nerve (ICBN is often encountered during axillary dissection for axillary lymph node dissection (ALND for diagnostic and therapeutic surgery for mastectomy. The present report is a case observed in the Department of Anatomy at Vardhman Mahavir Medical College, Delhi during routine dissection of the upper extremity of a male cadaver for first year undergraduate medical students. On the right side , the medial cord of brachial plexus gave two medial cutaneous nerves of arm. Both the nerves were seen communicating with the branches of the ICBN. The ICBN and one of its branches were surrounding the termination of an alar thoracic artery. These peripheral neural connections of the ICBN with the branches of the medial cord can be a cause of sensory impairment during axillary procedures done for mastectomy or exploration of long thoracic nerves. The alar thoracic artery found in relation to the ICBN could further be a cause of vascular complications during such procedures.

  20. Potential genotoxic effects of GSM-1800 exposure on human cutaneous and nerve cells

    Introduction The GSM-1800 signal has been in use for several years in Europe and questions raised about its potential biological effects, in view of the fact that, with respect to GSM-900, the increase in the carrier frequency corresponds to a more superficial absorption in the tissues. Consequently, the skin becomes an even more important target for the absorption of the radiofrequency radiation (R.F.R.) emitted by mobile phones. Nevertheless, brain tissues remain a critical target. Cells In order to determine whether R.F.R. at 1800 MHz could behave as a genotoxic agent, skin and brain cells were exposed to a 217-Hz-modulated GSM-1800 signal and assayed using the comet assay: (1) normal human epidermal keratinocytes (N.H.E.K.) and dermal fibroblasts (N.H.D.F.) which are cutaneous cells from epidermis and dermis respectively, and (2) the S.H. -S.Y.5.Y. and C.H.M.E.-5 human cell lines, which are neuroblastoma and micro-glial cells, respectively. Exposure The R.F.R. exposure system that was used in these experiments was manufactured by I.T. I.S. (Zurich, Switzerland). It consists in two shorted waveguides allowing to run exposed and sham conditions at the same time in the same culture incubator, at 37 Celsius degrees, 5% CO2. It is controlled by a software, which provides blind conditions until completion of data analysis. The specific absorption rate (S.A.R.) used was 2 W/kg, corresponding to the public exposure limit recommended by I.C.N.I.R.P. and the exposure duration was 48 hours. Comet assay At the end of the exposure, cells were removed from their Petri dish by trypsin/EDTA treatment, counted and 5 x 104 cells were used to detect DNA damage including single DNA breaks. Positive controls were performed using hydrogen peroxidase (1%, 1 hour). The genotoxic effects were detected using the alkaline comet assay kit (Trevigen slides) following the supplier procedure. Under these conditions, 6 independent experiments were performed for each cell type (2 Petri dishes

  1. Effect of superficial radial nerve stimulation on the activity of nigro-striatal dopaminergic neurons in the cat: role of cutaneous sensory input

    The release of 3H-dopamine (DA) continuously synthesized from 3H-thyrosine was measured in the caudate nucleus (CN) and in the substantia nigra (SN) in both sides of the brain during electrical stimulation of the superficial radial nerve in cats lightly anaesthetized with halothane. Use of appropriate electrophysiologically controlled stimulation led to selective activation of low threshold afferent fibers whereas high stimulation activated all cutaneous afferents. Results showed that low threshold fiber activation induced a decreased dopaminergic activity in CN contralateral to nerve stimulation and a concomitant increase in dopaminergic activity on the ipsilateral side. Stimulation of group I and threshold stimulation of group II afferent fibers induced changes in the release of 3H-DA mainly on the contralateral CN and SN and in the ipsilateral CN. High stimulation was followed by a general increase of the neurotransmitter release in the four structures. This shows that the nigro-striatal dopaminergic neurons are mainly-if not exclusively-controlled by cutaneous sensory inputs. This control, non-specific when high threshold cutaneous fibers are also activated. Such activations could contribute to restablish sufficient release of DA when the dopaminergic function is impaired as in Parkinson's disease. (Author)

  2. Herpetic Brachial Plexopathy: Application of Brachial Plexus Magnetic Resonance Imaging and Ultrasound-Guided Corticosteroid Injection.

    Kim, Jeong-Gil; Chung, Sun G

    2016-05-01

    Herpes zoster, commonly known as shingles, is an infectious viral disease characterized by painful, unilateral skin blisters occurring in specific sensory dermatomes. Motor paresis is reported in 0.5% to 5% of patients. Although the mechanism of zoster paresis is still unclear, the virus can spread from the dorsal root ganglia to the anterior horn cell or anterior spinal nerve roots. It rarely involves the brachial plexus. We report a case of brachial plexitis following herpes zoster infection in which pathological lesions were diagnosed using brachial plexus magnetic resonance imaging and treated with ultrasound-guided perineural corticosteroid injection. PMID:26829085

  3. MRI of the brachial plexus: A pictorial review

    Magnetic resonance imaging (MRI) of the brachial plexus is the imaging modality of first choice for depicting anatomy and pathology of the brachial plexus. The anatomy of the roots, trunks, divisions and cords is very well depicted due to the inherent contrast differences between the nerves and the surrounding fat. In this pictorial review the technique and the anatomy will be discussed. The following pathology will be addressed: neurogenic tumors of the brachial plexus and sympathetic chain, superior sulcus tumors, other tumors in the vicinity of the brachial plexus, the differentiation between radiation and metastatic plexopathy, trauma, neurogenic thoracic outlet syndrome and immune-mediated neuropathies.

  4. MRI of the brachial plexus: A pictorial review

    Es, Hendrik W. van [Department of Radiology, St. Antonius Hospital, Nieuwegein, Koekoekslaan 1, 3435 CM Nieuwegein (Netherlands)], E-mail: h.es@antoniusziekenhuis.nl; Bollen, Thomas L.; Heesewijk, Hans P.M. van [Department of Radiology, St. Antonius Hospital, Nieuwegein, Koekoekslaan 1, 3435 CM Nieuwegein (Netherlands)

    2010-05-15

    Magnetic resonance imaging (MRI) of the brachial plexus is the imaging modality of first choice for depicting anatomy and pathology of the brachial plexus. The anatomy of the roots, trunks, divisions and cords is very well depicted due to the inherent contrast differences between the nerves and the surrounding fat. In this pictorial review the technique and the anatomy will be discussed. The following pathology will be addressed: neurogenic tumors of the brachial plexus and sympathetic chain, superior sulcus tumors, other tumors in the vicinity of the brachial plexus, the differentiation between radiation and metastatic plexopathy, trauma, neurogenic thoracic outlet syndrome and immune-mediated neuropathies.

  5. Role of dexamethasone in brachial plexus block

    To evaluate the effect of dexamethasone added to (lignocaine) on the onset and duration of axillary brachial plexus block. Study Design: Randomized controlled trial. Place and Duration of Study: Combined Military Hospital Rawalpindi, from September 2009 to March 2010. Patients and Methods: A total of 100 patients, who were scheduled for elective hand and forearm surgery under axillary brachial plexus block, were randomly allocated to group A in which patients received 40 ml 1.5% lidocaine with 2 ml of isotonic saline (0.9%) and group B in which patients received 40 ml 1.5% lidocaine with 2 ml of dexamethasone (8 mg). Nerve stimulator with insulated needle for multiple stimulations technique was used to locate the brachial plexus nerves. After the injection onset of action and duration of sensory blockade of brachial plexus were recorded at 5 minutes and 15 minutes interval. Results: Group A showed the onset of action of 21.64 ± 2.30 min and in group B it was 15.42 ± 1.44 min (p< 0.001). Duration of nerve block was 115.08 ± 10.92 min in group A and 265.42 ± 16.56 min in group B (p < 0.001). Conclusion: The addition of dexamethasone to 1.5% lignocaine solution in axillary brachial plexus block prolongs the duration of sensory blockade significantly. (author)

  6. Can Local Anesthesia Prevent the Injury of Brachial Plexus?

    Alaattin Ozturk

    2014-01-01

    Schwannomas (neurilemmomas) are benign tumors arising from peripheral nerve sheaths. They can be seen all over the body, but approximately half of the cases occur in the head and neck region. The schwannoma arising from brachial plexus is a rare cause of neck masses. They are rarely diagnosed preoperatively. The risk of nerve damage after excision is high under general anesthesia. In this article, a case of brachial plexus schwannoma was presented and the excision with local anesthesia was sh...

  7. Avulsion of the brachial plexus in a great horned owl (Bubo virginaus)

    Moore, M.P.; Stauber, E.; Thomas, N.J.

    1989-01-01

    Avulsion of the brachial plexus was documented in a Great Horned Owl (Bubo virginianus). A fractured scapula was also present. Cause of these injuries was not known but was thought to be due to trauma. Differentiation of musculoskeletal injury from peripheral nerve damage can be difficult in raptors. Use of electromyography and motor nerve conduction velocity was helpful in demonstrating peripheral nerve involvement. A brachial plexus avulsion was suspected on the basis of clinical signs, presence of electromyographic abnormalities in all muscles supplied by the nerves of the brachial plexus and absence of median-ulnar motor nerve conduction velocities.

  8. Variations of the ventral rami of the brachial plexus.

    Lee, H. Y.; Chung, I. H.; Sir, W. S.; Kang, H S; Lee, H.S.; Ko, J S; Lee, M. S.; Park, S. S.

    1992-01-01

    We studied the variations in the ventral rami of 152 brachial plexuses in 77 Korean adults. Brachial plexus were composed mostly of the fifth, sixth, seventh and eighth cervical nerves and the first thoracic nerve (77.0%). In 21.7% of the cases examined, the fourth, fifth, sixth, seventh and eighth cervical and the first thoracic nerves contributed to the plexus. A plexus composed of the fourth, fifth, sixth, seventh and eighth cervical and the first and second thoracic nerves, and a plexus c...

  9. Brachial plexus variations during the fetal period.

    Woźniak, Jowita; Kędzia, Alicja; Dudek, Krzysztof

    2012-12-01

    The brachial plexus is an important nervous system structure. It can be injured during the perinatal period and by postnatal damage. The goal of this study was to assess human fetal brachial plexus variability. A total of 220 brachial plexuses were surgically prepared from 110 human fetuses aged 14-32 weeks of fetal life (50 females and 60 males) ranging in CRL from 80 to 233 mm. The study incorporated the following methods: dissectional and anthropological, digital image acquisition, digital image processing using Image J and GIMP software, and statistical methods (Statistica 9.0). Symmetry and sexual dimorphism were examined. Anomalies of the brachial plexuses were observed in 117 (53.18 %) cases. No sexual dimorphism was found. It was observed that cord variations occurred more often on the left side. Division variants (33.64 %) occurred most often, but also cords (18.18 %) as well as root nerves and terminal ramifications (15.90 %) were found. Trunk anomalies were rare and occurred in only 5.45 % of plexuses. Three height types of median nerve roots in combination with the nerve were distinguished. In one-third of cases, median nerve root connections were found below the axillary fossa and even half in the proximal part of the humerus. In conclusion, the brachial plexus was characterized for anatomical structural variability. Most often division and cord variations were observed. Anomalies occurred regardless of sex or body side except for cord variants. Brachial plexus variation recognition is significant from the neurosurgical and traumatological point of view. PMID:22945314

  10. MRI diagnosis of brachial plexus preganglionic injury

    Objective: To evaluate MRI in diagnosing brachial plexus preganglionic injury. Methods: Twenty cases with brachial plexus preganglionic injury underwent MR scanning before operation. MR imaging was obtained by GE Signa EXCITE 1.5 T scanner. The scanning sequences included SE T1WI, FSE T2WI, T2WI STIR and 3 D Fast imaging employing steady state with phase cycled (3D-FIESTA-c). All the patients had exploration of the supraclavicular plexus and electrophysiology examination. And the accuracy, sensitivity and specificity of MRI in diagnosing preganglionic brachial plexus injury were calculated with the standards of surgical and EMG results. Results: Among the 73 pairs of injured roots, MR imaging detected the abnormalities in 63 pairs. The accuracy, sensitivity and specificity of MRI in diagnosing preganglionic brachial plexus injury were 86.5% (83/96), 86.3% (63/73), 87.0% (20/23), respectively. The direct signs of brachial plexus preganglionic injury included (1) lack or mutilation of nerve root in 54 pairs (85.7%), (2) coarsening, bending, stiff course and unable to be traced to the intervertebral foramen continuously in 9 pairs (14.3%). The indirect signs included (1) cystic cerebrospinal fluid gathering in the vertebral canal, posttraumatic spinal meningocele in 46 pairs (73.0%), (2) abnormal shape of nerve sleeve in 13 pairs (20.6%), (3) displacement and deformity of spinal cord in 50 pairs (79.4%), (4) abnormal signal of paravertebral muscles in 19 patients. Conclusion: MRI can distinctly show the nerve rootlets within the vertebral canal, so it is helpful in making a correct diagnosis of brachial plexus preganglionic injuries. (authors)

  11. Idiopathic brachial neuritis in a child: A case report and review of the literature.

    Jain, Shikha; Bhatt, Girish Chandra; Rai, Nirendra; Bhan, Bhavna Dhingra

    2014-01-01

    Brachial neuritis is a rare disease in children, affecting mainly the lower motor neurons of the brachial plexus and/or individual nerves or nerve branches. We report a case of idiopathic brachial plexus neuritis in a 2½-year-old female child admitted with acute respiratory distress and given antibiotic therapy following which she developed weakness of the left hand. She was diagnosed as a case of idiopathic brachial plexus neuritis and was given supportive care. Although, the association with antibiotic therapy in this case could be incidental, indeed it is intriguing and requires further studies. PMID:25624937

  12. Idiopathic brachial neuritis in a child: A case report and review of the literature

    Shikha Jain

    2014-01-01

    Full Text Available Brachial neuritis is a rare disease in children, affecting mainly the lower motor neurons of the brachial plexus and/or individual nerves or nerve branches. We report a case of idiopathic brachial plexus neuritis in a 2³-year-old female child admitted with acute respiratory distress and given antibiotic therapy following which she developed weakness of the left hand. She was diagnosed as a case of idiopathic brachial plexus neuritis and was given supportive care. Although, the association with antibiotic therapy in this case could be incidental, indeed it is intriguing and requires further studies.

  13. Morphological description of the brachial plexus in ocelot (Leopardus pardalis

    Kylma Lorena Saldanha Chagas

    2014-06-01

    Full Text Available The brachial plexus is formed by the ventral roots of the spinal nerves, which unite to form the nerve trunks. It is usually formed by contributions of the last three cervical nerves and the first two thoracic nerves. Due to the scarcity of information on neuroanatomy, this study aimed to determine the macroscopic morphology of the brachial plexus of the ocelot (Leopardus pardalis. In this work, we used two ocelot specimens from the area of the Paragominas Bauxite Mine, PA, Brazil/Empresa Terra LTDA, with permission from SEMA – BP Nos. 455/2009 and 522/2009. The animals were donated to the Research Laboratory of Animal Morphology (LaPMA, Federal Rural University of Amazonia (UFRA, after they were accidentally run over. They were fixed by intramuscular injection of 10% formaldehyde. After fixation, the animals were dissected, allowing visualization of the thoracic nerves, as well as the identification of the ventral rami of the cervical and thoracic spinal nerves forming the brachial plexus. The brachial plexus was found to be formed by four trunks, which originated the ventral branches of cervical spinal nerves C6, C7 and C8 and the first thoracic (T1. These trunks gave rise to the suprascapular, subscapular, musculocutaneous, axillary, radial, median, ulnar, thoracodorsal and lateral thoracic nerves.

  14. Schwannoma of the brachial plexus presenting as a cystic swelling

    Somayaji, K. S. G.; Rajeshwari, A.; Gangadhara, K. S.

    2004-01-01

    Schwannomas are benign nerve sheath tumours. A small percentage of these tumours arise from the brachial plexus. Cystic degeneration and hemorrhagic necrosis can occur in these tumours in up to 40% of the cases. Detailed preoperative evaluation and careful dissection during surgery will avoid post operative neurological complications. We report a case of schwannoma of the brachial plexus presenting as a cystic neck swelling which was successfully managed by us.

  15. Technical note: the humeral canal approach to the brachial plexus.

    Frizelle, H. P.

    1998-01-01

    Many variations to the axillary approach to the brachial plexus have been described. However, the success rate varies depending on the approach used and on the definition of success. Recent work describes a new approach to regional anaesthesia of the upper limb at the humeral/brachial canal using selective stimulation of the major nerves. This report outlines initial experience with this block, describing the technique and results in 50 patients undergoing hand and forearm surgery. All patien...

  16. Sonographic evaluation of brachial plexus pathology

    Graif, Moshe; Blank, Anat; Weiss, Judith; Kessler, Ada [Department of Radiology, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 64239, Tel Aviv (Israel); Martinoli, Carlo; Derchi, Lorenzo E. [Department of Radiology, University of Genoa, Genoa (Italy); Rochkind, Shimon [Department of Neurosurgery, Tel Aviv Sourasky Medical Center and the Sackler faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 64239, Tel Aviv (Israel); Trejo, Leonor [Department of Pathology, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 64239, Tel Aviv (Israel)

    2004-02-01

    Pre-operative US examinations of the brachial plexus were performed with the purpose of exploring the potential of this technique in recognizing lesions in the region and defining their sonographic morphology, site, extent, and relations to adjacent anatomic structures, and comparing them to the surgical findings to obtain maximal confirmation. Twenty-eight patients with clinical, electro-conductive, and imaging findings suggestive of brachial plexus pathology were included in this study. There were four main etiology groups: post-traumatic brachial plexopathies; primary tumors (benign and malignant); secondary tumors; and post irradiation injuries. Twenty-one of the 28 patients underwent surgery. Advanced imaging (mostly MRI) served as an alternative gold standard for confirmation of the findings in the non-surgically treated group of patients. The US examinations were performed with conventional US units operating at 5- to 10-MHz frequencies. The nerves were initially localized at the level of the vertebral foramina and then were followed longitudinally and axially down to the axillary region. Abnormal US findings were detected in 20 of 28 patients. Disruption of nerve continuity and focal scar tissue masses were the principal findings in the post-traumatic cases. Focal masses within a nerve or adjacent to it and diffuse thickening of the nerve were the findings in primary and secondary tumors. Post-irradiation changes presented as nerve thickening. Color Doppler was useful in detecting internal vascularization within masses and relation of a mass to adjacent vessels. The eight sonographically negative cases consisted either of traumatic neuromas smaller than 12 mm in size and located in relatively small branches of posterior location or due to fibrotic changes of diffuse nature. Sonography succeeded in depicting a spectrum of lesions of traumatic, neoplastic, and inflammatory nature in the brachial plexus. It provided useful information regarding the lesion site

  17. Sonographic evaluation of brachial plexus pathology

    Pre-operative US examinations of the brachial plexus were performed with the purpose of exploring the potential of this technique in recognizing lesions in the region and defining their sonographic morphology, site, extent, and relations to adjacent anatomic structures, and comparing them to the surgical findings to obtain maximal confirmation. Twenty-eight patients with clinical, electro-conductive, and imaging findings suggestive of brachial plexus pathology were included in this study. There were four main etiology groups: post-traumatic brachial plexopathies; primary tumors (benign and malignant); secondary tumors; and post irradiation injuries. Twenty-one of the 28 patients underwent surgery. Advanced imaging (mostly MRI) served as an alternative gold standard for confirmation of the findings in the non-surgically treated group of patients. The US examinations were performed with conventional US units operating at 5- to 10-MHz frequencies. The nerves were initially localized at the level of the vertebral foramina and then were followed longitudinally and axially down to the axillary region. Abnormal US findings were detected in 20 of 28 patients. Disruption of nerve continuity and focal scar tissue masses were the principal findings in the post-traumatic cases. Focal masses within a nerve or adjacent to it and diffuse thickening of the nerve were the findings in primary and secondary tumors. Post-irradiation changes presented as nerve thickening. Color Doppler was useful in detecting internal vascularization within masses and relation of a mass to adjacent vessels. The eight sonographically negative cases consisted either of traumatic neuromas smaller than 12 mm in size and located in relatively small branches of posterior location or due to fibrotic changes of diffuse nature. Sonography succeeded in depicting a spectrum of lesions of traumatic, neoplastic, and inflammatory nature in the brachial plexus. It provided useful information regarding the lesion site

  18. Imaging tumours of the brachial plexus

    Tumours of the brachial plexus are rare lesions and may be classified as benign or malignant. Within each of these groups, they are further subdivided into those that are neurogenic in origin (schwannoma, neurofibroma and malignant peripheral nerve sheath tumour) and those that are non-neurogenic. Careful pre-operative diagnosis and staging is essential to the successful management of these lesions. Benign neurogenic tumours are well characterized with pre-operative MRI, appearing as well-defined, oval soft-tissue masses, which are typically isointense on T1-weighted images and show the ''target sign'' on T2-weighted images. Differentiation between schwannoma and neurofibroma can often be made by assessing the relationship of the lesion to the nerve of origin. Many benign non-neurogenic tumours, such as lipoma and fibromatosis, are also well characterized by MRI. This article reviews the imaging features of brachial plexus tumours, with particular emphasis on the value of MRI in differential diagnosis. (orig.)

  19. Post-operative brachial plexus neuropraxia: A less recognised complication of combined plastic and laparoscopic surgeries

    Jimmy Thomas

    2014-01-01

    This presentation is to increase awareness of the potential for brachial plexus injury during prolonged combined plastic surgery procedures. A case of brachial plexus neuropraxia in a 26-year-old obese patient following a prolonged combined plastic surgery procedure was encountered. Nerve palsy due to faulty positioning on the operating table is commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus has been a recently reported phenomenon due to the increasin...

  20. A comparison of infraclavicular and supraclavicular approaches to the brachial plexus using neurostimulation

    Yang, Chun Woo; Kwon, Hee Uk; Cho, Choon-Kyu; Jung, Sung Mee; Kang, Po-Soon; Park, Eun-Su; Heo, Youn Moo; Shinn, Helen Ki

    2010-01-01

    Background A prospective, double blind study was performed to compare the clinical effect of vertical infraclavicular and supraclavicular brachial plexus block using a nerve stimulator for upper limb surgery. Methods One hundred patients receiving upper limb surgery under infraclavicular or supraclavicular brachial plexus block were enrolled in this study. The infraclavicular brachial plexus block was performed using the vertical technique with 30 ml of 0.5% ropivacaine. The supraclavicular b...

  1. Evaluation of brachial plexus injury by MRI

    Objective: To evaluate the diagnostic value of MRI in brachial plexus injury. Methods: Total 98 patients with brachial plexus injury were examined by MRI before operation. Fifty-four of 98 patients MR imaging were obtained by 0.5 Tesla scanner and other 44 patients were obtained by 1.5 Tesla scanner. The scanning sequences include: SE T1WI, T2WI, FFE T2WI and T2WI SPIR. Exploration of the supraclavicular plexus was carried out and the MR imaging were compared with the operative finding in 63 patients. Thirty-five patients who had not surgery, were followed-up. Results: MR imaging found pre-ganglionic injuries in 45 patients and post- ganglionic injuries in 56 patients. Pre- and post- ganglionic injuries simultaneously in 16 patients among them. MR imaging can not find injury, sings in 13 patients. The positive rate was 86.73%. MR imaging finding of pre-ganglionic injuries include: (1) Spinal cord edema and hemorrhage, 2 patients (4.44%). (2) Displacement of spinal cord, 17 patients (37.78%). (3) Traumatic meningoceles, 37 patients( 82.22% ). (4) Absence of roots in spinal canal, 25 patients (55.56%). (5) Scarring in the spinal cnanl,24 patients (53.33%). (6) Denervation of erector spine, 13 patients (28.89%). MR imaging finding of post-ganglionic injuries include: (1) Trunk thickening with hypointensities in T2WI, 23 patients (41.07%). (2) Nerve trunk complete loss of continuity with disappeared of nerve structure, 16 patients (28.57%). (3) Continuity of nerve trunk was well with disappearance of nerve structure, 14 patients (25.00%). (4) Traumatic neurofibroma, 3 patients (5.36%). Conclusion: MR imaging can reveal Pre- and post- ganglionic injuries of brachial plexus simultaneously. MR imaging is able to determine the location (pre- or post- ganglionic) and extent of brachial plexus injury, provided important information for treatment method selection. (authors)

  2. Pleural effusion and atelectasis during continuous interscalene brachial plexus block -A case report-

    Yang, Chun Woo; Jung, Sung Mee; Cho, Choon Kyu; Kwon, Hee Uk; Kang, Po Soon; Lim, Young Su; Oh, Jin Young; Yi, Jin Woong

    2010-01-01

    An interscalene brachial plexus block is an effective means of providing anesthesia-analgesia for shoulder surgery. However, it has a multitude of potential side effects such as phrenic nerve block. We report a case of a patient who developed atelectasis of the lung, and pleural effusion manifested as chest discomfort during a continuous interscalene brachial plexus block for postoperative analgesia.

  3. Schwannoma of the brachial plexus; report of two cases involving the C7 root

    Rashid, Mamoon; Salahuddin, Omer; Yousaf, Shumaila; Qazi, Uzair A; Yousaf, Kanwal

    2013-01-01

    Brachial plexus schwannomas are rare tumors. They are benign nerve sheath tumors and only about 5% of Schwannoma arise from the brachial plexus. They pose a great challenge to surgeons due to their rare occurrence and complex anatomical location. We present two cases who presented with a supraclavicular swelling, that were proven to be schwannoma on histopathology.

  4. Unusual nerve supply of biceps from ulnar nerve and median nerve and a third head of biceps

    Arora L; Dhingra R

    2006-01-01

    Variations in branching pattern of the brachial plexus are common and have been reported by several investigators. Of the four main nerves traversing the arm, namely median, ulnar, radial and musculocutaneous, the ulnar and median nerve do not give any branches to muscles of the arm. Ulnar nerve after taking origin from medial cord of brachial plexus runs distally through axilla on medial side of axillary artery till middle of arm, where it pierces the medial intermuscular septum and enters t...

  5. Evaluation of brachial plexus injury by CT myelography

    Objective: To evaluate the diagnostic value of CT myelography (CTM) in brachial plexus injury. Methods: Twenty-seven patients with brachial plexus injury were examined by using cervical CTM with spiral scan and bone reconstruction algorithm. CT images were reviewed by the senior radiologists, who determined if the nerve root avulsion was presented. The criteria of diagnosing nerve root avulsion were loss of normal nerve root appearance in the Isovist filled thecal sac in consecutive CTM slices plus companion signs. The sensitivity, specificity, and accuracy of CTM in diagnosing nerve root injuries were calculated with operation findings and follow-up results as gold standard. Results: Direct sign of nerve root avulsion was the loss of normal nerve root defect seen in the Isovist filled thecal sac in consecutive CTM slices. Indirect signs included: (1) Pseudomeningocele bulge: The leak of Isovist into nerve root sheath, and extended into foramina; (2) Arachnoid cyst: displacement of spinal cord; (3) Dissymmetry of subarachnoid cavity: deformity of thecal sac, partially lack of Isovist into arachnoid space; (4) Non-integrity of dural cap sule wall: one side of cap sule cavity was obstructed. Part of the surface of spinal cord was exposed. Brachial plexus injury could be diagnosed by direct sign with one of the indirect signs. Of the 27 patients (128 nerve roots), 91 nerve root avulsions were found on CTM, and 37 was found normal. Compared with operation findings, 84 were true positive, 7 false positive, 34 true negative, and 3 false negative. Based on these results, the sensitivity, specificity, and accuracy were 96.6%, 82.9%, and 92.2%, respectively. Conclusion: CTM is accurate in detecting nerve root avulsion of brachial plexus. (authors)

  6. The excimer lamp induces cutaneous nerve degeneration and reduces scratching in a dry-skin mouse model.

    Kamo, Atsuko; Tominaga, Mitsutoshi; Kamata, Yayoi; Kaneda, Kazuyuki; Ko, Kyi C; Matsuda, Hironori; Kimura, Utako; Ogawa, Hideoki; Takamori, Kenji

    2014-12-01

    Epidermal hyperinnervation, which is thought to underlie intractable pruritus, has been observed in patients with atopic dermatitis (AD). The epidermal expression of axonal guidance molecules has been reported to regulate epidermal hyperinnervation. Previously, we showed that the excimer lamp has antihyperinnervative effects in nonpruritic dry-skin model mice, although epidermal expression of axonal guidance molecules was unchanged. Therefore, we investigated the antipruritic effects of excimer lamp irradiation and its mechanism of action. A single irradiation of AD model mice significantly inhibited itch-related behavior 1 day later, following improvement in the dermatitis score. In addition, irradiation of nerve fibers formed by cultured dorsal root ganglion neurons increased bleb formation and decreased nerve fiber expression of nicotinamide mononucleotide adenylyl transferase 2, suggesting degenerative changes in these fibers. We also analyzed whether attaching a cutoff excimer filter (COF) to the lamp, thus decreasing cytotoxic wavelengths, altered hyperinnervation and the production of cyclobutane pyrimidine dimer (CPD), a DNA damage marker, in dry-skin model mice. Irradiation with COF decreased CPD production in keratinocytes, as well as having an antihyperinnervative effect, indicating that the antipruritic effects of excimer lamp irradiation with COF are due to induction of epidermal nerve degeneration and reduced DNA damage. PMID:24940652

  7. Permanent upper trunk plexopathy after interscalene brachial plexus block.

    Avellanet, Merce; Sala-Blanch, Xavier; Rodrigo, Lidia; Gonzalez-Viejo, Miguel A

    2016-02-01

    Interscalene brachial plexus block (IBPB) has been widely used in shoulder surgical procedures. The incidence of postoperative neural injury has been estimated to be as high as 3 %. We report a long-term neurologic deficit after a nerve stimulator assisted brachial plexus block. A 55 year-old male, with right shoulder impingement syndrome was scheduled for elective surgery. The patient was given an oral dose of 10 mg of diazepam prior to the nerve stimulator assisted brachial plexus block. The patient immediately complained, as soon as the needle was placed in the interscalene area, of a sharp pain in his right arm and he was sedated further. Twenty-four hours later, the patient complained of severe shoulder and arm pain that required an increased dose of analgesics. Severe peri-scapular atrophy developed over the following days. Electromyography studies revealed an upper trunk plexus injury with severe denervation of the supraspinatus, infraspinatus and deltoid muscles together with a moderate denervation of the biceps brachii muscle. Chest X-rays showed a diaphragmatic palsy which was not present post operatively. Pulmonary function tests were also affected. Phrenic nerve paralysis was still present 18 months after the block as was dysfunction of the brachial plexus resulting in an inability to perform flexion, abduction and external rotation of the right shoulder. Severe brachial plexopathy was probably due to a local anesthetic having been administrated through the perineurium and into the nerve fascicles. Severe brachial plexopathy is an uncommon but catastrophic complication of IBPB. We propose a clinical algorithm using ultrasound guidance during nerve blocks as a safer technique of regional anesthesia. PMID:25744163

  8. The histomorphological study of the lateral femoral cutaneous nerve, the medial calcaneal nerve and the lateral calcaneal nerve:observation of sectional morphous and measurement of nerve fibre number%股外侧皮神经和跟内、外侧神经的截面形态观察与神经纤维计数

    唐举玉; 李康华; 吴梅英; 罗令; 宋达疆

    2009-01-01

    Objective To provide guidance for reconstructing the sensation of the anterolateral thigh flap (ALTF) used to repair extensive soft tissue defects in heel. Methods Choose 7 adult male corpses, take the nerval samples respectively from the lateral femoral cutaneous nerve (LFCN) 5cm below the anterior superior iliac spine (ASIS) and the initial segment of the medial caleaneal nerve (MCN) and the lateral calcaneal nerve (LCN), fixed, dewatered gradiendy, embedded, located, and made them into semithin sections, dyed with toluidine blue. The pictures were taken by a medicine figure imaging analysis system named MOTICMED 6.0, observe the nerves's sectional morphous, the quantity and distribution of their nerve fiber bundles, count the quantity of nerve fibers and determine the density of them. Use Photoshop 7.0 version precinct software for measuring and calculating the area of the nerve fiber bundles and the Photoshop grid function was used to measure the density of the nerve fibers. Results In our cross-section study, the median number of nerve bunches in LFCN, MCN and LCN1, was 4, 3 and 4, respectively. The median number of nerve fibers' area was 114.8 um2, 126.92 um2 and 102.76um2, respectively. The median number of nerve fibers' density was 11.43/um2, 6.47/um2 and 10.08/um2, respectively. The median number of nerve fibers was 987, 862 and 570, respectively. Conclusion The MCN and the LCN1 are ideal cutaneous nerves to suture with LFCN in the ALTF used to repair widespread soft tissue defects in heel because they have similar histomorphological characteristics with the LFCN.%目的 为临床开展股前外侧皮瓣移植修复足跟软组织缺损感觉重建提供指导. 方法 选择7具成年男性标本,分别于股外侧皮神经髂前上棘下5 cm、跟内侧神经和跟外侧神经第一支主干起始段切取神经样本.经固定、梯度脱水、包埋、修块定位和半薄切片后,以甲苯胺蓝染色.以MOTICMED6.0数码医学图像分析系统摄

  9. Post-operative brachial plexus neuropraxia: A less recognised complication of combined plastic and laparoscopic surgeries

    Jimmy Thomas

    2014-01-01

    Full Text Available This presentation is to increase awareness of the potential for brachial plexus injury during prolonged combined plastic surgery procedures. A case of brachial plexus neuropraxia in a 26-year-old obese patient following a prolonged combined plastic surgery procedure was encountered. Nerve palsy due to faulty positioning on the operating table is commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus has been a recently reported phenomenon due to the increasing number of laparoscopic and robotic procedures. Brachial plexus injury needs to be recognised as a potential complication of prolonged combined plastic surgery. Preventive measures are discussed.

  10. MR evaluation of brachial plexus injuries

    Ten cases of brachial plexus injury were subjected to magnetic resonance (MR) to demonstrate the roots, trunks, divisions or cord abnormalities. Both normal and abnormal brachial plexuses were imaged in sagittal, axial, coronal and axial oblique planes. Myelography, using water soluble contrast agents, was performed in seven cases. MR demonstrated one traumatic meningocele, one extradural cerebrospinal fluid (CSF) collection, trunk and/or root neuromas in four, focal root fibrosis in two and diffuse fibrosis in the remaining two cases. Results of MR were confirmed at surgery in four cases with neuromas, while myelography was normal in two and was not carried out in the remaining two. In two cases, where MR demonstrated diffuse fibrosis of the brachial plexus, myelography showed C7 and T1 traumatic meningocele in one and was normal in the other. Both these patients showed excellent clinical and electrophysiological correlation with MR findings and in one of them surgical confirmation was also obtained. In the other two cases with focal nerve root fibrosis, myelography was normal in one and showed a traumatic meningocele in another. Operative findings in these cases confirmed focal root fibrosis but no root avulsion was observed although seen on one myelogram. Focal fibrosis, however, was noted at operation in more roots than was observed with MR. Initial experience suggests that MR may be the diagnostic procedure of choice for complete evaluation of brachial plexus injuries. (orig.)

  11. New approaches in imaging of the brachial plexus

    Vargas, M.I. [Department of Neuroradiology, Geneva University Hospital and University of Geneva, Geneva (Switzerland)], E-mail: maria.i.vargas@hcuge.ch; Viallon, M. [Department of Radiology, Geneva University Hospital and University of Geneva, Geneva (Switzerland); Nguyen, D. [Department of Neuroradiology, Geneva University Hospital and University of Geneva, Geneva (Switzerland); Beaulieu, J.Y. [Unit of Hand Surgery, Geneva University Hospital and University of Geneva, Geneva (Switzerland); Delavelle, J. [Department of Neuroradiology, Geneva University Hospital and University of Geneva, Geneva (Switzerland); Becker, M. [Unit of Head and Neck Radiology, Geneva University Hospital and University of Geneva, Geneva (Switzerland)

    2010-05-15

    Imaging plays an essential role for the detection and analysis of pathologic conditions of the brachial plexus. Currently, several new techniques are used in addition to conventional 2D MR sequences to study the brachial plexus: the 3D STIR SPACE sequence, 3D heavily T2w MR myelography sequences (balanced SSFP = CISS 3D, True FISP 3D, bFFE and FIESTA), and the diffusion-weighted (DW) neurography sequence with fiber tracking reconstruction (tractography). The 3D STIR sequence offers complete anatomical coverage of the brachial plexus and the ability to slice through the volume helps to analyze fiber course modification and structure alteration. It allows precise assessment of distortion, compression and interruption of postganglionic nerve fibers thanks to the capability of performing maximum intensity projections (MIP) and multiplanar reconstructions (MPRs). The CISS 3D, b-SSFP sequences allow good visualization of nerve roots within the spinal canal and may be used for MR myelography in traumatic plexus injuries. The DW neurography sequence with tractography is still a work in progress, able to demonstrate nerves tracts, their structure alteration or deformation due to pathologic processes surrounding or located along the postganglionic brachial plexus. It may become a precious tool for the understanding of the underlying molecular pathophysiologic mechanisms in diseases affecting the brachial plexus and may play a role for surgical planning procedures in the near future.

  12. New approaches in imaging of the brachial plexus

    Imaging plays an essential role for the detection and analysis of pathologic conditions of the brachial plexus. Currently, several new techniques are used in addition to conventional 2D MR sequences to study the brachial plexus: the 3D STIR SPACE sequence, 3D heavily T2w MR myelography sequences (balanced SSFP = CISS 3D, True FISP 3D, bFFE and FIESTA), and the diffusion-weighted (DW) neurography sequence with fiber tracking reconstruction (tractography). The 3D STIR sequence offers complete anatomical coverage of the brachial plexus and the ability to slice through the volume helps to analyze fiber course modification and structure alteration. It allows precise assessment of distortion, compression and interruption of postganglionic nerve fibers thanks to the capability of performing maximum intensity projections (MIP) and multiplanar reconstructions (MPRs). The CISS 3D, b-SSFP sequences allow good visualization of nerve roots within the spinal canal and may be used for MR myelography in traumatic plexus injuries. The DW neurography sequence with tractography is still a work in progress, able to demonstrate nerves tracts, their structure alteration or deformation due to pathologic processes surrounding or located along the postganglionic brachial plexus. It may become a precious tool for the understanding of the underlying molecular pathophysiologic mechanisms in diseases affecting the brachial plexus and may play a role for surgical planning procedures in the near future.

  13. Brachial plexus neuropathy

    Hubka, Michael J; King, Laurie; Cassidy, J. David; Donat, JR

    1992-01-01

    Branchial plexus neuropathy is characterized by acute onset of intense pain in the shoulder or arm followed shortly by focal muscle weakness. This presentation may mislead the clinician into diagnosing shoulder or cervical spine pathology. Although brachial plexus neuropathy is not common, it should be considered in the differential diagnosis of pain and weakness of the arm. We present a patient with brachial plexus neuropathy who was originally misdiagnosed as having a cervical disc herniation.

  14. Evaluation of brachial plexus with MR echo planar imaging: initial experience

    Objective: To determine the optimal sequences and scan parameters of Brachial Plexus MRI. Methods: Eighteen volunteers were underwent conventional MRI and echo planar imaging scanning. The images acquired were compared with the standard anatomical pictures. Results: Ventral rami, ganglion, trunks, cords and some peripheral nerves of brachial plexus were demonstrated very well by echo planar imaging with the post-processing techniques such as MIP, thin slice MIP and MPR. In 18/18 cases the postganglions on both sides and 17/18 cases the preganglions of brachial plexus on both sides could be visualized in EPI pre-processed and post-processed images. Conclusion: Echo planar imaging is an effective technique of accurately displaying brachial plexus and adjacent structures. It has potential value in the diagnosis and treatment of brachial plexus diseases. It is also a potential technique to demonstrate other peripheral nerves accurately. (authors)

  15. Standard versus a novel technique for restoring neurological function following brachial plexus injuries

    Damien Kuffler

    2011-01-01

    The brachial plexus, a complex network of peripheral nerves, involves the motor, sensory, and sympathetic nerve supply to the upper extremity, and is formed by the union of the ventral primary rami of the spinal nerves. Brachial plexus trauma, damage to the complex of nerves, has a high incidence from delivery throughout life, leading to loss of all innervation of the arm and hand, their paralysis, and frequently results in excruciating neuropathic pain. The most frequent brachial plexus repair techniques use autologous sensory nerve grafts to bridge the nerve gaps. However, these do not induce reliable neurological recovery or reduce neuropathic pain, thus permanent neurological loss and neuropathic pain frequently occur. The present study evaluated the current best brachial plexus repair techniques and another involving a collagen tube filled with autologous platelet-rich fibrin that clinically induces extensive neurological recovery and a reduction/elimination of neuropathic pain, which are not possible by sural nerve grafts, even across long nerve gaps that are repaired years post trauma, and in older patients. This novel technique is proposed for use in restoring brachial plexus neurological function and in reducing/eliminating neuropathic pain.

  16. Myelography in obstetric palsies of brachial plexus

    The use of myelography in obstetric palsies of brachial plexus is aimed at diagnosing root avulsion.This kind of lesion appears as the disappearance of the slightly-transparent nerve roots which might be combined either with pseudo-meningocele or with deformation of radicular pouch. This study 69 operated patients who had previously undergone myelography have been considered. In 74.2% of cases mylographic findings were confirmed at surgery.False positives and false negatives were 9.7% and 3.2%, respectively. Uncorrect diagnoses were made in 12.9% of cases, because of misread lesions and uncorrect evaluation of their location, usually at the cervicol-dorsal junction.No side-effects were observed. Myelography appears thus to be extremely useful for both the preoperative evaluation and the choice of surgery in newborn children with obstetric palsy of the brachial plexus

  17. Brachial plexopathy after prone positioning

    Goettler, Claudia E; Pryor, John P; Reilly, Patrick M

    2002-01-01

    Two cases of brachial plexus injury after prone position in the intensive care unit are described. Mechanisms of brachial plexus injury are described, as are methods for prevention of this unusual complication.

  18. A comparative ultrastructural study of primary afferents from the brachial and cervical plexuses to the external cuneate nucleus of gerbils.

    Lan, C T; Wen, C. Y.; Tan, C K; Ling, E. A.; Shieh, J Y

    1995-01-01

    The synaptic organisation of the primary afferents from the brachial and cervical plexuses to the external cuneate nucleus of gerbils was compared following an intraneural injection of horseradish peroxidase into the musculocutaneous, median, ulnar and radial nerves of the brachial plexus or the main branches of the cervical plexus; 407 labelled primary afferent terminals from the brachial and 459 from the cervical plexus were studied. These boutons made synaptic contacts with 586 and 633 den...

  19. Functioning transferred free muscle innervated by part of the vascularized ulnar nerve connecting the contralateral cervical seventh root to themedian nerve: Case report

    Nakayama Ken; Ikeguchi Ryosuke; Kakinoki Ryosuke; Nakamura Takashi

    2007-01-01

    Abstract Background The limited nerve sources available for the reconstruction and restoration of upper extremity function is the biggest obstacle in the treatment of brachial plexus injury (BPI). We used part of a transplanted vascularized ulnar nerve as a motor source of a free muscle graft. Case presentation A 21-year-old man with a left total brachial plexus injury had received surgical intercostal nerve transfer to the musculocutaneous nerve and a spinal accessory nerve transfer to the s...

  20. Comparative efficacy of ropivacaine and levobupivacaine in combined femoral and lateral femoral cutaneous nerve block with adjuvant magnesium for post-operative analgesia

    Prakash Khairnar

    2016-01-01

    Full Text Available Background and Aims: Patients with burns may require multiple surgeries, but poor general condition and underlying protein energy malnutrition make them unsuitable candidates for general or spinal anaesthesia. This study evaluated the role of magnesium sulphate as an adjuvant with levobupivacaine and ropivacaine used in combined femoral and lateral femoral cutaneous nerve (LFCN blocks in burn patients with relative sparing of thigh portion. Methods: This prospective, randomised, double-blind study included 54 adult patients of 18-65 years age, undergoing split-thickness skin graft harvest from the thigh, allotted to three equal groups of 18 each. Group L patients received femoral nerve (FN block with 15 mL of 0.5% levobupivacaine and 8 mL for LFCN block; Group LM patients received 14 mL of 0.5% levobupivacaine along with 1.0 mL of 15% magnesium sulphate for FN block, 7.5 mL of 0.5% levobupivacaine with 0.5 mL of 15% of magnesium sulphate to LFCN block and Group R patients received 15 mL of 0.5% ropivacaine for FN block and 8 mL of 0.5% ropivacaine for LFCN block. Time to block onset and complete surgical block, duration of analgesia, total analgesic dose and the overall analgesia satisfaction score were measured in the first 24 h post-operatively. Quantitative data were analysed with ANOVA and qualitative data subjected to Chi-square tests. Intergroup comparison was performed with independent t-test. Results: The duration of post-operative analgesia did not differ with the addition of magnesium (P = 0.610. Time to onset of the block was significantly decreased with the addition of magnesium (P = 0.0341, but time to complete surgical block onset was similar across the groups. Conclusion: Both ropivacaine and levobupivacaine have good perioperative analgesic efficacy. Magnesium as an analgesia adjuvant with levobupivacaine does not prolong the duration of post-operative analgesia.

  1. 3 T MR tomography of the brachial plexus: Structural and microstructural evaluation

    Mallouhi, Ammar, E-mail: Ammar.Mallouhi@meduniwien.ac.at [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Marik, Wolfgang, E-mail: Wolfgang.Marik@meduniwien.ac.at [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Prayer, Daniela, E-mail: Daniela.Prayer@meduniwien.ac.at [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Kainberger, Franz, E-mail: Franz.Kainberger@meduniwien.ac.at [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Bodner, Gerd, E-mail: Gerd.Bodner@meduniwien.ac.at [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Kasprian, Gregor, E-mail: Gregor.Kasprian@meduniwien.ac.at [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria)

    2012-09-15

    Magnetic resonance (MR) neurography comprises an evolving group of techniques with the potential to allow optimal noninvasive evaluation of many abnormalities of the brachial plexus. MR neurography is clinically useful in the evaluation of suspected brachial plexus traumatic injuries, intrinsic and extrinsic tumors, and post-radiogenic inflammation, and can be particularly beneficial in pediatric patients with obstetric trauma to the brachial plexus. The most common MR neurographic techniques for displaying the brachial plexus can be divided into two categories: structural MR neurography; and microstructural MR neurography. Structural MR neurography uses mainly the STIR sequence to image the nerves of the brachial plexus, can be performed in 2D or 3D mode, and the 2D sequence can be repeated in different planes. Microstructural MR neurography depends on the diffusion tensor imaging that provides quantitative information about the degree and direction of water diffusion within the nerves of the brachial plexus, as well as on tractography to visualize the white matter tracts and to characterize their integrity. The successful evaluation of the brachial plexus requires the implementation of appropriate techniques and familiarity with the pathologies that might involve the brachial plexus.

  2. 3 T MR tomography of the brachial plexus: Structural and microstructural evaluation

    Magnetic resonance (MR) neurography comprises an evolving group of techniques with the potential to allow optimal noninvasive evaluation of many abnormalities of the brachial plexus. MR neurography is clinically useful in the evaluation of suspected brachial plexus traumatic injuries, intrinsic and extrinsic tumors, and post-radiogenic inflammation, and can be particularly beneficial in pediatric patients with obstetric trauma to the brachial plexus. The most common MR neurographic techniques for displaying the brachial plexus can be divided into two categories: structural MR neurography; and microstructural MR neurography. Structural MR neurography uses mainly the STIR sequence to image the nerves of the brachial plexus, can be performed in 2D or 3D mode, and the 2D sequence can be repeated in different planes. Microstructural MR neurography depends on the diffusion tensor imaging that provides quantitative information about the degree and direction of water diffusion within the nerves of the brachial plexus, as well as on tractography to visualize the white matter tracts and to characterize their integrity. The successful evaluation of the brachial plexus requires the implementation of appropriate techniques and familiarity with the pathologies that might involve the brachial plexus

  3. 3T MR tomography of the brachial plexus: structural and microstructural evaluation.

    Mallouhi, Ammar; Marik, Wolfgang; Prayer, Daniela; Kainberger, Franz; Bodner, Gerd; Kasprian, Gregor

    2012-09-01

    Magnetic resonance (MR) neurography comprises an evolving group of techniques with the potential to allow optimal noninvasive evaluation of many abnormalities of the brachial plexus. MR neurography is clinically useful in the evaluation of suspected brachial plexus traumatic injuries, intrinsic and extrinsic tumors, and post-radiogenic inflammation, and can be particularly beneficial in pediatric patients with obstetric trauma to the brachial plexus. The most common MR neurographic techniques for displaying the brachial plexus can be divided into two categories: structural MR neurography; and microstructural MR neurography. Structural MR neurography uses mainly the STIR sequence to image the nerves of the brachial plexus, can be performed in 2D or 3D mode, and the 2D sequence can be repeated in different planes. Microstructural MR neurography depends on the diffusion tensor imaging that provides quantitative information about the degree and direction of water diffusion within the nerves of the brachial plexus, as well as on tractography to visualize the white matter tracts and to characterize their integrity. The successful evaluation of the brachial plexus requires the implementation of appropriate techniques and familiarity with the pathologies that might involve the brachial plexus. PMID:21763092

  4. Structure of the brachial plexus root and adjacent regions displayed by ultrasound imaging

    Zhengyi Li; Xun Xia; Xiaoming Rong; Yamei Tang; Dachuan Xu

    2012-01-01

    Brachial plexuses of 110 healthy volunteers were examined using high resolution color Doppler ultrasound. Ultrasonic characteristics and anatomic variation in the intervertebral foramen, interscalene, supraclavicular and infraclavicular, as well as the axillary brachial plexus were investigated. Results confirmed that the normal brachial plexus on cross section exhibited round or elliptic hypoechoic texture. Longitudinal section imaging showed many parallel linear hypo-moderate echoes, with hypo-echo. The transverse processes of the seventh cervical vertebra, the scalene space, the subclavian artery and the deep cervical artery are important markers in an examination. The display rates for the interscalene, and supraclavicular and axillary brachial plexuses were 100% each, while that for the infraclavicular brachial plexus was 97%. The region where the normal brachial plexus root traversed the intervertebral foramen exhibited a regular hypo-echo. The display rate for the C5-7 nerve roots was 100%, while those for C8 and T1 were 83% and 68%, respectively. A total of 20 of the 110 subjects underwent cervical CT scan. High-frequency ultrasound can clearly display the outline of the transverse processes of the vertebrae, which were consistent with CT results. These results indicate that high-frequency ultrasound provides a new method for observing the morphology of the brachial plexus. The C7 vertebra is a marker for identifying the position of brachial plexus nerve roots.

  5. CT appearance of intercostal nerve neurotisation

    Gadahadh, R; Rachapalli, V; Roberts, D. E.

    2012-01-01

    A nerve transfer or neurotisation procedure is performed to repair damaged nerves, in particular those of the brachial plexus following an avulsion injury. An intercostal to phrenic nerve transfer to re-innervate the diaphragm in patients with high cervical spine injury has also been reported in the literature. We present the imaging finding in a 65-year-old female who had an intercostal nerve transfer for a damaged phrenic nerve following a resection for a non-small cell lung carcinoma.

  6. Hand Function in Children with an Upper Brachial Plexus Birth Injury: Results of the Nine-Hole Peg Test

    Immerman, Igor; Alfonso, Daniel T.; Ramos, Lorna E.; Grossman, Leslie A.; Alfonso, Israel; Ditaranto, Patricia; Grossman, John A. I.

    2012-01-01

    Aim: The aim of this study was to evaluate hand function in children with Erb upper brachial plexus palsy. Method: Hand function was evaluated in 25 children (eight males; 17 females) with a diagnosed upper (C5/C6) brachial plexus birth injury. Of these children, 22 had undergone primary nerve reconstruction and 13 of the 25 had undergone…

  7. Pediatric Stinger Syndrome: Acute Brachial Plexopathy After Minor Trauma.

    Quong, Whitney L; Hynes, Sally L; Arneja, Jugpal S

    2015-11-01

    The "stinger" or "burner" is a form of transient brachial plexopathy termed for its characteristic knife-like pain extending from the neck to the fingertips. Muscle weakness and paresthesia are oftentimes associated symptoms and are similarly temporary. Commonly observed in athletes of contact sports, the stinger results from high force trauma causing either traction/direct compression to the brachial plexus or extension/compression of the cervical nerve roots. We describe a pediatric case of a stinger in a 14-year-old boy, which was caused by a relatively low force trauma accident. Our management strategy and recommendations are discussed. PMID:26893985

  8. Penile erectile dysfunction after brachial plexus root avulsion injury in rats

    Guo Fu; Xuejia Li; Liqiang Gu; Bengang Qin; Li Jiang; Xijun Huang; Qinsen Lu; Dechun Zhang; Xiaolin Liu; Jiakai Zhu; Jianwen Zheng

    2014-01-01

    Our previous studies have demonstrated that some male patients suffering from brachial plexus injury, particularly brachial plexus root avulsion, show erectile dysfunction to varying degrees. However, the underlying mechanism remains poorly understood. In this study, we evaluated the erectile function after establishing brachial plexus root avulsion models with or without spinal cord injury in rats. After these models were established, we administered apomorphine (via a sub-cutaneous injection in the neck) to observe changes in erectile function. Rats subjected to simple brachial plexus root avulsion or those subjected to brachial plexus root avulsion combined with spinal cord injury had signiifcantly fewer erections than those subjected to the sham operation. Expression of neuronal nitric oxide synthase did not change in brachial plexus root avulsion rats. However, neuronal nitric oxide synthase expression was signiifcantly decreased in brachial plexus root avulsion + spinal cord injury rats. These ifndings suggest that a decrease in neuronal nitric oxide synthase expression in the penis may play a role in erectile dysfunction caused by the combi-nation of brachial plexus root avulsion and spinal cord injury.

  9. MR neurography in traumatic brachial plexopathy

    Upadhyaya, Vaishali, E-mail: vshali77@yahoo.co.in [Department of Radiology, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Lucknow 226 007 (India); Upadhyaya, Divya N. [Department of Plastic Surgery, King George Medical University, Shah Meena Road, Chowk, Lucknow 226 003 (India); Kumar, Adarsh [Department of Plastic Surgery, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Lucknow 226 007 (India); Gujral, Ratni B. [Department of Radiology, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Lucknow 226 007 (India)

    2015-05-15

    Highlights: • MR neurography is the imaging modality of choice in patients who have sustained brachial plexus injury. It is helpful in determining the level and extent of injury. • The authors have used a Visual Per-operative Scoring system to assess the usefulness of MR neurography in delineating the level and type of the lesion. • The imaging findings were classified based on the level of injury—root, trunk or cord. These findings were correlated with those seen on surgical exploration. A good correlation was found in the majority (65%) of patients and average correlation (30%) in others. - Abstract: Objectives: Imaging of the brachial plexus has come a long way and has progressed from plain radiography to CT and CT myelography to MRI. Evolution of MR imaging sequences has enabled good visualization of the small components of the plexus. The purpose of our study was to correlate the results of MR neurography (MRN) in patients with traumatic brachial plexopathy with their operative findings. We wanted to determine the usefulness of MRN and how it influenced surgical planning and outcome. Methods: Twenty patients with features of traumatic brachial plexopathy who were referred to the MRI section of the Department of Radiology between September 2012 and January 2014 and subsequently underwent exploration were included in the study. MR neurography and operative findings were recorded at three levels of the brachial plexus—roots, trunks and cords. Results: Findings at the level of roots and trunks were noted in 14 patients each and at the level of the cords in 16 patients. 10 patients had involvement at all levels. Axillary nerve involvement as a solitary finding was noted in two patients. These patients were subsequently operated and their studies were assigned a score based on the feedback from the operating surgeons. The MRN study was scored as three (good), two (average) or one (poor) depending on whether the MR findings correlated with operative

  10. MR neurography in traumatic brachial plexopathy

    Highlights: • MR neurography is the imaging modality of choice in patients who have sustained brachial plexus injury. It is helpful in determining the level and extent of injury. • The authors have used a Visual Per-operative Scoring system to assess the usefulness of MR neurography in delineating the level and type of the lesion. • The imaging findings were classified based on the level of injury—root, trunk or cord. These findings were correlated with those seen on surgical exploration. A good correlation was found in the majority (65%) of patients and average correlation (30%) in others. - Abstract: Objectives: Imaging of the brachial plexus has come a long way and has progressed from plain radiography to CT and CT myelography to MRI. Evolution of MR imaging sequences has enabled good visualization of the small components of the plexus. The purpose of our study was to correlate the results of MR neurography (MRN) in patients with traumatic brachial plexopathy with their operative findings. We wanted to determine the usefulness of MRN and how it influenced surgical planning and outcome. Methods: Twenty patients with features of traumatic brachial plexopathy who were referred to the MRI section of the Department of Radiology between September 2012 and January 2014 and subsequently underwent exploration were included in the study. MR neurography and operative findings were recorded at three levels of the brachial plexus—roots, trunks and cords. Results: Findings at the level of roots and trunks were noted in 14 patients each and at the level of the cords in 16 patients. 10 patients had involvement at all levels. Axillary nerve involvement as a solitary finding was noted in two patients. These patients were subsequently operated and their studies were assigned a score based on the feedback from the operating surgeons. The MRN study was scored as three (good), two (average) or one (poor) depending on whether the MR findings correlated with operative

  11. Changes in Spinal Cord Architecture after Brachial Plexus Injury in the Newborn

    Korak, Klaus J.; Tam, Siu Lin; Gordon, Tessa; Frey, Manfred; Aszmann, Oskar C.

    2004-01-01

    Obstetric brachial plexus palsy is a devastating birth injury. While many children recover spontaneously, 20-25% are left with a permanent impairment of the affected limb. So far, concepts of pathology and recovery have focused on the injury of the peripheral nerve. Proximal nerve injury at birth, however, leads to massive injury-induced…

  12. Five Roots Pattern of Median Nerve Formation

    Konstantinos Natsis

    2016-04-01

    Full Text Available An unusual combination of median nerve’s variations has been encountered in a male cadaver during routine educational dissection. In particular, the median nerve was formed by five roots; three roots originated from the lateral cord of the brachial plexus joined individually the median nerve’s medial root. The latter (fourth root was united with the lateral (fifth root of the median nerve forming the median nerve distally in the upper arm and not the axilla as usually. In addition, the median nerve was situated medial to the brachial artery. We review comprehensively the relevant variants, their embryologic development and their potential clinical applications.

  13. Lateral femoral cutaneous neuralgia: an anatomical insight.

    Dias Filho, L C; Valença, M M; Guimarães Filho, F A V; Medeiros, R C; Silva, R A M; Morais, M G V; Valente, F P; França, S M L

    2003-07-01

    A detailed anatomic study was carried out on the lateral femoral cutaneous nerve to better understand the etiology and treatment of lateral femoral cutaneous neuralgia. As it passed from the pelvis into the thigh, the lateral femoral cutaneous nerve ran through an "aponeuroticofascial tunnel," beginning at the iliopubic tract and ending at the inguinal ligament; as it passed through the tunnel, an enlargement in its side-to-side diameter was observed, suggesting that the fascial structures proximal to the inguinal ligament may be implicated in the genesis of lateral femoral cutaneous neuralgia. The finding of pseudoneuromas at this location, distant from the inguinal ligament, supports this hypothesis. The anterior superior iliac spine is located approximately 0.7 cm from the lateral femoral cutaneous nerve and serves as the bony landmark for nerve localization. Within the first 3 cm of leaving the pelvis, the lateral femoral cutaneous nerve was observed deep to the fascia lata; therefore, surgical dissection within the subcutaneous fascia may be conducted with relative impunity near the anterior superior iliac spine just inferior to the inguinal ligament. In 36% of cases there was no posterior branch of the nerve, which is correlated to lateral femoral cutaneous neuralgia symptoms often being limited to the anterior branch region. An accessory nerve was found in 30% of cases. PMID:12794914

  14. Imaging tumours of the brachial plexus

    Saifuddin, Asif [Department of Radiology, The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, HA7 4LP, Stanmore (United Kingdom)

    2003-07-01

    Tumours of the brachial plexus are rare lesions and may be classified as benign or malignant. Within each of these groups, they are further subdivided into those that are neurogenic in origin (schwannoma, neurofibroma and malignant peripheral nerve sheath tumour) and those that are non-neurogenic. Careful pre-operative diagnosis and staging is essential to the successful management of these lesions. Benign neurogenic tumours are well characterized with pre-operative MRI, appearing as well-defined, oval soft-tissue masses, which are typically isointense on T1-weighted images and show the ''target sign'' on T2-weighted images. Differentiation between schwannoma and neurofibroma can often be made by assessing the relationship of the lesion to the nerve of origin. Many benign non-neurogenic tumours, such as lipoma and fibromatosis, are also well characterized by MRI. This article reviews the imaging features of brachial plexus tumours, with particular emphasis on the value of MRI in differential diagnosis. (orig.)

  15. Idiopathic Brachial Neuritis

    Gonzalez-Alegre, Pedro; Recober, Ana; Kelkar, Praful

    2002-01-01

    Idiopathic brachial neuritis is a well defined clinical condition that most commonly affects young adults, seen usually by primary care physicians, neurologists or orthopaedic surgeons. Its onset is characterized by acute, aching shoulder pain lasting a few days to weeks, followed by progressive shoulder girdle and upper extremity weakness and atrophy, with a slow but progressive recovery of motor function over 6 to 18 months. Its early recognition can help avoid unnecessary and potentially h...

  16. Origins and branchings of the brachial plexus of the gray brocket deer Mazama gouazoubira (Artiodactyla: Cervidae)

    Lucélia Gonçalves Vieira; Priscilla Rosa Queiroz Ribeiro; Mariana Oliveira Lima; Rogério Rodrigues de Souza; Sady Alexis Chavauty Valdes; André Luiz Quagliatto Santos

    2013-01-01

    The brachial plexus is a set of nerves originated in the cervicothoracic medular region which innervates the thoracic limb and its surroundings. Its study in different species is important not only as a source of morphological knowledge, but also because it facilitates the diagnosis of neuromuscular disorders resulting from various pathologies. This study aimed to describe the origins and branchings of the brachial plexus of Mazama gouazoubira. Three specimens were used, belonging to the scie...

  17. Color Doppler Ultrasound-guided Supraclavicular Brachial Plexus Block to Prevent Vascular Injection

    Nagdev, Arun; Hahn, Christopher

    2014-01-01

    Ultrasound-guided nerve blocks are quickly becoming integrated into emergency medicine practice for pain control and as an alternative to procedural sedation. Common, but potentially catastophic errors have not been reported outside of the anesthesiology literature. Evaluation of the brachial plexus with color Doppler should be standard for clinicians performing a supraclavicular brachial plexus block to determine ideal block location and prevention of inadvertant intravascular injection. [We...

  18. Free functional gracilis muscle transfer in children with severe sequelae from obstetric brachial plexus palsy

    Ocampo-Pavez Claudia; Bahm Jörg

    2008-01-01

    Abstract We present 4 children between 6 and 13 years suffering from severe sequelae after a total obstetric brachial plexus lesion resulting in a hand without functional active long finger flexion. They had successfully reanimated long finger flexion using a free functional gracilis muscle transfer. These children initially presented a total obstetric brachial plexus palsy without neurotisation of the lower trunk in an early microsurgical nerve reconstruction procedure. We describe our indic...

  19. Schwannoma of the brachial plexus: cross-sectional imaging diagnosis using CT, sonography, and MR imaging

    Rettenbacher, Thomas; Soegner, Peter; Springer, Peter; Nedden, Dieter zur [Department of Radiology II, University Hospital Innsbruck, Anichstrasse 35, 6020 Innsbruck (Austria); Fiegl, Michael [Department of Internal Medicine, University Hospital Innsbruck, Anichstrasse 35, 6020 Innsbruck (Austria); Hussl, Heribert [Department of Plastic and Reconstructive Surgery, University Hospital Innsbruck, Anichstrasse 35, 6020 Innsbruck (Austria)

    2003-08-01

    Primary brachial plexus tumors are rare, usually benign, and in general have a good prognosis after surgical excision. We present a case of a schwannoma in which sonography enabled the correct diagnosis of a probably benign brachial plexus tumor. Key to the diagnosis was the demonstration of a smooth-bordered, longish, and well-defined nodule along a brachial plexus nerve root. Cross-sectional imaging modalities that provide a high degree of soft tissue contrast and spatial resolution, such as sonography and MR imaging, were suitable methods to establish the correct preoperative diagnosis. Findings at CT, sonography, MR imaging, and surgery are discussed. (orig.)

  20. Schwannoma of the brachial plexus: cross-sectional imaging diagnosis using CT, sonography, and MR imaging

    Primary brachial plexus tumors are rare, usually benign, and in general have a good prognosis after surgical excision. We present a case of a schwannoma in which sonography enabled the correct diagnosis of a probably benign brachial plexus tumor. Key to the diagnosis was the demonstration of a smooth-bordered, longish, and well-defined nodule along a brachial plexus nerve root. Cross-sectional imaging modalities that provide a high degree of soft tissue contrast and spatial resolution, such as sonography and MR imaging, were suitable methods to establish the correct preoperative diagnosis. Findings at CT, sonography, MR imaging, and surgery are discussed. (orig.)

  1. Distinction between neoplastic and radiation-induced brachial plexopathy, with emphasis on the role of EMG

    The results of clinical, radiologic, and electrophysiologic studies are retrospectively reviewed for 55 patients with neoplastic and 35 patients with radiation-induced brachial plexopathy. The presence or absence of pain as the presenting symptom, temporal profile of the illness, presence of a discrete mass on CT of the plexus, and presence of myokymic discharges on EMG contributed significantly to the prediction of the underlying cause of the brachial plexopathy. The distribution of weakness and the results of nerve conduction studies were of no help in distinguishing neoplastic from radiation-induced brachial plexopathy

  2. Neurolymphomatosis of Brachial Plexus in Patients with Non-Hodgkin's Lymphoma

    Yong Jun Choi; Shin, Jung A; Yong Hoon Kim; Soon Joo Cha; Joong-Yang Cho; Seung Hee Kang; Seong Yoon Yi; Hye Ran Lee

    2013-01-01

    Neurolymphomatosis (NL) is a rare clinical disease where neoplastic cells invade the cranial nerves and peripheral nerve roots, plexus, or other nerves in patients with hematologic malignancy. Most NL cases are caused by B-cell non-Hodgkin's lymphoma (NHL). Diagnosis can be made by imaging with positron emission tomography (PET) and magnetic resonance imaging (MRI). We experienced two cases of NL involving the brachial plexus in patients with NHL. One patient, who had NHL with central nervous...

  3. Management of Brachial Plexus Injuries

    J Gordon Millichap

    2005-01-01

    The results of early neurosurgical treatment of 58 infants with various types of brachial plexus birth injury have been compared with non-surgical intervention in 91 patients followed by a multidisciplinary team at the Brachial Plexus Program, Miami Children’s Hospital, FL.

  4. Neurolymphomatosis of Brachial Plexus in Patients with Non-Hodgkin's Lymphoma

    Yong Jun Choi

    2013-01-01

    Full Text Available Neurolymphomatosis (NL is a rare clinical disease where neoplastic cells invade the cranial nerves and peripheral nerve roots, plexus, or other nerves in patients with hematologic malignancy. Most NL cases are caused by B-cell non-Hodgkin’s lymphoma (NHL. Diagnosis can be made by imaging with positron emission tomography (PET and magnetic resonance imaging (MRI. We experienced two cases of NL involving the brachial plexus in patients with NHL. One patient, who had NHL with central nervous system (CNS involvement, experienced complete remission after 8 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy but relapsed into NL of the brachial plexus 5 months later. The other patient, who suffered from primary central nervous system lymphoma (PCNSL, had been undergoing chemoradiotherapy but progressed to NL of the brachial plexus.

  5. Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome

    Leandro Pretto Flores

    2011-08-01

    Full Text Available OBJECTIVE: The study aims to demonstrate the techniques employed in surgery of the brachial plexus that are associated to evidence-based improvement of the functional outcome of these patients. METHOD: A retrospective study of one hundred cases of traumatic brachial plexus injuries. Comparison between the postoperative outcomes associated to some different surgical techniques was demonstrated. RESULTS: The technique of proximal nerve roots grafting was associated to good results in about 70% of the cases. Significantly better outcomes were associated to the Oberlin's procedure and the Sansak's procedure, while the improvement of outcomes associated to phrenic to musculocutaneous nerve and the accessory to suprascapular nerve transfer did not reach statistical significance. Reinnervation of the hand was observed in less than 30% of the cases. CONCLUSION: Brachial plexus surgery renders satisfactory results for reinnervation of the proximal musculature of the upper limb, however the same good outcomes are not usually associated to the reinnervation of the hand.

  6. Origem e distribuição do plexo braquial de Saimiri sciureus Origin and distribution of the brachial plexus of Saimiri sciureus

    Elenara B. Araújo

    2012-12-01

    Full Text Available Os autores descreveram a origem e composição do plexo braquial de quatro Saimiri sciureus, pertencentes ao Centro Nacional de Primatas (Cenp, Ananindeua/PA, os quais foram fixados com formaldeído e dissecados. Os achados revelaram que o plexo braquial desta espécie é constituído por fibras neurais provenientes da união das raízes dorsais e ventrais das vértebras cervicais C4 a C8 e torácica T1, e organizado em quatro troncos. Cada tronco formou um nervo ou um grupo de nervos, cuja origem variou entre os animais; na maioria, foi encontrado o tronco cranial originando o nervo subclávio, o tronco médio-cranial dando origem aos nervos supraescapular, subescapular, parte do radial, e em alguns casos ao nervo axilar, nervo musculocutâneo e ao nervo mediano; o tronco médio-caudal formou parte do nervo radial, e em alguns casos os nervos axilar, nervo musculocutâneo, nervo mediano, nervo toracodorsal, nervo ulnar e nervo cutâneo medial do antebraço, sendo os dois últimos também originados no tronco caudal.The authors described the origin and composition of the brachial plexus of four Saimiri sciureus, from the National Primate Center (Cenp, Ananindeua/PA, which were fixed with formaldehyde and dissected. Findings revealed that the brachial plexus of this species is composed by nervous fibers from the roots of cervical vertebrae C4 to C8 and thoracic vertebrae T1, and organized into four branchs. Each branch has formed a nerve or a group of nerves, the origin was varied between animals, mostly were found the cranial trunk originate the subclavian nerve; the medium-cranial originate the suprascapular, subscapular, part of radial and in some cases the axillary, musculocutaneous and median nerves; the medium-caudal trunk originate part of radial nerve and in some cases the axillary, musculocutaneous, median, thoracodorsal, ulnar and medial cutaneous of forearm nerves, the last two nerves also originate from the caudal trunk.

  7. Cutaneous Sarcoidosis

    Rupali Bargotra , Jyotsna Suri, Yudhvir Gupta

    2010-07-01

    Full Text Available We present a case of exclusive cutaneous sarcoidosis with no clinical or radiological evidence of diseaseanywhere else in the body.Exclusive cutaneous involvement is rare and is reported in about 4.5%patientsof sarcoidosis.

  8. Adult traumatic brachial plexus injury

    Rankine, J.J. E-mail: james.rankine@leedsth.nhs.uk

    2004-09-01

    Injury to the brachial plexus in the adult is usually a closed injury and the result of considerable traction to the shoulder. Brachial plexus injury in the adult is an increasingly common clinical problem. Recent advances in neurosurgical techniques have improved the outlook for patients with brachial plexus injuries. The choice of surgical procedure depends on the level of the injury and the radiologist has an important role in guiding the surgeon to the site of injury. This article will describe the anatomy and pathophysiology of traction brachial plexus injury in the adult. The neurosurgical options available will be described with emphasis on the information that the surgeon wants from imaging studies of the brachial plexus. The relative merits of MRI and CT myelography are discussed.

  9. Adult traumatic brachial plexus injury

    Injury to the brachial plexus in the adult is usually a closed injury and the result of considerable traction to the shoulder. Brachial plexus injury in the adult is an increasingly common clinical problem. Recent advances in neurosurgical techniques have improved the outlook for patients with brachial plexus injuries. The choice of surgical procedure depends on the level of the injury and the radiologist has an important role in guiding the surgeon to the site of injury. This article will describe the anatomy and pathophysiology of traction brachial plexus injury in the adult. The neurosurgical options available will be described with emphasis on the information that the surgeon wants from imaging studies of the brachial plexus. The relative merits of MRI and CT myelography are discussed

  10. Origins and branchings of the brachial plexus of the gray brocket deer Mazama gouazoubira (Artiodactyla: Cervidae

    Lucélia Gonçalves Vieira

    2013-03-01

    Full Text Available The brachial plexus is a set of nerves originated in the cervicothoracic medular region which innervates the thoracic limb and its surroundings. Its study in different species is important not only as a source of morphological knowledge, but also because it facilitates the diagnosis of neuromuscular disorders resulting from various pathologies. This study aimed to describe the origins and branchings of the brachial plexus of Mazama gouazoubira. Three specimens were used, belonging to the scientific collection of the Laboratory for Teaching and Research on Wild Animals of Universidade Federal de Uberlandia (UFU; they were fixed in 3.7% formaldehyde and dissected. In M. gouazoubira, the brachial plexus resulted from connections between the branches of the three last cervical spinal nerves, C6, C7, C8, and the first thoracic one, T1, and it had as derivations the nerves suprascapular, cranial and caudal subscapular, axillary, musculocutaneous, median, ulnar, radial, pectoral, thoracodorsal, long thoracic and lateral thoracic. The muscles innervated by the brachial plexus nerves were the supraspinatus, infraspinatus, subscapularis, teres major, teres minor, deltoid, cleidobrachial, coracobrachialis, biceps brachialis, brachial, triceps brachialis, anconeus, flexor digitorum superficialis, flexor digitorum profundus, flexor carpi radialis, flexor carpi ulnaris, extensor carpi radialis, lateral ulnar, extensor carpi obliquus, extensor digitorum, superficial pectoral, deep pectoral, ventral serratus, and external oblique abdominal.

  11. Cervical myelographic findings of brachial plexus injury by trauma

    Authors reviewed 50 cases of cervical myelography during 4 years and 5 months, from February, 1985 to July, 1989 at Department of Radiography, Wonkwang University Hospital to analyse myelographic findings of traumatic brachial plexus injury with symptoms and signs and to discuss literature. The results were as follows: 1. Brachial plexus injury was predominant in male and the incidence was 50% in 3rd decade of the males. 2. Among the 50 patients, 11 were the peripheral type, which had symptoms but normal findings in cervical myelography and 39 were the central type, which were definitely abnormal findings in cervical myelography. 3. Cervical myelographic findings in the central type were divided into 5 groups. (all 39 cases) a. Obliteration of nerve root filling defect 39(cases) b. Pseudomeningocele. 32(cases) c. Narrowing of ipsilateral subarachnoid space 31(cases) d. Diverticulum. 4 (cases) e. Tracking of dye down the axillary sheath 1 (cases) 4. The most large numbers of pseudomeningoceles in cervical myelography were shown for two and in each case, the most multiple developing numbers of pseudomeningoceles were identified for four, that happened in one case. 5. In brachial plexus injury, there were two the most large involving numbers among the nerve roots, and in each involving nerve root, C7 was most common

  12. Cutaneous mechanisms of isometric ankle force control

    Choi, Julia T; Jensen, Jesper Lundbye; Leukel, Christian;

    2013-01-01

    cutaneous sensory function as evidenced by increased touch threshold. Absolute dorsiflexion force error increased without visual feedback during peroneal nerve stimulation. This was not a general effect of stimulation because force error did not increase during plantar nerve stimulation. The effects...... joint. Understanding how the nervous system normally uses cutaneous feedback in motor control will help us identify which functional aspects are impaired in aging and neurological diseases....

  13. Diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury

    Medina, L.S. [Miami Children' s Hospital, Division of Neuroradiology, Department of Radiology, Brain Institute, Health Outcomes, Policy, and Economics (HOPE) Center, Miami, FL (United States); Miami Children' s Hospital, Department of Radiology, Miami, FL (United States); Yaylali, Ilker [Miami Children' s Hospital, Brachial Plexus and Peripheral Nerve Surgery Program, Miami, FL (United States); Zurakowski, David [Harvard Medical School, Boston Children' s Hospital, Boston, MA (United States); Ruiz, Jennifer; Altman, Nolan R. [Miami Children' s Hospital, Division of Neuroradiology, Department of Radiology, Brain Institute, Health Outcomes, Policy, and Economics (HOPE) Center, Miami, FL (United States); Grossman, John A.I. [Miami Children' s Hospital, Brachial Plexus and Peripheral Nerve Surgery Program, Miami, FL (United States); New York University, Hospital for Joint Disease, New York, NY (United States)

    2006-12-15

    Detailed evaluation of a brachial plexus birth injury is important for treatment planning. To determine the diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury. Included in the study were 31 children with perinatal brachial plexus injury who underwent surgical intervention. All patients had cervical and brachial plexus MRI. The standard of reference was the combination of intraoperative (1) surgical evaluation and (2) electrophysiological studies (motor evoked potentials, MEP, and somatosensory evoked potentials, SSEP), and (3) the evaluation of histopathological neuronal loss. MRI findings of cord lesion, pseudomeningocele, and post-traumatic neuroma were correlated with the standard of reference. Diagnostic performance characteristics including sensitivity and specificity were determined. From June 2001 to March 2004, 31 children (mean age 7.3 months, standard deviation 1.6 months, range 4.8-12.1 months; 19 male, 12 female) with a brachial plexus birth injury who underwent surgical intervention were enrolled. Sensitivity and specificity of an MRI finding of post-traumatic neuroma were 97% (30/31) and 100% (31/31), respectively, using the contralateral normal brachial plexus as the control. However, MRI could not determine the exact anatomic area (i.e. trunk or division) of the post-traumatic brachial plexus neuroma injury. Sensitivity and specificity for an MRI finding of pseudomeningocele in determining exiting nerve injury were 50% and 100%, respectively, using MEP, and 44% and 80%, respectively, using SSEP as the standard of reference. MRI in infants could not image well the exiting nerve roots to determine consistently the presence or absence of definite avulsion. In children younger than 18 months with brachial plexus injury, the MRI finding of pseudomeningocele has a low sensitivity and a high specificity for nerve root avulsion. MRI and MR myelography cannot image well the exiting nerve roots to determine

  14. Diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury

    Detailed evaluation of a brachial plexus birth injury is important for treatment planning. To determine the diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury. Included in the study were 31 children with perinatal brachial plexus injury who underwent surgical intervention. All patients had cervical and brachial plexus MRI. The standard of reference was the combination of intraoperative (1) surgical evaluation and (2) electrophysiological studies (motor evoked potentials, MEP, and somatosensory evoked potentials, SSEP), and (3) the evaluation of histopathological neuronal loss. MRI findings of cord lesion, pseudomeningocele, and post-traumatic neuroma were correlated with the standard of reference. Diagnostic performance characteristics including sensitivity and specificity were determined. From June 2001 to March 2004, 31 children (mean age 7.3 months, standard deviation 1.6 months, range 4.8-12.1 months; 19 male, 12 female) with a brachial plexus birth injury who underwent surgical intervention were enrolled. Sensitivity and specificity of an MRI finding of post-traumatic neuroma were 97% (30/31) and 100% (31/31), respectively, using the contralateral normal brachial plexus as the control. However, MRI could not determine the exact anatomic area (i.e. trunk or division) of the post-traumatic brachial plexus neuroma injury. Sensitivity and specificity for an MRI finding of pseudomeningocele in determining exiting nerve injury were 50% and 100%, respectively, using MEP, and 44% and 80%, respectively, using SSEP as the standard of reference. MRI in infants could not image well the exiting nerve roots to determine consistently the presence or absence of definite avulsion. In children younger than 18 months with brachial plexus injury, the MRI finding of pseudomeningocele has a low sensitivity and a high specificity for nerve root avulsion. MRI and MR myelography cannot image well the exiting nerve roots to determine

  15. Diffusion-weighted MR neurography of the brachial and lumbosacral plexus: 3.0 T versus 1.5 T imaging

    Highlights: •DW MRN of brachial and lumbosacral plexus at 1.5 T and at 3.0 T was compared. •For lumbosacral plexus, nerve conspicuity on MIP images was superior at 3.0 T, also visible length and mean sharpness of the nerves. •For brachial plexus, nerve conspicuity at 3.0 T was rather inferior, nerve length was not significantly different, mean sharpness was superior at 3.0 T. -- Abstract: Purpose: To compare intraindividually the nerve conspicuity of the brachial and lumbosacral plexus on diffusion-weighted (DW) MR neurography (MRN) at two different field strengths. Materials and methods: 16 healthy volunteers were investigated at 3.0 T and 1.5 T applying optimized variants of a DW spin-echo echo-planar imaging sequence with short TI inversion recovery fat suppression. Full-volume (FV) and curved sub-volume (CSV) maximum intensity projection (MIP) images were reconstructed and nerve conspicuity was visually assessed. Moreover, visible length and sharpness of the nerves were quantitatively analyzed. Results: On FV MIP images, nerve conspicuity at 3.0 T compared to 1.5 T was worse for brachial plexus (P = 0.00228), but better for lumbosacral plexus (P = 0.00666). On CSV MIP images, nerve conspicuity did not differ significantly for brachial plexus, but was better at 3.0 T for lumbosacral plexus (P = 0.00091). The visible length of the analyzed nerves did not differ significantly with the exception of some lumbosacral nerves, which were significantly longer at 3.0 T. The sharpness of all investigated nerves was significantly higher at 3.0 T by about 40–60% for cervical and 97–169% for lumbosacral nerves. Conclusion: DW MRN imaging at 3.0 T compared to 1.5 T is superior for lumbosacral plexus, but not for brachial plexus

  16. Diffusion-weighted MR neurography of the brachial and lumbosacral plexus: 3.0 T versus 1.5 T imaging

    Mürtz, P., E-mail: petra.muertz@ukb.uni-bonn.de [Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany); Kaschner, M., E-mail: Marius.Kaschner@med.uni-duesseldorf.de [Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany); Lakghomi, A., E-mail: Asadeh.Lakghomi@ukb.uni-bonn.de [Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany); Gieseke, J., E-mail: juergen.gieseke@ukb.uni-bonn.de [Philips Healthcare, Lübeckertordamm 5, 20099 Hamburg (Germany); Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany); Willinek, W.A., E-mail: winfried.willinek@ukb.uni-bonn.de [Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany); Schild, H.H., E-mail: hans.schild@ukb.uni-bonn.de [Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany); Thomas, D., E-mail: daniel.thomas@ukb.uni-bonn.de [Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany)

    2015-04-15

    Highlights: •DW MRN of brachial and lumbosacral plexus at 1.5 T and at 3.0 T was compared. •For lumbosacral plexus, nerve conspicuity on MIP images was superior at 3.0 T, also visible length and mean sharpness of the nerves. •For brachial plexus, nerve conspicuity at 3.0 T was rather inferior, nerve length was not significantly different, mean sharpness was superior at 3.0 T. -- Abstract: Purpose: To compare intraindividually the nerve conspicuity of the brachial and lumbosacral plexus on diffusion-weighted (DW) MR neurography (MRN) at two different field strengths. Materials and methods: 16 healthy volunteers were investigated at 3.0 T and 1.5 T applying optimized variants of a DW spin-echo echo-planar imaging sequence with short TI inversion recovery fat suppression. Full-volume (FV) and curved sub-volume (CSV) maximum intensity projection (MIP) images were reconstructed and nerve conspicuity was visually assessed. Moreover, visible length and sharpness of the nerves were quantitatively analyzed. Results: On FV MIP images, nerve conspicuity at 3.0 T compared to 1.5 T was worse for brachial plexus (P = 0.00228), but better for lumbosacral plexus (P = 0.00666). On CSV MIP images, nerve conspicuity did not differ significantly for brachial plexus, but was better at 3.0 T for lumbosacral plexus (P = 0.00091). The visible length of the analyzed nerves did not differ significantly with the exception of some lumbosacral nerves, which were significantly longer at 3.0 T. The sharpness of all investigated nerves was significantly higher at 3.0 T by about 40–60% for cervical and 97–169% for lumbosacral nerves. Conclusion: DW MRN imaging at 3.0 T compared to 1.5 T is superior for lumbosacral plexus, but not for brachial plexus.

  17. Restoration and protection of brachial plexus injur y:hot topics in the last decade

    Kaizhi Zhang; Zheng Lv; Jun Liu; He Zhu; Rui Li

    2014-01-01

    Brachial plexus injury is frequently induced by injuries, accidents or birth trauma. Upper limb function may be partially or totally lost after injury, or left permanently disabled. With the de-velopment of various medical technologies, different types of interventions are used, but their effectiveness is wide ranging. Many repair methods have phasic characteristics, i.e., repairs are done in different phases. This study explored research progress and hot topic methods for pro-tection after brachial plexus injury, by analyzing 1,797 articles concerning the repair of brachial plexus injuries, published between 2004 and 2013 and indexed by the Science Citation Index database. Results revealed that there are many methods used to repair brachial plexus injury, and their effects are varied. Intervention methods include nerve transfer surgery, electrical stimula-tion, cell transplantation, neurotrophic factor therapy and drug treatment. Therapeutic methods in this ifeld change according to the hot topic of research.

  18. MRI of the brachial plexus and its region: anatomy and pathology

    Magnetic resonance imaging (MRI) of the brachial plexus and its region has become the imaging modality of choice, due to its multiplanar capabilities and inherent contrast differences between the brachial plexus, related vessels, and surrounding fat. A total of 41 patients with clinically suspected brachial plexus pathology or tumors in its region were studied. A normal anatomy was found in 12 patients. Pathologic entities included: traumatic nerve-root avulsion (n = 2), hematoma (n = 1), postoperative changes after scalenotomy (n = 2), primary tumor of the brachial plexus (n = 2), primary (n = 8) and metastatic (n = 1) tumors in the superior sulcus, primary (n = 5) and metastatic (n = 4) tumors in the axillary, supra- or infraclavicular region, and changes after nodal dissection and radiation therapy for breast carcinoma (n = 5; 1 patient also had had a prior scalenotomy). There was a positive correlation with surgery in 11 patients, and a negative correlation in 1 patient. (orig.)

  19. MRI of the brachial plexus and its region: anatomy and pathology

    Wouter van Es, H. [Dept. of Radiology, University Hospital, Utrecht (Netherlands); Witkamp, T.D. [Dept. of Radiology, University Hospital, Utrecht (Netherlands); Feldberg, M.A.M. [Dept. of Radiology, University Hospital, Utrecht (Netherlands)

    1995-08-01

    Magnetic resonance imaging (MRI) of the brachial plexus and its region has become the imaging modality of choice, due to its multiplanar capabilities and inherent contrast differences between the brachial plexus, related vessels, and surrounding fat. A total of 41 patients with clinically suspected brachial plexus pathology or tumors in its region were studied. A normal anatomy was found in 12 patients. Pathologic entities included: traumatic nerve-root avulsion (n = 2), hematoma (n = 1), postoperative changes after scalenotomy (n = 2), primary tumor of the brachial plexus (n = 2), primary (n = 8) and metastatic (n = 1) tumors in the superior sulcus, primary (n = 5) and metastatic (n = 4) tumors in the axillary, supra- or infraclavicular region, and changes after nodal dissection and radiation therapy for breast carcinoma (n = 5; 1 patient also had had a prior scalenotomy). There was a positive correlation with surgery in 11 patients, and a negative correlation in 1 patient. (orig.)

  20. Brachial plexus injury in newborns

    ... and vascular disorders. In: Fenichel GM, ed. Neonatal Neurology . 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2006: ... CB, Kratz JR, Jelin AC, Gelfand AA. Child neurology: brachial plexus birth injury: what every neurologist needs ...

  1. MRI of the brachial plexus

    Es, H.W. van [Dept. of Radiology, St. Antonius Ziekenhuis, Nieuwegein (Netherlands)

    2001-02-01

    Magnetic resonance imaging is the imaging method of first choice for evaluating the anatomy and pathology of the brachial plexus. This review discusses the used imaging techniques, the normal anatomy, and a variety of pathologies that can involve the brachial plexus. The pathology includes primary and secondary tumors (the most frequent secondary tumors being superior sulcus tumor and metastatic breast carcinoma), radiation plexopathy, trauma, thoracic outlet syndrome, neuralgic amyotrophy, chronic inflammatory demyelinating polyneuropathy (CIDP), and multifocal motor neuropathy (MMN). (orig.)

  2. MRI of the brachial plexus

    Magnetic resonance imaging is the imaging method of first choice for evaluating the anatomy and pathology of the brachial plexus. This review discusses the used imaging techniques, the normal anatomy, and a variety of pathologies that can involve the brachial plexus. The pathology includes primary and secondary tumors (the most frequent secondary tumors being superior sulcus tumor and metastatic breast carcinoma), radiation plexopathy, trauma, thoracic outlet syndrome, neuralgic amyotrophy, chronic inflammatory demyelinating polyneuropathy (CIDP), and multifocal motor neuropathy (MMN). (orig.)

  3. A novel technique of ultrasound-guided brachial plexus block in calves.

    Iwamoto, Jiro; Yamagishi, Norio; Sasaki, Kouya; Kim, Danil; Devkota, Bhuminand; Furuhama, Kazuhisa

    2012-12-01

    An interventional ultrasound technique to increase the safety of surgical treatment of the calf forelimb was tested. First, the brachial plexus was evaluated using ultrasonography and then 2% lidocaine was injected under ultrasound guidance. Ultrasonically, the brachial plexus appeared as multiple hypoechoic areas surrounded by a hyperechoic rim or a hyperechoic structure characterised by multiple discontinuous lines. It was located between the omotransverse muscle and axillary artery and vein. The sensitive effect in the forelimb was seen mainly in the area supplied by the musculocutaneous nerve, indicating successful blockage in the nerve plexus. Out of the eight forelimbs, the motor effect was observed in seven forelimbs. These results suggest the clinical feasibility of ultrasound-guided brachial plexus block in bovine medicine, although further studies are needed to examine various approaches, including the sites of needle insertion and the appropriate volume and dosage of anaesthetic. PMID:22682007

  4. Prolonged hemidiaphragmatic paresis following continuous interscalene brachial plexus block: A case report.

    Shinn, Helen Ki; Kim, Byung-Gun; Jung, Jong Kwon; Kwon, Hee Uk; Yang, Chunwoo; Won, Jonghun

    2016-06-01

    Interscalene brachial plexus block provides effective anesthesia and analgesia for shoulder surgery. One of the disadvantages of this technique is the risk of hemidiaphragmatic paresis, which can occur as a result of phrenic nerve block and can cause a decrease in the pulmonary function, limiting the use of the block in patients with reduced functional residual capacity or a preexisting pulmonary disease. However, it is generally transient and is resolved over the duration of the local anesthetic's action.We present a case of a patient who experienced prolonged hemidiaphragmatic paresis following a continuous interscalene brachial plexus block for the postoperative pain management of shoulder surgery, and suggest a mechanism that may have led to this adverse effect.Nerve injuries associated with peripheral nerve blocks may be caused by several mechanisms. Our findings suggest that perioperative nerve injuries can occur as a result of combined mechanical and chemical injuries. PMID:27310984

  5. COMMUNICATION BETWEEN RADIAL AND ULNAR NERVE AT A HIGH HUMERAL LEVEL

    Monika Lalit; Jagdev Singh Kullar; Sanjay Piplani

    2014-01-01

    Various communications between the different branches of brachial plexus have been reported by many authors but the communication between the radial and ulnar nerve; the branches of posterior and medial cords of brachial plexus in the arm is very rare. It features the communicating ramus travelling from proximal radial nerve and distal ulnar nerve at a high humeral level in the right arm of a 56 year old male cadaver. Knowledge of such variations may be of importance in the evalua...

  6. Technical note: the humeral canal approach to the brachial plexus.

    Frizelle, H P

    2012-02-03

    Many variations to the axillary approach to the brachial plexus have been described. However, the success rate varies depending on the approach used and on the definition of success. Recent work describes a new approach to regional anaesthesia of the upper limb at the humeral\\/brachial canal using selective stimulation of the major nerves. This report outlines initial experience with this block, describing the technique and results in 50 patients undergoing hand and forearm surgery. All patients were assessed for completeness of motor and sensory block. The overall success rate was 90 percent. Motor block was present in 80 percent of patients. Completion of the block was necessary in 5 patients. Two patients required general anaesthesia. The preponderance of ulnar deficiencies agrees with previously published data on this technique. No complications were described. Initial experience confirms the high success rate described using the Dupre technique. This technically straightforward approach with minimal complications can be recommended for regional anaesthesia of the upper limb.

  7. Magnetic resonance neurography in children with birth-related brachial plexus injury

    Smith, Alice B. [University of California, San Francisco, Department of Neuroradiology, San Francisco, CA (United States); University of California, San Francisco, Department of Radiology, Box 0628, San Francisco, CA (United States); Gupta, Nalin [University of California, San Francisco, Department of Neurosurgery, San Francisco, CA (United States); Strober, Jonathan [University of California, San Francisco, Department of Pediatric Neurology, San Francisco, CA (United States); Chin, Cynthia [University of California, San Francisco, Department of Neuroradiology, San Francisco, CA (United States)

    2008-02-15

    Magnetic resonance neurography (MRN) enables visualization of peripheral nerves. Clinical examination and electrodiagnostic studies have been used in the evaluation of birth-related brachial plexus injury. These are limited in their demonstration of anatomic detail and severity of injury. We investigated the utility of MRN in evaluating birth-related brachial plexus injury in pediatric patients, and assessed the degree of correlation between MRN findings and physical examination and electromyographic (EMG) findings. The MRN findings in 11 infants (age 2 months to 20 months) with birth-related brachial plexus injury were evaluated. A neuroradiologist blinded to the EMG and clinical examination findings reviewed the images. Clinical history, examination, EMG and operative findings were obtained. All infants had abnormal imaging findings on the affected side: seven pseudomeningoceles, six neuromas, seven abnormal nerve T2 signal, four nerve root enlargement, and two denervation changes. There was greater degree of correlation between MRN and physical examination findings (kappa 0.6715, coefficient of correlation 0.7110, P < 0.001) than between EMG and physical examination findings (kappa 0.5748, coefficient of correlation 0.5883, P = 0.0012). MRN in brachial plexus trauma enables localization of injured nerves and characterization of associated pathology. MRN findings demonstrated a statistically significant correlation with physical examination and EMG findings, and might be a useful adjunct in treatment planning. (orig.)

  8. Magnetic resonance neurography in children with birth-related brachial plexus injury

    Magnetic resonance neurography (MRN) enables visualization of peripheral nerves. Clinical examination and electrodiagnostic studies have been used in the evaluation of birth-related brachial plexus injury. These are limited in their demonstration of anatomic detail and severity of injury. We investigated the utility of MRN in evaluating birth-related brachial plexus injury in pediatric patients, and assessed the degree of correlation between MRN findings and physical examination and electromyographic (EMG) findings. The MRN findings in 11 infants (age 2 months to 20 months) with birth-related brachial plexus injury were evaluated. A neuroradiologist blinded to the EMG and clinical examination findings reviewed the images. Clinical history, examination, EMG and operative findings were obtained. All infants had abnormal imaging findings on the affected side: seven pseudomeningoceles, six neuromas, seven abnormal nerve T2 signal, four nerve root enlargement, and two denervation changes. There was greater degree of correlation between MRN and physical examination findings (kappa 0.6715, coefficient of correlation 0.7110, P < 0.001) than between EMG and physical examination findings (kappa 0.5748, coefficient of correlation 0.5883, P = 0.0012). MRN in brachial plexus trauma enables localization of injured nerves and characterization of associated pathology. MRN findings demonstrated a statistically significant correlation with physical examination and EMG findings, and might be a useful adjunct in treatment planning. (orig.)

  9. An unusual ulnar nerve-median nerve communicating branch.

    Hoogbergen, M M; Kauer, J M

    1992-01-01

    Branching of the ulnar nerve distal to the origin of the dorsal cutaneous branch was investigated in 25 hands in one of which an anatomical variation was observed. This finding may be of importance in the evaluation of certain entrapment phenomena of the ulnar nerve or unexplained sensory loss after trauma or surgical intervention in that particular area.

  10. Ultrasound-Guided Peripheral Nerve Procedures.

    Strakowski, Jeffrey A

    2016-08-01

    Ultrasound guidance allows real-time visualization of the needle in peripheral nerve procedures, improving accuracy and safety. Sonographic visualization of the peripheral nerve and surrounding anatomy can provide valuable information for diagnostic purposes and procedure enhancement. Common procedures discussed are the suprascapular nerve at the suprascapular notch, deep branch of the radial nerve at the supinator, median nerve at the pronator teres and carpal tunnel, lateral cutaneous nerve of the thigh, superficial fibular nerve at the leg, tibial nerve at the ankle, and interdigital neuroma. For each procedure, the indications, relevant anatomy, preprocedural scanning technique, and injection procedure itself are detailed. PMID:27468673

  11. Ankle Brachial Index

    Wikstroem, J.; Hansen, T.; Johansson, L.; Lind, L.; Ahlstroem, H. (Dept. of Radiology and Dept. of Medical Sciences, Uppsala Univ. Hospital, Uppsala (SE))

    2008-03-15

    Background: Whole-body magnetic resonance angiography (WBMRA) permits noninvasive vascular assessment, which can be utilized in epidemiological studies. Purpose: To assess the relation between a low ankle brachial index (ABI) and high-grade stenoses in the pelvic and leg arteries in the elderly. Material and Methods: WBMRA was performed in a population sample of 306 subjects aged 70 years. The arteries below the aortic bifurcation were graded after the most severe stenosis according to one of three grades: 0-49% stenosis, 50-99% stenosis, or occlusion. ABI was calculated for each side. Results: There were assessable WBMRA and ABI examinations in 268 (right side), 265 (left side), and 258 cases (both sides). At least one >=50% stenosis was found in 19% (right side), 23% (left side), and 28% (on at least one side) of the cases. The corresponding prevalences for ABI <0.9 were 4.5%, 4.2%, and 6.6%. An ABI cut-off value of 0.9 resulted in a sensitivity, specificity, and positive and negative predictive value of 20%, 99%, 83%, and 84% on the right side, and 15%, 99%, 82%, and 80% on the left side, respectively, for the presence of a >= 50% stenosis in the pelvic or leg arteries. Conclusion: An ABI <0.9 underestimates the prevalence of peripheral arterial occlusive disease in the general elderly population

  12. Enhancement of Median Nerve Regeneration by Mesenchymal Stem Cells Engraftment in an Absorbable Conduit: Improvement of Peripheral Nerve Morphology with Enlargement of Somatosensory Cortical Representation.

    Julia Teixeira Oliveira

    2014-10-01

    Full Text Available We studied the morphology and the cortical representation of the median nerve (MN, 10 weeks after a transection immediately followed by treatment with tubulization using a polycaprolactone (PCL conduit with or without bone marrow-derived mesenchymal stem cell (MSC transplant. In order to characterize the cutaneous representation of MN inputs in primary somatosensory cortex (S1, electrophysiological cortical mapping of the somatosensory representation of the forepaw and adjacent body parts was performed after acute lesion of all brachial plexus nerves, except for the MN. This was performed in ten adult male Wistar rats randomly assigned in 3 groups: MN Intact (n=4, PCL-Only (n=3 and PCL+MSC (n=3. Ten weeks before mapping procedures in animals from PCL-Only and PCL+MSC groups, animal were subjected to MN transection with removal of a 4-mm-long segment, immediately followed by suturing a PCL conduit to the nerve stumps with (PCL+MSC group or without (PCL-Only group injection of MSC into the conduit. After mapping the representation of the MN in S1, animals had a segment of the regenerated nerve processed for light and transmission electron microscopy. For histomorphometric analysis of the nerve segment, sample size was increased to 5 animals per experimental group. The PCL+MSC group presented a higher number of myelinated fibers and a larger cortical representation of MN inputs in S1 (3,383±390 fibers; 2.3 mm2, respectively than the PCL-Only group (2,226±575 fibers; 1.6 mm2. In conclusion, MSC-based therapy associated with PCL conduits can improve MN regeneration. This treatment seems to rescue the nerve representation in S1, thus minimizing the stabilization of new representations of adjacent body parts in regions previously responsive to the MN.

  13. Clinical application of first dorsal metacarpal artery radial cutaneous branch and superficial radial nerve flap%第一掌骨背动脉桡侧皮支蒂桡神经浅支皮瓣的临床应用

    沈小芳; 芮永军; 许亚军; 糜菁熠; 赵刚

    2012-01-01

    目的 介绍应用第一掌骨背动脉桡侧皮支蒂桡神经浅支皮瓣修复拇指软组织缺损的体会.方法 2006年6月至2009年8月,对9例拇指桡侧软组织缺损患者,应用以第一掌骨背动脉桡侧皮支为轴心血管并携带桡神经浅支皮瓣进行修复,切取面积4.0 cm×2.0cm~7.0 cm× 3.5 cm.结果 术后9例皮瓣全部存活,6例获得随访,3例失访,随访时间为11~34个月.皮瓣质地良好,感觉恢复至S2~S3+,供区植皮愈合良好,轻度色素沉着,无痛性神经瘤发生.结论 第一掌骨背动脉桡侧皮支蒂桡神经浅支皮瓣血供可靠,成活率高,方法简单,可修复拇指全指腹缺损,是修复拇指软组织缺损的方法之一.%Objective To explore the clinical outcomes of applying first dorsal metacarpal artery radial cutaneous branch and superficial radial nerve flap to repair soft tissue defects of the thumb. Methods Nine cases of soft tissue defects in the thumb were treated from June 2006 to August 2009 with a flap using the first dorsal metacarpal artery radial cutaneous branch as the axial vessel and including the superficial radial nerve.The size of the raised flaps ranged from 4.0 cm× 2.0 cm to 7.0 cm× 3.5 cm. Results All the flaps survived after the surgery.Follow-up time ranged from 11 to 34 months in 6 cases.Three cases were lost to follow-up.The flaps had good texture.Protective sensation was restored from S2 to S3 +.The donor site skin graft healed well with slight pigmentation.There were on painful neuroma in these 6 cases. Conclusion First dorsal metacarpal artery radial cutaneous branch and superficial radial nerve flap has a high survival rate and reliable blood supply.It is easy to operate and can cover large defects.This flap is an ideal flap for repair of soft tissue defects in the thumb.

  14. Significance of magnetic resonance imaging in differential diagnosis of nontraumatic brachial plexopathy

    Perić Stojan

    2011-01-01

    Full Text Available Background/Aim. Nontraumatic brachial plexopathies may be caused by primary or secondary tumors, radiation or inflammation. The aim of this study was to present the significance of MRI in revealing the cause of nontraumatic brachial plexopathy. Methods. A two-year retrospective study included 22 patients with nontraumatic brachial plexopathy. In all the patients typical clinical findings were confirmed by upper limb neurophysiological studies. In all of them MRI of brachial plexus was performed by 1.5 T scanner in T1 and T1 FS sequence with and without contrast, as well as in T2 and T2 FS sequences. Results. Seven (32% patients had brachial plexopathy with signs of inflammatory process, 5 (23% patients had secondary tumors, in 4 (18% patients multifocal motor neuropathy was established and in the same number (18% of the patients postradiation fibrosis was found. Two patients (9% had primary neurogenic tumors. Conclusion. According to the results of this study MRI is a method which may determine localization and cause of brachial plexopathy. MRI can detect focal nerve lesions when other methods fail to find them. Thus, MRI has a direct impact on further diagnostic and therapeutical procedures.

  15. True aneurysm of brachial artery.

    Hudorović, Narcis; Lovričević, Ivo; Franjić, Dario Bjorn; Brkić, Petar; Tomas, Davor

    2010-10-01

    True upper extremity peripheral artery aneurysms are a rarely encountered arterial disorder. Following computer-tomography angiographic (CT-a) imaging examination, true saccular aneurysm, originating from the left brachial artery was diagnosed in the 77-year-old female without history of trauma. The aneurysm was resected by surgical intervention, and primary repair of the brachial artery was performed by interposition of a part of great saphenous vein harvested from the left groin and creation of two end-to-end anastomoses between interposition graft and previously resected part of brachial artery. No complication was observed during the follow-up. Surgical intervention for upper extremity aneurysms should be initiated without delay. Factors combined with minimal morbidity associated with repair suggest that surgical repair should be performed routinely for true upper extremity arterial aneurysms. PMID:20865459

  16. Avulsão do plexo braquial em cães - 3: eletroneuroestimulação dos nervos radial, mediano, ulnar e musculocutâneo Brachial plexus avulsion in dogs - 3: electroneurostimulation of radial, median, ulnar and musculocutaneous nerves

    Mônica Vicky Bahr Arias

    1997-03-01

    Full Text Available O objetivo deste trabalho foi relacionar os aspectos clínicos, neurológicos e histopatológicos (descritos nas partes l e 2 deste trabalho com os resultados obtidos após estimulação elétrica dos nervos radiai, mediano, ulnar e musculocutâneo. Realizou-se a estimulação elétrica destes nervos durante o ato cirúrgico no qual foram coletados os fascículos para histopatolo gia. Os nervos radial, mediano e ulnar de todos os cães submetidos à eletroneuroestimulação apresentaram evidências de degenera- ção. enquanto que o nervo musculocutâneo apresentava função próxima do normal em 25% dos casos. A associação dos resultados do exame neurológico, da histologia e da eletroneuroestimulação sugeriu envolvimento quase que total das raízes do plexo braquial, enfatizando a necessidade de continuidade de pesquisas na área, visando principalmente a recuperação das raízes nervosas envolvidas.The purpose ofthis work was to relate lhe clinicai, neurological and histopathotogical aspects (as described in the sections I and 2 ofthis work with the obtained results after the electric stimulation of radial, median, ulnar and musculocutaneous nerrves. The electric stimulation of these nerves was realized during the cirurgic act, when the fascicle were obtained for the histopathologic examination. The radial, median and ulnar nerves of ali dogs submitted to electroneurostimulation presented evidences of degeneration, while the musculocutaneous nerve present almost normal functions in 25% of the cases. The interpretation ofthe results obtained from neurologic, histologic and electroneurostimulation examination suggested the almost total involvement of brachial plexus in ali cases. This work emphasized the need for further research in this área with lhe main purpose of recuperating the involved roots.

  17. Our experience on brachial plexus blockade in upper extremity surgery

    Ömer Uslukaya

    2012-03-01

    Full Text Available Objective: Peripheral nerve blocks are usually used either alone or along with general anesthesia for postoperative analgesia. We also aimed to present the results and experiences.Materials and methods: This retrospective study was conducted to scan the files of patients who underwent orthopedic upper extremity surgery with peripheral nerve block between September 2009 and October 2010. After ethics committee approval was obtained, 114 patients who were ASA physical status I-III, aged 18-70, performed upper extremity surgery in the Orthopedics and Traumatology Clinic were included to study. Patients’ demographic data, clinical diagnoses, premedication status, peripheral block type, local anesthetic dose, stimuplex needle types, hemodynamic parameters at the during surgery, the first postoperative analgesic requirements, complications and patient satisfaction were recorded.Results: Demographic data were similar to each other. Brachial plexus block was commonly performed for the forearm surgery. Infraclavicular block was performed the most frequently to patients. As the classical methods in the supine position were preferred in 98.2% of patients, Stimuplex A needle (B. Braun, Melsungen AG, Germany have been used for blockage in 80.7% of patients. Also, in 54.4% of patients, 30 ml of local anesthetic solution composed of bupivacaine + prilocaine was used for blockade. Blocks applied to patients had provided adequate anesthesia.Conclusion: Since the brachial plexus blockade guided peripheral nerve stimulator for upper extremity surgery provide adequate depth of anesthesia and analgesia, it may be a good alternative to general anesthesia because of unwanted side effects

  18. Boston Children's Hospital approach to brachial plexus birth palsy.

    Vuillermin, Carley; Bauer, Andrea S

    2016-07-01

    The treatment of infants with brachial plexus birth palsy (BPBP) continues to be a focus at Boston Children's Hospital. Over the last 15 years, there have been many developments in the treatment of infants with BPBP. Some of the greatest changes have emerged through technical advances such as the advent of distal nerve transfers to allow targeted reinnervation as well as through research to understand the pathoanatomical changes that lead to glenohumeral dysplasia and how this dysplasia can be remodeled. This review will discuss our current practice of evaluation of the infant with BPBP, techniques for microsurgical reconstruction, and prevention and treatment of secondary glenohumeral dysplasia. PMID:27137763

  19. Robot-assisted surgery of the shoulder girdle and brachial plexus.

    Facca, Sybille; Hendriks, Sarah; Mantovani, Gustavo; Selber, Jesse C; Liverneaux, Philippe

    2014-02-01

    New developments in the surgery of the brachial plexus include the use of less invasive surgical approaches and more precise techniques. The theoretical advantages of the use of robotics versus endoscopy are the disappearance of physiological tremor, three-dimensional vision, high definition, magnification, and superior ergonomics. On a fresh cadaver, a dissection space was created and maintained by insufflation of CO2. The supraclavicular brachial plexus was dissected using the da Vinci robot (Intuitive Surgical, Sunnyvale, CA). A segment of the C5 nerve root was grafted robotically. A series of eight clinical cases of nerve damage around the shoulder girdle were operated on using the da Vinci robot. The ability to perform successful microneural repair was confirmed in both the authors' clinical and experimental studies, but the entire potential of robotically assisted microneural surgery was not realized during these initial cases because an open incision was still required. Robotic-assisted surgery of the shoulder girdle and brachial plexus is still in its early stages. It would be ideal to have even finer and more suitable instruments to apply fibrin glue or electrostimulation in nerve surgery. Nevertheless, the prospects of minimally invasive techniques would allow acute and subacute surgical approach of traumatic brachial plexus palsy safely, without significant and cicatricial morbidity. PMID:24872778

  20. Bloqueio do plexo braquial pela via posterior com uso de neuroestimulador e ropivacaína a 0,5% Bloqueo del plexo braquial por la vía posterior con el uso de neuroestimulador y ropivacaína a 0,5% Posterior brachial plexus block with nerve stimulator and 0.5% ropivacaine

    Lúcia Beato

    2005-08-01

    ícula y húmero proximal. El objetivo de este estudio fue mostrar los resultados observados en pacientes sometidos a bloqueo del plexo braquial por la vía posterior con el uso del neuroestimulador y ropivacaína a 0,5%. MÉTODO: Veintidós pacientes con edad entre 17 y 76 años, estado físico ASA I y II, sometidos a cirugías ortopédicas envolviendo el hombro, clavícula y húmero proximal fueron anestesiados con bloqueo de plexo braquial por la vía posterior utilizando neuroestimulador desde 1 mA. Lograda la contracción deseada, la corriente fue disminuida para 0,5 MA y, permaneciendo la respuesta contráctil, fueron inyectados 40 mL de ropivacaína a 0,5%. Fueron evaluados los siguientes parámetros: latencia, analgesia, duración de la cirugía, duración de la analgesia y del bloqueo motor, complicaciones y efectos colaterales. RESULTADOS: El bloqueo fue efectivo en 20 de los 22 pacientes; la latencia media fue de 15,52 min; la duración media de la cirugía fue de 1,61 hora. La media de duración de la analgesia fue de 15,85 horas y del bloqueo motor 11,16 horas. No fueron observados señales y síntomas clínicos de toxicidad del anestésico local y ningún paciente presentó efectos adversos del bloqueo. CONCLUSIONES: En las condiciones de este estudio el bloqueo del plexo braquial por la vía posterior con el uso del neuroestimulador y ropivacaína a 0,5% demostró que es una técnica efectiva, confortable para el paciente y de fácil realización.BACKGROUND AND OBJECTIVES: There are several approaches to the brachial plexus depending on the experience of the anesthesiologist and the site of the surgery. Posterior brachial plexus block may be an alternative for shoulder, clavicle and proximal humerus surgery. This study aims at presenting the results of patients submitted to posterior brachial plexus block with 0.5% ropivacaine and the aid of nerve stimulator. METHODS: Participated in this study 22 patients aged 17 to 76 years, physical status ASA I and II

  1. OCT/PS-OCT imaging of brachial plexus neurovascular structures

    Raphael, David T.; Zhang, Jun; Zhang, Yaoping; Chen, Zhongping; Miller, Carol; Zhou, Li

    2004-07-01

    Introduction: Optical coherence tomography (OCT) allows high-resolution imaging (less than 10 microns) of tissue structures. A pilot study with OCT and polarization-sensitive OCT (PS-OCT) was undertaken to image ex-vivo neurovascular structures (vessels, nerves) of the canine brachial plexus. Methods: OCT is an interferometry-based optical analog of B-mode ultrasound, which can image through non-transparent biological tissues. With approval of the USC Animal Care and Use Committee, segments of the supra- and infraclavicular brachial plexus were excised from euthanized adult dogs, and the ex-vivo specimens were placed in cold pH-buffered physiologic solution. An OCT beam, in micrometer translational steps, scanned the fixed-position bisected specimens in transverse and longitudinal views. Two-dimensional images were obtained from identified arteries and nerves, with specific sections of interest stained with hematoxylin-eosin for later imaging through a surgical microscope. Results: with the beam scan direction transverse to arteries, the resulting OCT images showed an identifiable arterial lumen and arterial wall tissue layers. By comparison, transverse beam OCT images of nerves revealed a multitude of smaller nerve bundles contained within larger circular-shaped fascicles. PS-OCT imaging was helpful in showing the characteristic birefringence exhibited by arrayed neural structures. Discussion: High-resolution OCT imaging may be useful in the optical identification of neurovascular structures during attempted regional nerve blockade. If incorporated into a needle-shaped catheter endoscope, such a technology could prevent intraneural and intravascular injections immediately prior to local anesthetic injection. The major limitation of OCT is that it can form a coherent image of tissue structures only to a depth of 1.5 - 2 mm.

  2. Improved C3-4 transfer for treatment of root avulsion of the brachial plexus upper trunk Animal experiments and clinical application

    Lin Zou; Xuecheng Cao; Jing Li; Lifeng Liu; Pingshan Wang; Jinfang Cai

    2012-01-01

    Experimental rats with root avulsion of the brachial plexus upper trunk were treated with the improved C3-4 transfer for neurotization of C5-6. Results showed that Terzis grooming test scores were significantly increased at 6 months after treatment, the latency of C5-6 motor evoked potential was gradually shortened, and the amplitude was gradually increased. The rate of C3 instead of C5 and the C4 + phrenic nerve instead of C6 myelinated nerve fibers crossing through the anastomotic stoma was approximately 80%. Myelinated nerve fibers were arranged loosely but the thickness of the myelin sheath was similar to that of the healthy side. In clinical applications,39 patients with root avulsion of the brachial plexus upper trunk were followed for 6 months to 4.5 years after treatment using the improved C3 instead of C5 nerve root transfer and C4 nerve root and phrenic nerve instead of C6 nerve root transfer. Results showed that the strength of the brachial biceps and deltoid muscles recovered to level III-IV, scapular muscle to level III-IV, latissimus dorsi and pectoralis major muscles to above level III, and the brachial triceps muscle to level 0-III. Results showed that the improved C3-4 transfer for root avulsion of the brachial plexus upper trunk in animal models is similar to clinical findings and that C3-4 and the phrenic nerve transfer for neurotization of C5-6 can innervate the avulsed brachial plexus upper trunk and promote the recovery of nerve function in the upper extremity.

  3. Anatomical characteristics of the brachial plexus of the maned sloth (Bradypus torquatus Illiger, 1811)

    Gessica Ariane de Melo Cruz; Marta Adami; Vera Lúcia de Oliveira

    2013-01-01

    Eight male and female maned sloth (Bradypus torquatus) cadavers, previously fixed in formalin, were used to identify the origin of the brachial plexus, nerves and innervation territory in order to determine an anatomical pattern for this species. The plexus of B. torquatus was derived from the C7 to C10 and T1 to T2 spinal nerves, but the participation of T2 was variable. The spinal nerves gave origin to the cranial and caudal trunks, which joined to form a common trunk, from which two fascic...

  4. Perioperative nursing of 4 children receiving contralateral healthy cervical seventh nerve root transfer for brachial plexus injury%4例儿童臂丛神经损伤健侧C(7)椎体前移位直接修复术的护理

    黄天雯; 何翠环; 戚剑; 顾立强; 陈晓玲; 刘巧梨; 桂自珍; 刘回芬

    2011-01-01

    总结了4例儿童臂丛神经损伤健侧C(7)椎体前移位直接修复术围手术期的护理体会.术前通过心理护理、预防再损伤及功能锻炼、疼痛护理及术前体位训练等,患者情绪稳定,患者及家属对患者的伤残接受程度提高,患肢未出现再损伤.术后做好体位护理、病情观察、功能锻炼及出院指导,患儿术后康复过程顺利,切口Ⅰ级愈合,能够配合进行功能锻炼.%This paper summarizes the experience of perioperative nursing for 4 children receiving contralateral healthy cervical seventh nerve root transfer for brachial plexus injury. Before the operation,nursing care focused on psychological nursing,prevention from re-injury,functional training,pain management and posture training. The children and parents could face up the state of injury and keep calm in mood,and no re-injury occurred. The postoperative care included posture care,disease observation,functional training and discharge instruction. As a result,the children had a smooth recovery period after the operation. They could cooperate with physical therapy and the wounds healed well.

  5. Description of the brachial plexus of the short-eared dog (Atelocynus microtis Sclater, 1882: case report

    Luane Lopes Pinheiro

    2013-09-01

    Full Text Available The short-eared dog (Atelocynus microtis is one of the rarest species of South American canids. Aiming to describe the morphology of this animal and enhance the study of comparative neuroanatomy, we studied the anatomical makeup of the brachial plexus of a female specimen from Paragominas (PA. The specimen was donated, after natural death, to the Institute of Animal Health and Production (ISPA at the Universidade Federal Rural da Amazônia (UFRA. The animal was fixed in 10% formalin and later dissected bilaterally to reveal the origin of the brachial plexus. In A. microtis, the brachial plexus is derived from the ventral rami of the last three cervical spinal nerves and the first thoracic spinal nerve (C6-T1. The brachial plexus derivatives with their respective origins were: suprascapular n. (C6 and C7, subscapular n. (C6, musculocutaneous n. (C6 and C7, axillary n. (C6 and C7, radial n. (C7 and C8, median n. (C7, C8 and T1, ulnar n. (C8 and T1, thoracodorsal n. (C8 and T1, cranial pectoral nn. (C7, C8 and T1 and caudal pectoral nn. (C8 and T1. The brachial plexus of A. microtis resembled what has been described for the domestic dog, in relation to the origin of the initial and final segment, but showed differences in the composition of some nerves.

  6. Cutaneous Porphyrias

    Christiansen, Anne L; Aagaard, Lise; Krag, Aleksander; Rasmussen, Lars M; Bygum, Anette

    2016-01-01

    Porphyrias are rare diseases caused by altered haem synthesis leading to the accumulation of different haem intermediates. Neurovisceral attacks may occur in acute porphyrias, while photosensitivity is the presenting symptom in cutaneous porphyrias. We present here an overview of symptoms and a...... flowchart for the diagnosis of cutaneous porphyrias, with recommendations for monitoring and an update of treatment options. From the Danish Porphyria Register, we present the incidences and approximate prevalences of cutaneous porphyrias within the last 25 years. A total of 650 patients with porphyria...... cutanea tarda were identified, 73 with erythropoietic protoporphyria, 9 with variegate porphyria, 4 with hereditary coproporphyria and one with congenital erythropoietic porphyria. The total incidence of all porphyrias was ~0.52/100,000 per year....

  7. Radiation-induced malignant and atypical peripheral nerve sheath tumors

    The reported peripheral nerve complications of therapeutic irradiation in humans include brachial and lumbar plexus fibrosis and cranial and peripheral nerve atrophy. We have encountered 9 patients with malignant (7) and atypical (2) peripheral nerve tumors occurring in an irradiated site suggesting that such tumors represent another delayed effect of radiation treatment on peripheral nerve. In all instances the radio-theray was within an acceptable radiation dosage, yet 3 patients developed local radiation-induced skin and bony abnormalities. The malignant peripheral nerve sheath tumors developed only in the radiation port. Animal studies support the clinical observation that malignant peripheral nerve sheath tumors can occur as a delayed effect of irradiation

  8. Interscalenic approach to the cervico-brachial plexus.

    Evenepoel, M C; Blomme, A

    1981-12-01

    The concept of a closed peri-neurovascular space surrounding the cervicobrachial plexus, introduced by A. Winnie, allows the blockade of the cervical and brachial plexuses by means of a single puncture technique. The single puncture has positive advantages: 1. The rapidity of the blockade; 2. The simplicity of the blockade; 3. Comfort for the patient. The landmarks are easy to make. As with epidural blockade, the injection level and the volume of local anesthetic determine the quality and extent of the block. The traditional indication is surgery of the shoulder and of the supraclavicular area. A new indication seems to be the implantation of a cardiac pacemaker. Complications often quoted in literature are Horner syndrome-a minor complication-and blockade of the ascending branches of the recurrent laryngeal nerve and of the phrenic nerve. The risk of a pneumothorax is almost nil. PMID:7324853

  9. Unusual and Unique Variant Branches of Lateral Cord of Brachial Plexus and its Clinical Implications- A Cadaveric Study

    Padur, Ashwini Aithal; Shanthakumar, Swamy Ravindra; Shetty, Surekha Devadas; Prabhu, Gayathri Sharath; Patil, Jyothsna

    2016-01-01

    Introduction Adequate knowledge on variant morphology of brachial plexus and its branches are important in clinical applications pertaining to trauma and surgical procedures of the upper extremity. Aim Current study was aimed to report variations of the branches of the lateral cord of brachial plexus in the axilla and their possible clinical complications. Materials and Methods Total number of 82 upper limbs from 41 formalin embalmed cadavers was dissected. Careful observation was made to note the formation and branching pattern of lateral cord. Meticulous inspection for absence of branches, presence of additional or variant branches and presence of abnormal communications between its branches or with branches of other cords was carried out. Results In the present study, we noted varied branching pattern of lateral cord in 6 out of 82 limbs (7%). In one of the limb, the median nerve was formed by three roots; two from lateral cord and one from medial cord. Two limbs had absence of lateral pectoral nerve supplemented by medial pectoral nerves. One of which had an atypical ansa pectoralis. In 2 upper limbs, musculocutaneous nerve was absent and in both cases it was supplemented by median nerve. In one of the limb, coracobrachialis had dual nerve supply by musculocutaneous nerve and by an additional branch from the lateral cord. Conclusion Variations of brachial plexus and its branches could pose both intraoperative and postoperative complications which eventually affect the normal sensory and motor functions of the upper limb. PMID:27190783

  10. MR imaging of the brachial plexus

    Determining the cause of brachial plexopathy is often difficult. MR imaging allows for direct visualization of this region in multiple planes with high soft-tissue contrast. This paper defines the normal anatomy of the brachial plexus and demonstrates the ability of MR imaging to evaluate varied pathology in this region. Fifty-five patients with brachial plexopathy were evaluated with either a 1.5-T (General Electric, Milwaukee) or a 0.35-T (Diasonics, South San Francisco) superconducting MR system. Multiplanar, multiecho spin-echo images were obtained with either dual-coil imaging or a body coil. Individual fascicles to the brachial plexus were clearly separated from the subclavian artery and vein, clavicle, and surrounding musculature. Abnormalities well seen with MR imaging included primary tumors in the region of the brachial plexus, tumors metastatic to the brachial plexus, direct extension of pancoast tumors, postradiation fibrosis, and posttraumatic lesions, including fracture and edema

  11. Diagnostic value of combined magnetic resonance imaging examination of brachial plexus and electrophysiological studies in multifocal motor neuropathy

    Basta Ivana; Nikolić Ana; Apostolski Slobodan; Lavrnić Slobodan; Stošić-Opinćal Tatjana; Banjalić Sandra; Knežević-Apostolski Slađana; Ilić Tihomir V.; Marjanović Ivan; Milićev Milena; Lavrnić Dragana

    2014-01-01

    Background/Aim. Multifocal motor neuropathy (MMN) is an immune-mediated disorder characterized by slowly progressive asymetrical weakness of limbs without sensory loss. The objective of this study was to investigate the involvement of brachial plexus using combined cervical magnetic stimulation and magnetic resonance imaging (MRI) of plexus brachialis in patients with MMN. We payed special attention to the nerve roots forming nerves inervating weak muscles,...

  12. COMMUNICATION BETWEEN RADIAL AND ULNAR NERVE AT A HIGH HUMERAL LEVEL

    Monika Lalit

    2014-06-01

    Full Text Available Various communications between the different branches of brachial plexus have been reported by many authors but the communication between the radial and ulnar nerve; the branches of posterior and medial cords of brachial plexus in the arm is very rare. It features the communicating ramus travelling from proximal radial nerve and distal ulnar nerve at a high humeral level in the right arm of a 56 year old male cadaver. Knowledge of such variations may be of importance in the evaluation of certain entrapment phenomenon of ulnar nerve or unexplained sensory loss after trauma or surgical interventions in that particular area is also of clinical significance in anaesthetic blocks.

  13. MR imaging of the brachial plexus

    Es, Hendrik Wouter van

    2001-01-01

    In this retrospective study we describe the MR imaging findings in 230 consecutive patients with suspected pathology in or near the brachial plexus. These patients were studied from 1991 through to 1996. Chapter 2 describes the anatomy and the MR imaging techniques. As the anatomy of the brachial pl

  14. Neuromuscular hamartoma arising in the brachial plexus

    We report a case brachial plexus neuromuscular hamartoma (choristoma) in a 28-year-old man who complained of numbness of the left hand and forearm for several years. MRI revealed a circumscribed, rounded mass in the left brachial plexus. The patient is well 2 years after surgery, with no neurological deficit. (orig.)

  15. Neuromuscular hamartoma arising in the brachial plexus

    Lai, P.H.; Chen, C.; Yeh, L.R.; Pan, H.B. [Department of Radiology, Veterans General Hospital-Kaohsiung, 386 Ta-Chung First Rd, 813, Kaohsiung (Taiwan); Ho, J.T.; Hsu, S.S. [Department of Neurosurgery, Veterans General Hospital-Kaohsiung, 386 Ta-Chung First Rd, 813, Kaosiung (Taiwan); Lin, S.L. [Department of Pathology, Veterans General Hospital-Kaohsiung, 386 Ta-Chung First Rd, 813, Kaohsiung (Taiwan)

    2004-03-01

    We report a case brachial plexus neuromuscular hamartoma (choristoma) in a 28-year-old man who complained of numbness of the left hand and forearm for several years. MRI revealed a circumscribed, rounded mass in the left brachial plexus. The patient is well 2 years after surgery, with no neurological deficit. (orig.)

  16. Cutaneous leishmaniasis

    Mehmet Harman

    1990-01-01

    Leishmaniasis is used to describe a spectrum of diseases caused by the parasitic protozoa leishmania spp. and transmitted by infected female sandflies. There are three main forms of the disease; cutaneous, mucocutaneous, and visceral. According to the World Health Organization, almost 12 million people from 98 countries worldwide are currently infected with leishmaniasis, while 350 million people are at risk. It was reported that 2 million new cases are diagnosed every year, with three-fourth...

  17. Uso de concentrados autólogos de plaquetas como tratamiento de una fractura escapular y una lesión del plexo braquial producidas por un disparo en un caballo Use of autologous platelet concentrates as treatment for a scapular fracture and brachial plexus nerve injury produced by a gunshot in a horse

    C López

    2010-01-01

    Full Text Available Las heridas de bala han sido escasamente descritas en caballos. Los disparos a corta distancia suelen producir daños en tejidos blandos y fracturas conminutas. Un caso de una fractura conminuta del cuello de la escápula con lesión aguda del plexo braquial producida por una bala de 9 mm en un semental de seis años de edad es descrito. El paciente fue tratado con éxito mediante la combinación de desbridamiento quirúrgico de la región afectada e inyección local de varias dosis de concentrados autólogos de plaquetas (APC y fisioterapia. A pesar de la fractura de la escápula y del daño en los nervios periféricos que toman al menos 18-24 meses para una recuperación completa, este paciente se recuperó satisfactoriamente en nueve meses. Estos resultados sugieren que las inyecciones de APC en combinación con fisioterapia pueden proporcionar un beneficio terapéutico en el tratamiento de lesiones agudas de tejidos blandos y fracturas óseas en caballos.Gunshot injuries have been scarcely reported in horses. Close-range gunshots usually produce extensive soft tissue damage and comminute fractures. A case of a comminute fracture of the neck of the scapula with acute injury of the brachial plexus produced by a 9 mm gunshot in a six year-old stallion is described. The patient was successfully treated by combining surgical debridement of the affected region and local injection of several doses of autologous platelet concentrates (APCs and physiotherapy. Although scapular fractures and peripheral nerve damage take at least 18-24 months for full recovery, this patient reached full recuperation of the affected limb in 9 months. These results suggest that injections of APCs in combination with physiotherapy could provide a therapeutic benefit in the treatment of soft tissue acute injuries and bone fractures in horses.

  18. Cutaneous melanoma

    The study of boron neutron capture therapy (BNCT) for malignant melanoma was initiated by Y. Mishima and his associates. Following basic research of 13 years, this team started the first clinical trial of cutaneous melanoma BNCT using 10B-para-boronophenylalanine (BPA) in 1985. Since then, 32 patients have been treated. We developed the following regimen for BNCT of malignant melanoma: 1) 170 - 250 mg/kg of BPA-fructose complex is administered by drip infusion over 3-hours. 2) The minimum dose for melanoma control by single irradiation is assumed to be 25 Gy-eq. 3) The maximum tolerable dose to the skin by single irradiation is assumed to be 18 Gy-eq. 4) As the therapeutic dose, the maximum tolerable dose to the skin itself is chosen. We report the clinical results of two patients with cutaneous melanoma treated by BNCT. We believe that cutaneous melanoma are suitable for BNCT and that the excellent results will have a great impact on patients in QOL. (author)

  19. Proactive error analysis of ultrasound-guided axillary brachial plexus block performance.

    O'Sullivan, Owen

    2012-07-13

    Detailed description of the tasks anesthetists undertake during the performance of a complex procedure, such as ultrasound-guided peripheral nerve blockade, allows elements that are vulnerable to human error to be identified. We have applied 3 task analysis tools to one such procedure, namely, ultrasound-guided axillary brachial plexus blockade, with the intention that the results may form a basis to enhance training and performance of the procedure.

  20. Multichannel somato sensory evoked potential study demonstrated abnormalities in cervical cord function in brachial monomelic amyotrophy

    Nalini A; Praveen-Kumar S; Ebenezer Beulah; Ravishankar S; Subbakrishna D

    2008-01-01

    Background: Brachial monomelic amyotrophy (BMMA) is known to affect the central cervical cord gray matter resulting in single upper limb atrophy and weakness. Settings and Design: Case series of BMMA patients who underwent somatosensory evoked potentials (SEP) studies at a tertiary referral center. Aims: We proposed to record Multichannel Somatosensory Evoked Potentials (MCSSEP) from median and ulnar nerves with neck in neutral and neck fully flexed position in 17 patients with classical...

  1. MR Imaging of Brachial Plexus and Limb-Girdle Muscles in Patients with Amyotrophic Lateral Sclerosis.

    Gerevini, Simonetta; Agosta, Federica; Riva, Nilo; Spinelli, Edoardo G; Pagani, Elisabetta; Caliendo, Giandomenico; Chaabane, Linda; Copetti, Massimiliano; Quattrini, Angelo; Comi, Giancarlo; Falini, Andrea; Filippi, Massimo

    2016-05-01

    Purpose To assess brachial plexus magnetic resonance (MR) imaging features and limb-girdle muscle abnormalities as signs of muscle denervation in patients with amyotrophic lateral sclerosis (ALS). Materials and Methods This study was approved by the local ethical committees on human studies, and written informed consent was obtained from all subjects before enrollment. By using an optimized protocol of brachial plexus MR imaging, brachial plexus and limb-girdle muscle abnormalities were evaluated in 23 patients with ALS and clinical and neurophysiologically active involvement of the upper limbs and were compared with MR images in 12 age-matched healthy individuals. Nerve root and limb-girdle muscle abnormalities were visually evaluated by two experienced observers. A region of interest-based analysis was performed to measure nerve root volume and T2 signal intensity. Measures obtained at visual inspection were analyzed by using the Wald χ(2) test. Mean T2 signal intensity and volume values of the regions of interest were compared between groups by using a hierarchical linear model, accounting for the repeated measurement design. Results The level of interrater agreement was very strong (κ = 0.77-1). T2 hyperintensity and volume alterations of C5, C6, and C7 nerve roots were observed in patients with ALS (P brachial nerve roots do not exclude a diagnosis of ALS and suggest involvement of the peripheral nervous system in the ALS pathogenetic cascade. MR imaging of the peripheral nervous system and the limb-girdle muscle may be useful for monitoring the evolution of ALS and distinguishing patients with ALS from those with inflammatory neuropathy, respectively. (©) RSNA, 2015. PMID:26583760

  2. Surgical outcomes of the brachial plexus lesions caused by gunshot wounds in adults

    Duz Bulent

    2009-07-01

    Full Text Available Abstract Background The management of brachial plexus injuries due to gunshot wounds is a surgical challenge. Better surgical strategies based on clinical and electrophysiological patterns are needed. The aim of this study is to clarify the factors which may influence the surgical technique and outcome of the brachial plexus lesions caused by gunshot injuries. Methods Two hundred and sixty five patients who had brachial plexus lesions caused by gunshot injuries were included in this study. All of them were male with a mean age of 22 years. Twenty-three patients were improved with conservative treatment while the others underwent surgical treatment. The patients were classified and managed according to the locations, clinical and electrophysiological findings, and coexisting lesions. Results The wounding agent was shrapnel in 106 patients and bullet in 159 patients. Surgical procedures were performed from 6 weeks to 10 months after the injury. The majority of the lesions were repaired within 4 months were improved successfully. Good results were obtained in upper trunk and lateral cord lesions. The outcome was satisfactory if the nerve was intact and only compressed by fibrosis or the nerve was in-contunuity with neuroma or fibrosis. Conclusion Appropriate surgical techniques help the recovery from the lesions, especially in patients with complete functional loss. Intraoperative nerve status and the type of surgery significantly affect the final clinical outcome of the patients.

  3. The Role of Neuromediators and Innervation in Cutaneous Wound Healing.

    Ashrafi, Mohammed; Baguneid, Mohamed; Bayat, Ardeshir

    2016-06-15

    The skin is densely innervated with an intricate network of cutaneous nerves, neuromediators and specific receptors which influence a variety of physiological and disease processes. There is emerging evidence that cutaneous innervation may play an important role in mediating wound healing. This review aims to comprehensively examine the evidence that signifies the role of innervation during the overlapping stages of cutaneous wound healing. Numerous neuropeptides that are secreted by the sensory and autonomic nerve fibres play an essential part during the distinct phases of wound healing. Delayed wound healing in diabetes and fetal cutaneous regeneration following wounding further highlights the pivotal role skin innervation and its associated neuromediators play in wound healing. Understanding the mechanisms via which cutaneous innervation modulates wound healing in both the adult and fetus will provide opportunities to develop therapeutic devices which could manipulate skin innervation to aid wound healing. PMID:26676806

  4. Absence of musculocutaneous nerve in the left axilla

    Virupaxi RD

    2009-11-01

    Full Text Available Variations of the arrangement and distribution of the lateral cord and its branches in the infraclavicular part of the brachial plexus are common in one or both axillae. These variations are important to the surgeons, neurologists, anesthetists and anatomists during surgery and dissection in the region of axilla. The present case report describes the absence of musculocutaneous nerve in the infraclavicular part of left brachial plexus, observed during routine dissection of a 40-year-old male Indian cadaver. On the right side usual origin and course of musculocutaneous nerve was seen. The clinical importances of these variations are discussed.

  5. Traumatic injuries of brachial plexus

    The authors report their experience in 144 patients with traumatic brachial plexus injury who underwent Direct Cervical Myelography (DCM). Sometimes the diagnostic investigation was completed by CT. Various myelographic patterns are described: pseudomeningocele, missing sheet of the root, scarring lesions. In 9 cases only, myelography was not sufficient to provide a complete diagnosis. The examination showed all plexus roots lacerated in 14 patients, a monoradicular lesion in 75 cases, and no lesion in 26 cases. Twenty-one out of the 26 negative cases were confirmed during surgery, while in 2 patients an intracanalar injury was found, which had not been detected due to the presence of scars. Scars often compress healty roots, and may mask intracanalar injuries. In such cases, and when the spinal cord stretches towards the side of the lesion, Myelo-CT can be useful. DCM proved to be an extremely sensitive and specific method, which can be used as a first-choice radiological procedure in the study of traumatic injuries of the brachial plexus

  6. Absence of upper trunk of the brachial plexus

    Adam, Ali H; Mohammed, Ammar M A; Grebballa, Abbas; Rizig, Sahar

    2011-01-01

    The brachial plexus is a complicated plexus supplying the upper limb. The brachial plexus is of great practical importance to the surgeon. It is encountered during operations upon the root of the neck, and hence it is in danger. Variations in the formation of the brachial plexus are common; and knowledge of the variation of the brachial plexus may be useful for surgeons, for improved guidance during supraclavicular block procedures, and for surgical approaches for brachial plexus. Here we rep...

  7. Brachial plexus palsy caused by halo traction before posterior correction in patients with severe scoliosis

    QIAN Bang-ping; QIU Yong; WANG Bin; YU Yang; ZHU Ze-zhang

    2007-01-01

    Objective: To explore the clinical features and treatment results of brachial plexus palsy caused by halo traction before posterior correction in patients with severe scoliosis.Methods: A total of 300 cases of severe scoliosis received halo traction before posterior correction in our department from July 1997 to November 2004. Among them, 7 cases were complicated with brachial plexus palsy.The average Cobb angle was 110° (range, 90°-135°).Diagnoses were made as idiopathic scoliosis in 1 case,congenital scoliosis in 3 cases, and neuromuscular scoliosis in 3 cases. Additionally, diastematomyelia and tethered cord syndrome were found in 3 cases and thoracolumbar kyphosis in 2 cases. Weight of traction was immediately reduced when the patient developed any abnormal neurological symptoms in the upper extremity, and rehabilitation training was undertaken. Simultaneously,neurotrophic pharmacotherapy was applied, and the neurological function restoration of the upper limbs and the recovery time were documented.Results: Traction was used for an average of 3.5 weeks (range, 2-6 weeks) before spinal fusion for these 7 patients. The average traction weight was 8 kg, which was 19% on average (range, 13%-26%) of the average body weight (40.2 kg). These 7 patients had long and thin body configuration with a mean height of 175 cm. The duration between symptoms of brachial plexus paralysis and the diagnosis was 1-3 hours. All of these 7 patients presented various degrees of numbness in the ulnar side of the hand and forearm. Median nerve paresis was found in 3 cases and ulnar nerve paresis in 4 cases. Complete recovery of the neurological function had been achieved by the end of three months.Conclusions: The clinical features of brachial plexus palsy caused by halo traction include median nerve paresis,ulnar nerve paralysis, and numbness in the ulnar side of the hand and forearm, which may be due to the injury of the inferior part of the brachial plexus, i.e. , damage of Cs and

  8. Schwannomatosis of the sciatic nerve

    A 52-year-old woman with schwannomatosis in the left sciatic nerve is presented. The patient had no stigmata of neurofibromatosis (NF) type 1 or 2. Cutaneous or spinal schwannomas were not detected. Magnetic resonance (MR) imaging of the sciatic nerve revealed more than 15 tumors along the course of the nerve. Histological examination revealed schwannomas consisting of Antoni A and B areas. Immunohistochemical study showed most cells reacting intensely for S-100 protein. The patient underwent conservative follow-up treatment due to the minimal symptoms. The relationship of the disease with NF-2 and plexiform schwannoma is discussed. (orig.)

  9. Schwannomatosis of the sciatic nerve

    Yamamoto, Tetsuji; Maruyama, Shigeki; Mizuno, Kosaku [Dept. of Orthopaedic Surgery, Kobe University School of Medicine (Japan)

    2001-02-01

    A 52-year-old woman with schwannomatosis in the left sciatic nerve is presented. The patient had no stigmata of neurofibromatosis (NF) type 1 or 2. Cutaneous or spinal schwannomas were not detected. Magnetic resonance (MR) imaging of the sciatic nerve revealed more than 15 tumors along the course of the nerve. Histological examination revealed schwannomas consisting of Antoni A and B areas. Immunohistochemical study showed most cells reacting intensely for S-100 protein. The patient underwent conservative follow-up treatment due to the minimal symptoms. The relationship of the disease with NF-2 and plexiform schwannoma is discussed. (orig.)

  10. 3.0-T magnetic resonance imaging in children with brachial plexus birth injury

    Shinong Pan; Qiyong Guo; Lijie Tian; Wei Liao; Feng Tian; Jian Mao; Fei Wang; Rongjie Bai; Qi Li; Zhian Chen

    2011-01-01

    Brachial plexus birth injuries in children are usually diagnosed using 1.5-T magnetic resonance imaging, while the application of high-field magnetic resonance imaging is rarely reported. Therefore, a retrospective comparison of 18 cases of children with brachial plexus injury was performed to investigate the characteristics of 3.0-T magnetic resonance imaging and intraoperative observations. Magnetic resonance examinations in 18 cases of children showed that pseudo-meningocele sensitivity, specificity, accuracy, and positivity rates were 83.3%, 79.6%, 81.1%, and 40.0%, respectively. As for the neuroma and fibrous scar encapsulation, the sensitivity, specificity, accuracy, and positivity rates were 92.9%, 50.0%, 83.3%, and 77.8%, respectively. These results confirm that 3.0-T high-field magnetic resonance imaging can clearly reveal abnormal changes in brachial plexus injury, in which pseudo-meningocele, fibrous scar encapsulation, and neuroma are the characteristic changes of obstetric brachial plexus preganglionic and postganglionic nerve injury.

  11. Radiation-induced brachial plexus neuropathy in breast cancer patients

    Olsen, N.K.; Pfeiffer, P.; Mondrup, K.; Rose, C. (Odense Univ. Hospital (Denmark). Dept. of Neurology Odense Univ. Hospital (Denmark). Dept. of Clinical Neurophysiology Odense Univ. Hospital (Denmark). Dept. of Oncology R)

    1990-01-01

    The incidence and latency period of radiation-induced brachial plexopathy (RBP) were assessed in 79 breast cancer patients by a neurological follow-up examination at least 60 months (range 67-130 months) after the primary treatment. All patients were treated primarily with simple mastectomy, axillary nodal sampling and radiotherapy (RT). Postoperatively, pre- and postmenopausal patients were randomly allocated chemotherapy for antiestrogen treatment. All patients were recurrence-free at time of examination. Clinically, 35% (25-47%) of the patients had RBP; 19% (11-29%) had definite RBP, i.e. were physically disabled, and 16% (9-26%) had probable RBP. Fifty percent (31-69%) had affection of the entire plexus, 18% (7-35%) of the upper trunk only, and 4% (1-18%) of the lower trunk. In 28% (14-48%) of cases assessment of a definite level was not possible. RBP was more common after radiotherapy and chemotherapy (42%) than after radiotherapy alone (26%) but the difference was not statistically significant (p = 0.10). The incidence of definite RBP was significantly higher in the younger age group (p = 0.02). This could be due to more extensive axillary surgery but also to the fact that chemotherapy was given to most premenopausal patients. In most patients with RBP the symptoms began during or immediately after radiotherapy, and were thus without significant latency. Chemotherapy might enhance the radiation-induced effect on nerve tissue, thus diminishing the latency period. Lymphedema was present in 22% (14-32%), especially in the older patients, and not associated with the development of RBP. In conclusion, the damaging effect of RT on peripheral nerve tissue was documented. Since no successful treatment is available, restricted use of RT to the brachial plexus is warranted, especially when administered concomitantly with cytotoxic therapy. (orig.).

  12. Radiation-induced brachial plexus neuropathy in breast cancer patients

    The incidence and latency period of radiation-induced brachial plexopathy (RBP) were assessed in 79 breast cancer patients by a neurological follow-up examination at least 60 months (range 67-130 months) after the primary treatment. All patients were treated primarily with simple mastectomy, axillary nodal sampling and radiotherapy (RT). Postoperatively, pre- and postmenopausal patients were randomly allocated chemotherapy for antiestrogen treatment. All patients were recurrence-free at time of examination. Clinically, 35% (25-47%) of the patients had RBP; 19% (11-29%) had definite RBP, i.e. were physically disabled, and 16% (9-26%) had probable RBP. Fifty percent (31-69%) had affection of the entire plexus, 18% (7-35%) of the upper trunk only, and 4% (1-18%) of the lower trunk. In 28% (14-48%) of cases assessment of a definite level was not possible. RBP was more common after radiotherapy and chemotherapy (42%) than after radiotherapy alone (26%) but the difference was not statistically significant (p = 0.10). The incidence of definite RBP was significantly higher in the younger age group (p = 0.02). This could be due to more extensive axillary surgery but also to the fact that chemotherapy was given to most premenopausal patients. In most patients with RBP the symptoms began during or immediately after radiotherapy, and were thus without significant latency. Chemotherapy might enhance the radiation-induced effect on nerve tissue, thus diminishing the latency period. Lymphedema was present in 22% (14-32%), especially in the older patients, and not associated with the development of RBP. In conclusion, the damaging effect of RT on peripheral nerve tissue was documented. Since no successful treatment is available, restricted use of RT to the brachial plexus is warranted, especially when administered concomitantly with cytotoxic therapy. (orig.)

  13. Hands-up positioning during asymmetric sternal retraction for internal mammary artery harvest: a possible method to reduce brachial plexus injury.

    Jellish, W S; Blakeman, B; Warf, P; Slogoff, S

    1997-02-01

    This study compares the hands-up (HU) with the arms at side (AAS) position to determine whether one is beneficial in reducing brachial plexus stress during asymmetric sternal retraction. Eighty patients undergoing cardiac surgery were assigned to either Group 1 (AAS) or Group 2 (HU). Perioperative neurologic evaluations of the brachial plexus were performed and somatosensory evoked potentials (SSEPs) were collected during internal mammary artery harvest using asymmetric sternal retraction. Demographic data, SSEP changes, and postoperative brachial plexus symptoms were compared between groups. SSEP amplitude decreased in 95% of all patients during retractor placement with substantial decreases (> 50%) observed on the left side in 50% of the AAS and 35% of the HU patients. Amplitude recovery was normally seen in both groups after asymmetric retractor removal. Similar changes were noted, to a lesser degree, on the right side. During asymmetric sternal retraction, HU positioning offered minimal benefit in reducing brachial plexus stress as measured by SSEP. Three of the seven AAS patients who reported brachial plexus symptoms had an ulnar nerve distribution of injury. However, none of the four patients with plexus symptoms in the HU group had ulnar nerve problems, suggesting that the higher incidence of postoperative symptoms observed with AAS positioning may occur from ulnar nerve compression. PMID:9024012

  14. Cutaneous angiomyolipoma

    Anand S Ammanagi

    2012-01-01

    Full Text Available We report a case of cutaneous angiomyolipoma (AML found on the anterior abdominal wall of a 3-year-old female child. Histologic examination showed a well-circumscribed nodule in the dermis composed of an intimate mixture of convoluted thick-walled blood vessels, smooth muscle, and mature fat. This lesion differs from renal AML in terms of a lack of association with tuberous sclerosis, circumscription, absence of epithelioid cells, and male predominance. We concluded that the unique features of this lesion distinguish it from other lesions such as angiomyoma, angiolipoma, myolipoma, haemangioma, and other mixed mesenchymal tumors. This case report suggests that the features considered diagnostic of AML can occur in extrarenal sites and, therefore, this diagnosis cannot be excluded on the basis of site alone.

  15. Radiodiagnosis of closed fractures of brachial plexus

    To clarify localization of brachial plexus (BP) root abruption, contrasting of spinal cord subarachnoidal space using X ray contrast preparation (myeloradiculography) is applied. Analysis of results of X-ray investigation in 91 patients is given. Typical symptoms of root abruption from the spinal cord on myelograms are described. it is shown that X ray contrast investigation is the main method in the diagnosis of brachial plexus injuries and selection of surgical treatment tactics

  16. Neonatal brachial plexus palsy: a permanent challenge

    Carlos Otto Heise; Roberto Martins; Mário Siqueira

    2015-01-01

    Neonatal brachial plexus palsy (NBPP) has an incidence of 1.5 cases per 1000 live births and it has not declined despite recent advances in obstetrics. Most patients will recover spontaneously, but some will remain severely handicapped. Rehabilitation is important in most cases and brachial plexus surgery can improve the functional outcome of selected patients. This review highlights the current management of infants with NBPP, including conservative and operative approaches.

  17. Neonatal brachial plexus palsy: a permanent challenge

    Carlos Otto Heise

    2015-09-01

    Full Text Available Neonatal brachial plexus palsy (NBPP has an incidence of 1.5 cases per 1000 live births and it has not declined despite recent advances in obstetrics. Most patients will recover spontaneously, but some will remain severely handicapped. Rehabilitation is important in most cases and brachial plexus surgery can improve the functional outcome of selected patients. This review highlights the current management of infants with NBPP, including conservative and operative approaches.

  18. Brachial neuritis following a corticosteroid injection

    Robinson, Matthew; Fulcher, Mark

    2014-01-01

    This report presents a case of brachial neuritis following a subacromial corticosteroid injection. The patient developed an anterior interosseous neuropathy shortly after the injection, with no other trigger being identified. This neuropathy has unfortunately not shown any sign of recovery at 2 years. The authors propose that corticosteroid injection be added to the list of possible triggering events of brachial neuritis and highlight the frequent use of oral corticosteroids in its treatment....

  19. Acute brachial neuritis following influenza vaccination

    Shaikh, Maliha Farhana; Baqai, Tanya Jane; Tahir, Hasan

    2012-01-01

    Brachial neuritis following vaccination is an uncommon but clinically important presentation of severe shoulder and arm pain associated with globally reduced range of movement. It may be confused with the more common diagnoses of rotator cuff pathology, adhesive capsulitis (frozen shoulder), shoulder arthritis or cervical spondylosis. We present a case of acute brachial neuritis, which posed a clinical diagnostic challenge to emergency, acute medical and rheumatology clinicians.

  20. MR Imaging of the Brachial Plexus.

    Es, Hendrik Wouter van

    2000-01-01

    In this retrospective study we describe the MR imaging findings in 230 consecutive patients with suspected pathology in or near the brachial plexus. These patients were studied from 1991 through to 1996. Chapter 2 describes the anatomy and the MR imaging techniques. As the anatomy of the brachial plexus and the related structures is quite complicated, we eventually use as protocol of choice a 3D volume acquisition for the best understanding of this complex anatomy. The advantages of this 3D v...

  1. MORPHOLOGY OF ULNAR NERVE IN AXILLA & ARM & ITS VARIATIONS

    Vijay Kumar S

    2014-11-01

    Full Text Available The ulnar nerve arises from the medial cord (C8, T1; medial cord also receives fibres from the ventral ramus of C7. Lesions of the ulnar nerve occur behind the medial epicondyle & in the cubital tunnel. When muscles are affected due to ulnar nerve dysfunction, there is ulnar neuropathy at the shoulder, arm & elbow. The study was done on 50 embalmed human cadavers (25 right & 25 left of both sexes of South Indian adult population obtained from the Department of Anatomy, Bangalore Medical College and Research Institute, Bangalore. Variations in the ulnar nerve in its presence, origin, relations, distribution & communications were observed. Ulnar nerve was present in all 50 upper limb specimens (100%. Ulnar nerve originated from the medial cord of the brachial plexus in 49 cases (98%. In 1 case (2%, the ulnar nerve received C7 fibers from lateral cord i.e. the lateral root of the median nerve and then later fused with the median root of the median nerve. In 49 specimens (98% ulnar nerve took origin from the tip of the acromion processes. In 1 case (2% it took origin from distal to the tip of the acromion process. 49 specimens (98% showed the normal course, i.e. medial to axillary & brachial artery. 1 case (2% showed ulnar nerve present anterior to the third part of the axillary artery and brachial artery. In the midarm it passed medially as a normal course, then runs distally through the cubital tunnel. The awareness of these variations along the normal pattern are helpful for the interventional radiologists, orthopaedicians and neurologists in preventing untoward iatrogenic injury to the ulnar nerve during radiological procedures or operating on fractured patients or diagnostic therapy.

  2. Variant course and branching of right brachial artery: a case study

    Preeti Goswami

    2013-04-01

    Full Text Available A variant course and branching pattern of the right brachial artery was recorded in a 54-year-old male cadaver during the practical sessions of University College of Medical Sciences, Delhi, India. The right brachial artery divided in the middle third of arm into a medial superficial and lateral deep branch. The superficial medial branch descended anterior to the median nerve and ended by dividing in the cubital fossa into ulnar and radial arteries, whereas the lateral branch descended postero-medial to the median nerve, ending deep to pronator teres as the common interosseous artery. The left brachial artery showed a normal branching pattern by dividing into radial and ulnar arteries in the cubital fossa. The probable origin of such a variation is embryological and familiarity with such variations is imperative as they might affect dynamics of limb function or alter the course of interventional procedures. [Int J Res Med Sci 2013; 1(2.000: 62-65

  3. Infraclavicular brachial plexus block: Comparison of posterior cord stimulation with lateral or medial cord stimulation, a prospective double blinded study

    Dushyant Sharma

    2013-01-01

    Full Text Available Background: Infraclavicular approach to the brachial plexus sheath provides anesthesia for surgery on the distal arm, elbow, forearm, wrist, and hand. It has been found that evoked distal motor response or radial nerve-type motor response has influenced the success rate of single-injection infraclavicular brachial plexus block. Aim: We conducted this study to compare the extent and effectiveness of infraclavicular brachial plexus block achieved by injecting a local anesthetic drug after finding specific muscle action due to neural stimulator guided posterior cord stimulation and lateral cord/medial cord stimulation. Methods: After ethical committee approval, patients were randomly assigned to one of the two study groups of 30 patients each. In group 1, posterior cord stimulation was used and in group 2 lateral/medial cord stimulation was used for infraclavicular brachial plexus block. The extent of motor block and effectiveness of sensory block were assessed. Results: All four motor nerves that were selected for the extent of block were blocked in 23 cases (76.7% in group 1 and in 15 cases (50.0% in group 2 (P:0.032. The two groups did not differ significantly in the number of cases in which 0, 1, 2, and 3 nerves were blocked (P>0.05. In group 1, significantly lesser number of patients had pain on surgical manipulation compared with patients of group 2 (P:0.037. Conclusion: Stimulating the posterior cord guided by a nerve stimulator before local anesthetic injection is associated with greater extent of block (in the number of motor nerves blocked and effectiveness of block (in reporting no pain during the surgery than stimulation of either the lateral or medial cord.

  4. Treatment of kid foot soft tissue defect with reverse flap with cutaneous branch of fibular artery combine with sural nerve nutritional vessel axial%腓动脉皮支与腓肠神经联合远端蒂皮瓣修复小儿足踝部皮肤缺损

    喻伟光; 邵新中; 吕莉; 苏晓清; 石硕

    2010-01-01

    Objective To investigate the clinical efficiency of kid foot soft tissue defect with reverse flap with cutaneous branch of fibular artery combine with sural nerve nutritional vessel axial. Methods From Feb. 2006 to Feb. 2009, according to the position and size of the soft tissue defects, the sural nerve nutritional vessel flap combine with the cutaneous branch of the peroneal artery were desingned and obtained to repair the 5 cases soft tissue defects of the foot. The flap size ranged from 8 cm × 7 cm to 18 cm × 10 cm. The vessel pedicle of cutaneous branches ranged from 1.7 cm to 3.0 cm. The distribution of the vessel pedicle of cutaneous branches ranged from 4.5 cm to 8.0 cm on the lateral malleolus. Results All flaps survived completely in 6 cases. The outline and function were satisfactory during 6-18 months follow-up. Among of 6 cases, the sural nerve were anastomosed with the acceptor sensory nerve in all cases. The skin sense were sat-isfactory after 1 year of operation and 2-point discrimination was 10-13 mm. Conclusion The blood supply of this flap is reliable without sacrifice of major arteries. Flap elevation is easy. It can reverse to a long dis-tance and can repair large skin defects. Especially this flap could have some sensory nerve. It is very useful in repairing kid foot large soft tissue defect.%目的 探讨腓动脉皮支与腓肠神经营养血管联合远端蒂皮瓣逆行修复小儿足踝部皮肤缺损的临床应用效果.方法 根据缺损部位及大小设计以腓动脉下段皮支与腓肠神经营养血管的联合远端蒂及旋转点,沿腓肠神经营养血管轴线切取皮瓣,逆行移位修复小儿足踝部皮肤软组织缺损6例.皮瓣切取范围8.0 cm × 7.0 cm~18.0 cm×10.0 cm,联合血管蒂长1.7~3.0 cm,血管蒂发出部位位于外踝上4.0~8.0 cm.结果 术后6例皮瓣其中5例完全成活,创面Ⅰ期愈合.1例远端1.0 cm发生干性坏死,面积约2.0 cm×1.0 cm,经换药后愈合.随访6~18个月,

  5. Adult motor axons preferentially reinnervate predegenerated muscle nerve

    M. Abdullah; O'Daly, A.; A Vyas; Rohde, C.; Brushart, T.M.

    2013-01-01

    Preferential motor reinnervation (PMR) is the tendency for motor axons regenerating after repair of mixed nerve to reinnervate muscle nerve and/or muscle rather than cutaneous nerve or skin. PMR may occur in response to the peripheral nerve pathway alone in juvenile rats (Brushart, 1993; Redett et al., 2005), yet the ability to identify and respond to specific pathway markers is reportedly lost in adults (Uschold et al., 2007). The experiments reported here evaluate the relative roles of path...

  6. Pinched Nerve

    ... Enhancing Diversity Find People About NINDS NINDS Pinched Nerve Information Page Table of Contents (click to jump ... being done? Clinical Trials Organizations What is Pinched Nerve? The term "pinched nerve" is a colloquial term ...

  7. Nerve biopsy

    Biopsy - nerve ... A nerve biopsy is most often done on a nerve in the ankle, forearm, or along a rib. The health care ... feel a prick and a mild sting. The biopsy site may be sore for a few days ...

  8. Use of brachial plexus blockade and medetomidine-ketamine-isoflurane anaesthesia for repair of radio-ulna fracture in an adult cheetah (acinonyx jubatus)

    Kimeli, Peter; Mogoa, Eddy M; Mwangi, Willy E; Kipyegon, Ambrose N; Kirui, Gilbert; Muasya, Daniel W; John D. Mande; Kariuki, Edward; Mijele, Dominic

    2014-01-01

    Background Regional anaesthetic techniques have been used in combination with systemic analgesics during small animal surgery to provide multimodal analgesia. Brachial plexus nerves block using local anaesthetics provides analgesia of the thoracic limb through desensitization of the nerves that provide sensory and motor innervation. This has been shown to reduce intra-operative anesthetic requirements and provide postoperative pain relief. Decreasing the doses of general anaesthetics allows m...

  9. An Unusual Case of Neuralgic Amyotrophy Presenting with Bilateral Phrenic Nerve and Vocal Cord Paresis

    Holtbernd, F.; Zehnhoff-Dinnesen, A. am; Duning, T.; Kemmling, A.; Ringelstein, E.B.

    2011-01-01

    Background Neuralgic amyotrophy (brachial plexus neuropathy, brachial plexus neuritis, or Parsonage-Turner syndrome) is an uncommon inflammatory condition typically characterized by acute and severe shoulder pain followed by paresis with muscle weakness and atrophy of the upper limb or shoulder girdle. We report an unusual clinical manifestation of neuralgic amyotrophy, namely bilateral phrenic nerve palsy with concomitant laryngeal paresis. Case Report A 55-year-old male presented with ortho...

  10. Radiation-induced brachial plexopathy: MR imaging

    Wouter van Es, H. [Department of Radiology, University Hospital Utrecht, Heidelberglaan 100, 3584 CX Utrecht (Netherlands); Engelen, A.M. [Department of Radiation Therapy, University Hospital Utrecht, Utrecht (Netherlands); Witkamp, T.D. [Department of Radiology, University Hospital Utrecht, Heidelberglaan 100, 3584 CX Utrecht (Netherlands); Ramos, L.M.P. [Department of Radiology, University Hospital Utrecht, Heidelberglaan 100, 3584 CX Utrecht (Netherlands); Feldberg, M.A.M. [Department of Radiology, University Hospital Utrecht, Heidelberglaan 100, 3584 CX Utrecht (Netherlands)

    1997-05-01

    Objective. To describe the MR imaging appearance of radiation-induced brachial plexopathy. Design. MR imaging was performed in two patients with the clinical diagnosis of radiation-induced brachial plexopathy and in one with surgically proven radiation fibrosis of the brachial plexus. Patients. Three patients who had had radiation therapy to the axilla and supraclavicular region (two with breast carcinoma and one with Hodgkin`s lymphoma) presented with symptoms in the arm and hand. To exclude metastases or tumor recurrence MR imaging was performed. Results and conclusion. In one patient, fibrosis showing low signal intensity was found, while in two patients high signal intensity fibrosis surrounding the brachial plexus was found on the T2-weighted images. In one case gadolinium enhancement of the fibrosis was seen 21 years after radiation therapy. It is concluded that radiation-induced brachial plexopathy can have different MR imaging appearances. We found that radiation fibrosis can have both low or high signal intensities on T2-weighted images, and that fibrosis can enhance even 21 years after radiation therapy. (orig.). With 3 figs.

  11. Diagnostic value of combined magnetic resonance imaging examination of brachial plexus and electrophysiological studies in multifocal motor neuropathy

    Basta Ivana

    2014-01-01

    Full Text Available Background/Aim. Multifocal motor neuropathy (MMN is an immune-mediated disorder characterized by slowly progressive asymetrical weakness of limbs without sensory loss. The objective of this study was to investigate the involvement of brachial plexus using combined cervical magnetic stimulation and magnetic resonance imaging (MRI of plexus brachialis in patients with MMN. We payed special attention to the nerve roots forming nerves inervating weak muscles, but without detectable conduction block (CB using conventional nerve conduction studies. Methods. Nine patients with proven MMN were included in the study. In all of them MRI of the cervical spine and brachial plexus was performed using a Siemens Avanto 1.5 T unit, applying T1 and turbo spinecho T1 sequence, axial turbo spin-echo T2 sequence and a coronal fat-saturated turbo spin-echo T2 sequence. Results. In all the patients severe asymmetric distal weakness of muscles inervated by radial, ulnar, median and peroneal nerves was observed and the most striking presentation was bilateral wrist and finger drop. Three of them had additional proximal weakness of muscles inervated by axillar and femoral nerves. The majority of the patients had slightly increased cerebrospinal fluid (CSF protein content. Six of the patients had positive serum polyclonal IgM anti-GM1 antibodies. Electromyoneurography (EMG showed neurogenic changes, the most severe in distal muscles inervated by radial nerves. All the patients had persistent partial CBs outside the usual sites of nerve compression in radial, ulnar, median and peroneal nerves. In three of the patients cervical magnetic stimulation suggested proximal CBs between cervical root emergence and Erb’s point (prolonged motor root conduction time. In all the patients T2-weighted MRI revealed increased signal intensity in at least one cervical root, truncus or fasciculus of brachial plexus. Conclusion. We found clinical correlation between muscle weakness

  12. Bloqueio do nervo frênico após realização de bloqueio do plexo braquial pela via interescalênica: relato de caso A bloqueo del nervio frénico después de la realización de bloqueo del plexo braquial por la vía interescalénica: relato de caso Phrenic nerve block after interscalene brachial plexus block: case report

    Luis Henrique Cangiani

    2008-04-01

    embargo, en su mayoría, sin repercusiones clínicas importantes. El objetivo de este relato fue presentar un caso en que ocurrió bloqueo del nervio frénico, con comprometimiento ventilatorio en paciente con insuficiencia renal crónica, sometido a la instalación de fístula arterio-venosa extensa, bajo bloqueo del plexo braquial por la vía perivascular interescalénica. RELATO DEL CASO: Paciente del sexo masculino, 50 años, tabaquista, portador de insuficiencia renal crónica en régimen de hemodiálisis, hipertensión arterial, hepatitis C, diabetes melito, enfermedad pulmonar obstructiva crónica, sometido a la instalación de fístula arterio-venosa extensa en el miembro superior derecho bajo bloqueo de plexo braquial por la vía interescalénica. El plexo braquial fue localizado con la utilización del estimulador de nervio periférico. Se inyectaron 35 mL de una solución de anestésico local constituida de una mezcla de lidocaína a 2% con epinefrina a 1:200.000 y ropivacaína a 0,75% en partes iguales. Al final de la inyección el paciente estaba lúcido, pero sin embargo con disnea y predominio de incursión respiratoria intercostal ipsilateral al bloqueo. No había murmullo vesicular en la base del hemitórax derecho. La SpO2 se mantuvo en un 95%, con catéter nasal de oxígeno. No fue necesaria la instalación de métodos de auxilio ventilatorio invasivo. La radiografía del tórax reveló que el hemidiafragma derecho ocupaba el 5° espacio intercostal. El cuadro clínico se revirtió en tres horas. CONCLUSIONES: El caso mostró que hubo parálisis total del nervio frénico con síntomas respiratorios. A pesar de no haber sido necesaria la terapéutica invasiva para el tratamiento, queda el aviso aquí para la restricción de la indicación de la técnica en esos casos.BACKGROUND AND OBJECTIVES: Phrenic nerve block is a common adverse event of brachial plexus block. However, in most cases it does not have any important clinical repercussion. The objective

  13. MR imaging of the brachial plexus: comparison between 1.5-T and 3-T MR imaging: preliminary experience

    Tagliafico, Alberto; Neumaier, Carlo Emanuele; Calabrese, Massimo [National Institute for Cancer Research, Department of Radiology, Genova (Italy); Succio, Giulia; Serafini, Giovanni; Ghidara, Matteo [Santa Corona Hospital, Radiology Department, Savona (Italy); Martinoli, Carlo [Universita di Genova, Radiology Department, Genova (Italy)

    2011-06-15

    To compare 1.5-T and 3-T magnetic resonance (MR) imaging of the brachial plexus. Institutional review board approval and informed consent were obtained from 30 healthy volunteers and 30 consecutive patients with brachial plexus disturbances. MR was prospectively performed with comparable sequence parameters and coils with a 1.5-T and a 3-T system. Imaging protocols at both field strengths included T1-weighted turbo spin-echo (tSE) sequences and T2-weighed turbo spin-echo (tSE) sequences with fat saturation. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) between muscle and nerve were calculated for both field strengths. The visibility of brachial plexus nerve at various anatomic levels (roots, interscalene area, costoclavicular space, and axillary level) was analyzed with a four-point grading scale by two radiologists. MR imaging diagnoses and pathological findings were also compared qualitatively. SNR and CNRs were significantly higher on 3-T MR images than on 1.5-T MR images (Friedman test) for all sequences. Nerve visibility was significantly better on 3-T MR images than on 1.5-T MR images (paired sign test). Pathological findings (n = 30/30) were seen equally well with both field strengths. MR imaging diagnoses did not differ for the 1.5- and 3-T protocols. High-quality MR images of the brachial plexus can be obtained with 3-T MR imaging by using sequences similar to those used at 1.5-T MR imaging. In patients and healthy volunteers, the visibility of nerve trunks and cords at 3-T MR imaging appears to be superior to that at 1.5-T MR imaging. (orig.)

  14. Case report 388: Transient paralysis of the left hemidiaphragm secondary to blocking anesthesia of the intrascalene brachial plexus

    Radiologists and clinicians should be aware of the phenomenon of transient, unilateral paralysis of the phrenic nerve, secondary to anesthesia performed in a block of the brachial plexus used in surgical procedures of the upper extremity and in manipulation of fractures and dislocations. The disorder is self-limited and requires no further investigation or treatment. This entity is well-illustrated and fully described in this case report. (orig.)

  15. MR imaging of the brachial plexus: comparison between 1.5-T and 3-T MR imaging: preliminary experience

    To compare 1.5-T and 3-T magnetic resonance (MR) imaging of the brachial plexus. Institutional review board approval and informed consent were obtained from 30 healthy volunteers and 30 consecutive patients with brachial plexus disturbances. MR was prospectively performed with comparable sequence parameters and coils with a 1.5-T and a 3-T system. Imaging protocols at both field strengths included T1-weighted turbo spin-echo (tSE) sequences and T2-weighed turbo spin-echo (tSE) sequences with fat saturation. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) between muscle and nerve were calculated for both field strengths. The visibility of brachial plexus nerve at various anatomic levels (roots, interscalene area, costoclavicular space, and axillary level) was analyzed with a four-point grading scale by two radiologists. MR imaging diagnoses and pathological findings were also compared qualitatively. SNR and CNRs were significantly higher on 3-T MR images than on 1.5-T MR images (Friedman test) for all sequences. Nerve visibility was significantly better on 3-T MR images than on 1.5-T MR images (paired sign test). Pathological findings (n = 30/30) were seen equally well with both field strengths. MR imaging diagnoses did not differ for the 1.5- and 3-T protocols. High-quality MR images of the brachial plexus can be obtained with 3-T MR imaging by using sequences similar to those used at 1.5-T MR imaging. In patients and healthy volunteers, the visibility of nerve trunks and cords at 3-T MR imaging appears to be superior to that at 1.5-T MR imaging. (orig.)

  16. The Importance of Needle Echogenity in Ultrasound Guided Axillary Brachial Plexus Block: A Randomized Controlled Clinical Study

    Duger, Cevdet; ISBIR, Ahmet Cemil; Kaygusuz, Kenan; Kol, Iclal Ozdemir; Gursoy, Sinan; Ozturk, Hayati; Mimaroğlu, Caner

    2013-01-01

    Objective: In this study we aimed to compare the echogenic needles and the nerve stimulation addition to non-echogenic needles in ultrasound guided axillary brachial plexus block for upper extremity surgery. Methods: 90 patients were enrolled to the study. The patients were allocated into three groups randomly: Group E (n=30): ultrasound guided axillary block using echogenic needle, Group N (n=30): ultrasound guided axillary block using non-echogenic needle, Group NS (n=30): ultrasound guided...

  17. Multiple Cutaneous Reticulohistiocytoma

    Hemmady, Karishma D; Someshwar, Shylaja S; Jerajani, Hemangi R

    2016-01-01

    Multicentric reticulohistiocytosis is a rare non-Langerhans cell histiocytosis characterized in its full form by severe destructive arthritis, cutaneous nodules, and systemic manifestations. Cutaneous lesions may precede, accompany, or more commonly develop later than other features in this disease. We describe a case of multiple cutaneous reticulohistiocytoma without any systemic associations after thorough investigations. PMID:26955136

  18. Radiation-induced brachial plexus paralysis

    Fifteen patients with radiation-induced brachial plexus paralysis were studied. Thirteen women had been treated for breast cancer. Two men developed symptoms and signs following radiation therapy for lung cancer. The brachial plexus paralysis initially was not static and progressed, but spontaneous arrest with permanent residual paralysis was seen in three patients. Three were noted to have intractable pain, but the major complaint of the remaining 12 was the inability to use their hands. The ten patients on whom an earlier operation directed at the brachial plexus had been performed were not relieved. Two of these were later considered excellent candidates for a tendon transfer in the hand. One did not desire surgery. The other underwent operation and showed marked improvement of her grasp and general hand function

  19. Radiation-included brachial plexus injury

    All 449 breast cancer patients treated with post-operative radiotherapy to the breast and lymph nodes between 1982 and 1984 have been followed for 3-5.5 years. In this group two different fractionation schedules were used, one five times a fortnight and one daily, both over 6 weeks. The calculated dose to the brachial plexus was 45 Gy in 15 fractions or 5e Gy in 30 fractions. These schedules are equivalent doses using the standard NSD formula. The diagnosis of a brachial plexus injury was made clinically and computed tomography from recurrent disease. The actuarial incidence of a radiation-induced brachial plexus injury for the whole group was 4.9% at 5.5 years. No cases were seen in the first 10 months following radiotherapy. The incidence rises between 1 and 4 years and then starts to plateau. When the large fraction size group is compared with the small fraction size group the incidence at 5.5 years is 5.9% and 1.0%, respectively (p 0.09). Two different treatment techniques were used in this group but were not found to contribute to the probability of developing a brachial plexud injury. It is suggested that radiation using large doses per fraction are less well tolerated by the brachial plexus than small doses per fraction; a commonly used fractionation schedule such as 45 Gy in 15 fractions may give unacceptably high brachial plexus morbidity; and the of small doses per fraction or avoiding lymphatic irradiation is advocated. (author). 13 refs.; 6 figs.; 1 tab

  20. COMPARISON BETWEEN INTERSCALENE AND SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK: A CADAVERIC STUDY

    Suvalagna

    2014-07-01

    Full Text Available INTRODUCTION: Without mastery of the anatomy, luck rather than skill becomes the primary determinant of successful neural blockade. In this educational study our intent was to compare the level of nerve roots blocked by these two techniques of peripheral nerve block, widely used in clinical anesthesia practice. AIMS: To have a three dimensional view of nerve plexus involvement in inter scalene and supraclavicular techniques of brachial plexus block and compare in between them. MATERIAL AND METHOD: 6 recently deceased cadavers preserved in formalin were used. In both the techniques the classical methods usually pursued in daily clinical practice were followed. Dyes used were methylene blue and tartrazine of same dilution. RESULTS: Careful dissection showed that in all cases of inter scalene approach the dye was more concentrated in upper and middle trunk than in lower trunk of brachial plexus. In contrast in supraclavicular approach dye concentration was more in lower and middle trunk and less in upper trunk. DISCUSSION: After reviewing the anatomy it can be concluded that injection of local anesthetic at the interscalene level tends to produce a block that is most intense at the C5-C7 distribution and injection at supraclavicular level provide more compact anesthesia in C8-T1 distribution. CONCLUSION: Supraclavicular block is preferable for operations on the elbow, forearm, and hand and inter scalene block for shoulder.

  1. Management of brachial plexus injuries in adults: Clinical evaluation and diagnosis

    Sumit Sinha

    2015-01-01

    Full Text Available Brachial plexus injuries are devastating injuries that usually affect the younger population. The usual modes of injuries are roadside accidents, falls, and assaults. The affected individuals are crippled and may suffer from excruciating peripheral or central deafferentation pain for rest of their lives. The loss of functional capacity accounts for a significant number of man-hours lost at the workplace and consequent financial burden on the family. The results of brachial plexus reconstructive surgery have generally been unsatisfactory in the past. However, in recent decades, the efficacy of surgery has been proven beyond doubt, and there have been various published series in literature that have reported a good outcome after surgical management of these injuries. This has been made possible by the use of operating microscopes, better microsuture techniques for nerve graft and nerve or tendon transfer repair, and advanced perioperative electrophysiological techniques. The key to successful management lies in the proper clinical evaluation, supplemented with electrophysiology, preoperative imaging studies, and planning of surgical strategy. The partial injuries have a better outcome as compared with global palsies, and early referral should be emphasized. Selective combinations of nerve graft and transfers provide a moderate shoulder and elbow control. However, a multispecialty approach involving hand surgeons, plastic surgeons, and physiotherapists is required.

  2. A case of multiple cutaneous schwannomas; schwannomatosis or neurofibromatosis type 2?

    Murray, A. J.; Hughes, T A T; Neal, J W; Howard, E.; Evans, D G R; P.S. Harper

    2006-01-01

    A 54 year old man presented with numerous cutaneous schwannomas, cranial nerve lesions, and spinal cord lesions, but no evidence of vestibular nerve involvement. There was no family history of neurocutaneous lesions. To help discriminate between the various possible diagnoses in this patient, molecular analysis of two cutaneous schwannomas was undertaken. An identical point mutation in the NF2 gene in the two anatomically distinct tumours was found, confirming this as a case of NF2 mosaicism.

  3. Comparative analysis of MR myelography and conventional myelography in diagnosing traumatic brachial plexus lesions

    Nerve root avulsion is the most serious type of traumatic brachial plexus injury. The main radiological sign of this lesion is traumatic meningocele. Until recently the imaging method of choice in these cases was X-ray myelography, which in some patients was supplemented by computed tomography myelography (CT myelography). Recently, non-invasive magnetic resonance myelography (MR myelography) has an increasing significance. The aim of the study was to assess the value of MR myelography in diagnosing nerve root avulsions in patients with traumatic brachial plexus injuries by comparing it with X-ray myelography and to establish if MR myelography could replace X-ray myelography. Material consisted of 30 patients with traumatic brachial plexus injury, in whom MR myelography and X-ray myelography (in 4 cases also CT myelography) were performed. In 16 patients MR myelography was performed using open low-field MR unit (FSE 2D sequence) and in the remaining 14 patients middle-field closed MR unit was used (PSIF 3D sequence). MR myelography revealed traumatic meningoceles in 18 patients, while in 12 patients it showed normal appearance. MR myelography was compatible with X-ray myelography in 25 cases (83.3%). Among the not compatible or partially compatible results of the studies mentioned above, 4 patients were operated on. In 3 of them surgery confirmed the result of MR myelography and in 1 - of X-ray myelography. Among all 20 patients who were operated on, MR myelography was confirmed by surgery in 18 cases (90%), while X-ray myelography - in 17 patients (85%). MR myelography is not inferior and in some cases even superior to conventional invasive X-ray myelography in diagnosing nerve root avulsion injuries, therefore it could replace it in most cases. X-ray myelography and CT myelography remain the methods of choice in patients with contraindications to MR study. (author)

  4. Diffusion weighted MR imaging of brachial plexus diseases

    Diffusion weighted image (DWI) can specifically give running of nerve fibers as they have diffusion anisotropic property and DW whole body imaging with background body signal suppression (DWIBS) procedure, which being capable of imaging cervical and lumber nerve roots, is thus suggested to be useful for diagnosis of diseases related to brachial plexus (BP). The purpose of the present study is to confirm the usefulness of DWIBS by comparison of its images of the normal and sick plexuses. Subjects are 5 normal healthy males (27-36 y), 29 patients (19 M/10 F, 7-73 y) with BP diseases (10 cases of external injury, 6 of obstetric palsy, 2 of paralysis by dysfunctional position, 6 by Schwannoma, 2 by metastasis of breast cancer and 3 by radiation) and, to see the diagnostic specificity, 9 patients (M 7/F 2, 15-64 y) with severely reduced hand force by nervous causes other than BP ones. MRI with Philips Gyroscan INTERA 1.5T machine is conducted for DWIBS by DWI with single shot EPI (echo planar imaging) with the coil of either sensitivity encoding (SENSE) Cardiac, Flex-M or -S. Images are reconstructed 3D by a radiological technician possessing no information concerning patient's conditions, with Philips software Soap-bubble tool on the workstation, and are then evaluated by a radiologist and an orthopedist separately. It is found that BP disorders by injury, obstetric palsy and tumors, of which diagnosis has been difficult hitherto, can be imaged either negatively or positively depending on their history. In radiation paralysis, only 1/3 cases give a reduced signal intensity in the whole BP. DWIBS will be a new diagnostic mean for systemic peripheral nerve diseases as well as BP ones. (T.T.)

  5. Improved C3-4 transfer for treatment of root avulsion of the brachial plexus upper trunk

    Zou, Lin; Cao, Xuecheng; Li, Jing; Liu, Lifeng; Wang, Pingshan; Cai, Jinfang

    2012-01-01

    Experimental rats with root avulsion of the brachial plexus upper trunk were treated with the improved C3-4 transfer for neurotization of C5-6. Results showed that Terzis grooming test scores were significantly increased at 6 months after treatment, the latency of C5-6 motor evoked potential was gradually shortened, and the amplitude was gradually increased. The rate of C3 instead of C5 and the C4 + phrenic nerve instead of C6 myelinated nerve fibers crossing through the anastomotic stoma was...

  6. Paralysis of the peripheral nerve following radiotherapy for mammary carcinoma

    After radiation therapy of 135 cases with postoperative or recurrent breast carcinoma, complete mortor paralysis of the fingers, the hand or the arm was noticed in five cases. The patient with paralysis of the peripheral nerve originated in brachial plexus, was accompained with edema of the arm and subcutaneous induration of the clavico-axillar region. The latent period of this complication was 6.3 years on the average. The tolerance dose of the brachial plexus was estimated to be 6,600 rad/40 days in minimum and NSD was about 1950 ret. (author)

  7. Effect of dexamethasone added to lidocaine in supraclavicular brachial plexus block: A prospective, randomised, double-blind study

    Prashant A Biradar

    2013-01-01

    Full Text Available Background: Different additives have been used to prolong brachial plexus block. We performed a prospective, randomised, double-blind study to evaluate the effect of dexamethasone added to lidocaine on the onset and duration of supraclavicular brachial plexus block as this is the most common type of brachial block performed in our institute. Methods: Sixty American Society of Anaesthesiologist′s physical status I and II patients undergoing elective hand, forearm and elbow surgery under brachial plexus block were randomly allocated to receive either 1.5% lidocaine (7 mg/kg with adrenaline (1:200,000 and 2 ml of normal saline (group C, n=30 or 1.5% lidocaine (7 mg/kg with adrenaline (1:200,000 and 2 ml of dexamethasone (8 mg (group D, n=30. The block was performed using a nerve stimulator. Onset and duration of sensory and motor blockade were assessed. The sensory and motor blockade of radial, median, ulnar and musculocutaneous nerves were evaluated and recorded at 5, 10, 20, 120 min, and at every 30 min thereafter. Results: Two patients were excluded from the study because of block failure. The onset of sensory and motor blockade (13.4±2.8 vs. 16.0±2.3 min and 16.0±2.7 vs. 18.7±2.8 min, respectively were significantly more rapid in the dexamethasone group than in the control group ( P=0.001. The duration of sensory and motor blockade (326±58.6 vs. 159±20.1 and 290.6±52.7 vs. 135.5±20.3 min, respectively were significantly longer in the dexamethasone group than in the control group ( P=0.001. Conclusion: Addition of dexamethasone to 1.5% lidocaine with adrenaline in supraclavicular brachial plexus block speeds the onset and prolongs the duration of sensory and motor blockade.

  8. Shoulder deformities from obstetrical brachial plexus paralysis

    Abnormalities are described in the shoulders of 11 patients up to 17 years of age who have chronic brachial plexus paralyses from birth injuries. These abnormalities include a poorly formed and hypoplastic humeral head, a short abnormally formed clavicle, and a hypoplastic elevated scapula with a shallow glenoid fossa, inferiorly directed coracoid process, and abnormally tapered acromion. Four also had subluxated shoulders. (orig.)

  9. Spinal Cord Involvement in Brachial Plexus Injury

    J Gordon Millichap

    2004-01-01

    The role of spinal cord plasticity after birth injury and recovery from obstetric brachial plexus lesions was investigated in newborn rats with selective crush injury to spinal roots C5 and C6, in a study at University Clinics of Vienna School of Medicine, Austria.

  10. Fastklemt nerve som årsag til svære postoperative smerter fra arvæv

    Møller, Michael; Venzo, Alessandro

    2014-01-01

    Entrapment of a cutaneous nerve in a surgical scar may cause chronic post-operative pain. The condition presents with similar symptoms as a traumatic neuroma or as an anterior cutaneous nerve entrapment syndrome, which, however, is often idiopathic. We present a case, where entrapment of a...

  11. Sonoanatomy of the median, ulnar and radial nerves

    There are 5 nerve roots emerging from the brachial plexus. Three of these are readily seen ultrasonographically and can be followed throughout most of their course. The purpose of this article is twofold - to demonstrate the sonoanatomy of the median, ulnar and radial nerves and to provide background material for understanding the pathologic conditions or abnormalities that may be encountered. Only the most common pathways will be described here; the reader is encouraged to consult anatomy texts for the multitude of variations that can occur. Before delving into the anatomy, the normal ultrasonographic (US) appearance of a nerve will be presented. (author)

  12. Sonoanatomy of the median, ulnar and radial nerves

    Loewy, J. [Humber River Regional Hospital, Dept. of Radiology, Toronto, Ontario (Canada)

    2002-02-01

    There are 5 nerve roots emerging from the brachial plexus. Three of these are readily seen ultrasonographically and can be followed throughout most of their course. The purpose of this article is twofold - to demonstrate the sonoanatomy of the median, ulnar and radial nerves and to provide background material for understanding the pathologic conditions or abnormalities that may be encountered. Only the most common pathways will be described here; the reader is encouraged to consult anatomy texts for the multitude of variations that can occur. Before delving into the anatomy, the normal ultrasonographic (US) appearance of a nerve will be presented. (author)

  13. Ultrasound-guided block of the suprascapular nerve - a volunteer study of a new proximal approach

    Rothe, C; Steen-Hansen, C; Lund, J;

    2014-01-01

    BACKGROUND: The standard approach for the suprascapular nerve block is deep in the supraspinous fossa. However, with this approach, the suprascapular nerve is difficult to visualize by ultrasound. The aim of this study was to describe a new method to visualize and selectively block the...... suprascapular nerve in a more superficial and proximal location. METHODS: Twelve healthy volunteers were included. We located the brachial plexus in transverse section with ultrasound, and by longitudinal slide, we identified the departure of the suprascapular nerve from the superior trunk. The suprascapular...... nerve was followed under ultrasound visualization into the subclavian triangle under the inferior belly of the omohyoid muscle. We performed in-plane ultrasound-guided selective suprascapular nerve block by injecting 1 ml of lidocaine, 20 mg/ml close to the nerve. Nerve identification was aided by nerve...

  14. Nerve conduction

    ... the central nervous system (CNS) and peripheral nervous system (PNS). The CNS contains the brain and the spinal cord and the PNS consists of thousands of nerves that connect the spinal cord to muscles and sensory receptors. A peripheral nerve is composed of nerve ...

  15. Primary cutaneous amyloidosis

    Shah Mona; Padhiar Bela; Karia Umesh; Shah Bela; Rawal R; Bilimoria F

    1997-01-01

    Three cases of primary cutaneous amyloidosis are reported. Family history was negative. Systemic involvement was ruled out. Histopathology was confirmed by congored stain. Patients responded to oral colchicine.

  16. Giant cutaneous horn

    Kumaresan M

    2008-01-01

    Full Text Available A 53-year-old male presented with a giant cutaneous horn over the left leg. Cutaneous horn was excised and primary closure of the defect was done under spinal anesthesia. Histopathology showed underlying seborrheic keratosis. Cutaneous horn has been noticed on top of many clinical conditions of diverse etiology, such as actinic keratoses, wart, molluscum contagiosum, seborrheic keratoses, keratoacanthoma, basal cell and squamous cell carcinoma. We report a patient with giant cutaneous horn on the leg successfully treated by excision and wound closure.

  17. Inhibition of motoneurons during the cutaneous silent period in the spinal cord of the turtle

    Guzulaitis, Robertas; Hounsgaard, Jørn Dybkjær; Alaburda, Aidas

    2012-01-01

    motoneurons in the isolated carapace-spinal cord preparation from adult turtles during rhythmic scratch-like reflex. Electrical stimulation of cutaneous nerves induced CSP-like suppression of motor nerve firing during rhythmic network activity. The stimulus that generated the CSP-like suppression of motor...

  18. Extra and Intramuscular Distribution of the Thoracodorsal Nerve with Regard to Nerve Reconstruction Surgeries.

    Malalasekera, Ajith; Beneragama, Thushan; Kanesu, Sivasuganthan; Sahathevan, Vithoosan; Jayasekara, Rohan

    2016-06-01

    Background The lateral branch of the thoracodorsal nerve (LBTN) is used for nerve transfer in facial, musculocutaneous, axillary nerve injuries and for irreparable C5, C6 spinal nerve lesions and accessory nerve defects. For a successful surgical outcome, the nerve to be used in nerve transfer should be of adequate length and thickness for nerve coaptation. Aim Our objective was to evaluate the length of the LBTN that could be obtained as a donor nerve, externally and within the muscle. Method Eight (8) cadavers with intact upper limbs and thorax which could be positioned in the anatomical position were selected for the study. Cadavers with dissected axillae, brachial plexus or upper limbs were excluded. The thoracodorsal neurovascular bundle was dissected and the number of branches of the thoracodorsal nerve was identified along with its lateral branch. The lateral branch was dissected up to the latissimus dorsi muscle and further intramuscularly. All lengths were measured using a vernier caliper. Results The mean length of the LBTN, up to its first intramuscular branch, is 8.14 cm (range 5.99-12.29 cm). Beyond this, the intramuscular nerve branched further and was of very minute diameter. The mean unbranched intramuscular length of the nerve is 3.36 cm (range 1.3-7.71 cm) which is 41.28% of the total length of the LBTN. Conclusion A significant proportion of the LBTN is found within the latissimus dorsi muscle. This length could potentially be used for direct nerve coaptation by intrafascicular dissection. PMID:26890860

  19. Evaluation of the brachial plexus with MR imaging

    MR imaging allows excellent visualization of the brachial plexus, including its cervical, subscapular, and axillary course. The anatomy of the normal brachial plexus as it appears on 5-mm coronal (short TR) and axial (1st and 2nd spin-echo sequences) images obtained using a body coil at 1.5 T is presented. Normal findings are compared with examples of pathologic masses arising in or adjacent to each part of the brachial plexus. Selected surface coil views were useful in the evaluation of the proximal brachial plexus. The MR imaging demonstration of the morphology of mass lesions and their relationship to the brachial plexus is superior to CT demonstration and can be accomplished in little time and without the use of intravenous contrast media. Currently it is not possible to achieve sufficient detail to detect infiltrative, fibrotic, or atrophic processes unless these cause significant changes in the size, shape, or position of the brachial plexus

  20. Minimum effective concentration of bupivacaine for axillary brachial plexus block guided by ultrasound

    Alexandre Takeda

    2015-06-01

    Full Text Available INTRODUCTION: The use of ultrasound in regional anesthesia allows reducing the dose of local anesthetic used for peripheral nerve block. The present study was performed to determine the minimum effective concentration (MEC90 of bupivacaine for axillary brachial plexus block. METHODS: Patients undergoing hand surgery were recruited. To estimate the MEC90, a sequential up-down biased coin method of allocation was used. The bupivacaine dose was 5 mL for each nerve (radial, ulnar, median, and musculocutaneous. The initial concentration was 0.35%. This concentration was changed by 0.05% depending on the previous block; a blockade failure resulted in increased concentration for the next patient; in case of success, the next patient could receive or reduction (0.1 probability or the same concentration (0.9 probability. Surgical anesthesia was defined as driving force ≤2 according to the modified Bromage scale, lack of thermal sensitivity and response to pinprick. Postoperative analgesia was assessed in the recovery room with numeric pain scale and the amount of drugs used within 4 h after the blockade. RESULTS: MEC90 was 0.241% [R 2: 0.978, confidence interval: 0.20-0.34%]. No patient, with successful block, reported pain after 4 h. CONCLUSION: This study demonstrated that ultrasound guided axillary brachial plexus block can be performed with the use of low concentration of local anesthetics, increasing the safety of the procedure. Further studies should be conducted to assess blockade duration at low concentrations.

  1. Brachial plexus birth palsy: Management during the first year of life.

    Abid, A

    2016-02-01

    Brachial plexus birth palsy (BPBP) is defined as an injury to any nerve root of the brachial plexus during difficult delivery. BPBP is relatively rare; its incidence has remained constant over the last few decades, mostly due to unpredictable risk factors, such as shoulder dystocia. Both diagnosis and assessment of spontaneous recovery is based on clinical examination. Electromyography is difficult to interpret in the newborn and is therefore not meaningful. MRI of the cervical spine requires sedation or general anesthesia. Searching for a pre-ganglion tear prior to surgery is indicted. Prognosis depends on the level of the injury (pre- or post-ganglion), size and severity of the post-ganglion tears, speed of recovery, and quality of initial management. Although spontaneous recovery is frequent, some children suffer various degrees of sequelae, up to complete loss of function of the affected upper limb. Recent publications have improved general knowledge and indications for surgery. However, some aspects, such as indication and timing of nerve repair continue to be debated. PMID:26774906

  2. Pharyngeal-cervical-brachial variant of Guillain-Barre syndrome.

    Wakerley, Benjamin R; Yuki, Nobuhiro

    2014-03-01

    The pharyngeal-cervical-brachial (PCB) variant of Guillain-Barré syndrome is defined by rapidly progressive oropharyngeal and cervicobrachial weakness associated with areflexia in the upper limbs. Serial nerve conduction studies suggest that PCB represents a localised subtype of Guillain-Barré syndrome characterised by axonal rather than demyelinating neuropathy. Many neurologists are unfamiliar with PCB, which is often misdiagnosed as brainstem stroke, myasthenia gravis or botulism. The presence of additional ophthalmoplegia and ataxia indicates overlap with Fisher syndrome. Half of patients with PCB carry IgG anti-GT1a antibodies which often cross-react with GQ1b, whereas most patients with Fisher syndrome carry IgG anti-GQ1b antibodies which always cross-react with GT1a. Significant overlap between the clinical and serological profiles of these patients supports the view that PCB and Fisher syndrome form a continuous spectrum. In this review, we highlight the clinical features of PCB and outline new diagnostic criteria. PMID:23804237

  3. 动态三维MRI臂丛成像在臂丛根性损伤的临床应用%Clinical application of dynamic 3d-MRI brachial plexus imaging in the diagnosis of brachial plexus root injuries

    王美豪; 张勇; 程敬亮; 王健; 汪娟; 滕红林; 杨运俊; 王溯源; 王维卓; 刘会茹

    2013-01-01

    Objective To investigate radiological findings and clinical application of the dynamic 3d-MRI in the diagnosis of brachial plexus root injuries. Methods 10 cases of brachial plexus root injury patients underwent dynamic three dimensional MRI (3d-MRI) with short TI inversion recovery sequence (STIR). All cases were confirmed having brachial plexus root injuries by intraopcrativc exploration. Results No characteristic signs of brachial plexus root injuries were found in the early 3d-MRI scanning within one and three days after injuric. At 10-15 days(avcragc 10 days)aftcr injury. Characteristic signs of brachial plexus root injuries were found in the second 3d-MRI scanning, including absence and abnormal conduction of the nerve roots, traumatic spinal mcningocclc, displacement of the spinal cord, etc. Conclusion Brachial plexus nerve anatomical structure could be displayed well in 3d-MRI,thc change in short time and the characteristic radiological findings of brachial plexus root injuries could be found in dynamic 3d-MRI. Dynamic 3d-MRI is a noninvasivc and effective imaging method for the diagnosis of brachial plexus root injuries,which could show the accurate location of the injured brachial plexus root nerve, has significant value in clinical application.%目的 探讨动态三维MRI臂丛成像技术在诊断臂丛神经根性损伤的影像学表现与临床应用.方法 采用短时反转恢复序列(STIR)技术对10例臂丛神经根性损伤患者行动态三维MRI臂丛成像,所有10例患者均手术证实为臂丛根性损伤.结果 本组患者在伤后早期(1~3天)内行三维MRI臂丛成像均未见明显臂丛根性损伤的特征性MRI表现;伤后10~15天(平均10天)后,再次行三维MRI臂丛成像,出现典型的臂丛根性损伤MRI表现:神经根消失或离断、创伤性脊膜囊肿、脊髓偏移等.结论 三维MRI臂丛成像可以很好地地显示臂丛神经的解剖结构,通过动态成像可以显示臂丛根性神经损伤短

  4. Quantitative MRI and EMG study of the brachial plexus

    Mahbub, Zaid Bin

    2014-01-01

    This thesis describes the development and applications of quantitative MRI and combined EMG and MRI study of Brachial Plexus. The protocols developed in this thesis have been used on normal healthy subjects, aiming at characterizing the tissues based on their MR and EMG parameters. The Brachial Plexus is the upper portion of the peripheral nervous system and controls the movements of shoulder and arms. Neurological disorders in the brachial plexus can result from cervical spondylotic neuro...

  5. Post-irradiation pareses of brachial plexus

    Damage of brachial plexus as a sequel of breast carcinoma radiotherapy in 5 patients of an average age of 48 years is described. Complaints first appeared on the average 17.4 months after irradiation. The condition is characterized by initial pain, motor disturbances, reflex alteration. Skin alterations, atrophies, depilations, pigmentations, telangiectases and fibrous changes, and also lymphedema have been recorded. The necessity is stressed of an early start of therapy; the prognosis, however, is not very optimistic. (M.D.). 8 refs

  6. Treatment Options for Brachial Plexus Injuries

    Sakellariou, Vasileios I.; Badilas, Nikolaos K.; Stavropoulos, Nikolaos A; George Mazis; Kotoulas, Helias K.; Stamatios Kyriakopoulos; Ioannis Tagkalegkas; Sofianos, Ioannis P.

    2014-01-01

    The incidence of brachial plexus injuries is rapidly growing due to the increasing number of high-speed motor-vehicle accidents. These are devastating injuries leading to significant functional impairment of the patients. The purpose of this review paper is to present the available options for conservative and operative treatment and discuss the correct timing of intervention. Reported outcomes of current management and future prospects are also analysed.

  7. Nerve injuries about the elbow in the athlete.

    Harris, Joshua D; Lintner, David M

    2014-09-01

    The athlete's elbow is a remarkable example of motion, strength, and durability. The stress placed on the elbow during sport, including the throwing motion, may lead to soft-tissue ligamentous and nerve injury. The thrower's elbow illustrates one example of possible nerve injury about the elbow in sport, related to chronic repetitive tensile and compressive stresses to the ulnar nerve associated with elbow flexion and valgus position. Besides the throwing athlete, nerve injury from high-energy direct-impact forces may also damage nerves around the elbow in contact sports. Detailed history and physical examination can often make the diagnosis of most upper extremity neuropathies. The clinician must be aware of the possibility of isolated or combined nerve injury as far proximal as the cervical nerve roots, through the brachial plexus, to the peripheral nerve terminal branches. Electrodiagnostic studies are occasionally beneficial for diagnosis with certain nerves. Nonoperative management is often successful in most elbow and upper extremity neuropathies. If conservative treatment fails, then surgical treatment should address all potentially offending structures. In the presence of medial laxity and concurrent ulnar neuritis, the medial ulnar collateral ligament warrants surgical treatment, in addition to transposition of the ulnar nerve. The morbidity of open surgical decompression of nerves in and around the elbow is potentially career threatening in the throwing athlete. This mandates an assessment of the adequacy of the nonsurgical treatment and a thorough preoperative discussion of the risks and benefits of surgery. PMID:25077754

  8. Terminal nerve: cranial nerve zero

    Jorge Eduardo Duque Parra

    2006-12-01

    Full Text Available It has been stated, in different types of texts, that there are only twelve pairs of cranial nerves. Such texts exclude the existence of another cranial pair, the terminal nerve or even cranial zero. This paper considers the mentioned nerve like a cranial pair, specifying both its connections and its functional role in the migration of liberating neurons of the gonadotropic hormone (Gn RH. In this paper is also stated the hypothesis of the phylogenetic existence of a cerebral sector and a common nerve that integrates the terminal nerve with the olfactory nerves and the vomeronasals nerves which seem to carry out the odors detection function as well as in the food search, pheromone detection and nasal vascular regulation.

  9. TRPV1, but not TRPA1, in primary sensory neurons contributes to cutaneous incision-mediated hypersensitivity

    Barabas, Marie E.; Cheryl L Stucky

    2013-01-01

    Background Mechanisms underlying postoperative pain remain poorly understood. In rodents, skin-only incisions induce mechanical and heat hypersensitivity similar to levels observed with skin plus deep incisions. Therefore, cutaneous injury might drive the majority of postoperative pain. TRPA1 and TRPV1 channels are known to mediate inflammatory and nerve injury pain, making them key targets for pain therapeutics. These channels are also expressed extensively in cutaneous nerve fibers. Therefo...

  10. Advanced radiological work-up as an adjunct to decision in early reconstructive surgery in brachial plexus injuries

    Björkman Anders

    2010-07-01

    Full Text Available Abstract Background As neurophysiologic tests may not reveal the extent of brachial plexus injury at the early stage, the role of early radiological work-up has become increasingly important. The aim of the study was to evaluate the concordance between the radiological and clinical findings with the intraoperative findings in adult patients with brachial plexus injuries. Methods Seven consecutive male patients (median age 33; range 15-61 with brachial plexus injuries, caused by motor cycle accidents in 5/7 patients, who underwent extensive radiological work-up with magnetic resonance imaging (MRI, computed tomography myelography (CT-M or both were included in this retrospective study. A total of 34 spinal nerve roots were evaluated by neuroradiologists at two different occasions. The degree of agreement between the radiological findings of every individual nerve root and the intraoperative findings was estimated by calculation of kappa coefficient (К-value. Using the operative findings as a gold standard, the accuracy, sensitivity, specificity, positive predictive value (PPV and negative predictive value (NPV of the clinical findings and the radiological findings were estimated. Results The diagnostic accuracy of radiological findings was 88% compared with 65% for the clinical findings. The concordance between the radiological findings and the intraoperative findings was substantial (К = 0.76 compared with only fair (К = 0.34 for the clinical findings. There were two false positive and two false negative radiological findings (sensitivity and PPV of 0.90; specificity and NPV of 0.87. Conclusions The advanced optimized radiological work-up used showed high reliability and substantial agreement with the intraoperative findings in adult patients with brachial plexus injury.

  11. Visualization of Cervical Nerve Roots and Their Distal Nerve Fibers by Diffusion-Weighted Scanning Using Parallel Imaging

    Purpose: To report a technique developed for visualizing cervical nerve roots and distal nerve fibers using diffusion-weighted magnetic resonance imaging employing parallel imaging. Material and Methods: We performed maximum intensity projection for a stack of isotropic axial diffusion-weighted images obtained with parallel imaging applying a motion-probing gradient in six directions with a b-value of 500 s/mm2 in a preliminary series of 13 subjects. Results: This method worked well for visualizing the spinal cord and most of the nerve roots, the dorsal root ganglia, and proximal peripheral nerves. Conclusion: Although the technique remains limited in depicting the brachial plexus and distal nerves, the ability to visualize the proximal peripheral nervous system at the cervical level is promising

  12. Visualization of Cervical Nerve Roots and Their Distal Nerve Fibers by Diffusion-Weighted Scanning Using Parallel Imaging

    Tsuchiya, K.; Fujikawa, A.; Tateishi, H.; Nitatori, T. [Kyorin Univ. School of Medicine, Tokyo (Japan). Dept. of Radiology

    2006-07-15

    Purpose: To report a technique developed for visualizing cervical nerve roots and distal nerve fibers using diffusion-weighted magnetic resonance imaging employing parallel imaging. Material and Methods: We performed maximum intensity projection for a stack of isotropic axial diffusion-weighted images obtained with parallel imaging applying a motion-probing gradient in six directions with a b-value of 500 s/mm{sup 2} in a preliminary series of 13 subjects. Results: This method worked well for visualizing the spinal cord and most of the nerve roots, the dorsal root ganglia, and proximal peripheral nerves. Conclusion: Although the technique remains limited in depicting the brachial plexus and distal nerves, the ability to visualize the proximal peripheral nervous system at the cervical level is promising.

  13. Diffuse spinal and intercostal nerve involvement in chronic inflammatory demyelinating polyradiculoneuropathy: MRI findings

    Oguz, B.; Oguz, K.K.; Cila, A. [Dept. of Radiology, Hacettepe Univ. Faculty of Medicine, Ankara (Turkey); Tan, E. [Dept. of Neurology, Hacettepe Univ. Faculty of Medicine, Ankara (Turkey)

    2003-12-01

    Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an uncommon demyelinating disorder with a relapsing and remitting or continuously progressive course. Hypertrophic nerve roots, sometimes associated with gadolinium enhancement, has been reported more commonly in lumbar spine and less commonly in the brachial plexus and cervical roots; however, diffuse involvement of intercostal nerves bilaterally has never been reported previously. We present MRI findings which include diffuse enlargement and mild enhancement of roots and extraforaminal segments of nerves in all segments except a short segment between T12-L2 as well as all the intercostal nerves in a case of CIPD with a 10-year history. (orig.)

  14. Diffuse spinal and intercostal nerve involvement in chronic inflammatory demyelinating polyradiculoneuropathy: MRI findings

    Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an uncommon demyelinating disorder with a relapsing and remitting or continuously progressive course. Hypertrophic nerve roots, sometimes associated with gadolinium enhancement, has been reported more commonly in lumbar spine and less commonly in the brachial plexus and cervical roots; however, diffuse involvement of intercostal nerves bilaterally has never been reported previously. We present MRI findings which include diffuse enlargement and mild enhancement of roots and extraforaminal segments of nerves in all segments except a short segment between T12-L2 as well as all the intercostal nerves in a case of CIPD with a 10-year history. (orig.)

  15. Origin and distribution of the thoracodorsal nerve in pig fetuses of the lineage Pen Ar Lan

    Eleusa Marta Mendonça Tavares; Juliana França Ortega; Angelita das Graças de Oliveira Honorato; Lázaro Antônio dos Santos; Frederico Ozanam Carneiro e Silva

    2012-01-01

    Considering the importance of the nerves that make up the brachial plexus, the aim was to study the origin and distribution of the thoracodorsal nerve. Thus, 30 pig fetuses from the lineage Pen Ar Lan obtained from natural abortions in breedings of the Triangulo Mineiro region were used. The specimens were prepared through the injection of 50% Neoprene Latex “450” and 10% formaldehyde solutions in the descending aorta artery, and immersion in the same solution for least 48 hours. The dissecti...

  16. An unusual presentation of whiplash injury: long thoracic and spinal accessory nerve injury

    N. Omar; Alvi, F.; M. S. Srinivasan

    2007-01-01

    Whiplash injuries from motor vehicle accidents are very common. The usual presentation and course of this condition normally results in resolution of symptoms within a few weeks. Brachial plexus traction injuries without any bone or joint lesion of the cervical spine have been reported before. We report a case where a gentleman was involved in a rear end vehicle collision, sustained a whiplash injury and was later found to have a long thoracic nerve palsy and spinal accessory nerve palsy. Alt...

  17. Terminal nerve: cranial nerve zero

    Jorge Eduardo Duque Parra; Carlos Alberto Duque Parra

    2006-01-01

    It has been stated, in different types of texts, that there are only twelve pairs of cranial nerves. Such texts exclude the existence of another cranial pair, the terminal nerve or even cranial zero. This paper considers the mentioned nerve like a cranial pair, specifying both its connections and its functional role in the migration of liberating neurons of the gonadotropic hormone (Gn RH). In this paper is also stated the hypothesis of the phylogenetic existence of a cerebral sector and a co...

  18. A comparison of two approaches to brachial plexus anaesthesia

    Rajib Hazarika

    2016-05-01

    Conclusions: Supraclavicular brachial plexus block may be easier to perform than infraclavicular brachial plexus block. The infraclavicular approach may be preferred to the supraclavicular approach when considering the complications. [Int J Res Med Sci 2016; 4(5.000: 1335-1338

  19. Comparison of two approaches of infraclavicular brachial plexus block for orthopaedic surgery below mid-humerus

    Vikas Trehan

    2010-01-01

    Full Text Available The brachial plexus in infraclavicular region can be blocked by various approaches. Aim of this study was to compare two approaches (coracoid and clavicular regarding success rate, discomfort during performance of block, tourniquet tolerance and complications. The study was randomised, prospective and observer blinded. Sixty adult patients of both sexes of ASA status 1 and 2 requiring orthopaedic surgery below mid-humerus were randomly assigned to receive nerve stimulator guided infraclavicular brachial plexus block either by lateral coracoid approach (group L, n = 30 or medial clavicular approach (group M, n = 30 with 25-30 ml of 0.5% bupivacaine. Sensory block in the distribution of five main nerves distal to elbow, motor block (Grade 1-4, discomfort during performance of block and tourniquet pain were recorded by a blinded observer. Clinical success of block was defined as the block sufficient to perform the surgery without any supplementation. All the five nerves distal to elbow were blocked in 77 and 67% patients in groups L and M respectively. Successful block was observed in 87 and 73% patients in groups L and M, respectively (P > 0.05. More patients had moderate to severe discomfort during performance of block due to positioning of limb in group M (14 vs. 8 in groups M and L. Tourniquet was well tolerated in most patients with successful block in both groups. No serious complication was observed. Both the approaches were equivalent regarding success rate, tourniquet tolerance and safety. Coracoid approach seemed better as positioning of operative limb was less painful, coracoids process was easy to locate and the technique was easy to learn and master.

  20. Progressive Brachial Plexus Palsy after Osteosynthesis of an Inveterate Clavicular Fracture

    Rosati, Marco; Andreani, Lorenzo; Poggetti, Andrea; Zampa, Virna; Parchi, Paolo; Lisanti, Michele

    2013-01-01

    Introduction: The thoracic outlet syndrome (TOS) is a rare complication of clavicular fracture, occurring in 0.5-9% of cases. In the literature from 1965 – 2010, 425 cases of TOS complicating a claviclular fracture were described. However, only 5 were observed after a surgical procedure of reduction and fixation. The causes of this complication were due to the presence of an exuberant callus, to technical surgery errors or to vascular lesions. In this paper we describe a case of brachial plexus plasy after osteosynthesis of clavicle fracture Case Report: A 48 year old female, presented to us with inveterate middle third clavicle fracture of 2 months duration. She was an alcoholic, smoker with an history of opiate abuse and was HCV positive. At two month the fracture was displaced with no signs of union and open rigid fixation with plate was done. The immediate postoperative patient had signs of neurologic injury. Five days after surgery showed paralysis of the ulnar nerve, at 10 days paralysis of the median nerve, radial and ulnar paresthesias in the territory of the C5-C6-C7-C8 roots. She was treated with rest, steroids and neurotrophic drugs. One month after surgery the patient had signs of complete denervation around the brachial plexus. Implant removal was done and in a month ulnar and median nerve functions recovered. At three months post implant removal the neurological picture returned to normal. Conclusion: We can say that TOS can be seen as arising secondary to an “iatrogenic compartment syndrome” justified by the particular anatomy of the space cost joint. The appropriateness of the intervention for removal of fixation devices is demonstrated by the fact that the patient has returned to her daily activities in the absence of symptoms and good functional recovery in about three months, despite fracture nonunion. PMID:27298912

  1. TRPA1 modulates mechanotransduction in cutaneous sensory neurons

    Kwan, Kelvin Y.; Glazer, Joshua M.; David P Corey; Rice, Frank L.; Stucky, Cheryl L.

    2009-01-01

    TRPA1 is expressed by nociceptive neurons of the dorsal root ganglia (DRG) and trigeminal ganglia, but its roles in cold and mechanotransduction are controversial. To determine the contribution of TRPA1 to cold and mechanotransduction in cutaneous primary afferent terminals, we used the ex-vivo skin-nerve preparation from Trpa1+/+, Trpa1+/− or Trpa1−/− adult mouse littermates. Cutaneous fibers from TRPA1-deficient mice showed no deficits in acute cold sensitivity, but they displayed striking ...

  2. [Penile sporotrichoid cutaneous leishmaniasis].

    Masmoudi, A; Boudaya, S; Bouzid, L; Frigui, F; Meziou, T J; Akrout, F; Turki, H; Zahaf, A

    2005-12-01

    The localisation of the cutaneous leishmaniasis of L. major at the penis level is rare, we report here a new observation. Mr K. R aged of 41, without known pathological background presented for 20 days a nodular lesion of the anterior face of the neck, 2 juxtaposed ulcerated nodular lesions of the left wrist. He presented also subcutaneous nodules ranged linearly and extended to the root of the penis. Theses lesions were covered by an erythematous or ulcerated skin. The smear made from the genital lesions of the penis confirmed the diagnosis of a cutaneous leishmaniasis. The evolution was favourable after a 21 days treatment by doxycyclin after an interval of one week. Our observation was specific by the localisation of the cutaneous leishmaniasis and by the clinical form. This shows that in our region cutaneous leishmaniasis is characterised by different clinical symptoms. PMID:16425718

  3. Mastocytosis, diffuse cutaneous (image)

    This is a picture of diffuse, cutaneous mastocytosis. Abnormal collections of cells in the skin (mast cells) produce this rash. Unlike bullous mastocytosis, rubbing will not lead to formation of blisters ( ...

  4. A comparison between brachial and echocardiographic systolic time intervals.

    Ho-Ming Su

    Full Text Available Systolic time interval (STI is an established noninvasive technique for the assessment of cardiac function. Brachial STIs can be automatically determined by an ankle-brachial index (ABI-form device. The aims of this study are to evaluate whether the STIs measured from ABI-form device can represent those measured from echocardiography and to compare the diagnostic values of brachial and echocardiographic STIs in the prediction of left ventricular ejection fraction (LVEF <50%. A total of 849 patients were included in the study. Brachial pre-ejection period (bPEP and brachial ejection time (bET were measured using an ABI-form device and pre-ejection period (PEP and ejection time (ET were measured from echocardiography. Agreement was assessed by correlation coefficient and Bland-Altman plot. Brachial STIs had a significant correlation with echocardiographic STIs (r = 0.644, P<0.001 for bPEP and PEP; r  = 0.850, P<0.001 for bET and ET; r = 0.708, P<0.001 for bPEP/bET and PEP/ET. The disagreement between brachial and echocardiographic STIs (brachial STIs minus echocardiographic STIs was 28.55 ms for bPEP and PEP, -4.15 ms for bET and ET and -0.11 for bPEP/bET and PEP/ET. The areas under the curve for bPEP/bET and PEP/ET in the prediction of LVEF <50% were 0.771 and 0.765, respectively. Brachial STIs were good alternatives to STIs obtained from echocardiography and also helpful in prediction of LVEF <50%. Brachial STIs automatically obtained from an ABI-form device may be helpful for evaluation of left ventricular systolic dysfunction.

  5. Idiopathic brachial plexus neuritis after laparoscopic treatment of endometriosis: a complication that may mimic position-related brachial plexus injury.

    Minas, Vasileios; Aust, Thomas

    2013-01-01

    We report the case of a 37-year-old woman who developed idiopathic brachial plexus neuritis, also referred to as Parsonage-Turner syndrome, after laparoscopic excision of endometriosis. The differential diagnosis between this non-position-related neuritis and brachial plexus injury is discussed. The aim of this report was to raise awareness on this distressing postoperative complication. PMID:24183278

  6. West Nile virus-associated brachial plexopathy.

    Chahil, Mandeep; Nguyen, Thy Phuong

    2016-01-01

    West Nile virus (WNV) is the most frequent cause of arbovirus infection in the USA. Only 20% of infected individuals are symptomatic. Less than 1% of symptomatic individuals display West Nile neuroinvasive disease. We report a rare case of WNV-associated brachial plexopathy in a young immunocompetent individual, without cerebrospinal fluid pleocytosis or encephalitis. Additionally, there was subjective and objective improvement after high-dose corticosteroids. This case adds to the clinical spectrum of WNV neuroinvasive disease. The literature regarding immunomodulatory treatment and WNV is reviewed. PMID:27030459

  7. Recurrent ulnar nerve entrapment at the elbow: Correlation of surgical findings and 3-Tesla magnetic resonance neurography

    Chhabra, Avneesh; Wadhwa, Vibhor; Thakkar, Rashmi S; John A Carrino; Dellon, A. Lee

    2013-01-01

    The authors describe the correlation between 3-Tesla magnetic resonance neurography (MRN) and surgical findings in two patients who underwent multiple previous failed ulnar nerve surgeries. MRN correctly localized the site of the abnormality. Prospectively observed MRN findings of perineural fibrosis, ulnar nerve re-entrapment abnormalities, medial antebrachial cutaneous neuroma and additional median nerve entrapment were confirmed surgically.

  8. Evaluation of Low-Intensity Transcutaneous Electrical Nerve Stimulation in Combination with Aspirin for Reduction of Controlled Thermal Sensation

    Kajander, Keith C.

    1988-01-01

    Reductions in cutaneous thermal sensation produced by placebo, aspirin, transcutaneous electrical nerve stimulation, and transcutaneous electrical nerve stimulation plus aspirin were compared in 60 normal volunteers. The combination of transcutaneous electrical nerve stimulation plus aspirin produced a statistically significant reduction as compared with placebo. The results suggest this treatment combination may provide levels of analgesia useful for completion of minor dental procedures.

  9. Disseminated Cutaneous Larva Migrans

    Karthikeyan Kaliaperumal

    2002-01-01

    Full Text Available A 30 year old male agricultural labourer presented with generalized itchy lesions over the back and extremities of 5 days duration. Cutaneous examination revealed multiple erythematous linear to serpentine lesions (numbering about 40 about 1-2 mm in width and ranging in length from 7 to 9 cm. The patient had eosinophilia and classical skin lesions, which responded very well to albendazole therapy. All these features supported the clinical diagnosis of dissenmintal cutaneous larva migrans.

  10. Update on cutaneous calciphylaxis

    Uwe Wollina

    2013-01-01

    Calciphylaxis is a devastating disorder with a mortality rate of 80% due to sepsis and organ failure. Hallmarks of this rare disease are arteriolar media calcification, thrombotic cutaneous ischemia, and necrotic ulcerations. Different mechanisms of vascular calcification can lead to calciphylaxis. Early diagnosis by deep cutaneous ulcer biopsy is most important for prognosis. Here, dermatologists play a significant role although treatment usually needs an interdisciplinary approach. Surgical...

  11. Microvascular Cranial Nerve Palsy

    ... Español Eye Health / Eye Health A-Z Microvascular Cranial Nerve Palsy Sections What Is Microvascular Cranial Nerve Palsy? ... Microvascular Cranial Nerve Palsy Treatment What Is Microvascular Cranial Nerve Palsy? Aug. 02, 2012 Microvascular cranial nerve palsy ( ...

  12. Subtraction of unidirectionally encoded images for suppression of heavily isotropic objects (SUSHI) for selective visualization of peripheral nerves

    The aim of this study was to introduce and assess a new magnetic resonance (MR) technique for selective peripheral nerve imaging, called ''subtraction of unidirectionally encoded images for suppression of heavily isotropic objects'' (SUSHI). Six volunteers underwent diffusion-weighted MR neurography (DW-MRN) of the brachial plexus, and seven volunteers underwent DW-MRN of the sciatic, common peroneal, and tibial nerves at the level of the knee, at 1.5 T. DW-MRN images with SUSHI (DW-MRNSUSHI) and conventional DW-MRN images (DW-MRNAP) were displayed using a coronal maximum intensity projection and evaluated by two independent observers regarding signal suppression of lymph nodes, bone marrow, veins, and articular fluids and regarding signal intensity of nerves and ganglia, using five-point grading scales. Scores of DW-MRNSUSHI were compared to those of DW-MRNAP using Wilcoxon tests. Suppression of lymph nodes around the brachial plexus and suppression of articular fluids at the level of the knee at DW-MRNSUSHI was significantly better than that at DW-MRNAP (P SUSHI was significantly lower than that at DW-MRNAP (P SUSHI was judged as significantly better than that at DW-MRNAP (P < 0.05). The SUSHI technique allows more selective visualization of the sciatic, common peroneal, and tibial nerves at the level of the knee but is less useful for brachial plexus imaging because signal intensity of the brachial plexus nerves and ganglia can considerably be decreased. (orig.)

  13. Subtraction of unidirectionally encoded images for suppression of heavily isotropic objects (SUSHI) for selective visualization of peripheral nerves

    Takahara, Taro; Kwee, Thomas C.; Hendrikse, Jeroen; Niwa, Tetsu; Mali, Willem P.T.M.; Luijten, Peter R. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Van Cauteren, Marc [Philips Healthcare, Asia Pacific, Tokyo (Japan); Koh, Dow-Mu [Royal Marsden Hospital, Department of Radiology, Sutton (United Kingdom)

    2011-02-15

    The aim of this study was to introduce and assess a new magnetic resonance (MR) technique for selective peripheral nerve imaging, called ''subtraction of unidirectionally encoded images for suppression of heavily isotropic objects'' (SUSHI). Six volunteers underwent diffusion-weighted MR neurography (DW-MRN) of the brachial plexus, and seven volunteers underwent DW-MRN of the sciatic, common peroneal, and tibial nerves at the level of the knee, at 1.5 T. DW-MRN images with SUSHI (DW-MRN{sub SUSHI}) and conventional DW-MRN images (DW-MRN{sub AP}) were displayed using a coronal maximum intensity projection and evaluated by two independent observers regarding signal suppression of lymph nodes, bone marrow, veins, and articular fluids and regarding signal intensity of nerves and ganglia, using five-point grading scales. Scores of DW-MRN{sub SUSHI} were compared to those of DW-MRN{sub AP} using Wilcoxon tests. Suppression of lymph nodes around the brachial plexus and suppression of articular fluids at the level of the knee at DW-MRN{sub SUSHI} was significantly better than that at DW-MRN{sub AP} (P < 0.05). However, overall signal intensity of brachial plexus nerves and ganglia at DW-MRN{sub SUSHI} was significantly lower than that at DW-MRN{sub AP} (P < 0.05). On the other hand, signal intensity of the sciatic, common peroneal, and tibial nerves at the level of the knee at DW-MRN{sub SUSHI} was judged as significantly better than that at DW-MRN{sub AP} (P < 0.05). The SUSHI technique allows more selective visualization of the sciatic, common peroneal, and tibial nerves at the level of the knee but is less useful for brachial plexus imaging because signal intensity of the brachial plexus nerves and ganglia can considerably be decreased. (orig.)

  14. Modified trapezius transfer technique for restoration of shoulder abduction in brachial plexus injury

    Singh Arun

    2007-01-01

    Full Text Available Aims and Objectives: Shoulder stability and restoration are very important in providing greater range of motion to the arm and forearm. When brachial plexus repair does not have the desired outcome and in patients with long standing denervation, the trapezius muscle is frequently used for transfer to restore the shoulder abduction and external rotation. We propose a modified simple technique for trapezius muscle transfer. Materials and Methods: From February 2004 to February 2006, eight patients with posttraumatic brachial plexus injury with insufficient shoulder abduction were treated by trapezius muscle transfer. All patients with brachial plexus palsy were posttraumatic, often resulted from motor cycle accidents. Before operation a full evaluation of muscle function in the affected arm was carried out. All patients were treated with trapezius muscle transfer performed by the modified technique. S-shaped incision from the anterior border of the trapezius just above the clavicle to the Deltoid up to its insertion was made. The accessory nerve and its branches to the trapezius were secured. The trapezius was dissected and detached from its insertion along with the periosteum and sutured to the insertion of the Deltoid muscle. Results: All patients had improved functions and were satisfied with the outcome. The average increase in active abduction of shoulder was from 13.7 degrees (0 to 35 degrees preoperatively to 116 degrees (45 to 180 degrees postoperatively and of shoulder flexion from 24.3 degrees (15 to 30 degrees to 107 degrees (90 to 180 degrees. Conclusion: The modified technique proposed here for trapezius transfer is safe, convenient, simple and reliable for restoration of shoulder abduction and stability with clear subjective benefits.

  15. Reimplantation combined with transplantation of transgenic neural stem cells for treatment of brachial plexus root avulsion

    CHEN Lei; LU Lai-jin; MENG Xiao-ting; CHEN Dong; ZHANG Zhi-xin; YANG Fan

    2008-01-01

    Objective: To explore a new method to treat brachial plexus root avulsion experimentally by reimplantation combined with transplantation of neural stem cells (NSCs) modified by neurotrophin-3 gene (NT-3).Methods: The total RNA was extracted from neonatal rat striatum and the NT-3 cDNA was obtained by reverse transcription and amplified by polymerase chain reaction.The NT-3 gene was transferred into NSCs via the pLEGFP-Cl,an expression plasmid vectors.The untransfected NSCs,the pLEGFP-Cl treated NSCs,and the pLEGFP-Cl-NT-3 treated NSCs were transplanted into corresponding spinal cord segment with brachial plexus root avulsion.The survival,differentiation,and migration of the transplanted cells were determined under confoeal laser scanning microscope or by immunohistochemistry method.The nerve regeneration was evaluated by gross observation,electrophysiologieal examination and reverse horseradish peroxidase tracing.Results: The NT-3 gene was successfully amplified and transferred into neural stem cells via the plasmid vectors.The transplanted cells survived,differentiated,and migrated and NT-3 was expressed within the spinal cord.The animals regained some muscle strength which was less than 3-degree muscular strength according to the British Medical Research Council (BMRC) evaluating system.The resuits of electrophysiological examination and reverse horseradish peroxidase tracing were superior in the pLEGFP-Cl-NT-3 group to the NSCs untransfected group orthe pLEGFP-Cl group.Conclusion: Transplantation of NSCs modified by NT-3gene combined with reimplantantion is a relatively effective way to treat brachial plexus root avuision experimentally.It still need further study to improve the results.

  16. Cell population kinetics and dose-time relationships for post-irradiation injury of the brachial plexus in man

    Collected data on radiation-induced lesions of the brachial plexus were analyzed on the assuption that this reaction arises from depletion of some unidentified cell population in the irradiated tissues. A multi-probit search program was used to derive best-fitting cell kinetic parameters in a composite multi-target model for cellular radiation lethality and repopulation. From these parameters, a comprehensive iso-effect table, for a wide range of treatment schedules including daily treatment as well as fractionation at shorter and longer intervals, was constructed. The table provides a useful set of tolerance dosage limits for late effects in irradiation peripheral nerve. (Auth.)

  17. MR-myelography for the brachial plexus injury. Comparison of the MR-myelography, myelography and CT myelography

    The usefulness of MR-myelography was evaluated in 6 patients with brachial plexus injury. Pseudo-meningocele was confirmed clearly on MR-myelography in 4 patients with whole plexus injury. In 2 patients with upper plexus injury, damages of C6 nerve root were confirmed but pseudo-meningocele was not found on MR-myelography. MR-myelography is noninvasive and the accuracy is not inferior to myelography. Because MR-myelography needs no contrast media and the images can be observed in three-dimensional direction, it is expected in future application. (H.O.)

  18. MR-myelography for the brachial plexus injury. Comparison of the MR-myelography, myelography and CT myelography

    Nakamura, Toshiyasu; Yabe, Hiroshi; Horiuchi, Ikuo; Takayama, Shinichiro; Yamanaka, Kazuyoshi; Ichikawa, Toru [Keio Univ., Tokyo (Japan). School of Medicine

    1996-03-01

    The usefulness of MR-myelography was evaluated in 6 patients with brachial plexus injury. Pseudo-meningocele was confirmed clearly on MR-myelography in 4 patients with whole plexus injury. In 2 patients with upper plexus injury, damages of C6 nerve root were confirmed but pseudo-meningocele was not found on MR-myelography. MR-myelography is noninvasive and the accuracy is not inferior to myelography. Because MR-myelography needs no contrast media and the images can be observed in three-dimensional direction, it is expected in future application. (H.O.)

  19. Motor cortex neuroplasticity following brachial plexus transfer

    Michael Biggs

    2013-08-01

    Full Text Available In the past decade, research has demonstrated that cortical plasticity, once thought only to exist in the early stages of life, does indeed continue on into adulthood. Brain plasticity is now acknowledged as a core principle of brain function and describes the ability of the central nervous system to adapt and modify its structural organization and function as an adaptive response to functional demand. In this clinical case study we describe how we used neuroimaging techniques to observe the functional topographical expansion of a patch of cortex along the sensorimotor cortex of a 27 year-old woman following brachial plexus transfer surgery to re-innervate her left arm. We found bilateral activations present in the thalamus, caudate, insula as well as across the sensorimotor cortex during an elbow flex motor task. In contrast we found less activity in the sensorimotor cortex for a finger tap motor task in addition to activations lateralised to the left inferior frontal gyrus and thalamus and bilaterally for the insula. From a pain perspective the patient who had experienced extensive phantom limb pain before surgery found these sensations were markedly reduced following transfer of the right brachial plexus to the intact left arm. Within the context of this clinical case the results suggest that functional improvements in limb mobility are associated with increased activation in the sensorimotor cortex as well as reduced phantom limb pain.

  20. Brachial plexus MR imaging: accuracy and reproducibility of DTI-derived measurements and fibre tractography at 3.0-T

    To estimate intrastudy, intraobserver and interobserver reproducibility of DTI-derived measurements and fibre tractography (FT) at 3.0 T MR imaging in subjects without known brachial plexus pathology. IRB approval and written informed consent were obtained. Forty healthy volunteers underwent bilateral 3.0-T DTI of the brachial plexus. Postprocessing included FT and analysis of fractional anisotropy (FA) and apparent diffusion coefficient (ADC). Four authors performed postprocessing and analysis independently and in different sessions at baseline and after 4 weeks. Non-parametric tests and Bland-Altman statistics were used. Minimum and maximum percent variability were 6% and 20% for FA (85%-93% reproducibility). For ADC minimum and maximum percent variability were 6% and 18% (86%-97% reproducibility). Quality of fibre tract was rated equal in 80% and slightly different in 20% of subjects. Minimum detectable differences between limb were 37% for FA and 32% for ADC. Intra- and inter-observer agreement were good. Evaluating the combined influence of the observer and of the repeated measurements the reproducibility was 81-92%. DTI of brachial plexus nerves is reliable. The healthy contralateral side can be used as an internal control considering that changes in FA and ADC values of less that 37% and 32% will not be clinically detectable with confidence. (orig.)

  1. Brachial plexus MR imaging: accuracy and reproducibility of DTI-derived measurements and fibre tractography at 3.0-T

    Tagliafico, Alberto; Calabrese, Massimo; Pace, Daniele; Baio, Gabriella; Neumaier, Carlo Emanuele [National Institute for Cancer Research (IST), Department of Radiology, Genova (Italy); Puntoni, Matteo [Galliera Hospital, Clinical Trials Research Unit, Genova (Italy); Martinoli, Carlo [University of Genova, Department of Radiology- DISC, Genova (Italy)

    2011-08-15

    To estimate intrastudy, intraobserver and interobserver reproducibility of DTI-derived measurements and fibre tractography (FT) at 3.0 T MR imaging in subjects without known brachial plexus pathology. IRB approval and written informed consent were obtained. Forty healthy volunteers underwent bilateral 3.0-T DTI of the brachial plexus. Postprocessing included FT and analysis of fractional anisotropy (FA) and apparent diffusion coefficient (ADC). Four authors performed postprocessing and analysis independently and in different sessions at baseline and after 4 weeks. Non-parametric tests and Bland-Altman statistics were used. Minimum and maximum percent variability were 6% and 20% for FA (85%-93% reproducibility). For ADC minimum and maximum percent variability were 6% and 18% (86%-97% reproducibility). Quality of fibre tract was rated equal in 80% and slightly different in 20% of subjects. Minimum detectable differences between limb were 37% for FA and 32% for ADC. Intra- and inter-observer agreement were good. Evaluating the combined influence of the observer and of the repeated measurements the reproducibility was 81-92%. DTI of brachial plexus nerves is reliable. The healthy contralateral side can be used as an internal control considering that changes in FA and ADC values of less that 37% and 32% will not be clinically detectable with confidence. (orig.)

  2. Small Fiber Neuropathy Associated with Hyperlipidemia: Utility of Cutaneous Silent Periods and Autonomic Tests

    Morkavuk, G.; Leventoglu, A.

    2014-01-01

    Background. Established electrophysiological methods have limited clinical utility in the diagnosis of small fiber neuropathy. The cutaneous silent period (CSP) may be useful as a method for the evaluation of smaller and unmyelinated fiber dysfunctions. Hyperlipidemia is a very rare cause of small fiber neuropathy. In this study, hyperlipidemia and small fiber neuropathy in symptomatic patients with normal nerve conduction studies were evaluated with autonomic tests and cutaneous silent perio...

  3. Non-traumatic brachial plexopathies, clinical, radiological and neurophysiological findings from a tertiary centre.

    Mullins, G M

    2012-02-03

    OBJECTIVE: To establish the clinical characteristics, aetiology, neuro-physiological characteristics, imaging findings and other investigations in a cohort of patients with non-traumatic brachial plexopathy (BP). METHODS: A 3-year retrospective study of patients with non-traumatic BP identified by electromyography (EMG) and nerve conduction studies (NCS). Clinical information was retrieved from patients\\' medical charts. RESULTS: Twenty-five patients were identified. Causes of BP included neuralgic amyotrophy (NA) (48%), neoplastic (16%), radiation (8%), post infectious (12%), obstetric (4%), rucksack injury (4%), thoracic outlet syndrome (4%) and iatrogenic (4%). Patients with NA presented acutely in 50%. The onset was subacute in all others. Outcome was better for patients with NA. All patients with neoplastic disease had a previous history of cancer. MRI was abnormal in 3\\/16 patients (18.8%). PET scanning diagnosed metastatic plexopathy in two cases. CONCLUSIONS: NA was the most common cause of BP in our cohort and was associated with a more favourable outcome. The authors note potentially discriminating clinical characteristics in our population that aid in the assessment of patients with brachial plexopathies. We advise NCS and EMG be performed in all patients with suspected plexopathy. Imaging studies are useful in selected patients.

  4. [Measurement ofthe ankle-brachial pressure index (ABPI)].

    Kulisić, Sandra Marinović

    2012-10-01

    Measurement of the ankle-brachial pressure index, also known as ankle-brachial index or ankle-arm index is a ratio of the ankle blood pressure and brachial blood pressure. It is easy to perform and allows for diagnosis and further definition of the severity of peripheral arterial disease with sensitivity 90% and specificity 98%. The test is not appropriate for mild arterial changes as in case of comorbidity. Its further objectives are to identify patients at an higher risk of cardiovascular events. PMID:23193828

  5. Obstetrical brachial plexus injuries: a MRI diagnostic approach

    Purpose: To demonstrate the utility of Magnetic Resonance (MR) imaging in the evaluation of the obstetric injuries of the brachial plexus. Material and methods: 23 patients with semiology of brachial plexus palsy have been evaluated with high field MR. Patients were evaluated with a brain coil in axial, oblique coronal and sagittal planes with T1, T2 and STIR sequences. Results: In four patients (17%) the study was normal. In 19 patients (83%) we got pathological findings (pseudomeningoceles, neuromas, tumour and arachnoid cyst). Conclusion: The MR is a non-invasive method that permits to determinate the site and range of the brachial plexus damage, allowing to plan therapy. (author)

  6. Ultrasound-guided block of the axillary nerve: a volunteer study of a new method

    Rothe, C; Asghar, S; Andersen, H L;

    2011-01-01

    Interscalene brachial plexus block (IBPB) is the gold standard for perioperative pain management in shoulder surgery. However, a more distal technique would be desirable to avoid the side effects and potential serious complications of IBPB. Therefore, the aim of the present study was to develop a...... describe a new method to perform an ultrasound-guided specific axillary nerve block.......Interscalene brachial plexus block (IBPB) is the gold standard for perioperative pain management in shoulder surgery. However, a more distal technique would be desirable to avoid the side effects and potential serious complications of IBPB. Therefore, the aim of the present study was to develop and...

  7. Radiological Imaging Findings of a Case with Vertebral Osteoid Osteoma Leading to Brachial Neuralgia

    Erkan Gokce

    2013-01-01

    Full Text Available Osteoid osteoma is a small, benign osteoblastic tumor consisting of a highly vascularized nidus of connective tissue surrounded by sclerotic bone. Three-quarters of osteoid osteomas are located in the long bones, and only 7-12% in the vertebral column. The classical clinical presentation of spinal osteoid osteoma is that of painful scoliosis. Other clinical features include nerve root irritation and night pain. Osteoid osteoma has characteristic computed tomography (CT findings. Because magnetic resonance imaging (MRI findings of the osteoid osteomas causing intense perinidal edema can be confusing, these patients should be evaluated with clinical findings and other imaging techniques. In this study, we present X-ray, CT, and MRI findings of a case with osteoid osteoma located in thoracic 1 vertebra left lamina and transverse process junction leading to brachial neuralgia symptoms.

  8. Neurocutaneous disease: Cutaneous neuroanatomy and mechanisms of itch and pain.

    Chuquilin, Miguel; Alghalith, Yazan; Fernandez, Kristen Heins

    2016-02-01

    Few sources of information exist regarding cutaneous innervation and how to apply this basic neurologic science to the clinical treatment of itch, as often performed on a daily basis by dermatologists. We address the types of nerve fibers that innervate the skin and their different components and discuss the similarities and differences between itch and pain. We hope that increased knowledge of this topic will improve the recognition and treatment of neuropathic itch. PMID:26775771

  9. Cutaneous hypoesthesia following plate fixation in clavicle fractures

    Lushun Wang; Muliang Ang; Keng Thiam Lee; Ganesan Naidu; EBK Kwek

    2014-01-01

    Background: We report the functional impact and natural history of cutaneous hypoesthesia after plate internal fixation for mid shaft clavicle fractures with a horizontal skin incision from year 2009 to 2011. Materials and Methods: 38 patients had complete followup data with an average followup period of 23.2 months (range 8-43 months). The impact of supraclavicular nerve injury was studied by assessment of the incidence, functional impact and natural history of numbness with detailed rev...

  10. Cutaneous signs of piety.

    Ramesh, V; Al Aboud, Khalid

    2014-07-01

    It is important for dermatologists to be aware of cutaneous changes related to religious practices to help in their recognition and management. The anatomic location of cutaneous lesions associated with friction from praying varies based on religious practice. Allergic contact dermatitis from products and substances commonly used in worshipping also vary by religion. Some religious practices may render individuals prone to infections that manifest on the skin. Tattoos of godly figures also may adorn the body. Religious practices also have been implicated in cases of urticaria, köbnerization, and leukoderma. This article reviews the clinical presentation of some of the most common cutaneous changes that occur in individuals who practice the following religions: Christianity, Islam, Judaism, Hinduism, and Sikhism. PMID:25101349

  11. Update on cutaneous calciphylaxis.

    Wollina, Uwe

    2013-03-01

    Calciphylaxis is a devastating disorder with a mortality rate of 80% due to sepsis and organ failure. Hallmarks of this rare disease are arteriolar media calcification, thrombotic cutaneous ischemia, and necrotic ulcerations. Different mechanisms of vascular calcification can lead to calciphylaxis. Early diagnosis by deep cutaneous ulcer biopsy is most important for prognosis. Here, dermatologists play a significant role although treatment usually needs an interdisciplinary approach. Surgical procedures had been the cornerstone of treatment in the past including parathyroidectomy, but recently new medical treatments emerged aiming to normalize disturbances of minerals to reduce the serum concentration of sodium phosphate and to prevent precipitation and calcification. Multimodal therapy is warranted but only aggressive surgical debridement of cutaneous ulcers has shown significant outcome improvement. PMID:23716795

  12. Update on cutaneous calciphylaxis

    Uwe Wollina

    2013-01-01

    Full Text Available Calciphylaxis is a devastating disorder with a mortality rate of 80% due to sepsis and organ failure. Hallmarks of this rare disease are arteriolar media calcification, thrombotic cutaneous ischemia, and necrotic ulcerations. Different mechanisms of vascular calcification can lead to calciphylaxis. Early diagnosis by deep cutaneous ulcer biopsy is most important for prognosis. Here, dermatologists play a significant role although treatment usually needs an interdisciplinary approach. Surgical procedures had been the cornerstone of treatment in the past including parathyroidectomy, but recently new medical treatments emerged aiming to normalize disturbances of minerals to reduce the serum concentration of sodium phosphate and to prevent precipitation and calcification. Multimodal therapy is warranted but only aggressive surgical debridement of cutaneous ulcers has shown significant outcome improvement.

  13. Restoration of shoulder abduction by transfer of the spinal accessory nerve to suprascapular nerve through dorsal approach: a clinical study

    GUAN Shi-bing; HOU Chun-lin; CHEN De-song; GU Yu-dong

    2006-01-01

    Background In recent years, transfer of the spinal accessory nerve to suprascapular nerve has become a routine procedure for restoration of shoulder abduction. However, the operation via the traditional supraclavicular anterior approach often leads to partial denervation of the trapezius muscle. The purpose of the study was to introduce transfer of the spinal accessory nerve through dorsal approach, using distal branch of the spinal accessory nerve, to repair the suprascapular nerve for restoration of shoulder abduction, and to observe its therapeutic effect.Methods From January to October 2003, a total of 11 patients with a brachial plexus injury and an intact or nearly intact spinal accessory nerve were treated by transferring the spinal accessory nerve to the suprascapular nerve through dorsal approach. The patients were followed up for 18 to 26 months [mean (23.5 ±5.2) months] to evaluate their shoulder abduction and function of the trapezius muscle. The outcomes were compared with those of 26 patients treated with traditional anterior approach. And the data were analyzed by Student's t test using SPSS 10.5.Results In the 11 patients, the spinal accessory nerves were transferred to the suprascapular nerve through the dorsal approach successfully. Intact function of the upper trapezius was achieved in all of them. In the patients,the location of the two nerves was relatively stable at the level of superior margin of the scapula, the mean distance between them was (4.2±1.4) cm, both the nerves could be easily dissected and end-to-end anastomosed without any tension. During the follow-up, the first electrophysiological sign of recovery of the infraspinatus appeared at (6.8±2.7) months and the first sign of restoration of the shoulder abduction at (7.6±2.9) months after the operation, which were earlier than that after the traditional operation [(8.7±2.4) months and (9.9±2.8)months, respectively; P<0.05]. The postoperative shoulder abduction was 62.8°± 12

  14. Imported Cutaneous Diphtheria, United Kingdom

    de Benoist, Anne-Claire; White, Joanne Margaret; Efstratiou, Androulla; Kelly, Carole; Mann, Ginder; Nazareth, Bernadette; Irish, Charles James; Kumar, Deepti; Crowcroft, Natasha Sarah

    2004-01-01

    Cutaneous diphtheria is endemic in tropical countries but unusual in the United Kingdom. Four cases occurred in the United Kingdom within 2 months in 2002. Because cutaneous diphtheria causes outbreaks of both cutaneous and pharyngeal forms, early diagnosis is essential for implementing control measures; high diphtheria vaccination coverage must also be maintained.

  15. Brachial and lumbar plexuses in chronic inflammatory demyelinating polyradiculoneuropathy: MRI assessment including apparent diffusion coefficient

    Adachi, Yuko; Sato, Noriko; Yamashita, Fumio; Kida, Jiro; Takahashi, Tomoyuki [National Center Hospital of Neurology and Psychiatry, Department of Radiology, Kodaira, Tokyo (Japan); Okamoto, Tomoko [National Center Hospital of Neurology and Psychiatry, Department of Neurology, Kodaira, Tokyo (Japan); Sasaki, Masayuki; Komaki, Hirofumi [National Center Hospital of Neurology and Psychiatry, Department of Child Neurology, Kodaira, Tokyo (Japan); Matsuda, Hiroshi [Saitama Medial University Hospital, Department of Nuclear Medicine, Iruma-gun, Saitama (Japan)

    2011-01-15

    Our purpose was to clarify the magnetic resonance (MR) imaging characteristics of the brachial and lumbar plexuses in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) using various kinds of sequences, including diffusion-weighted images (DWI). We evaluated the MR imaging findings for lumbar and/or brachial nerve plexuses in 13 CIDP patients and 11 normal volunteers. The nerve swelling was evaluated in comparison with normal controls by coronal short tau inversion recovery (STIR), and signal abnormalities were evaluated by coronal STIR, T1-weighted images, and DWIs. The degrees of contrast enhancement and apparent diffusion coefficient (ADC) values of the plexus were also assessed. In the patient group, diffuse enlargement and abnormally high signals were detected in 16 out of 24 plexuses (66.7%) on STIR, a slightly high signal was detected in 12 of 24 plexuses (50%) on T1-weighted images, and a high-intensity signal was detected in 10 of 18 plexuses (55.6%) on DWIs with high ADC values. Contrast enhancement of the plexuses was revealed in 6 of 19 plexuses (31.6%) and was mild in all cases. There were statistically significant differences between the ADC values of patients with either swelling or abnormal signals and those of both normal volunteers and patients without neither swelling nor abnormal signals. There were no relationships between MR imaging and any clinical findings. STIR is sufficient to assist clinicians in diagnosing CIDP. T1-weighted images and DWIs seemed useful for speculating about the pathological changes in swollen plexuses in CIDP patients. (orig.)

  16. Electrodiagnosis in traumatic brachial plexus injury

    K A Mansukhani

    2013-01-01

    Full Text Available Electrodiagnosis (EDX is a useful test to accurately localize the site, determine the extent, identify the predominant pathophysiology, and objectively quantify the severity of brachial plexopathies. It can also be used to examine muscles not easily assessed clinically and recognize minimal defects. Post-operatively and on follow up studies, it is important for early detection of re-innervation. It can be used intra-operatively to assess conduction across a neuroma, which would help the surgeon to decide further course of action. Localization of the site of the lesion can be very challenging as there may be multiple sites of involvement and hence the electroneuromyographic evaluation must be adequate. The unaffected limb also needs to be examined for comparison. The final impression must be co-related with the type and severity of injury.

  17. Ankle-brachial index in HIV infection

    Martos Francisco

    2009-04-01

    Full Text Available Abstract Prognosis for patients with the human immunodeficiency virus (HIV has improved with the introduction of highly active antiretroviral therapy (HAART. Evidence over recent years suggests that the incidence of cardiovascular disease is increasing in HIV patients. The ankle-brachial index (ABI is a cheap and easy test that has been validated in the general population. Abnormal ABI values are associated with increased cardiovascular mortality. To date, six series of ABI values in persons with HIV have been published, but none was a prospective study. No agreement exists concerning the risk factors for an abnormal ABI, though its prevalence is clearly higher in these patients than in the general population. Whether this higher prevalence of an abnormal ABI is associated with a higher incidence of vascular events remains to be determined.

  18. Cutaneous lupus erythematosus

    Biazar, Cyrus; Sigges, Johanna; Patsinakidis, Nikolaos;

    2013-01-01

    In this prospective, cross-sectional, multicenter study, we assessed clinical and laboratory characteristics from patients with cutaneous lupus erythematosus (CLE) using the Core Set Questionnaire of the European Society of Cutaneous Lupus Erythematosus (EUSCLE). 1002 (768 females, 234 males...... included gender, age at onset of disease, LE-specific and LE-nonspecific skin lesions, photosensitivity, laboratory features, and the criteria of the American College of Rheumatology (ACR) for the classification of systemic lupus erythematosus. The mean age at onset of disease was 43.0±15.7 years and...

  19. Brachial access technique for aortoiliac stenting revisited

    2007-01-01

    We report a modified technique to perform iliac artery stenting through the brachial artery access. A 6F Brite tip sheath (Cordis, Jonhson & Jonhson Medical, Miami Lakes, FL, USA) is inserted into either brachial artery and a standard 4F Judkins Right diagnostic catheter was inserted over a 260 cm 0.038" Terumo Stiff wire (Terumo Corp, Tokyo, Japan) through the sheath. The catheter is navigated down to the aortic bifurcation, and after selecting the common iliac artery ostium, the wire is navigated through the lesion and advanced to the ipsilateral superficial femoral arteries. The catheter should be then moved forward over the wires beyond the lesion and the Terumo guidewire is replaced by two 0.038" 260 cm Supracor wires (Boston Scientific Corporation, San Jose, CA, USA). In order to facilitate advancement of the stent without risk of dislodgement as well as to check the position with low contrast dose injection, a 6 F (or 7F if large stent is selected) 90cm Shuttle Flexor introducer long sheath (Cook Group, Bloomington, IN, USA) should be advanced over the Supracor wire until it reaches the common iliac artery ostium. A road-map technique can be used to check the ostium position in order to properly deploy the selected stent. This technique promises to be safe and effective offering more support than guiding catheter technique; moreover it reduces the stress on the arterial vessel at the subclavian site and enables a stiff balloon or stent catheter to be advanced even through a very elongated and calcified aorta without the risk of stent dislodgement.

  20. HIGH BIFURCATION OF THE BRACHIAL ARTERY - A COMMON VARIANT

    Sesi

    2015-10-01

    Full Text Available 28 cadavers were dissected for variations in the bifurcation of brachial artery bilaterally {n=56} at the department of anatomy, Rangaraya Medical College, Kakinada, A.P. from 2010 to 2015 . Found variations during routine dissections for first year MBBS students. The findings have thrown light on the common as well as rare variants in the anatomy of brachial artery bifurcation and the course of radial and ulnar arteries in current study

  1. Management of Intrathoracic Benign Schwannomas of the Brachial Plexus

    Alessandro Bandiera; Giampiero Negri; Giulio Melloni; Carlo Mandelli; Simonetta Gerevini; Angelo Carretta; Paola Ciriaco; Armando Puglisi; Piero Zannini

    2014-01-01

    Primary tumours of the brachial plexus are rare entities. They usually present as extrathoracic masses located in the supraclavicular region. This report describes two cases of benign schwannomas arising from the brachial plexus with an intrathoracic growth. In the first case the tumour was completely intrathoracic and it was hardly removed through a standard posterolateral thoracotomy. In the second case the tumour presented as a cervicomediastinal lesion and it was resected through a one-st...

  2. Brachial plexus variations in its formation and main branches

    Valéria Paula Sassoli Fazan; André de Souza Amadeu; Adilson L. Caleffi; Omar Andrade Rodrigues Filho

    2003-01-01

    PURPOSE: The brachial plexus has a complex anatomical structure since its origin in the neck throughout its course in the axillary region. It also has close relationship to important anatomic structures what makes it an easy target of a sort of variations and provides its clinical and surgical importance. The aims of the present study were to describe the brachial plexus anatomical variations in origin and respective branches, and to correlate these variations with sex, color of the subjects ...

  3. Interscalene brachial plexus blocks in the management of shoulder dislocations.

    Underhill, T J; Wan, A; Morrice, M

    1989-01-01

    Interscalene brachial plexus block is a simple and effective alternative to intravenous benzodiazepines or general anaesthesia for manipulation of the dislocated shoulder. Thirty interscalene brachial plexus blocks were performed on 29 patients with dislocations of the shoulder to provide regional anaesthesia for reduction. Pain was abolished by 14 out of the 30 blocks performed, improved by 13 and unchanged by three. Muscle relaxation (MRC grade 3 or less) occurred in 21 patients. In 26 case...

  4. Malignant melanoma - cutaneous metastases

    Padmavathy L; Rao L; Ethirajan N; Swamy B

    2008-01-01

    Melanoma composed of melanocytes may arise in the skin or other tissues harboring melanocytes, such muco-cutaneous junctions, mucosa including the conjunctiva, iris, choroids and substantia nigra.1 Metastases to the skin and subcutaneous tissues from a malignant melanoma are less common. A case of multiple painless nodules on the body that revealed metastatic deposits of melanoma on histopathological examination is being reported.

  5. The Cutaneous Rabbit Revisited

    Flach, Rudiger; Haggard, Patrick

    2006-01-01

    In the cutaneous rabbit effect (CRE), a tactile event (so-called attractee tap) is mislocalized toward an adjacent attractor tap. The effect depends on the time interval between the taps. The authors delivered sequences of taps to the forearm and asked participants to report the location of one of the taps. The authors replicated the original CRE…

  6. Cutaneous Leishmaniasis, Sri Lanka

    Sujeevi S. K. Nawaratna; Weilgama, Danister J.; Wijekoon, Chandana J.; Dissanayake, Manel; Rajapaksha, Kosala

    2007-01-01

    Cutaneous leishmaniasis (CL) is an emerging disease in Sri Lanka. Of 116 patients with clinical symptoms suggestive of CL, 86 were confirmed positive for Leishmania donovani. Most patients had single dry lesions, usually on the face. Patients were from 5 of the 7 agroclimatic zones in Sri Lanka.

  7. Nerve biopsy (image)

    Nerve biopsy is the removal of a small piece of nerve for examination. Through a small incision, a sample ... is removed and examined under a microscope. Nerve biopsy may be performed to identify nerve degeneration, identify ...

  8. Traumatic injuries of brachial plexus: present methods of surgical treatment Part II. Treatment policy for brachial plexus injuries

    M. L. Novikov; T. E. Torno

    2015-01-01

    The task of this paper is to familiarize practicing neurologists, neurosurgeons, traumatologists, and orthopedists with the current principles of diagnosis and treatment of different brachial plexus (BP) injuries. Part I describes the anatomy of BP in detail, considers the main mechanisms of its injuries, and gives their current classification (Nervno-Myshechnye Bolezni (Neuromuscular Diseases) 2012;4:19–27).Part II presents the author's approach to treatment of brachial plexus injuries accor...

  9. Sporotrichoid pattern of nerve abscesses in borderline tuberculoid leprosy: A Case Report (sporotrichoid like abscesses in leprosy).

    Garg, G; Thami, G P; Mohan, H

    2014-01-01

    Linear distribution of multiple subcutaneous nodules or ulcers along the course of lymphatics, classically seen in lymphocutaneous sporotrichosis, has been observed in a number of other infections like localized cutaneous leishmaniasis, cutaneous tuberculous and non tuberculous mycobacterial infections, Pasteurella tularensis, Scopulariopsis blochi, Nocardia brasiliensis, yaws and syphilis. A case of borderline tuberculoid leprosy with multiple cutaneous nodules corresponding to resolving nerve abscesses in a sporotrichoid pattern is being reported. PMID:26411249

  10. The H-reflex of the flexor carpi radialis muscle; a study in controls and radiation-induced brachial plexus lesions

    H-reflexes of the flexor carpi radialis muscle were studied in 52 controls and 25 cancer patients with radiation-induced brachial plexopathy. It was found that H-reflex conduction velocity (H-RCV) decreased with increasing age. This was not true for H-reflex latency (H-RL) and inter-latency times. There were no H-RCV and latency differences between age-matched male and female subjects. In the affected arm the reflex was absent in nine patients and delayed in 16 patients in whom H-RCV was decreased in 13 patients. Three patients showed large H-RL differences which were also notable features in median nerve disease in the region of the brachial plexus. (author)

  11. Multiple impairments of cutaneous nociceptor function induced by cardiotoxic doses of Adriamycin in the rat.

    Boros, Krisztina; Jancsó, Gábor; Dux, Mária; Fekécs, Zoltán; Bencsik, Péter; Oszlács, Orsolya; Katona, Márta; Ferdinandy, Péter; Nógrádi, Antal; Sántha, Péter

    2016-09-01

    Besides their deleterious action on cardiac muscle, anthracycline-type cytostatic agents exert significant neurotoxic effects on primary sensory neurons. Since cardiac sensory nerves confer protective effects on heart muscle and share common traits with cutaneous chemosensitive nerves, this study examined the effects of cardiotoxic doses of adriamycin on the function and morphology of epidermal nerves. Sensory neurogenic vasodilatation, plasma extravasation, and the neural CGRP release evoked by TRPV1 and TRPA1 agonists in vitro were examined by using laser Doppler flowmetry, the Evans blue technique, and ELISA, respectively. Carrageenan-induced hyperalgesia was assessed with the Hargreaves method. Immunohistochemistry was utilized to study cutaneous innervation. Adriamycin treatment resulted in profound reductions in the cutaneous neurogenic sensory vasodilatation and plasma extravasation evoked by the TRPV1 and TRPA1 agonists capsaicin and mustard oil, respectively. The in vitro capsaicin-, but not high potassium-evoked neural release of the major sensory neuropeptide, CGRP, was markedly attenuated after adriamycin treatment. Carrageenan-induced inflammatory hyperalgesia was largely abolished following the administration of adriamycin. Immunohistochemistry revealed a substantial loss of epidermal TRPV1-expressing nociceptive nerves and a marked thinning of the epidermis. These findings indicate impairments in the functions of TRPV1 and TRPA1 receptors expressed on cutaneous chemosensitive nociceptive nerves and the loss of epidermal axons following the administration of cardiotoxic doses of adriamycin. Monitoring of the cutaneous nociceptor function in the course of adriamycin therapy may well be of predictive value for early detection of the deterioration of cardiac nerves which confer protection against the deleterious effects of the drug. PMID:27342418

  12. The clinical course of non-operated peripheral nerve tumor

    Peripheral nerve tumors are routinely removed by operation, however, complete enucleation is not always possible with schwannomas. Even if such tumors were completely enucleated, neurological deficits may still appear. Recently, a few studies have described the clinical course of spinal cord tumors but, there has been no study showing the clinical course of non-operated peripheral nerve tumors. This study reviewed the clinical course of non-operated peripheral nerve tumors. Ten tumors diagnosed as peripheral nerve tumors by clinical findings and MR images (MRI) were studied semiannually. The patients included seven males and three females with a mean age of 59 (range 20 to 89) years at final follow-up. The involved nerves were the radial nerve in four cases, the brachial plexus in three cases, and the median nerve, the femoral nerve, the tibial nerve in one case each. The mean follow-up interval was 43 (range 24-81) months. One patient was followed for four years and three patients were followed over six years. The initial complaint was of a palpable mass in eight cases. The mean time from clinical presentation to the first examination was 16.1 (range 1-48) months. No tumors caused sensory deficit although two tumors caused objective muscle weakness by Medical Research Council (MRC) grading. All ten tumors demonstrated a positive Tinel's sign over the mass. The mean tumor size on MRI was 36.8 (range 20-85) mm. In this study, there was no significant change of the clinical findings and the size on MRI in the peripheral nerve tumors in the follow-up of over two years. All ten tumors were static in size when examined by MRI. Only one of the ten patients experienced slightly increased pain. We conclude that the decision to operate on peripheral nerve tumors should be considered more carefully, since in patients with no or little symptoms, tumor size and symptoms did not increase. (author)

  13. REGIONAL ANESTHESIA CONTINUOUS BRACHIAL PLEXUS BLOCK WITH ULTRASONOGRAPHY GUIDANCE

    T. G. A. Senapathi

    2015-03-01

    Full Text Available Background: Regional anesthesia has an anti-inflammatory effect that blockade the C-fiber hence reduced cytokine production and blocked the activity of the sympathetic nerve fibers. Postoperative pain caused primarily by tissue inflammation and activity of the C-fibers in the manner of reduced the production of cytokines, regional anesthesia may limit the inflammatory response after surgery and severity of postoperative pain. Methods: This study is a clinical experimental study with randomized pre and post test control group design. A total of 24 samples were recruited in this study divided into two groups each consisting of 12 samples. The first group was given regional anesthesia method of continuous brachial plexus block with ultrasound guidance and the second group with general anesthesia method. T-test or Mann-Whitney continued multivariate linear regression analysis was performed to analyze the differences in treatment and not because of differences in the initial values with significance level of p<0.05. Results: This study reports that the mean decreased levels of IL-6 postoperatively in 1stgroup is 29.8 lower than in 2ndgroup and it is statistically significant p< 0.05. There was an increase of IL-10 mean levels from preoperative to postoperatively with significance level of p<0.05 in both groups. Declined in the mean levels of PAF postoperatively in 1st group 1.3 lower than 2nd group and it was statistically significant p<0.05. The declined of  postoperative VAS in 1st group is 3.1 lower than 2nd group and it is statistically significant p< 0.05, and it also contained the pure effect of PAF levels against value of VAS that any increased 1ng/ml levels of PAF then an increase in the value of 0.18 cm VAS and this was statistically significant p<0.05. Selection of this anesthesia technique in orthopedic antebrachii surgery provides better inflammatory response and improved clinical outcomes.

  14. Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults

    ... Force Recommendations Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults The ... Recommendation | 1 Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults Potential ...

  15. Update on cutaneous tuberculosis.

    Dias, Maria Fernanda Reis Gavazzoni; Bernardes Filho, Fred; Quaresma, Maria Victória; Nascimento, Leninha Valério do; Nery, José Augusto da Costa; Azulay, David Rubem

    2014-01-01

    Tuberculosis continues to draw special attention from health care professionals and society in general. Cutaneous tuberculosis is an infection caused by M. tuberculosis complex, M. bovis and bacillus Calmette-Guérin. Depending on individual immunity, environmental factors and the type of inoculum, it may present varied clinical and evolutionary aspects. Patients with HIV and those using immunobiological drugs are more prone to infection, which is a great concern in centers where the disease is considered endemic. This paper aims to review the current situation of cutaneous tuberculosis in light of this new scenario, highlighting the emergence of new and more specific methods of diagnosis, and the molecular and cellular mechanisms that regulate the parasite-host interaction. PMID:25387498

  16. Update on cutaneous tuberculosis*

    Dias, Maria Fernanda Reis Gavazzoni; Bernardes Filho, Fred; Quaresma, Maria Victória; do Nascimento, Leninha Valério; Nery, José Augusto da Costa; Azulay, David Rubem

    2014-01-01

    Tuberculosis continues to draw special attention from health care professionals and society in general. Cutaneous tuberculosis is an infection caused by M. tuberculosis complex, M. bovis and bacillus Calmette-Guérin. Depending on individual immunity, environmental factors and the type of inoculum, it may present varied clinical and evolutionary aspects. Patients with HIV and those using immunobiological drugs are more prone to infection, which is a great concern in centers where the disease is considered endemic. This paper aims to review the current situation of cutaneous tuberculosis in light of this new scenario, highlighting the emergence of new and more specific methods of diagnosis, and the molecular and cellular mechanisms that regulate the parasite-host interaction. PMID:25387498

  17. Primary cutaneous myoepithelial carcinoma

    Frost, Markus Winther; Steiniche, Torben; Damsgaard, Tine Engberg;

    2013-01-01

    This study describes a case of primary myoepithelial carcinoma of the skin and reviews the available literature on this topic. Myoepitheliomas and carcinomas arise most frequently from myoepithelial cells within the salivary glands but are found in many anatomical locations. We documented a case of...... an 80-year-old man with a 2 × 2 × 1 cm tumour located on the scalp. This tumour emerged over a period of 2 months. The tumour was radically excised, and histological examination revealed a cutaneous myoepithelial carcinoma. At an 18-month follow-up, no recurrence of the tumour was found. A systematic...... literature search identified 23 papers that reported 58 cases of cutaneous myoepitheliomas and myoepithelial carcinomas. All cases are reviewed in the presented paper. This case report and literature review serves to increase awareness regarding myoepithelial carcinomas. These tumours exhibit high metastatic...

  18. 臂丛神经MRI扫描方案探讨%MRI scan protocols of brachial plexus.

    宋海岩; 雷益; 林帆; 夏军; 侯严振

    2011-01-01

    Objective To analyze the appearance of normal brachial plexus employing different MRI sequences, and determine the best MRI scan protocol for brachial plexus. Methods A total of 18 healthy volunteers were examined with routine and DWIBS sequences. The manifestations of normal brachial plexus in these sequences were observed. Results The signal intensity of brachial plexus was isointense on T1WI and T2WI, lightly hyperintense on TIPM images, and significantly hyperintense on DWIBS. On the wansverse sections, the nerve roots appeared as linear structure exiting from the imervertebral foramen and passing through the scalene gap, and then surrounding flow void of the subclavian artery. On coronal images, the roots appeared as linear structures exiting from C5~T1 intervertebral foramen and collecting to infraclavicular and axillary fossa. Conclusion By the combination of routine and DWIBS sequences, the brachial plexus can be manifested comprehensively and distinctly.%目的 探讨臂丛神经图像常规扫描方案以及各个序列臂丛神经的不同表现.方法 对18例健康志愿者分别行常规及弥散加权背景抑制神经成像(Diffusion weighted whole body imaging with background body signal suppression,DWIBS)扫描,观察各序列中臂丛神经的表现.结果 常规T1WI、T2WI臂丛神经呈等信号,横轴位反转恢复(TIRM)序列呈稍高信号,DWIBS呈明显高信号.横断面上,显示神经根自椎间孔处穿出,行于斜角肌间隙,后与锁骨下动脉及腋动脉伴行;冠状面上,显示为由C5~T1神经孔旁起始的条索状结构.结论 联合常规及DWIBS序列,可全面、清晰地显示臂丛神经.

  19. Cutaneous manifestations in Brucellosis

    Zeynep Karaali; Birol Baysal; Sule Poturoglu; Mehmet Kendir

    2011-01-01

    Brucellosis is a common worldwide zoonotic disease. Cutaneous manifestations are not specific and affect 1–14% of patients with brucellosis. Here, we describe 49-year-old female with fever and a diffuse maculopapular rash due to Brucella melitensis infection. Histopathology of skin biopsy revealed leukocytoclastic vasculitis; positive blood cultures for B. melitensis established the diagnosis of brucellosis. We provide a review of the relevant literature.

  20. Malignant melanoma - cutaneous metastases

    Padmavathy L

    2008-01-01

    Full Text Available Melanoma composed of melanocytes may arise in the skin or other tissues harboring melanocytes, such muco-cutaneous junctions, mucosa including the conjunctiva, iris, choroids and substantia nigra. Metastases to the skin and subcutaneous tissues from a malignant melanoma are less common. A case of multiple painless nodules on the body that revealed metastatic deposits of melanoma on histopathological examination is being reported.

  1. Malignant melanoma - cutaneous metastases.

    L, Padmavathy; L, Lakshmana Rao; N, Ethirajan; B, Krishna Swamy

    2008-01-01

    Melanoma composed of melanocytes may arise in the skin or other tissues harboring melanocytes, such muco-cutaneous junctions, mucosa including the conjunctiva, iris, choroids and substantia nigra.1 Metastases to the skin and subcutaneous tissues from a malignant melanoma are less common. A case of multiple painless nodules on the body that revealed metastatic deposits of melanoma on histopathological examination is being reported. PMID:19882041

  2. Chitosan against cutaneous pathogens

    Champer, Jackson; Patel, Julie; Fernando, Nathalie; Salehi, Elaheh; Wong, Victoria; Kim, Jenny

    2013-01-01

    Propionibacterium acnes and Staphylococcus aureus are cutaneous pathogens that have become increasingly resistant to antibiotics. We sought to determine if chitosan, a polymer of deacetylated chitin, could be used as a potential treatment against these bacteria. We found that higher molecular weight chitosan had superior antimicrobial properties compared to lower molecular weights, and that this activity occurred in a pH dependent manner. Electron and fluorescence microscopy revealed that chi...

  3. Novel Axillary Approach for Brachial Plexus in Robotic Surgery: A Cadaveric Experiment

    Cihangir Tetik; Metin Uzun

    2014-01-01

    Brachial plexus surgery using the da Vinci surgical robot is a new procedure. Although the supraclavicular approach is a well known described and used procedure for robotic surgery, axillary approach was unknown for brachial plexus surgery. A cadaveric study was planned to evaluate the robotic axillary approach for brachial plexus surgery. Our results showed that robotic surgery is a very useful method and should be used routinely for brachial plexus surgery and particularly for thoracic outl...

  4. Cutaneous lymphoid hyperplasias.

    Gilliam, A C; Wood, G S

    2000-06-01

    Benign hyperplastic lymphoid infiltrates of the skin (pseudolymphoma, older term) simulate lymphoma clinically and histologically. They can be divided into B-cell predominant (typical cutaneous lymphoid hyperplasia (CLH), angiolymphoid hyperplasia, Kimura's disease, and Castleman's disease) and T-cell predominant (T-cell CLH, lymphomatoid contact dermatitis, and lymphomatoid drug eruption). Both types may represent exaggerated reactions to diverse external antigens (insect bite, tattoo, zoster, trauma, among others). A composite assessment of clinical presentation and behavior, routine histology, immunophenotyping, and molecular studies is essential for the diagnosis of benign cutaneous lymphoid infiltrates. Treatment includes antibiotics, intralesional and systemic corticosteroids, excision, radiotherapy, and immunosuppressants. Treatment depends on the assessment and biologic behavior, which is usually benign. Molecular biologic analysis has shown that a significant proportion of cases harbor occult B- or T-cell clones (clonal CLH). Progression to overt cutaneous lymphoma has been observed in a minority of cases. Patients with clonal populations of B or T cells and persistent lesions should be closely observed for emergence of a lymphoma. PMID:10892716

  5. Neurinoma del plexo braquial simulando metastasis de adenocarcinoma de mama Schwannoma of the brachial plexus resembling a breast adenocarcinoma metastasis

    Gregorio Rodríguez Boto

    2011-10-01

    Full Text Available Los neurinomas del plexo braquial son tumores infrecuentes que pueden confundirse con otras lesiones de índole tumoral. Se presenta el caso de una mujer de 40 años, tratada previamente de un adenocarcinoma de mama derecha en el pasado, que en el estudio de extensión realizado 5 años después se detectó una lesión localizada en el plexo braquial derecho. La paciente se encontraba asintomática. El diagnóstico radiológico de presunción fue metástasis de adenocarcinoma mamario. Se realizó un abordaje axilar derecho descubriendo una lesión bien delimitada en el plexo braquial. Con ayuda de la monitorización neurofisiológica intraoperatoria, se observó que la lesión dependía de la rama cubital y se pudo realizar una resección completa preservando la función de dicho nervio. El estudio anatomopatológico confirmó que se trataba de un neurinoma, descartando así la existencia de metástasis. La evolución postoperatoria fue satisfactoria. Seis años después de la intervención no existe recidiva tumoral. En nuestro conocimiento este es el primer caso publicado en la literatura de un neurinoma del plexo braquial dependiente de la rama cubital. La monitorización neurofisiológica intraoperatoria resulta fundamental para abordar este tipo de lesiones con baja morbilidad.Schwa nomas originating from the brachial plexus, although rare, may be mistaken for another type of tumour. A 40 year-old woman, who had been treated years earlier for a breast adenocarcinoma, showed in the 5-year follow-up magnetic resonance examination a localized lesion in the right brachial plexus. The presumptive radiological diagnosis was a metastasis from the primary adenocarcinoma. Following surgical access via the right axilla, a well-circumscribed mass in the brachial plexus was detected. Under intraoperative electrophysiological guidance, the lesion was observed to depend on the ulnar nerve and its complete resection was possible without compromising nerve

  6. Electrostimulation with or without ultrasound-guidance in interscalene brachial plexus block for shoulder surgery.

    Salem, Mohamed H; Winckelmann, Jörg; Geiger, Peter; Mehrkens, Hans-Hinrich; Salem, Khaled H

    2012-08-01

    In a prospective controlled trial to compare conventional interscalene brachial plexus block (ISBPB) using anatomic landmarks and electro-stimulation with a combined technique of ultrasound guidance followed by nerve stimulation, 60 patients were randomized into 2 matched equal groups: Group A using nerve stimulation (NS) alone and Group B using the combination of ultrasound and NS. The time to detect the plexus (3.9 ± 4 min in Group A and 3.3 ± 1.4 min in Group B) was not significantly different. We needed to reposition the needle once (n = 13) or twice (n = 4) in Group B. First-shot motor response was achieved in all but one patient in Group A; here we were only able to locate the plexus by use of ultrasound. None of the patients needed general anaesthesia. There were no significant differences between postoperative pain, motor power, or patient's satisfaction. ISBPB seems similarly effective using electro-stimulation and ultrasound if performed by experienced anesthesiologists. PMID:22391670

  7. THE EFFECT OF CLONIDINE ON LIDOCAINE INDUCED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

    Shrinivas

    2014-08-01

    Full Text Available BACKGROUND: Brachial plexus nerve blocks (BPB are the most common nerve blocks used for upper limb surgeries. Techniques using only Local Anaesthetics (LA have limited duration of post-operative analgesia. Clonidine has been used to prolong the duration of LA s for neuraxial blocks. Hence the effect of clonidine on Lidocaine induced BPB was studied. METHODS: 60 patients of American Society of Anesthesiologists (ASA class I and II were randomly divided into 2 groups. Group L given 30 ml of Lidocaine with adrenaline 1.5% with 0.6 ml of normal saline and the Group C given 30 ml of same LA with 0.6 ml of 90mcg of Clonidine. All the patients’ supraclavicular BPB was given using Winnies’ peri-vascular approach. The primary outcome was onset, duration of sensory and motor blockade. The secondary outcomes were motor block duration, opioid supplementation, and BPB complication. RESULTS: There was no statistically significant difference in the onset of sensory and motor block, motor blockade quality and overall quality of block. Duration of sensory and motor blockade was prolonged in groups with Clonidine. No adverse events / hemodynamic instability noted in either group. Sedation scores were higher in Clonidine group. No patients required any intervention. CONCLUSIONS: 90µg Clonidine added to Lidocaine 1.5% with adrenaline produces prolongation of both the duration of sensory and motor blockade with minimal adverse effects.

  8. Cutaneous myeloid sarcoma of the penile foreskin.

    Afrose, Ruquiya; Nebhnani, Deepa; Wadhwa, Neelam

    2015-01-01

    Myeloid sarcoma, considered to herald the onset of a blast crisis in the setting of chronic myeloproliferative neoplasm/dysplasia, typically presents during the course of the disorder. Cutaneous involvement is uncommon and lesions on genital skin are seldom seen. We present a case of a well-differentiated myeloid sarcoma in the penile foreskin in an apparently healthy 29-year-old male presenting with phimosis. The unusual composition of the inflammatory cell infiltrate, and characteristic sparing of dermal blood vessels, nerves and smooth muscle fibres led to the correct diagnosis. Absence of commonly observed changes in the circumcision skin like those of balanitis xerotica was also helpful. Detailed hematological work up revealed a previously undiagnosed chronic myeloid leukemia in chronic phase. The patient also had simultaneous priapism, another rare presentation of chronic myeloid leukemia. One year hence, the patient is in hematological remission with no evidence of extramedullary disease. Although priapism has been described as a rare presenting symptom in chronic myeloid leukemia, the present case is unique as this is the first time a cutaneous myeloid sarcoma has been documented in the penile foreskin. PMID:24913300

  9. Topical menthol increases cutaneous blood flow.

    Craighead, Daniel H; Alexander, Lacy M

    2016-09-01

    Menthol, the active ingredient in several topically applied analgesics, activates transient receptor potential melastatin 8 (TRPM8) receptors on sensory nerves and on the vasculature inducing a cooling sensation on the skin. Ilex paraguariensis is also a common ingredient in topical analgesics that has potential vasoactive properties and may alter the mechanisms of action of menthol. We sought to characterize the microvascular effects of topical menthol and ilex application and to determine the mechanism(s) through which these compounds may independently and combined alter cutaneous blood flow. We hypothesized that menthol would induce vasoconstriction and that ilex would not alter skin blood flow (SkBF). Three separate protocols were conducted to examine menthol and ilex-mediated changes in SkBF. In protocol 1, placebo, 4% menthol, 0.7% ilex, and combination menthol+ilex gels were applied separately to the skin and red cell flux was continuously measured utilizing laser speckle contrast imaging (LSCI). In protocol 2, seven concentrations of menthol gel (0.04%, 0.4%, 1%, 2%, 4%, 7%, 8%) were applied to the skin to model the dose-response curve. In protocol 3, placebo, menthol, ilex, and menthol+ilex gels were applied to skin under local thermal control (34°C) both with and without sensory nerve blockage (topical lidocaine 4%). Post-occlusive reactive hyperemia (PORH) and local heating (42°C) protocols were conducted to determine the relative contribution of endothelium derived hyperpolarizing factors (EDHFs)/sensory nerves and nitric oxide (NO), respectively. Red cell flux was normalized to mean arterial pressure expressed as cutaneous vascular conductance (CVC: flux·mmHg(-1)) in all protocols. Topical menthol application increased SkBF compared to placebo (3.41±0.33 vs 1.1±0.19CVC: peffect, p<0.05) with an ED50 of 1.0%. Similarly, SkBF was increased after menthol application during PORH (3.62±0.29 vs. 2.50±0.21flux·mmHg(-1); p<0.001), but not local heating

  10. Prognostic value of thumb pain sensation in birth brachial plexopathy

    Carlos O. Heise

    2012-08-01

    Full Text Available OBJECTIVE: To evaluate the prognostic value of absent thumb pain sensation in newborns and young infants with birth brachial plexopathy. METHODS: We evaluated 131 patients with birth brachial plexopathy with less than two months of age. Pain sensation was evoked by thumb nail bed compression to evaluate sensory fibers of the upper trunk (C6. The patients were followed-up monthly. Patients with less than antigravity elbow flexion at six months of age were considered to have a poor outcome. RESULTS: Thirty patients had absent thumb pain sensation, from which 26 showed a poor outcome. Sensitivity of the test was 65% and specificity was 96%. CONCLUSION: Evaluation of thumb pain sensation should be included in the clinical assessment of infants with birth brachial plexopathy.

  11. Reversible brachial plexopathy following primary radiation therapy for breast cancer

    Salner, A.L.; Botnick, L.E.; Herzog, A.G.; Goldstein, M.A.; Harris, J.R.; Levene, M.B.; Hellman, S.

    Reversible brachial plexopathy has occurred in very low incidence in patients with breast carcinoma treated definitively with radiation therapy. Of 565 patients treated between January 1968 and December 1979 with moderate doses of supervoltage radiation therapy (average axillary dose of 5000 rad in 5 weeks), eight patients (1.4%) developed the characteristic symptoms at a median time of 4.5 months after radiation therapy. This syndrome consists of paresthesias in all patients, with weakness and pain less commonly seen. The symptom complex differs from other previously described brachial plexus syndromes, including paralytic brachial neuritis, radiation-induced injury, and carcinoma. A possible relationship to adjuvant chemotherapy exists, though the etiology is not well-understood. The cases described demonstrate temporal clustering. Resolution is always seen.

  12. External evaluation of the Radiation Therapy Oncology Group brachial plexus contouring protocol: several issues identified

    The aims of the study were to evaluate interobserver variability in contouring the brachial plexus (BP) using the Radiation Therapy Oncology Group (RTOG)-approved protocol and to analyse BP dosimetries. Seven outliners independently contoured the BPs of 15 consecutive patients. Interobserver variability was reviewed qualitatively (visually by using planning axial computed-tomography images and anteroposterior digitally reconstructed radiographs) and quantitatively (by volumetric and statistical analyses). Dose–volume histograms of BPs were calculated and compared. We found significant interobserver variability among outliners in both qualitative and quantitative analyses. These were most pronounced for the T1 nerve roots on visual inspection and for the BP volume on statistical analysis. The BP volumes were smaller than those described in the RTOG atlas paper, with a mean volume of 20.8cc (range 11–40.7 cc) compared with 33±4cc (25.1–39.4cc). The average values of mean dose, maximum dose, V60Gy, V66Gy and V70Gy for patients treated with conventional radiotherapy and IMRT were 42.2Gy versus 44.8Gy, 64.5Gy versus 68.5Gy, 6.1% versus 7.6%, 2.9% versus 2.4% and 0.6% versus 0.3%, respectively. This is the first independent external evaluation of the published protocol. We have identified several issues, including significant interobserver variation. Although radiation oncologists should contour BPs to avoid dose dumping, especially when using IMRT, the RTOG atlas should be used with caution. Because BPs are largely radiologically occult on CT, we propose the term brachial-plexus regions (BPRs) to represent regions where BPs are likely to be present. Consequently, BPRs should in principle be contoured generously.

  13. DOES BRACHIAL ARTERY FMD PROVIDE A BIOASSAY FOR NITRIC OXIDE?

    Wray, D. Walter; Witman, Melissa A. H.; Ives, Stephen J.; McDaniel, John; Trinity, Joel D.; Conklin, Jamie D.; Supiano, Mark A.; Richardson, Russell S.

    2013-01-01

    This study sought to better define the role of nitric oxide (NO) in brachial artery flow-mediated vasodilation (FMD) in young, healthy humans. Brachial artery blood velocity and diameter were determined (ultrasound Doppler) in eight volunteers (26 ± 1 yrs) before and after 5-min forearm circulatory occlusion with and without intra-arterial infusion of the endothelial nitric oxide synthase (eNOS) inhibitor L-NMMA (0.48 mg/dl/min). Control (CON) and L-NMMA trials were performed with the occlusi...

  14. Traumatic injuries of brachial plexus: present methods of surgical treatment Part II. Treatment policy for brachial plexus injuries

    M. L. Novikov

    2013-01-01

    Full Text Available The task of this paper is to familiarize practicing neurologists, neurosurgeons, traumatologists, and orthopedists with the current principles of diagnosis and treatment of different brachial plexus (BP injuries. Part I describes the anatomy of BP in detail, considers the main mechanisms of its injuries, and gives their current classification (Nervno-Myshechnye Bolezni (Neuromuscular Diseases 2012;4:19–27.Part II presents the author's approach to treatment of brachial plexus injuries according to the type of lesion and period of denervation: nonoperative methods; rehabilitation; preoperative management; indications for surgical treatment. The tactics and techniques of primary brachial plexus reconstructions are discussed in detail.

  15. Lateral Pectoral Nerve Injury Mimicking Cervical Radiculopathy.

    Aktas, Ilknur; Palamar, Deniz; Akgun, Kenan

    2015-07-01

    The lateral pectoral nerve (LPN) is commonly injured along with the brachial plexus, but its isolated lesions are rare. Here, we present a case of an isolated LPN lesion confused with cervical radiculopathy. A 41-year-old man was admitted to our clinic because of weakness in his right arm. Previous magnetic resonance imaging (MRI) examination revealed right posterolateral protrusion at the C6-7 level. At the initial assessment, atrophy of the right pectoralis major muscle was evident, and mild weakness of the right shoulder adductor, internal rotator, and flexor muscles was observed. Therefore, electrodiagnostic evaluation was performed, and a diagnosis of isolated LPN injury was made. Nerve injury was thought to have been caused by weightlifting exercises and traction injury. Lateral pectoral nerve injury can mimic cervical radiculopathy, and MRI examination alone may lead to misdiagnosis. Repeated physical examinations during the evaluation and treatment phase will identify the muscle atrophy that occurs 1 or more months after the injury. PMID:25290103

  16. SURGICAL ANATOMY OF DORSAL ROOT ENTRY ZONE OF CERVICAL SPINAL NERVES : CADAVERIC STUDY

    A Arun Kumar; Sudha Seshayyan; V.Tamilalagan; Sindou, M

    2014-01-01

    Background: The main purpose of this study is to determine the detailed morphometric data of Dorsal Root Entry Zone (DREZ) of cervical spinal nerves. This knowledge is necessary for diagnosis, treatment and surgical management of pain due to many conditions like brachial plexus avulsion injury, post-herpetic neuralgia, phantom pain and cancer pain involved in cervical myelo-radiculopathy. There are fewer studies reported in this field of DREZ. Materials and Methods: Twenty five...

  17. Breast metastases from a malignant peripheral nerve sheath tumor of the kidney: An unusual presentation

    Shalini Koppisetty; Ricardo C Alessio; Atul Rajpurkar

    2016-01-01

    Malignant peripheral nerve sheath tumors (MPNSTs) are extremely rare soft tissue sarcomas of ectomesenchymal origin. They are commonly seen in association with neurofibromatosis type 1 (NF-1), but can also occur without a history of NF (isolated MPNST). MPNSTs are most commonly located on the extremities (brachial and sacral plexus), head and neck, and trunk regions and are rarely reported in genitourinary organs. These tumors are aggressive, with a high recurrence rate and distant metastases...

  18. Etiology and mechanisms of ulnar and median forearm nerve injuries

    Puzović Vladimir

    2015-01-01

    Full Text Available Bacgraund/Aim. Most often injuries of brachial plexus and its branches disable the injured from using their arms and/or hands. The aim of this study was to investigate the etiology and mechanisms of median and ulnar forearm nerves injuries. Methods. This retrospective cohort study included 99 patients surgically treated in the Clinic of Neurosurgery, Clinical Center of Serbia, from January 1st, 2000 to December 31st, 2010. All data are obtained from the patients' histories. Results. The majority of the injured patients were male, 81 (81.8%, while only 18 (18.2% were females, both mainly with nerve injuries of the distal forearm - 75 (75.6%. Two injury mechanisms were present, transection in 85 patients and traction and contusion in 14 of the patients. The most frequent etiological factor of nerve injuries was cutting, in 61 of the patients. Nerve injuries are often associated with other injuries. In the studied patients there were 22 vascular injuries, 33 muscle and tendon injuries and 20 bone fractures. Conclusion. The majority of those patients with peripheral nerve injuries are represented in the working age population, which is a major socioeconomic problem. In our study 66 out of 99 patients were between 17 and 40 years old, in the most productive age. The fact that the majority of patients had nerve injuries of the distal forearm and that they are operated within the first 6 months after injury, promises them good functional prognosis.

  19. Chronic zosteriform cutaneous leishmaniasis

    Omidian M

    2006-01-01

    Full Text Available Cutaneous leishmanasis (CL may present with unusual clinical variants such as acute paronychial, annular, palmoplantar, zosteriform, erysipeloid, and sporotrichoid. The zosteriform variant has rarely been reported. Unusual lesions may be morphologically attributed to an altered host response or owing to an atypical strain of parasites in these lesions. We report a patient with CL in a multidermatomal pattern on the back and buttock of a man in Khozestan province in the south of Iran. To our knowledge, this is the first reported case of multidermatomal zosteriform CL. It was resistant to conventional treatment but responded well to a combination of meglumine antimoniate, allopurinol, and cryotherapy.

  20. Multichannel somato sensory evoked potential study demonstrated abnormalities in cervical cord function in brachial monomelic amyotrophy

    Nalini A

    2008-01-01

    Full Text Available Background: Brachial monomelic amyotrophy (BMMA is known to affect the central cervical cord gray matter resulting in single upper limb atrophy and weakness. Settings and Design: Case series of BMMA patients who underwent somatosensory evoked potentials (SEP studies at a tertiary referral center. Aims: We proposed to record Multichannel Somatosensory Evoked Potentials (MCSSEP from median and ulnar nerves with neck in neutral and neck fully flexed position in 17 patients with classical BMMA seen over three years. Materials and Methods: Recordings were done from both median (MN and ulnar nerves (UN. N9, P9, N13, N20 potentials were recorded and amplitudes measured. SSEPs were performed in 22 age-matched healthy men. Amplitudes of cervical response were calculated by N13/P9 ratio and compared in both positions. Results: Among the controls N13 amplitude was always normal {MN: mean N13/P9 - 0.96 in neutral; 0.95 in flexed}{UN: mean N13/P9 - 0.82 in neutral; 0.83 in flexed}, and mean amplitudes did not reveal any difference in both conditions ( P >0.05. Among 17 patients N9, P9 and N20 responses were normal in neutral position. Flexion showed no change in latency or amplitude of N9 and N20 responses ( P -0.63 whereas the N13 response was abnormal in at least one tested nerve in the affected limb (MN: P < 0.01; UN: P < 0.01. During flexion, N13 response was abnormal in 14 (82% patients after MN stimulation and in all 17(100% after UN stimulation {MN: mean N13/P9 - 0.62 in neutral; 0.38 in flexed}{UN: mean N13/P9 - 0.55 in neutral; 0.31 in flexed}. Conclusion: MCSSEP in BMMA with neck flexion caused a significant reduction of the cervical N13 response indicating segmental cervical cord dysfunction.

  1. [Brachial plexus. Long lasting neurological deficit following interscalene blockade of the brachial plexus].

    Funk, W; Angerer, M; Sauer, K; Altmeppen, J

    2000-07-01

    An interscalene block of the brachial plexus was combined with general anaesthesia for repair of a complex chronic lesion of the shoulder. The localisation of the plexus with electro-stimulation and the injection of Bupivacain 0.5% were accomplished easily and without painful sensations. 48 hours later the block was still partially present. Paraesthesia and a sensory and motor innervation deficit affected mainly the dorsal fascicle, but also areas innervated by the median and lateral fascicles. The deficit did not completely disappear for 18 month. The cause could have been due to direct traumatisation during blockade or operation, toxic action of the injected substance (Bupivacain 0.5%, 30 ml), distension of the plexus, a cervical syndrome or an aseptic plexitis, although a definite determination is not possible. However, the pattern of the lesion and the lack of pain during localisation of the plexus and injection favour traumatisation during the acromioplasty. PMID:10969388

  2. US imaging of the musculocutaneous nerve

    Tagliafico, Alberto Stefano [National Institute for Cancer Research, Department of Radiology, Genoa (Italy); Michaud, Johan [University of Montreal, Department of Physiatry, Montreal, Quebec (Canada); Marchetti, Alessandra; Garello, Isabella; Martinoli, Carlo [Universita di Genova, Radiology Department, Genova (Italy); Padua, Luca [Universita Cattolica del Sacro Cuore-Rome, Institute of Neurology, Rome (Italy); Fondazione Don Carlo Gnocchi, Rome (Italy)

    2011-05-15

    To describe the potential value of high-resolution sonography for evaluation of the musculocutaneous nerve (MCN). The normal anatomy of the MCN was evaluated on three cadaveric limbs and correlated with the US images obtained in 15 healthy subjects. Seven consecutive patients with MCN neuropathy were then evaluated with sonography using 17.5 and 12.5-MHz broadband linear array transducers. All patients had abnormal nerve conduction studies and underwent correlative MR imaging on a 1.5-T system. One-to-one comparison between cadaveric specimens and sonographic images showed that the MCN can be reliably identified from the axilla through the elbow, including the lateral antebrachial cutaneous (LAbC) nerve. In the patients group with MCN neuropathy, sonography allowed detection of a wide spectrum of abnormalities. In 5/7 cases, a spindle neuroma was depicted in continuity with the nerve. In one case, US identified focal swelling of the nerve and in another case US was negative. The neuroma was hyperintense on T2-weighted sequences in 75% of cases. In one patient, the nerve showed Gd-enhancement on fat-suppressed T1-weighted sequences. The nerve was never detected on unenhanced T1-scans. Owing to its small-size and out-of-plane course, the MCN may be more reliably depicted with sonography rather than with MR imaging. US is promising for evaluating traumatic injuries of the MCN. By providing unique information on the entire course of the nerve, US can be used as a valuable complement of clinical and electrophysiologic findings. (orig.)

  3. [Cutaneous lesion associated with multiple endocrine neoplasms type 2A (Sipple's syndrome). An early clinical marker].

    Chabre, O; Labat-Moleur, F; Berthod, F; Tarel, V; Stoebner, P; Sobol, H; Bachelot, I

    1992-02-22

    We report the association of a cutaneous lesion with multiple endocrine neoplasia type 2A (MEN 2A) in three patients from a French family. These lesions are very similar to those previously described in an Italian and an American MEN 2A family and called cutaneous lichen amyloidosis. In all three families the patients presented with a pruritic and pigmented cutaneous lesion localized unilaterally on the upper back. However, in the French family the patients also complained of paroxysmal pain in the same area, in which we could elicit a touch hypoesthesia and pain hyperesthesia. Such an association of cutaneous and neurological features in the upper back is known as Notalgia Paresthetica (NP). NP is believed to represent a neuropathy of the posterior dorsal nerve rami. Unlike the two previously reported families, the histological, immunohistochemical and ultrastructural analysis of the skin biopsies of the French patients did not show any amyloid material. This suggests that the presence of amyloid may not be a constant feature of the cutaneous lesions associated with MEN 2A. We consider these lesions as a form of dorsal neuropathy rather than a cutaneous lichen amyloidosis. Whatever their origin, these cutaneous lesion usually precede the appearance of the neoplastic lesions of MEN 2A. They may act as an early clinical marker that must be searched for in each subject at risk for MEN 2A. In addition, all patients presenting with NP should be screened for MEN 2A. PMID:1348355

  4. Cervical Radiculopathy (Pinched Nerve)

    ... the seven small vertebrae that form the neck. Spinal nerve root. AAOS does not endorse any treatments, procedures, ... whether your symptoms are caused by pressure on spinal nerve roots and nerve damage or by another condition ...

  5. Nerve conduction velocity

    Nerve conduction velocity (NCV) is a test to see how fast electrical signals move through a nerve. ... surface electrodes are placed on the skin over nerves at different spots. Each patch gives off a ...

  6. Optic Nerve Imaging

    ... News About Us Donate In This Section Optic Nerve Imaging email Send this article to a friend ... measurements of nerve fiber damage (or loss). The Nerve Fiber Analyzer (GDx) uses laser light to measure ...

  7. Femoral nerve damage (image)

    The femoral nerve is located in the leg and supplies the muscles that assist help straighten the leg. It supplies sensation ... leg. One risk of damage to the femoral nerve is pelvic fracture. Symptoms of femoral nerve damage ...

  8. Skin innervation: important roles during normal and pathological cutaneous repair.

    Laverdet, Betty; Danigo, Aurore; Girard, Dorothée; Magy, Laurent; Demiot, Claire; Desmoulière, Alexis

    2015-08-01

    The skin is a highly sensitive organ. It is densely innervated with different types of sensory nerve endings, which discriminate between pain, temperature and touch. Autonomic nerve fibres which completely derive from sympathetic (cholinergic) neurons are also present. During all the phases of skin wound healing (inflammatory, proliferative and remodelling phases), neuromediators are involved. Several clinical observations indicate that damage to the peripheral nervous system influences wound healing, resulting in chronic wounds within the affected area. Patients with cutaneous sensory defects due to lepromatous leprosy, spinal cord injury and diabetic neuropathy develop ulcers that fail to heal. In addition, numerous experimental observations suggest that neurogenic stimuli profoundly affect wound repair after injury and that delayed wound healing is observed in animal models after surgical resection of cutaneous nerves. All these observations clearly suggest that innervation and neuromediators play a major role in wound healing. Interactions between neuromediators and different skin cells are certainly crucial in the healing process and ultimately the restoration of pain, temperature, and touch perceptions is a major challenge to solve in order to improve patients' quality of life. PMID:25799052

  9. Brief reports: a clinical evaluation of block characteristics using one milliliter 2% lidocaine in ultrasound-guided axillary brachial plexus block.

    O'Donnell, Brian

    2010-09-01

    We report onset and duration of ultrasound-guided axillary brachial plexus block using 1 mL of 2% lidocaine with 1:200,000 epinephrine per nerve (total local anesthetic volume 4 mL). Block performance time, block onset time, duration of surgery, and block duration were measured. Seventeen consecutive patients were recruited. The mean (SD) block performance and onset times were 271 (67.9) seconds and 9.7 (3.7) minutes, respectively. Block duration was 160.8 (30.7) minutes. All operations were performed using regional anesthesia alone. The duration of anesthesia obtained is sufficient for most ambulatory hand surgery.

  10. Brachial versus central blood pressure and vascular stiffness

    Rasmussen, Susanne; Hansen, Tine; Frimodt-Møller, Marie

    2010-01-01

    Central blood pressure (BP) estimates the true load imposed on the left ventricle to a higher degree than does brachial BP. Increased aortic pulse wave velocity (aPWV) and central BP are risk markers for cardiovascular disease. Both can be measured by simple and noninvasive methods. Guidelines...

  11. Axillary Brachial Plexus Blockade for the Reflex Sympathetic Dystrophy Syndrome.

    Ribbers, G. M.; Geurts, A. C. H.; Rijken, R. A. J.; Kerkkamp, H. E. M.

    1997-01-01

    Reflex sympathetic dystrophy syndrome (RSD) is a neurogenic pain syndrome characterized by pain, vasomotor and dystrophic changes, and often motor impairments. This study evaluated the effectiveness of brachial plexus blockade with local anaesthetic drugs as a treatment for this condition. Three patients responded well; three did not. (DB)

  12. Imaging diagnosis of neurogenic tumors of the brachial plexus

    To analyse the imaging characteristics of neurogenic tumors in the brachial plexus, six cases of neurogenic tumors of the brachial plexus were reported pathologically proved as schwannoma in 4 and neurofibroma in 2 cases. The plain films demonstrated the mass at the apex of lung in 3 cases, enlargement of cervical intervertebral foremen in 1. CT scan revealed that the average diameter of the masses was 4 cm, with spindle shape in 4, dumb-bell shape in 2 cases. The averaged CT value was similar to that of muscle on plain scan. The density of the tumor was higher than that of muscle and lower than that of vessels after contrast enhancement. On MRI T1W image, the masses were all hyperintense. Three schwannoma presented high signal intensity similar to CSF. The lesion demonstrated moderate enhancement after contrast administration in 1 case. Based on the location of the mass and its imaging features, diagnosis of neurogenic tumor of the brachial plexus could possibly be established before operation. MRI imaging is the imaging modality of choice in displaying the anatomy and the lesion of brachial plexus

  13. Treatment for idiopathic and hereditary neuralgic amyotrophy (brachial neuritis) (Review)

    Alfen, N. van; Engelen, B.G.M. van; Hughes, R.A.

    2009-01-01

    BACKGROUND: Neuralgic amyotrophy (also know as Parsonage-Turner syndrome or brachial plexus neuritis) is a distinct peripheral nervous system disorder characterised by episodes (attacks) of extreme neuropathic pain and rapid multifocal weakness and atrophy in the upper limbs. Neuralgic amyotrophy ha

  14. Brachial plexus neuropathy - A long-term outcome study

    Geertzen, JHB; Groothoff, JW; Nicolai, JP; Rietman, JS

    2000-01-01

    This retrospective study assessed the long-term outcome of brachial plexus neuropathy in 16 patients. The mean follow up was 8 years. Nine patients complained of persistent pain and muscle weakness, four had continuing problems with various activities of daily living and 11 had trouble with some hou

  15. Genetic determinants of the ankle-brachial index

    Wassel, Christina L; Lamina, Claudia; Nambi, Vijay;

    2012-01-01

    Candidate gene association studies for peripheral artery disease (PAD), including subclinical disease assessed with the ankle-brachial index (ABI), have been limited by the modest number of genes examined. We conducted a two stage meta-analysis of ∼50,000 SNPs across ∼2100 candidate genes to...

  16. Brachial plexopathy after postoperative radiotherapy of breast cancer patients--A long-term follow-up

    Johansson, Silvia; Svensson, Hans; Larsson, Lars-Gunnar; Denekamp, J. [Umea Univ. (Sweden). Dept. of Oncology and Radiation Physics

    2000-07-01

    In 1963-1965 a group of 71 patients operated on for breast cancer with total mastectomy and axillary clearance were given aggressive postoperative telecobalt therapy to the axillary, supraclavicular and parasternal lymph node regions. The prescribed dose to these lymph node regions was 44 Gy in 11 fractions. Only two of the three fields were treated per day. Retrospective dose calculations showed that the total dose in the brachial plexus from the axillary and supraclavicular fields was c. 57 Gy in 16-17 fractions over 3-4 weeks. After a few years, symptoms and signs of brachial plexus injury appeared in many patients, which was reported in some early papers. The cohort has now been followed-up to 34 years. As expected, there was progression of both prevalence and severity of the late effects between 5 and 34 years and 11 of 12 patients who are still alive have paralysis of their arms. The neuropathy seems to be closely linked to fibrosis around the nerve trunks. The use of large daily fractions, in some cases combined with hot spots from overlapping fields, was certainly the cause of the complication.

  17. Substance P mRNA expression in the rat spinal cord following selective brachial plexus injury

    Na Liu; Longju Chen; Feng Li; Wutian Wu

    2008-01-01

    BACKGROUND: The neuropeptide, substance P, has various bioactivities and is widely distributed in the central nervous system. Substance P participates in neural transmission in the spinal cord and plays an important role in regeneration and repair of nerve injury.OBJECTIVE: To investigate substance P mRNA expression in the anterior horn of the spinal cord following brachial plexus injury.DESIGN, TIME AND SETTING: A molecular cell biology randomized controlled study was performed at the Department of Anatomy, Zhongshan Medical College, Sun Yat-sen University and the DaAn Gene Laboratory in May 2005.MATERIALS: A total of 29 adult male Sprague Dawley rats were randomly assigned to a control group (n=5) and an injury group (n = 24).METHODS: The injury group was divided into three subgroups. In subgroup A, the right seventh cervical vertebra (C7) anterior root was avulsed, and the residual nerve root at the distal end was removed. In subgroup B, the right C7 anterior root was avulsed, and the right C5 first thoracic vertebrae (TO posterior root was incised. Thus afferent pathways of the posterior root that connected with the anterior horn motor neurons were blocked. In subgroup C, the right C7 anterior root was avulsed, and a right C5-6 hemisection was performed. Thus the descending fiber pathways of the cortex that connected with anterior horn motor neurons were blocked. In the control group, the C5-T1 vertebral plate was opened, and then the skin was sutured.MAIN OUTCOME MEASURE: Substance P mRNA expression in the anterior horn of the spinal cord was quantified using fluorescent quantitative reverse transcription-polymerase chain reaction.RESULTS: Substance P mRNA expression was low in the anterior horn of the rat spinal cord in the control group. Substance P mRNA expression in the anterior horn of the spinal cord was upregulated and was significantly higher in the injury group compared with the control group (P < 0.01 ). Substance P mRNA expression was highest in

  18. To determine block establishment time of supraclavicular brachial plexus block using blunt versus short bevel needle: A prospective randomized trial

    V Ahuja

    2016-01-01

    Full Text Available Background: Unintentional intraneural injection under ultrasound guidance (USG with fine caliber needles and lower success rate with large caliber Tuohy needles in supraclavicular brachial plexus block (SCB have been reported. Materials and Methods: We undertook study to standardize the use of 20-gauge short versus blunt bevel needle for SCB. After approval of Institutional Ethics Committee and written informed consent, patients were randomized using computer-generated random number table to either of the two groups; blunt bevel needle group (n = 30: SCB under USG using 20-gauge Tuohy needle or short bevel needle group (n = 30: SCB under USG using 20-gauge short bevel needle. The primary outcome of the study was time to establishment of sensory and motor block of individual nerves, and secondary outcome was tolerability and any adverse effects. Results: The time to establishment of sensory and motor block in individual nerve territory was similar in both the groups. The complete sensory and motor anesthesia was achieved in 78.3% patients and complete sensory and motor anesthesia after supplementary block was achieved in 86.6% patients. Paresthesias during SCB were recorded in 15 patients. Out of these eight patients were of blunt bevel group and seven patients were of short bevel group. None of the patients experienced any neurological adverse effects. Conclusion: The establishment of sensory and motor blockade of individual nerves was similar to 20-gauge short and blunt bevel needle under ultrasound guide with no neurological adverse events.

  19. Origin and distribution of the thoracodorsal nerve in pig fetuses of the lineage Pen Ar Lan

    Eleusa Marta Mendonça Tavares

    2012-03-01

    Full Text Available Considering the importance of the nerves that make up the brachial plexus, the aim was to study the origin and distribution of the thoracodorsal nerve. Thus, 30 pig fetuses from the lineage Pen Ar Lan obtained from natural abortions in breedings of the Triangulo Mineiro region were used. The specimens were prepared through the injection of 50% Neoprene Latex “450” and 10% formaldehyde solutions in the descending aorta artery, and immersion in the same solution for least 48 hours. The dissections were carried out bilaterally until reaching the brachial plexus, that emerged from the spinal ventral branches of the sixth (C6, seventh (C7 and eighth (C8 cervical nerves and from the first thoracic (T1. It was found that the thoracodorsal nerve was formed from C8 in two antimeres (3.33%; fromT1 in 17 antimeres (28.33%; and from C8 and T1 in 41 antimeres (68.33 and that there was symmetry with regard to its origin in 23 animals (76.66%. It was also found that the thoracodorsal nerve sent branches in 100% of cases for the latissimus dorsi muscle, and 36.66% for the teres major.

  20. Cutaneous polyarteritis nodosa: A rare isolated cutaneous vasculitis

    Praveen Kumar A Subbanna

    2012-01-01

    Full Text Available Cutaneous polyarteritis nodosa (CPAN is a rare form of cutaneous vasculitis that involves small and medium sized arteries of the dermis and subcutaneous tissue without systemic involvement. It presents with tender subcutaneous nodules, digital gangrene, livedo reticularis and subcutaneous ulcerations. The diagnosis is by skin biopsy and characteristic pathologic feature is a leukocytoclastic vasculitis in the small to medium-sized arterioles of the dermis. We report a rare case of benign cutaneous PAN in a 14-year-old girl who presented with history of fever, subcutaneous nodules with cutaneous ulcer and digital gangrene. The skin biopsy showed leukocytoclastic vasculitis with fibrinoid necrosis in the dermal vessels. She received treatment with steroids and lesions resolved completely over a period of month.

  1. Miltefosine in cutaneous leishmaniasis

    To determine the efficacy of oral Miltefosine in patients with cutaneous leishmaniasis and its comparison with the most effective standard treatment, pentavalent antimony compound. Thirty patients, 12 years of age or older clinically and histopathologically diagnosed as cutaneous leishmaniasis were selected. Fifteen patients received orally administered Miltefosine 2.5mg/kg/day for 28 days and remaining 15 received injectable pentavalent antimony 20mg/kg/day for 28 days. Pre-treatment complete physical examination was done along with necessary laboratory investigations in all cases. These were repeated again after 2 weeks and at the end of treatment to note any deviation from the normal limits. Groups were almost matched in terms of age, weight, parasitological score. The efficacy was evaluated by ulcer size, before therapy, at 2 weeks and 4 weeks. Patients were followed-up at 3 and 6 months. Efficacy of two groups was statistically compared by calculating p-value by z-test. All patients completed the study without any serious complication. Lesions improved significantly and only scarring and post-inflammatory pigmentation was left. At 3 months, cure rate was 93% in group A and it was 73.33% in group B while at the end of 6 months, it was 86% and 66.6% respectively. This difference between efficacies of two groups was not found to be statistically significant (p-value >0.5). Miltefosine appears to be a safe and effective alternative to currently used therapies. The striking advantage of Miltefosine is its oral administration and it may also be helpful in regions where parasites are resistant to current agents. (author)

  2. MRI DIAGNOSIS OF TWO CASES OF FIBROLIPOMATOUS HAMARTOMA OF THE MEDIAN NERVE WITH HISTOPATHOLOGICAL CORRELATION

    Mary Hazarika

    2015-08-01

    Full Text Available Fibrolipomatous hamartoma is an uncommon congenital disorder, which is characterized by disproportionate hyperplasia of adipose tissue infiltrating along the perineurium, the epineurium and the affected nerve trajectory. 1 The median nerve and its branches are most commonly affected, followed by the radial nerve, ulnar nerve, nerves at the dorsal aspect of the foot, brachial plexus and cranial nerves. 1,2 Magnetic resonance imaging demonstrated a typical fibrolipomatous hamartoma with high signal intensity o f fat on both T1 - weighted and T2 - weighted images, characteristic coaxial cable appearance on axial images, and spaghetti appearance on sagittal images in two of our cases. Fibrolipomatous hamartoma (FLH of nerve is a rare tumor - like condition in which mat ure fat infiltrates the neural sheath, with the majority of the lesions occurring in the median nerve. 3 W e present two cases of Fibrolipomatous hamartoma of median nerve at the wrist with an unusual proximal extension to the forearm in one case.

  3. Pseudolymphomatous cutaneous angiosarcoma: a rare variant of cutaneous angiosarcoma readily mistaken for cutaneous lymphoma.

    Requena, Luis; Santonja, Carlos; Stutz, Nathalie; Kaddu, Steven; Weenig, Roger H; Kutzner, Heinz; Menzel, Thomas; Cerroni, Lorenzo

    2007-08-01

    Cutaneous angiosarcoma is probably the most malignant neoplasm involving the skin. Three clinical variants of cutaneous angiosarcoma are recognized, including angiosarcoma of the scalp and face of elderly patients, angiosarcoma associated with chronic lymphedema, and postirradiation angiosarcoma. Histopathologically, these three variants of angiosarcoma show similar features, which consist of poorly circumscribed, irregularly dilated, and anastomosing vascular channels lined by prominent endothelial cells that dissect through the dermis. Focally, neoplastic endothelial cells show large, hyperchromatic, and pleomorphic nuclei, protruding within vascular lumina and creating small papillations. Usually, inflammatory infiltrate is sparse and consists of a patchy, perivascular lymphoid infiltrate around the neoformed vessels. In rare instances, cutaneous angiosarcomas may exhibit prominent inflammatory infiltrate, and the neoplasm may be mistaken for an inflammatory process, both from clinical and histopathologic points of view. We describe four examples of cutaneous angiosarcomas with dense lymphocytic infiltrates involving the neoplasm. Immunohistochemically, lymphocytes expressed immunoreactivity for CD3, CD5, and CD45 markers, whereas the germinal centers were positive for CD20, CD79a, and Bcl-6. The neoplastic endothelial cells expressed immunoreactivity for the CD31, CD34, podoplanin, Prox-1, Lyve-1, and D2-40. We discuss the possible relationship between neoplastic endothelial lymphatic cells and reactive lymphocytes. Cutaneous angiosarcoma with prominent lymphocytic infiltrate may be readily mistaken for cutaneous follicle center cell lymphoma or cutaneous pseudolymphoma. PMID:17667166

  4. Cutaneous nociception and neurogenic inflammation evoked by PACAP38 and VIP

    Schytz, Henrik Winther; Holst, Helle; Arendt-Nielsen, Lars;

    2010-01-01

    Pituitary adenylate cyclase-activating peptide-38 (PACAP38) and vasoactive intestinal peptide (VIP) belong to the same secretin-glucagon superfamily and are present in nerve fibers in dura and skin. Using a model of acute cutaneous pain we explored differences in pain perception and vasomotor res...... conclusion, we found that peripheral nociceptive cutaneous responses elicited by PACAP38 and VIP are similar in healthy volunteers. This suggests that acute pain and vasomotor responses following intradermal injections of PACAP38 and VIP are primarily mediated by VPAC receptors....

  5. Traumatic and compressive pathology of the peripheral nerves: value of the MRI

    Evaluate the usefulness of the magnetic resonance (MRI) in the diagnosis of traumatic and compressive pathology of the peripheral nerves and analyze the etiology of the lesions and their severity. 25 MRI in patients with compressive and traumatic lesions of the peripheral nerves are analyzed. They were studied with MRI (1,5T) using T1 weighted spin-echo (SE), T2 gradient echo (GE) and STIR sequences. The morphological and nerve signal alterations make it possible to locate the lesion site and to assess the course of the lesion with successive studies. In our series, the most frequent cause of compressive pathology is fibrosis. Brachial plexus root avulsion is the most frequent finding in traumatic lesions. The MTI capacity for multiplanar study and its high resolution make it possible for us to detect small lesions in the peripheral nerves and to plan the best treatment. (Author) 17 refs

  6. Serious axillary nerve injury caused by subscapular artery compression resulting from use of backpacks.

    Haninec, Pavel; Mencl, Libor; Bačinský, Peter; Kaiser, Radek

    2013-12-01

    A palsy of the brachial plexus elements caused by carrying a heavy backpack is a very rare injury usually occurring in soldiers or hikers, and recovery is usually spontaneous. We describe here the case of male civilian presenting with an isolated serious axillary nerve palsy associated with chronic backpack use. During the surgery, a dumbbell-shaped neuroma-in-continuity was found which was caused by direct pressure from the subscapular artery. After resection of the neuroma, a nerve graft from the sural nerve was used to reconstruct the nerve. Reinnervation was successful and the patient was able to abduct his arm to its full range, with full muscle strength, within 24 months. PMID:23696291

  7. Normal tissue tolerance to external beam radiation therapy: Peripheral nerves

    Plexopathies and peripheral neuropathies appear progressively and with several years delay after radiotherapy. These lesions are observed principally after three clinical situations: supraclavicular and axillar irradiations for breast cancer, pelvic irradiations for various pathologies and limb irradiations for soft tissue sarcomas. Peripheral nerves and plexus (brachial and lumbosacral) are described as serial structures and are supposed to receive less than a given maximum dose linked to the occurrence of late injury. Literature data, mostly ancient, define the maximum tolerable dose to a threshold of 60 Gy and highlight also a great influence of fractionation and high fraction doses. For peripheral nerves, most frequent late effects are pain with significant differences of occurrence between 50 and 60 Gy. At last, associated pathologies (diabetes, vascular pathology, neuropathy) and associated treatments have probably to be taken into account as additional factors, which may increase the risk of these late radiation complications. (authors)

  8. Cutaneous ectopic schistosomiasis: diagnostic challenge*

    Barros, Cláudia Renata Castro do Rêgo; Maia, Daniela Cristina Caetano; dos Santos, Josemir Belo; Medeiros, Camila Carolina Queiroz; de Araújo, Jessica Guido

    2016-01-01

    Cutaneous schistosomiasis is a rare clinical manifestation of schistosomiasis, an infectious and parasitic disease, caused in Brazil by the trematode Schistosoma mansoni. The lesions are due to the deposition of eggs or, rarely, adult worms, usually involving the genital and groin areas. Extra-genital lesions occur mainly on the torso as papules of zosteriform appearance. The case of a patient with ectopic cutaneous schistosomiasis is reported in this article, due to the rarity of its occurre...

  9. Cutaneous leishmaniasis: a case report:

    Kokol, Rok; Marovt, Maruška; Miljković, Jovan; Stanimirović, Andrija

    2010-01-01

    Cutaneous leishmaniasis is the most common form of leishmaniasis caused by flagellate protozoa of the genus Leishmania transmitted by sand fly bites. OldWorld leishmaniasis is endemic in the Mediterranean Sea and the neighbouring countries. We present a case of a 10-year-old boy with a cutaneous leishmaniasis in form of papules on the nose, right and left lower leg. Histopathological examination showed diffuse dermal infiltrate predominantly of macrophages with admixture of few lymphocytes, e...

  10. Cutaneous lesions of the nose

    Altmeyer Peter; Paech Volker; Thrandorf Christina; Sand Daniel; Sand Michael; Bechara Falk G

    2010-01-01

    Abstract Skin diseases on the nose are seen in a variety of medical disciplines. Dermatologists, otorhinolaryngologists, general practitioners and general plastic and dermatologic surgeons are regularly consulted regarding cutaneous lesions on the nose. This article is the second part of a review series dealing with cutaneous lesions on the head and face, which are frequently seen in daily practice by a dermatologic surgeon. In this review, we focus on those skin diseases on the nose where su...

  11. Intracranial Management of Perineural Spread in the Trigeminal Nerve.

    Redmond, Michael J; Panizza, Benedict J

    2016-04-01

    Since the mid-1960s surgeons have attempted to cure intracranial perineural spread (PNS) of cutaneous malignancies. Untreated patients with trigeminal PNS die from brainstem invasion and leptomeningeal disease. It was understood that resection with clear margins was potentially curative, but early surgical attempts were unsuccessful. The prevailing wisdom considered that this surgery failed to improve the results achieved with radiation therapy alone and was associated with high morbidity. However, with improved imaging, surgical equipment, and better understanding of cavernous sinus (CS) anatomy and access, contemporary surgeons can improve outcomes for this disease. The aim of this paper is to describe a technique to access the interdural compartment of the CS and treat PNS of cutaneous squamous cell carcinoma (cSCC) in the intracranial trigeminal nerve and ganglion. It is based on the experience of the Queensland Skull Base Unit, Australia in managing PNS of cutaneous squamous cell carcinoma of the head and neck (cSCCHN). PMID:27123391

  12. Karolinska institutet 200-year anniversary. Symposium on traumatic injuries in the nervous system: injuries to the spinal cord and peripheral nervous system - injuries and repair, pain problems, lesions to brachial plexus.

    Sköld, Mattias K; Svensson, Mikael; Tsao, Jack; Hultgren, Thomas; Landegren, Thomas; Carlstedt, Thomas; Cullheim, Staffan

    2011-01-01

    The Karolinska Institutet 200-year anniversary symposium on injuries to the spinal cord and peripheral nervous system gathered expertise in the spinal cord, spinal nerve, and peripheral nerve injury field spanning from molecular prerequisites for nerve regeneration to clinical methods in nerve repair and rehabilitation. The topics presented at the meeting covered findings on adult neural stem cells that when transplanted to the hypoglossal nucleus in the rat could integrate with its host and promote neuron survival. Studies on vascularization after intraspinal replantation of ventral nerve roots and microarray studies in ventral root replantation as a tool for mapping of biological patterns typical for neuronal regeneration were discussed. Different immune molecules in neurons and glia and their very specific roles in synapse plasticity after injury were presented. Novel strategies in repair of injured peripheral nerves with ethyl-cyanoacrylate adhesive showed functional recovery comparable to that of conventional epineural sutures. Various aspects on surgical techniques which are available to improve function of the limb, once the nerve regeneration after brachial plexus lesions and repair has reached its limit were presented. Moreover, neurogenic pain after amputation and its treatment with mirror therapy were shown to be followed by dramatic decrease in phantom limb pain. Finally clinical experiences on surgical techniques to repair avulsed spinal nerve root and the motoric as well as sensoric regain of function were presented. PMID:21629875

  13. Brachial plexopathy after chemoradiotherapy for head and neck squamous cell carcinoma

    Platteaux, Nele; Dirix, Piet; Nuyts, Sandra [Dept. of Radiation Oncology, Leuvens Kankerinstituut (LKI), Univ. Hospitals Leuven, Campus Gasthuisberg (Belgium); Hermans, Robert [Dept. of Radiology, Leuvens Kankerinstituut (LKI), Univ. Hospitals Leuven, Campus Gasthuisberg (Belgium)

    2010-09-15

    Purpose: To evaluate late brachial plexopathy after primary chemoradiotherapy for locally advanced head and neck squamous cell carcinoma. Patients and Methods: Consecutive 43 disease-free patients were evaluated by a specifically developed 26-item questionnaire. Retrospectively, the brachial plexus was delineated and the dose-volume histograms were calculated. Results: After a median follow-up of 24 months, no radiation-induced brachial plexopathy was reported in these 43 patients. Conclusion: No radiation-induced brachial plexopathy was seen in the patient group, although 72.1% of the brachial plexuses received doses > 60 Gy. These findings should prompt further prospective studies and also stress the importance of trying to keep the doses to the brachial plexus as low as possible while covering the target volumes well. (orig.)

  14. An anatomical study of double brachial arteries – a case report

    Krstonosic B

    2010-02-01

    Full Text Available Superficial brachial artery is one of the major variations of the arterial pattern in the upper limb. During routine anatomical dissection in our department, we observed a case of unilateral double brachial artery in a formalin-fixed female cadaver.Left axillary artery entered into the anterior region of the arm, where it branched into two brachial arteries – the superficial brachial artery (SBA, which was longer, tortuous and with a smaller caliber, and the brachial artery (BA, which was placed deep and medially. In the cubital fossa, covered with an aponeurosis of the biceps brachii muscle, both brachial arteries were connected with an anastomotic vessel. Under this anastomotic branch, in the forearm, SBA continued as the radial artery, whereas BA continued as the ulnar artery.Variations of the arterial pattern in the upper limb are undoubtedly of interest to the anatomists as well as to the clinicians.

  15. Clinical and electrodiagnostic findings in breast cancer patients with radiation-induced brachial plexus neuropathy

    The clinical and neurophysiological characteristics of radiation-induced brachial plexopathy (RBP) were assessed in 79 breast cancer patients without signs of recurrent disease at least 60 months after radiotherapy (RT). Clinically, 35% (95% confidence limits: 25-47%) had RBP. Fifty percent (31-69%) had affection of the entire plexus, 18% (7-36%) of the upper trunk only, and 4% (1-18%) of the lower trunk. In 28% (14-48%), assessment of a definite level was not possible. In most, symptoms began during or immediately after RT, thus being without significant latency. Numbness or paresthesias (71%, 52-86%) and pain (43%, 25-62%) were the most prominent symptoms, while the most prominent objective signs were decreased or absent muscle stretch reflexes (93%, 77-99%) closely followed by sensory loss (82%, 64-93%) and weakness (71%, 52-86%). Neurophysiological investigations were carried out in 46 patients (58%). The most frequent abnormalities in patients with RBP were signs of chronic partial denervation with increased mean duration of individual motor unit potentials, and decreased amplitude of compound muscle and sensory action potentials. Nerve conduction velocities were normal. (author)

  16. Penile erectile dysfunction after brachial plexus root avulsion injury in rats

    Fu, Guo; Qin, Bengang; Jiang, Li; Huang, Xijun; Lu, Qinsen; Zhang, Dechun; Liu, Xiaolin; Zhu, Jiakai; Zheng, Jianwen; Li, Xuejia; Gu, Liqiang

    2014-01-01

    Our previous studies have demonstrated that some male patients suffering from brachial plexus injury, particularly brachial plexus root avulsion, show erectile dysfunction to varying degrees. However, the underlying mechanism remains poorly understood. In this study, we evaluated the erectile function after establishing brachial plexus root avulsion models with or without spinal cord injury in rats. After these models were established, we administered apomorphine (via a subcutaneous injection...

  17. Delayed rupture of a pseudoaneurysm in the brachial artery of a burn reconstruction patient

    Lee, Jun Yong; Kim, Hyeri; Kwon, Ho; Jung, Sung-No

    2013-01-01

    A brachial artery pseudoaneurysm is a rare but serious condition that can be limb threatening. A number of reports have found that it may be the result of damage to the blood vessels around the brachial artery, either directly or indirectly, due to trauma or systemic diseases. We present our experience of delayed pseudoaneurysm rupture of the brachial artery in a rehabilitation patient with burns of the upper extremity who underwent fasciotomy and musculocutaneous flap coverage. We also provi...

  18. MR evaluation of the brachial plexus: Optimal imaging technique

    The authors compared four different reception coils, different degrees of T1 and T2 weighting, and different imaging planes for ability to depict normal brachial plexus anatomy at 1.5 T in 67 subjects. The use of loop gap resonators (axial opposed and butterfly) resulted in better resolution but a more limited field of view than did use of a rectangular surface coil (placed transversely behind the base of the neck) and the body coil. T1 and spin-density coronal images showed normal anatomy of the roots, trunks, and cords in a high proportion of cases. Double-echo (spin-density and T2-weighted) coronal imaging performed with a transversely oriented rectangular coil may be the best technique for imaging all three portions of the brachial plexus in the neck, retroclavicular, and axillary regions

  19. Brachial plexus lesions in patients with cancer: 100 cases

    In patients with cancer, brachial plexus signs are usually caused by tumor infiltration or injury from radiation therapy (RT). We analyzed 100 cases of brachial plexopathy to determine which clinical criteria helped differentiate tumor from radiation injury. Seventy-eight patients had tumor and 22 had radiation injury. Severe pain occurred in 80% of tumor patients but in only 19% of patients with radiation injury. The lower trunk was involved in 72% of the tumors. Seventy-eight percent of the radiation injuries affected the upper plexus (C5-6). Horner syndrome was more common in tumor, and lymphedema in radiation injury. The time from RT to onset of plexus symptoms, and the dose of RT, also differed

  20. Hyperglycemia- and neuropathy-induced changes in mitochondria within sensory nerves

    Hamid, Hussein S; Mervak, Colin M; Münch, Alexandra E; Robell, Nicholas J; Hayes, John M.; Porzio, Michael T; Singleton, J. Robinson; Smith, A. Gordon; Eva L Feldman; Lentz, Stephen I

    2014-01-01

    Objective This study focused on altered mitochondrial dynamics as a potential mechanism for diabetic peripheral neuropathy (DPN). We employed both an in vitro sensory neuron model and an in situ analysis of human intraepidermal nerve fibers (IENFs) from cutaneous biopsies to measure alterations in the size distribution of mitochondria as a result of hyperglycemia and diabetes, respectively. Methods Neurite- and nerve-specific mitochondrial signals within cultured rodent sensory neurons and hu...

  1. Delayed presentation of a traumatic brachial artery pseudoaneurysm.

    Forde, James C

    2009-09-01

    Delayed presentation of a brachial artery pseudoaneurysm following penetrating trauma is infrequently reported. We report the case of a 23-year-old male who presented three months following a penetrating trauma to his antecubital fossa with a sudden exacerbation of swelling and tenderness of his elbow. Doppler ultrasound and computed tomography arteriography confirmed the presence of a large pseudoaneurysm. Surgical reconstruction was performed using the long saphenous vein as an interposition vein graft, restoring normal arterial circulation.

  2. Ankle Brachial Pressure Index (ABPI): An update for practitioners

    Al-Qaisi, Mo

    2009-01-01

    Mo Al-Qaisi1, David M Nott1, David H King2, Sam Kaddoura11Imperial College, London, UK; 2Broomfield Hospital, Chelmsford, Essex, UKAbstract: Peripheral vascular disease affects some 12%–14% of the general population, and the majority of people with the disease are asymptomatic. The Ankle Brachial Pressure Index (ABPI) test is widely used by a diverse range of practitioners (in the community and hospital setting) in order to screen asymptomatic patients, diagnose patients with clinic...

  3. “Huge Axillary Mass - Neurofibroma Brachial Plexus”

    Mehta, Dharmendra; Mehta, D. D.; Shaam, M. B.; Yadav, J. K.

    2011-01-01

    Axillary swelling arising from soft tissue is not uncommon. Lipoma, Lymphadenopathy due to Kochs or Lymphoma are commonest swellings seen but firm to hard non tender mass arising from maninges of Brachial plexus is not so common. Usually these masses are benign but one may come across malignant tumour. Twenty-three year male presented with mass in anterior chest wall & arm pit having no other specific complaints, was diagnosed as Spindle cell tumour on FNAC & excision biopsy turned out to be ...

  4. The Relationship between Multiple Health Behaviours and Brachial Artery Reactivity

    Gordon, Jennifer L.; Lavoie, Kim L; André Arsenault; Bernard Meloche; Blaine Ditto; Campbell, Tavis S.; Simon L Bacon

    2012-01-01

    Background. The effects of smoking, alcohol consumption, obesity, and a sedentary lifestyle on endothelial function (EF) have only been examined separately. The relative contributions of these behaviours on EF have therefore not been compared. Purpose. To compare the relative associations between these four risk factors and brachial artery reactivity in the same sample. Methods. 328 patients referred for single-photon emission computed tomography (SPECT) exercise stress tests completed a nucl...

  5. Trapezius transfer to treat flail shoulder after brachial plexus palsy

    Diaz Humberto

    2007-01-01

    Full Text Available Abstract Background After severe brachial palsy involving the shoulder, many different muscle transfers have been advocated to restore movement and stability of the shoulder. Paralysis of the deltoid and supraspinatus muscles can be treated by transfer of the trapezius. Methods We treated 10 patients, 8 males and 2 females, by transfer of the trapezius to the proximal humerus. In 6 patients the C5 and C6 roots had been injuried; in one C5, C6 and C7 roots; and 3 there were complete brachial plexus injuries. Eight of the 10 had had neurosurgical repairs before muscle transfer. Their average age was 28.3 years (range 17 to 41, the mean delay between injury and transfer was 3.1 years (range 14 months to 6.3 years and the average follow-up was 17.5 months (range 6 to 52, reporting the clinical and radiological results. Evaluation included physical and radiographic examinations. A modification of Mayer's transfer of the trapezius muscle was performed. The principal goal of this work was to evaluate the results of the trapezius transfer for flail shoulder after brachial plexus injury. Results All 10 patients had improved function with a decrease in instability of the shoulder. The average gain in shoulder abduction was 46.2°; the gain in shoulder flexion average 37.4°. All patients had stable shoulder (no subluxation of the humeral head on radiographs. Conclusion Trapezius transfer for a flail shoulder after brachial plexus palsy can provide satisfactory function and stability.

  6. Novel Axillary Approach for Brachial Plexus in Robotic Surgery: A Cadaveric Experiment

    Cihangir Tetik

    2014-01-01

    Full Text Available Brachial plexus surgery using the da Vinci surgical robot is a new procedure. Although the supraclavicular approach is a well known described and used procedure for robotic surgery, axillary approach was unknown for brachial plexus surgery. A cadaveric study was planned to evaluate the robotic axillary approach for brachial plexus surgery. Our results showed that robotic surgery is a very useful method and should be used routinely for brachial plexus surgery and particularly for thoracic outlet syndrome. However, we emphasize that new instruments should be designed and further studies are needed to evaluate in vivo results.

  7. Cutaneous leishmaniasis: an overview.

    Hepburn N

    2003-01-01

    Full Text Available Leishmaniasis is a major world health problem, which is increasing in incidence. In Northern Europe it is seen in travellers returning from endemic areas. The protozoa is transmitted by sandflies and may produce a variety of clinical syndromes varying from a simple ulcer to fatal systemic disease. This review considers the management of simple cutaneous leishmaniasis. Patients usually have a single ulcer that may heal spontaneously, requiring only topical, or no treatment at all. Lesions caused by Leishmania braziliensis may evolve into the mucocutaneous form, ′espundia′, and should be treated with systemic antimony. Sodium stibogluconate 20mg/kg/day i.v. for 20 days is the appropriate first line treatment in these cases. Although it may cause transient bone marrow suppression, liver damage, a chemical pancreatitis, and disturbances in the electrocardiogram, it appears safe. The success of treatment should be assessed 6 weeks after it has been completed and patients should be followed up for 6 months.

  8. Continuous shoulder analgesia via an indwelling axillary brachial plexus catheter.

    Reuben, S S; Steinberg, R B

    2000-09-01

    Continuous interscalene brachial plexus blockade can provide anesthesia and analgesia in the shoulder region. Difficulty accessing the interscalene space and premature displacement of interscalene catheters may preclude their use in certain situations. We present two case reports in which a catheter was advanced from the axilla along the brachial plexus sheath to the interscalene space to provide continuous cervicobrachial plexus analgesia. In the first case report, previous neck surgery made the anatomic landmarks for performing an interscalene block very difficult. An epidural catheter was advanced from the axillary brachial plexus sheath to the interscalene space under fluoroscopic guidance. This technique provided both intraoperative analgesia for shoulder surgery as well as 24-hour postoperative analgesia by an infusion of 0.125% bupivacaine. In the second case report, a catheter was inserted in a similar fashion from the axillary to the interscalene space to provide 14 days of continuous analgesia in the management of complex regional pain syndrome. We have found that this technique allows us to secure the catheter more easily than with the traditional interscalene approach and thus prevents premature dislodgment. This approach may be a suitable alternative when either an interscalene or an infraclavicular catheter may not be inserted. PMID:11090734

  9. Neurolysis and myocutaneous flap for radiation induced brachial plexus neuropathy

    Surgical treatment for radiation induced brachial plexus neuropathy is difficult. We followed 9 patients of radiation induced brachial plexus neuropathy who were surgically treated with neurolysis and myocutaneous flap coverage. Their ages ranged from 29 to 72 years old. Their diagnoses were breast cancer in 6 patients, lingual cancer in 1, thyroid cancer in 1 and malignant lymphoma in 1. Total dose of radiation ranged from 44 to 240 Gy. Interval from radiation therapy to our surgery ranged from 1 to 18 years (mean 6.7 years). Chief complaints were dysesthesia in 9 patients, motor weakness in 7 patients and dullach in scar formation of radiated skin in 7 patients. Preoperative neural functions were slight palsy in 1, moderate palsy in 5 and complete palsy in 3. In surgical treatment, neurolysis of the brachial plexus was done and it was covered by latissimus dorsi myocutaneous flap. We evaluated about dysesthesia and motor recovery after treatment for neuropathy. Follow up periods ranged from 1 to 11 years (average in 5 years). Dysesthesia improved in 6 patients and got worse in 3 patients. Motor weakness recovered in only 2 patients and got worse in 7 patients. From our results, intolerable dysesthesia which was first complaint of these patients improved. But motor function had not recovered. Our treatment was thought to be effective for extraneural factor like an compression neuropathy by scar formation and poor vascularity. But it was not effective for intraneural damage by radiation therapy. (author)

  10. Neurolysis and myocutaneous flap for radiation induced brachial plexus neuropathy

    Hirachi, Kazuhiko; Minami, Akio; Kato, Hiroyuki; Nishio, Yasuhiko [Hokkaido Univ., Sapporo (Japan). School of Medicine; Ohnishi, Nobuki

    1998-11-01

    Surgical treatment for radiation induced brachial plexus neuropathy is difficult. We followed 9 patients of radiation induced brachial plexus neuropathy who were surgically treated with neurolysis and myocutaneous flap coverage. Their ages ranged from 29 to 72 years old. Their diagnoses were breast cancer in 6 patients, lingual cancer in 1, thyroid cancer in 1 and malignant lymphoma in 1. Total dose of radiation ranged from 44 to 240 Gy. Interval from radiation therapy to our surgery ranged from 1 to 18 years (mean 6.7 years). Chief complaints were dysesthesia in 9 patients, motor weakness in 7 patients and dullach in scar formation of radiated skin in 7 patients. Preoperative neural functions were slight palsy in 1, moderate palsy in 5 and complete palsy in 3. In surgical treatment, neurolysis of the brachial plexus was done and it was covered by latissimus dorsi myocutaneous flap. We evaluated about dysesthesia and motor recovery after treatment for neuropathy. Follow up periods ranged from 1 to 11 years (average in 5 years). Dysesthesia improved in 6 patients and got worse in 3 patients. Motor weakness recovered in only 2 patients and got worse in 7 patients. From our results, intolerable dysesthesia which was first complaint of these patients improved. But motor function had not recovered. Our treatment was thought to be effective for extraneural factor like an compression neuropathy by scar formation and poor vascularity. But it was not effective for intraneural damage by radiation therapy. (author)

  11. The significance of diagnostic MRI for visualisation of trauma-induced cervical nerve root avulsion. Case report; Die Bedeutung der MRT-Diagnostik zur Darstellung traumatisch bedingter zervikaler Wurzelausrisse. Kasuistik

    Muth, C.P. [Carl-Thiem-Klinikum, Cottbus (Germany). Inst. fuer Radiologie; Biemelt, F. [Carl-Thiem-Klinikum, Cottbus (Germany). Inst. fuer Radiologie; Kamenz, M. [Carl-Thiem-Klinikum, Cottbus (Germany). Inst. fuer Radiologie

    1996-11-01

    The article is intended to show the value of MRI for diagnostic visualisation and evaluation of posttraumatic nerve root avulsion as a brachial plexus injury. (orig./MG) [Deutsch] Das Ziel der Arbeit besteht in der Darstellung des Wertes der MRT-Diagnostik bei der Abklaerung traumatischer Wurzelausrisse im Bereich des Plexus brachialis. (orig./MG)

  12. High-resolution and functional magnetic resonance imaging of the brachial plexus using an isotropic 3D T2 STIR (Short Term Inversion Recovery) SPACE sequence and diffusion tensor imaging

    This technical note demonstrates the relevance of the isotropic 3D T2 turbo-spin-echo (TSE) sequence with short-term inversion recovery (STIR) and variable flip angle RF excitations (SPACE: Sampling Perfection with Application optimized Contrasts using different flip angle Evolutions) for high-resolution brachial plexus imaging. The sequence was used in 11 patients in the diagnosis of brachial plexus pathologies involving primary and secondary tumors, and in six volunteers. We show that 3D STIR imaging is not only a reliable alternative to 2D STIR imaging, but it also better evaluates the anatomy, nerve site compression and pathology of the plexus, especially to depict space-occupying tumors along its course. Finally, due to its appropriate contrast we describe how 3D-STIR can be used as a high-resolution mask to be fused with fraction of anisotropy (FA) maps calculated from diffusion tensor imaging (DTI) data of the plexus. (orig.)

  13. High-resolution and functional magnetic resonance imaging of the brachial plexus using an isotropic 3D T2 STIR (Short Term Inversion Recovery) SPACE sequence and diffusion tensor imaging

    Viallon, M.; Vargas, M.I.; Jlassi, H.; Loevblad, K.O.; Delavelle, J. [University Hospital of Geneva, Department of Radiology, Geneva (Switzerland)

    2008-05-15

    This technical note demonstrates the relevance of the isotropic 3D T2 turbo-spin-echo (TSE) sequence with short-term inversion recovery (STIR) and variable flip angle RF excitations (SPACE: Sampling Perfection with Application optimized Contrasts using different flip angle Evolutions) for high-resolution brachial plexus imaging. The sequence was used in 11 patients in the diagnosis of brachial plexus pathologies involving primary and secondary tumors, and in six volunteers. We show that 3D STIR imaging is not only a reliable alternative to 2D STIR imaging, but it also better evaluates the anatomy, nerve site compression and pathology of the plexus, especially to depict space-occupying tumors along its course. Finally, due to its appropriate contrast we describe how 3D-STIR can be used as a high-resolution mask to be fused with fraction of anisotropy (FA) maps calculated from diffusion tensor imaging (DTI) data of the plexus. (orig.)

  14. Deep Peroneal Nerve Palsy Caused by an Extraneural Ganglion Cyst: A Rare Case

    Dimitrios Nikolopoulos

    2015-01-01

    Full Text Available Lower extremities peripheral neuropathies caused by ganglion cysts are rare. The most frequent location of occurrence is the common peroneal nerve and its branches, at the level of the fibular neck. We report the case of a 57-year-old patient admitted with foot drop, due to an extraneural ganglion of the upper tibiofibular syndesmosis, compressing the deep branch of the peroneal nerve. Although there have been many previous reports of intraneural ganglion involvement with the lower limb nerves, to our knowledge, this is the second reported occurrence of an extraneural ganglion distinctly localized to the upper tibiofibular syndesmosis and palsying deep peroneal nerve. The diagnosis was made preoperatively using MRI. The common peroneal nerve and its branches were recognized and traced to its bifurcation during the operation, and the ganglion cyst was removed. Two months after surgery, the patient was pain-free and asymptomatic except for cutaneous anesthesia in the distribution of the deep peroneal nerve.

  15. Deep peroneal nerve palsy caused by an extraneural ganglion cyst: a rare case.

    Nikolopoulos, Dimitrios; Safos, George; Sergides, Neoptolemos; Safos, Petros

    2015-01-01

    Lower extremities peripheral neuropathies caused by ganglion cysts are rare. The most frequent location of occurrence is the common peroneal nerve and its branches, at the level of the fibular neck. We report the case of a 57-year-old patient admitted with foot drop, due to an extraneural ganglion of the upper tibiofibular syndesmosis, compressing the deep branch of the peroneal nerve. Although there have been many previous reports of intraneural ganglion involvement with the lower limb nerves, to our knowledge, this is the second reported occurrence of an extraneural ganglion distinctly localized to the upper tibiofibular syndesmosis and palsying deep peroneal nerve. The diagnosis was made preoperatively using MRI. The common peroneal nerve and its branches were recognized and traced to its bifurcation during the operation, and the ganglion cyst was removed. Two months after surgery, the patient was pain-free and asymptomatic except for cutaneous anesthesia in the distribution of the deep peroneal nerve. PMID:25632363

  16. Anatomical peculiarities of sensory tracts of the wrist median nerve pedicled with nutrient vessels transferring to bridge wrist ulnar nerve defect

    Sixin Ouyang; Zhenshan Peng; Jianguo Tan; Tianhong Peng; Jianzhong Xiao

    2006-01-01

    -damaged separated length was about 10.0 cm to 14.0 cm. The third, second and first tracts of cutaneous branches at digital interspace and radialis of thumb arrayed from ulnaris to radial④ Nutrient artery of median nerve locates constantly; journey table is superficial and is easily to find out; caliber of arterial canal is thick; blood supply is plentiful; length of pedicel is suitable for translocation. The sensory tracts of wrist median nerve pedicled with nutrient vessels can be applied as nervous grafts to join injured gap in wrist ulnar nerve.

  17. Diabetes and nerve damage

    Nerve damage that occurs in people with diabetes is called diabetic neuropathy. This condition is a complicaiton ... In people with diabetes, the body's nerves can be damaged by ... sugar level . This condition is more likely when the blood sugar ...

  18. Degenerative Nerve Diseases

    Degenerative nerve diseases affect many of your body's activities, such as balance, movement, talking, breathing, and heart function. Many ... viruses. Sometimes the cause is not known. Degenerative nerve diseases include Alzheimer's disease Amyotrophic lateral sclerosis Friedreich's ...

  19. Radial nerve dysfunction (image)

    The radial nerve travels down the arm and supplies movement to the triceps muscle at the back of the upper arm. ... the wrist and hand. The usual causes of nerve dysfunction are direct trauma, prolonged pressure on the ...

  20. Management of cutaneous metastases using electrochemotherapy

    Matthiessen, Louise Wichmann; Chalmers, Richard Ling; Sainsbury, David Christopher George;

    2011-01-01

    Cutaneous metastases may cause considerable discomfort as a consequence of ulceration, oozing, bleeding and pain. Electrochemotherapy has proven to be highly effective in the treatment of cutaneous metastases. Electrochemotherapy utilises pulses of electricity to increase the permeability of the...

  1. Sensory nerves and pancreatitis

    Li, Qingfu; PENG, JIE

    2014-01-01

    Sensory nerves are a kind of nerve that conduct afferent impulses from the periphery receptors to the central nervous system (CNS) and are able to release neuromediators from the activated peripheral endings. Sensory nerves are particularly important for microcirculatory response, and stimulation of pancreatic sensory nerves releases a variety of neuropeptides such as substance P (SP), calcitonin gene-related peptide (CGRP), etc., leading to neurogenic inflammation characterized as the local ...

  2. The Furcal Nerve Revisited

    Harshavardhana, Nanjundappa S.; Harshad V. Dabke

    2014-01-01

    Atypical sciatica and discrepancy between clinical presentation and imaging findings is a dilemma for treating surgeon in management of lumbar disc herniation. It also constitutes ground for failed back surgery and potential litigations thereof. Furcal nerve (Furcal = forked) is an independent nerve with its own ventral and dorsal branches (rootlets) and forms a link nerve that connects lumbar and sacral plexus. Its fibers branch out to be part of femoral and obturator nerves in-addition to t...

  3. The involvement of cutaneous receptors in the biological effects of electromagnetic millimeter waves

    Anton Emil; Aurel Saulea; Gabriela Saulea; Ciobica Alin; Bruma SI.; Anton C. R.

    2014-01-01

    The involvement of peripheral nerve terminations in the mechanisms of action of electromagnetic millimeter waves (mmW) was assessed. It is currently thought that mmW could be used in noninvasive complementary therapy because of their analgesic effect. However, the mechanisms of their antinociceptive effect and non-ionizing radiation are the subjects of controversy. The mechanisms of interaction of mmW and the cutaneous tissue have not been elucidated. We ob...

  4. Karolinska Institutet 200 year anniversary - Symposium on Traumatic Injuries in the Nervous System: Injuries to the spinal cord and peripheral nervous system - Injuries and repair, pain problems, lesions to brachial plexus

    MattiasK.Sköld

    2011-05-01

    Full Text Available The Karolinska Institutet 200 year anniversary symposium on injuries to the spinal cord and peripheral nervous system gathered expertise in the spinal cord, spinal nerve and peripheral nerve injury field spanning from molecular prerequisites for nerve regeneration to clinical methods in nerve repair and rehabilitation. The topics presented at the meeting covered findings on adult neural stem cells that when transplanted to the hypoglossal nucleus in the rat could integrate with its host and promote neuron survival. Studies on vascularization after intraspinal replantation of ventral nerve roots and microarray studies in ventral root replantation as a tool for mapping of biological patterns typical for neuronal regeneration were discussed. Different immune molecules in neurons and glia and their very specific roles in synapse plasticity after injury were presented. Novel strategies in repair of injured peripheral nerves with ethyl-cyanoacrylate adhesive showed functional recovery comparable to that of conventional epineural sutures. Various aspects on surgical techniques which are available to improve function of the limb, once the nerve regeneration after brachial plexus lesions and repair has reached its limit were presented. Mo

  5. Cutaneous Plasmacytosis with Perineural Involvement

    Elizabeth A. Brezinski

    2014-01-01

    Full Text Available Importance. Cutaneous and systemic plasmacytosis are rare conditions of unknown etiology with characteristic red-brown skin lesions and a mature polyclonal plasma cell infiltrate within the dermis. Perineural plasma cell infiltrates may be a histologic clue to the diagnosis of cutaneous plasmacytosis. Observations. Our patient had a five-year history of persistent reddish-brown plaques on the neck and trunk without systemic symptoms. Histologic examination showed dermal perivascular and perineural plasma cells with excess lambda light chain expression. Due to decreased quality of life caused by his skin lesions, he was placed on a chemotherapeutic regimen with bortezomib. Conclusions and Relevance. The patient was diagnosed with cutaneous plasmacytosis based on classic histopathology results with a recently characterized pattern of perineural involvement. Bortezomib therapy was initiated to manage his skin eruption, which has not been previously described as a treatment for this chronic condition.

  6. The Physics of Nerves

    Heimburg, Thomas

    2010-01-01

    The accepted model for nerve pulse propagation in biological membranes seems insufficient. It is restricted to dissipative electrical phenomena and considers nerve pulses exclusively as a microscopic phenomenon. A simple thermodynamic model that is based on the macroscopic properties of membranes allows explaining more features of nerve pulse propagation including the phenomenon of anesthesia that has so far remained unexplained.

  7. Intraparotid facial nerve schwannoma.

    Shah H; Kantharia C; Shenoy A

    1997-01-01

    Intraparotid facial nerve schwannoma are uncommon. Preoperative diagnosis of parotid tumour as schwannoma is difficult when facial nerve function is normal. A rare case of solitary schwannoma involving the upper branch of the facial nerve is described and the literature on the subject is reviewed.

  8. Laryngeal nerve damage

    Laryngeal nerve damage is injury to one or both of the nerves that are attached to the voice box. ... Injury to the laryngeal nerves is uncommon. When it does occur, it can be from: A complication of neck or chest surgery (especially thyroid, lung, ...

  9. Optic Nerve Pit

    ... Conditions Frequently Asked Questions Español Condiciones Chinese Conditions Optic Nerve Pit What is optic nerve pit? An optic nerve pit is a ... may be seen in both eyes. How is optic pit diagnosed? If the pit is not affecting ...

  10. Cutaneous mastocytosis: Report of six cases

    Inamadar Arun

    2006-01-01

    Full Text Available Cutaneous mastocytosis is a rare infiltrative disorder of the skin. Though often asymptomatic, systemic features may be associated with any clinical pattern of the disorder at any age group. We present our experience with six cases of cutaneous mastocytosis, including three with diffuse cutaneous mastocytosis, a rare entity.

  11. Cutaneous mastocytosis: Report of six cases

    Inamadar Arun; Palit Aparna

    2006-01-01

    Cutaneous mastocytosis is a rare infiltrative disorder of the skin. Though often asymptomatic, systemic features may be associated with any clinical pattern of the disorder at any age group. We present our experience with six cases of cutaneous mastocytosis, including three with diffuse cutaneous mastocytosis, a rare entity.

  12. Subtraction of unidirectionally encoded images for suppression of heavily isotropic objects (SUSHI) for selective visualization of peripheral nerves

    Takahara, Taro; Kwee, Thomas C.; Hendrikse, Jeroen; van Cauteren, Marc; Koh, Dow-Mu; Niwa, Tetsu; Mali, Willem P. Th. M.; Luijten, Peter R.

    2010-01-01

    Introduction The aim of this study was to introduce and assess a new magnetic resonance (MR) technique for selective peripheral nerve imaging, called “subtraction of unidirectionally encoded images for suppression of heavily isotropic objects” (SUSHI). Methods Six volunteers underwent diffusion-weighted MR neurography (DW-MRN) of the brachial plexus, and seven volunteers underwent DW-MRN of the sciatic, common peroneal, and tibial nerves at the level of the knee, at 1.5 T. DW-MRN images with ...

  13. RNase 7 in Cutaneous Defense

    Rademacher, Franziska; Simanski, Maren; Harder, Jürgen

    2016-01-01

    RNase 7 belongs to the RNase A superfamily and exhibits a broad spectrum of antimicrobial activity against various microorganisms. RNase 7 is expressed in human skin, and expression in keratinocytes can be induced by cytokines and microbes. These properties suggest that RNase 7 participates in innate cutaneous defense. In this review, we provide an overview about the role of RNase 7 in cutaneous defense with focus on the molecular mechanism of the antimicrobial activity of RNase 7, the regulation of RNase 7 expression, and the role of RNase 7 in skin diseases. PMID:27089327

  14. Cutaneous ectopic schistosomiasis: diagnostic challenge.

    Barros, Cláudia Renata Castro do Rêgo; Maia, Daniela Cristina Caetano; dos Santos, Josemir Belo; Medeiros, Camila Carolina Queiroz; de Araújo, Jessica Guido

    2016-01-01

    Cutaneous schistosomiasis is a rare clinical manifestation of schistosomiasis, an infectious and parasitic disease, caused in Brazil by the trematode Schistosoma mansoni. The lesions are due to the deposition of eggs or, rarely, adult worms, usually involving the genital and groin areas. Extra-genital lesions occur mainly on the torso as papules of zosteriform appearance. The case of a patient with ectopic cutaneous schistosomiasis is reported in this article, due to the rarity of its occurrence and its difficult clinical diagnosis. PMID:26982792

  15. Cutaneous cancer and xeroderma pigmentosum; Cancer cutane et xeroderma pigmentosum

    Ben Salah, H.; Bahri, M.; Mnejja, W.; Siala, W.; Daoud, J. [Centre Hospitalier Universitaire Habib-Bourguiba, Service de Radiotherapie Carcinologique, Sfax (Tunisia); Sallemi, T. [Centre Hospitalier Universitaire Habib-Bourguiba, Service d' Anatomie Pathologique, Sfax (Tunisia); Turki, H. [Centre Hospitalier Universitaire Habib-Bourguiba, Service de Dermatologie, Sfax (Tunisia)

    2007-11-15

    The cutaneous cancer at the patients affected by xeroderma pigmentosum is characterized by its multifocal character and its strong radiosensitivity. A premature care and a regular follow-up for life of these patients is indispensable for the detection and the treatment of new hurts. The precautionary measures are also important by the school eviction. (N.C.)

  16. Disturbed function of the brachial plexus after irradiation for a malignant disease

    In reference to the case history of a woman aged 26 years in whom approx. 7 years after irradiation for Hodgkin's disease, lesions of the upper roots of the brachial plexus (Erb-Duchenne type) developed, the differential diagnosis is discussed of brachial plexus lesions in the presence of a recurrent malignant disease or as the consequence of irradiation. (Auth.)

  17. On the cause of brachial plexus neuropathy after radiation therapy of patients with mamma carcinoma

    Radiation therapy is often considered as cause of brachial plexus neuropathy in patients with mamma carcinoma. One case (in which metastases could be established as specific cause) is used as specific example for the possible differential diagnosis of brachial plexus neuropathy. (orig.)

  18. Pictorial essay: Role of magnetic resonance imaging in evaluation of brachial plexus pathologies

    Malini Lawande; Patkar, Deepak P; Sona Pungavkar

    2012-01-01

    Brachial plexopathies, traumatic and nontraumatic, often present with vague symptoms. Clinical examination and electrophysiological studies are useful but may not localize the lesion accurately. Magnetic resonance imaging (MRI) with its multiplanar imaging capability and soft tissue contrast resolution plays an important role in evaluation of the abnormal brachial plexus.

  19. Measurement of blood pressure, ankle blood pressure and calculation of ankle brachial index in general practice

    Nexøe, Jørgen; Damsbo, Bent; Lund, Jens Otto;

    2012-01-01

    BACKGROUND: Low ankle brachial index (ABI) is a sensitive measure of 'burden' of atherosclerosis, indicating cardiovascular risk of the asymptomatic patient. Conventionally, ABI values......BACKGROUND: Low ankle brachial index (ABI) is a sensitive measure of 'burden' of atherosclerosis, indicating cardiovascular risk of the asymptomatic patient. Conventionally, ABI values...

  20. The role of skin nociceptive afferent nerves in blister healing.

    Westerman, R A; Carr, R W; Delaney, C A; Morris, M J; Roberts, R G

    1993-01-01

    Because sensory neuropeptides improve survival of critical skin and muscle flaps in rats, skin nociceptive sensory nerve function in blister healing was examined. Sensory nerve ablation by unilateral hindlimb denervation or cutaneous axon reflex enhancement by 14 days systemic nicotine treatment (5 mg kg-1 day-1) decreased and increased, respectively, peripheral motor functions of nociceptive (peptidergic) skin nerves. Effects on nociception were measured by a radiant heat tail-flick test. Axon reflex flares were evoked by transdermal iontophoresis of acetylcholine or noxious electrical stimulation under pentobarbitone 40 mg kg-1 anaesthesia. Resultant changes in cutaneous microvascular blood flux were measured non-invasively by laser Doppler flowmetry. In nicotine-treated rats compared with placebo-treated controls, acetylcholine-evoked axon reflex flare was enhanced by 240% (p skin using a constant weight and diameter of compressed dry ice pellet applied for 30 secs at constant force. Dry-ice blisters raised on the hindpaw 14 days post-denervation were significantly slower to heal completely (42 days) than controls (30 days: P skin. The data signal a possible important role for neuropeptides in these processes and question the function of nicotinic receptors on sensory nerves. PMID:7712628

  1. Optic nerve oxygenation

    Stefánsson, Einar; Pedersen, Daniella Bach; Jensen, Peter Koch;

    2005-01-01

    The oxygen tension of the optic nerve is regulated by the intraocular pressure and systemic blood pressure, the resistance in the blood vessels and oxygen consumption of the tissue. The oxygen tension is autoregulated and moderate changes in intraocular pressure or blood pressure do not affect the...... optic nerve oxygen tension. If the intraocular pressure is increased above 40 mmHg or the ocular perfusion pressure decreased below 50 mmHg the autoregulation is overwhelmed and the optic nerve becomes hypoxic. A disturbance in oxidative metabolism in the cytochromes of the optic nerve can be seen at...... similar levels of perfusion pressure. The levels of perfusion pressure that lead to optic nerve hypoxia in the laboratory correspond remarkably well to the levels that increase the risk of glaucomatous optic nerve atrophy in human glaucoma patients. The risk for progressive optic nerve atrophy in human...

  2. [Ganglia of peripheral nerves].

    Tatagiba, M; Penkert, G; Samii, M

    1993-01-01

    The authors present two different types of ganglion affecting the peripheral nerves: extraneural and intraneural ganglion. Compression of peripheral nerves by articular ganglions is well known. The surgical management involves the complete removal of the lesion with preservation of most nerve fascicles. Intraneural ganglion is an uncommon lesion which affects the nerve diffusely. The nerve fascicles are usually intimately involved between the cysts, making complete removal of all cysts impossible. There is no agreement about the best surgical management to be applied in these cases. Two possibilities are available: opening of the epineural sheath lengthwise and pressing out the lesion; or resection of the affected part of the nerve and performing a nerve reconstruction. While in case of extraneural ganglion the postoperative clinical evolution is very favourable, only long follow up studies will reveal in case of intraneural ganglion the best surgical approach. PMID:8128785

  3. Role of magnetic resonance imaging in entrapment and compressive neuropathy - what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: Part 2. Upper extremity

    The diagnosis of nerve entrapment and compressive neuropathy has been traditionally based on the clinical and electrodiagnostic examinations. As a result of improvements in the magnetic resonance (MR) imaging modality, it plays not only a fundamental role in the detection of space-occupying lesions, but also a compensatory role in clinically and electrodiagnostically inconclusive cases. Although ultrasound has undergone further development in the past decades and shows high resolution capabilities, it has inherent limitations due to its operator dependency. We review the course of normal peripheral nerves, as well as various clinical demonstrations and pathological features of compressed and entrapped nerves in the upper extremities on MR imaging, according to the nerves involved. The common sites of nerve entrapment of the upper extremity are as follows: the brachial plexus of the thoracic outlet; axillary nerve of the quadrilateral space; radial nerve of the radial tunnel; ulnar nerve of the cubital tunnel and Guyon's canal; median nerve of the pronator syndrome, anterior interosseous nerve syndrome, and carpal tunnel syndrome. Although MR imaging can depict the peripheral nerves in the extremities effectively, radiologists should be familiar with nerve pathways, common sites of nerve compression, and common space-occupying lesions resulting in nerve compression in MR imaging. (orig.)

  4. Role of magnetic resonance imaging in entrapment and compressive neuropathy - what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: Part 2. Upper extremity

    Kim, Sungjun [Yonsei University, Department of Diagnostic Radiology, College of Medicine, Seoul (Korea); Hanyang University, Kuri Hospital, Department of Diagnostic Radiology, College of Medicine, Kuri City, Kyunggi-do (Korea); Choi, Jin-Young; Huh, Yong-Min; Song, Ho-Taek; Lee, Sung-Ah [Yonsei University, Department of Diagnostic Radiology, College of Medicine, Seoul (Korea); Kim, Seung Min [Yonsei University, Department of Neurology, College of Medicine, Seoul (Korea); Suh, Jin-Suck [Yonsei University, Department of Diagnostic Radiology, College of Medicine, Seoul (Korea); Yonsei University, Research Institute of Radiological Science, College of Medicine, Seoul (Korea)

    2007-02-15

    The diagnosis of nerve entrapment and compressive neuropathy has been traditionally based on the clinical and electrodiagnostic examinations. As a result of improvements in the magnetic resonance (MR) imaging modality, it plays not only a fundamental role in the detection of space-occupying lesions, but also a compensatory role in clinically and electrodiagnostically inconclusive cases. Although ultrasound has undergone further development in the past decades and shows high resolution capabilities, it has inherent limitations due to its operator dependency. We review the course of normal peripheral nerves, as well as various clinical demonstrations and pathological features of compressed and entrapped nerves in the upper extremities on MR imaging, according to the nerves involved. The common sites of nerve entrapment of the upper extremity are as follows: the brachial plexus of the thoracic outlet; axillary nerve of the quadrilateral space; radial nerve of the radial tunnel; ulnar nerve of the cubital tunnel and Guyon's canal; median nerve of the pronator syndrome, anterior interosseous nerve syndrome, and carpal tunnel syndrome. Although MR imaging can depict the peripheral nerves in the extremities effectively, radiologists should be familiar with nerve pathways, common sites of nerve compression, and common space-occupying lesions resulting in nerve compression in MR imaging. (orig.)

  5. Nerve sheath tumors of the head and neck - a radiological review

    Peripheral nerve sheath tumors of the head and neck - a review. Peripheral nerve sheath tumors are derived from neural crest and rare classified as neuroectodermal in origin. They can be divided into neurofibroma, schwannoma and neurogenic sarcoma. Neurofifromas are benign well circumscribed, nonencapsulated tumors which involve all elements of normal peripheral nerves. Schwannomas are beginning encapsulated tumors composed fundamentally by Schwann cells. Neurogenic sarcomas are malignant tumors which can be de novo or arise from preexisting neurofibroma or schwannoma. Peripheral nerve sheath tumors can arise from any nerve that contain myelin sheath, but are more frequent in extremities and trunk, being rare on cervical region. neurogenic tumors of head and neck can arise from cranial nerves, especially vagus nerve, brachial plexus and other small nervous plexus. Computed tomography and magnetic resonance imaging are the methods of choice in the evaluation of those tumors and can demonstrate lesions with several patterns. Areas of cystic degeneration are frequent in schwannomas, while neurofibromas are usually homogeneous. About 1/3 of those tumors are hyper vascularized and those who arise nervous spinal; roots can have an aspect of dumbbell which contain cervical and intravertebral components. (author)

  6. Effect of skilled and unskilled training on nerve regeneration and functional recovery

    A.S. Pagnussat

    2012-08-01

    Full Text Available The most disabling aspect of human peripheral nerve injuries, the majority of which affect the upper limbs, is the loss of skilled hand movements. Activity-induced morphological and electrophysiological remodeling of the neuromuscular junction has been shown to influence nerve repair and functional recovery. In the current study, we determined the effects of two different treatments on the functional and morphological recovery after median and ulnar nerve injury. Adult Wistar male rats weighing 280 to 330 g at the time of surgery (N = 8-10 animals/group were submitted to nerve crush and 1 week later began a 3-week course of motor rehabilitation involving either "skilled" (reaching for small food pellets or "unskilled" (walking on a motorized treadmill training. During this period, functional recovery was monitored weekly using staircase and cylinder tests. Histological and morphometric nerve analyses were used to assess nerve regeneration at the end of treatment. The functional evaluation demonstrated benefits of both tasks, but found no difference between them (P > 0.05. The unskilled training, however, induced a greater degree of nerve regeneration as evidenced by histological measurement (P < 0.05. These data provide evidence that both of the forelimb training tasks used in this study can accelerate functional recovery following brachial plexus injury.

  7. Ultrasound guided distal peripheral nerve block of the upper limb: A technical review

    Herman Sehmbi

    2015-01-01

    Full Text Available Upper extremity surgery is commonly performed under regional anesthesia. The advent of ultrasonography has made performing upper extremity nerve blocks relatively easy with a high degree of reliability. The proximal approaches to brachial plexus block such as supraclavicular plexus block, infraclavicular plexus block, or the axillary block are favored for the most surgical procedures of distal upper extremity. Ultrasound guidance has however made distal nerve blocks of the upper limb a technically feasible, safe and efficacious option. In recent years, there has thus been a resurgence of distal peripheral nerve blocks to facilitate hand and wrist surgery. In this article, we review the technical aspects of performing the distal blocks of the upper extremity and highlight some of the clinical aspects of their usage.

  8. Assessment of nerve morphology in nerve activation during electrical stimulation

    Gomez-Tames, Jose; Yu, Wenwei

    2013-10-01

    The distance between nerve and stimulation electrode is fundamental for nerve activation in Transcutaneous Electrical Stimulation (TES). However, it is not clear the need to have an approximate representation of the morphology of peripheral nerves in simulation models and its influence in the nerve activation. In this work, depth and curvature of a nerve are investigated around the middle thigh. As preliminary result, the curvature of the nerve helps to reduce the simulation amplitude necessary for nerve activation from far field stimulation.

  9. Cutaneous cancer and xeroderma pigmentosum

    The cutaneous cancer at the patients affected by xeroderma pigmentosum is characterized by its multifocal character and its strong radiosensitivity. A premature care and a regular follow-up for life of these patients is indispensable for the detection and the treatment of new hurts. The precautionary measures are also important by the school eviction. (N.C.)

  10. UV-induced cutaneous photobiology.

    Beissert, S; Granstein, R D

    1996-12-01

    Ultraviolet radiation (UVR) present in sunlight is a major environmental factor capable of affecting human health and well being. The organ primarily affected by UVR is the skin, which is composed of a variety of different cell types. Here, UVR is needed for production of active vitamin D as well as producing undesirable effects such as sunburn, premature cutaneous photoaging, and promoting skin cancer development. Depending on the radiation dose, UVR influences virtually every cutaneous cell type investigated differently. Since the end of the nineteenth century, sun exposure has been known to induce skin cancer, which is now the human malignancy with the most rapidly increasing incidence. In several experimental models, mid-range UVR has been demonstrated to be the major cause of UV-induced cutaneous tumors. The stratospheric ozone layer protecting the terrestrial surface from higher quantum energy solar radiation is being damaged by industrial activities resulting in the possibility of increased UVR exposure in the future. Investigations in the field of experimental dermatology have shown that within the skin an immunosurveillance system exists that may be able to detect incipient neoplasms and to elicit a host responses against it. This article reviews the literature on studies designed to investigate the effects of UVR on cutaneous cellular components, with special focus on the immune system within the skin and the development of UV-induced cancer. PMID:8994803

  11. Cutaneous malignant lymphomas: update 2006.

    Burg, Günter; Kempf, Werner; Cozzio, Antonio; Döbbeling, Udo; Feit, Josef; Golling, Philippa; Michaelis, Sonja; Schärer, Leo; Nestle, Frank; Dummer, Reinhard

    2006-11-01

    Cutaneous lymphomas represent a unique group of lymphomas and are the second most frequent extranodal lymphomas. As with other neoplasias, the pathogenesis is based mainly on a stepwise accumulation of mutations of suppressor genes and oncogenes caused by genetic, environmental or infectious factors. The diagnostic work-up includes clinical, histological, imaging and hematological investigations and in many cases immunohistochemical and molecular biological analyses. The current WHO/EORTC classification of cutaneous lymphomas differentiates "mature T-cell and NK-cell lymphomas", "mature B-cell lymphomas" and "immature hematopoietic malignancies", their variants and subgroups. It is compatible with the WHO classification for neoplasias of the hematopoietic and lymphoid tissue and respects the organ-specific peculiarities of primary cutaneous lymphomas. The assignment of the various types of cutaneous lymphomas into prognostic categories (pre-lymphomatous "abortive" disorders; definite malignant lymphomas of low-grade malignancy; definite malignant lymphomas of high-grade malignancy) provides essential information on the biological behavior and allows an appropriate planning of the therapeutic strategy, which may be topical or systemic and aggressive or non-aggressive. Besides the classical options for therapy, there are new and "experimental" strategies, the efficacy of which has to be studied in clinical trials. PMID:17081267

  12. Resident Rounds: Primary Cutaneous Mucormycosis.

    Johnson, Mariah; Fathi, Ramin; Alkousakis, Theodore

    2015-08-01

    We present the case of a 36-year-old neutropenic man with acute myelogenous leukemia who presented for evaluation of a rapidly expanding necrotic eschar after adhesive placement. Histopathology revealed infection with primary cutaneous mucormycosis. Our case reviews the presentation and management of this condition as well highlights an uncommon cause in the hospital that can lead to this dangerous infection. PMID:27120566

  13. Sporotrichoid pattern of cutaneous nocardiosis

    Inamadar A

    2003-01-01

    Full Text Available A young male patient, having linearly arranged nodular lesions on lower extremity was diagnosed to have lymphocutaneous variety of cutaneous nocardiosis. This is a rare entity and has to be differentiated form other causes of nodular lymphangitis. The patient responded dramatically to Cotrimoxazole therapy.

  14. Ultraviolet light and cutaneous lupus

    Bijl, Marc; Kallenberg, Cees G. M.

    2006-01-01

    Exposure to ultraviolet (UV) light is one of the major factors known to trigger cutaneous disease activity in (systemic) lupus erythematosus patients. UV light, UVB in particular, is a potent inducer of apoptosis. Currently, disturbed clearance of apoptotic cells is one of the concepts explaining th

  15. Vacuum Enhanced Cutaneous Biopsy Instrument

    Collins, Joseph

    1999-06-25

    A syringe-like disposable cutaneous biopsy instrument equipped with a tubular blade at its lower end, and designed so that a vacuum is created during use, said vacuum serving to retain undeformed a plug of tissue cut from a patient's skin.

  16. TUBERCULOUS SIALO-CUTANEOUS FISTULA

    Bapi Lal; Shyamashis; Dilip Chandra; Smarajit; Tapan Das

    2013-01-01

    ABSTRACT: Tuberculosis of the parotid gland is a rare clinica l entity. We present a case of parotid gland tuberculosis that presented with a sial o-cutaneous fistula. This case was successfully treated with antituberculous drugs onl y without any surgical excision.

  17. TUBERCULOUS SIALO-CUTANEOUS FISTULA

    Bapi Lal

    2013-04-01

    Full Text Available ABSTRACT: Tuberculosis of the parotid gland is a rare clinica l entity. We present a case of parotid gland tuberculosis that presented with a sial o-cutaneous fistula. This case was successfully treated with antituberculous drugs onl y without any surgical excision.

  18. Cutaneous, mucocutaneous and neurocutaneous cysticercosis

    Arora P

    1990-01-01

    Full Text Available Cutaneous cysticerci are often a pointer to the involvement of internal organs. A series of 33 patients including 5 vegetarians, between 10 to 48 years age, were investigated. Almost half the patients presented with cutaneous cysts of less than one month duration or were unaware of it. In the, other the duration varied upto 10 years. Cutaneous cysts were present in the case&Mental retardation, diminished vision and flashes of lights were, recorded in one case each, raised intracranial tension in 11 and seizures in 29 patients. Four, of the 6 patients with solitary cysts had no involvement of the internal- organs, whereas all the 27 patients with multiple had in nt of brain. Trunk was the commonest site in 16 patients. The other sites involved were scalp, eyelids, face, tongue neck, breast and limbs. Stool examination -for tapeworm segments/ eggs was positive in 2,calcification was seen on X-ray examination of skull in one and of soft tissues in 3, CT scan of skull was suggestive of cysticerci in 27 and skin biopsy for cysticercosis was confirmatory in all the 33 patients. Four patients with a solitary cutaneous cyst were treated by excision. One patients with neurocutaneous cysts was treated with albendazole without response. Out of 16patients with mucocutaneous and neurocutaneous cysticercosis treated with praziquantel, one did not respond. 7 responded partially and 8 had complete relief.

  19. Biology of Human Cutaneous Melanoma

    Sharma, Bhuvnesh K.; Hasskamp, Joanne H.; Elias, Elias G.

    2010-01-01

    A review of the natural behavior of cutaneous melanoma, clinical and pathological factors, prognostic indicators, some basic research and the present and possible futuristic strategies in the management of this disease are presented. While surgery remains to be the most effective therapeutic approach in the management of early primary lesions, there is no standard adjuvant therapy after surgical resection, or for metastatic disease.

  20. Postirradiation lesions of the brachial plexus. Results of surgical treatment

    In a series of 103 cases of postirradiation lesions of the brachial plexus operated on between 1978 and 1986--of which 60 patients have been reviewed with a follow up from 2 to 9 years--the surgical results are analyzed according to an anatomic classification, a clinical classification, and the surgical procedures. We conclude that the radiation plexitis should be treated surgically and at the earliest possible time after the onset of paresthesias. Also, the surgical procedure which gives the best results is neurolysis with pedicled omentoplasty