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1

Nerve transfer in brachial plexus traction injuries  

Directory of Open Access Journals (Sweden)

Full Text Available Background. The aim of this study was to analyze the results of nerve transfer to the musculocutaneous and axillary nerves, using some technical modalities such as intercostal, spinal accessory or intraplexal transfer, and on the basis of the results to try to clarify the most common controversies concerning these operations. Methods. The study included 82 patients with brachial plexus traction injuries, who were operated on using various techniques of nerve transfer. The follow-up period was at least two years. The analysis of biceps and deltoid muscles recovery was performed according to the type of the donor nerve. Results. The corresponding rates of recovery for the musculocutaneous and axillary nerves were 46.7% and 68.1% in intercostal nerve transfer, 71.4% and 75% in accessory nerve transfer, 93.1% and 88.8% in nerve transfer of the brachial plexus collateral branches, and 55.5% and 60% in classical intraplexal nerve transfer, respectively. Comparative statistical analysis demonstrated significantly better final outcome and quality of recovery in regional nerve transfers in comparison to the other methods. Conclusion. Our findings suggest that nerve transfer of collateral branches, where possible, (such as in cases with upper or extended upper brachial plexus palsy) might be a method of choice, offering better results and quality of recovery.

Samardži? Miroslav M.; Gruji?i? Danica M.; Rasuli? Lukas G.; Ba?eti? Dragoljub; Mili?i? Biljana

2003-01-01

2

?-Synuclein in cutaneous autonomic nerves.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To develop a cutaneous biomarker for Parkinson disease (PD). METHODS: Twenty patients with PD and 14 age- and sex-matched control subjects underwent examinations, autonomic testing, and skin biopsies at the distal leg, distal thigh, and proximal thigh. ?-Synuclein deposition and the density of intraepidermal, sudomotor, and pilomotor nerve fibers were measured. ?-Synuclein deposition was normalized to nerve fiber density (the ?-synuclein ratio). Results were compared with examination scores and autonomic function testing. RESULTS: Patients with PD had a distal sensory and autonomic neuropathy characterized by loss of intraepidermal and pilomotor fibers (p < 0.05 vs controls, all sites) and morphologic changes to sudomotor nerve fibers. Patients with PD had greater ?-synuclein deposition and higher ?-synuclein ratios compared with controls within pilomotor nerves and sudomotor nerves (p < 0.01, all sites) but not sensory nerves. Higher ?-synuclein ratios correlated with Hoehn and Yahr scores (r = 0.58-0.71, p < 0.01), with sympathetic adrenergic function (r = -0.40 to -0.66, p < 0.01), and with parasympathetic function (r = -0.66 to -0.77, p > 0.01). CONCLUSIONS: We conclude that ?-synuclein deposition is increased in cutaneous sympathetic adrenergic and sympathetic cholinergic fibers but not sensory fibers of patients with PD. Higher ?-synuclein deposition is associated with greater autonomic dysfunction and more advanced PD. These data suggest that measures of ?-synuclein deposition in cutaneous autonomic nerves may be a useful biomarker in patients with PD.

Wang N; Gibbons CH; Lafo J; Freeman R

2013-10-01

3

The incidence and aetiology of phrenic nerve blockade associated with supraclavicular brachial plexus block.  

UK PubMed Central (United Kingdom)

A trial to ascertain the true incidence of inadvertent phrenic nerve block with brachial plexus block via the supraclavicular approach was carried out. Phrenic nerve block was monitored by x-ray screening of the diaphragm. There was an incidence of phrenic nerve block of 67% (10 cases of diaphragmatic paralysis in 15 brachial blocks). The possible causes of phrenic nerve block with brachial block are discussed. It is concluded that the phrenic nerve is blocked peripherally in front of the scalenus anterior.

Knoblanche GE

1979-11-01

4

Axillary Brachial Plexus Block  

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The axillary approach to brachial plexus blockade provides satisfactory anaesthesia for elbow, forearm, and hand surgery and also provides reliable cutaneous anaesthesia of the inner upper arm including the medial cutaneous nerve of arm and intercostobrachial nerve, areas often missed with other app...

Satapathy, Ashish R.; Coventry, David M.

5

Surgical outcomes following nerve transfers in upper brachial plexus injuries  

Directory of Open Access Journals (Sweden)

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 degrees). Eight patients scored M4 power in elbow flexion and assessed as excellent results. Good results (M3+) were obtained in seven patients. Five patients had fair results (M2+ to M3).

Bhandari P; Sadhotra L; Bhargava P; Bath A; Mukherjee M; Bhatti Tejinder; Maurya Sanjay

2009-01-01

6

[Nerve reconstruction techniques in traumatic brachial plexus surgery. Part 2: intraplexal nerve transfers].  

UK PubMed Central (United Kingdom)

After the great enthusiasm generated in the '70s and '80s in brachial plexus surgery as a result of the incorporation of microsurgical techniques and other advances, brachial plexus surgery has been shaken in the last two decades by the emergence of nerve transfer techniques or neurotizations. This technique consists in sectioning a donor nerve, sacrificing its original function, to connect it with the distal stump of a receptor nerve, whose function was lost during the trauma. Neurotizations are indicated when direct repair is not possible, i.e. when a cervical root is avulsed at its origin in the spinal cord. In recent years, due to the positive results of some of these nerve transfer techniques, they have been widely used even in some cases where the roots of the plexus were preserved. In complete brachial plexus injuries, it is mandatory to determine the exact number of roots available (not avulsed) to perform a direct reconstruction. In case of absence of available roots, extraplexual nerve transfers are employed, such as the spinal accessory nerve, the phrenic nerve, the intercostal nerves, etc., to increase the amount of axons transferred to the injured plexus. In cases of avulsion of all the roots, extraplexal neurotizations are the only reinnervation option available to limit the long-term devastating effects of this injury. Given the large amount of reports that has been published in recent years regarding brachial plexus traumatic injuries, the present article has been written in order to clarify the concerned readers the indications, results and techniques available in the surgical armamentarium for this condition. Since the choice of either surgical technique is usually taken during the course of the procedure, all this knowledge should be perfectly embodied by the surgical team before the procedure. In a previous paper extraplexual nerve transfers were analyzed; this literature review complements the preceding paper analyzing intraplexual nerve transfers, and thus completing the analysis of the nerve transfers available in brachial plexus surgery.

Robla-Costales J; Socolovsky M; Di Masi G; Robla-Costales D; Domitrovic L; Campero A; Fernández-Fernández J; Ibáñez-Plágaro J; García-Cosamalón J

2011-12-01

7

Contralateral C7 nerve transfer with direct coaptation to restore lower trunk function after traumatic brachial plexus avulsion.  

UK PubMed Central (United Kingdom)

BACKGROUND: Contralateral C7 nerve transfer to the median nerve has been used in an attempt to restore finger flexion in patients with total brachial plexus avulsion injury. However, the results have not been satisfactory mainly because of the requirement to use a long bridging nerve graft, which causes an extended nerve regeneration process and irreversible muscle atrophy. A new procedure involving contralateral C7 nerve transfer via a modified prespinal route and direct coaptation with the injured lower trunk is presented here. METHODS: Contralateral C7 nerve transfer via the modified prespinal route and direct coaptation with the injured lower trunk was performed in seventy-five patients with total brachial plexus avulsion injury. Thirty-five required humeral shortening osteotomy (3 to 4.5 cm) in order to accomplish the direct coaptation. The contralateral C7 nerve was also transferred to the musculocutaneous nerve through the bridging medial antebrachial cutaneous nerve arising from the lower trunk in forty-seven of the seventy-five patients. Recovery of finger, wrist, and elbow flexion was evaluated with use of the modified British Medical Research Council muscle grading system. RESULTS: The mean follow-up period (and standard deviation) was 57 ± 6 months (range, forty-eight to seventy-eight months). Motor function with a grade of M3+ or greater was attained in 60% of the patients for elbow flexion, 64% of the patients for finger flexion, 53% of the patients for thumb flexion, and 72% of the patients for wrist flexion. CONCLUSIONS: Contralateral C7 nerve transfer via a modified prespinal route and direct coaptation with the injured lower trunk decreases the distance for nerve regeneration in patients with total brachial plexus avulsion injury. There was satisfactory recovery of finger flexion and wrist flexion in this series. In addition, contralateral C7 nerve transfer was successfully used to repair two different target nerves: the lower trunk and the musculocutaneous nerve.

Wang SF; Li PC; Xue YH; Yiu HW; Li YC; Wang HH

2013-05-01

8

Neurotization from two medial pectoral nerves to musculocutaneous nerve in a pediatric brachial plexus injury.  

Science.gov (United States)

Traumatic brachial plexus injuries can be devastating, causing partial to total denervation of the muscles of the upper extremities. Surgical reconstruction can restore motor and/or sensory function following nerve injuries. Direct nerve-to-nerve transfers can provide a closer nerve source to the target muscle, thereby enhancing the quality and rate of recovery. Restoration of elbow flexion is the primary goal for patients with brachial plexus injuries. A 4-year-old right-hand-dominant male sustained a fracture of the left scapula in a car accident. He was treated conservatively. After the accident, he presented with motor weakness of the left upper extremity. Shoulder abduction was grade 3 and elbow flexor was grade 0. Hand function was intact. Nerve conduction studies and an electromyogram were performed, which revealed left lateral and posterior cord brachial plexopathy with axonotmesis. He was admitted to Rehabilitation Medicine and treated. However, marked neurological dysfunction in the left upper extremity was still observed. Six months after trauma, under general anesthesia with the patient in the supine position, the brachial plexus was explored through infraclavicular and supraclavicular incisions. Each terminal branch was confirmed by electrophysiology. Avulsion of the C5 roots and absence of usable stump proximally were confirmed intraoperatively. Under a microscope, neurotization from the musculocutaneous nerve to two medial pectoral nerves was performed with nylon 8-0. Physical treatment and electrostimulation started 2 weeks postoperatively. At a 3-month postoperative visit, evidence of reinnervation of the elbow flexors was observed. At his last follow-up, 2 years following trauma, the patient had recovered Medical Research Council (MRC) grade 4+ elbow flexors. We propose that neurotization from medial pectoral nerves to musculocutaneous nerve can be used successfully to restore elbow flexion in patients with brachial plexus injuries. PMID:23115676

Yu, Dong-Woo; Kim, Min-Su; Jung, Young-Jin; Kim, Seong-Ho

2012-09-30

9

Neurotization from two medial pectoral nerves to musculocutaneous nerve in a pediatric brachial plexus injury.  

UK PubMed Central (United Kingdom)

Traumatic brachial plexus injuries can be devastating, causing partial to total denervation of the muscles of the upper extremities. Surgical reconstruction can restore motor and/or sensory function following nerve injuries. Direct nerve-to-nerve transfers can provide a closer nerve source to the target muscle, thereby enhancing the quality and rate of recovery. Restoration of elbow flexion is the primary goal for patients with brachial plexus injuries. A 4-year-old right-hand-dominant male sustained a fracture of the left scapula in a car accident. He was treated conservatively. After the accident, he presented with motor weakness of the left upper extremity. Shoulder abduction was grade 3 and elbow flexor was grade 0. Hand function was intact. Nerve conduction studies and an electromyogram were performed, which revealed left lateral and posterior cord brachial plexopathy with axonotmesis. He was admitted to Rehabilitation Medicine and treated. However, marked neurological dysfunction in the left upper extremity was still observed. Six months after trauma, under general anesthesia with the patient in the supine position, the brachial plexus was explored through infraclavicular and supraclavicular incisions. Each terminal branch was confirmed by electrophysiology. Avulsion of the C5 roots and absence of usable stump proximally were confirmed intraoperatively. Under a microscope, neurotization from the musculocutaneous nerve to two medial pectoral nerves was performed with nylon 8-0. Physical treatment and electrostimulation started 2 weeks postoperatively. At a 3-month postoperative visit, evidence of reinnervation of the elbow flexors was observed. At his last follow-up, 2 years following trauma, the patient had recovered Medical Research Council (MRC) grade 4+ elbow flexors. We propose that neurotization from medial pectoral nerves to musculocutaneous nerve can be used successfully to restore elbow flexion in patients with brachial plexus injuries.

Yu DW; Kim MS; Jung YJ; Kim SH

2012-09-01

10

[Nerve reconstruction techniques in traumatic brachial plexus surgery. Part 1: extraplexal nerve transfers].  

UK PubMed Central (United Kingdom)

After the great enthusiasm generated in the '70s and '80s in brachial plexus surgery as a result of the incorporation of microsurgical techniques and other advances, brachial plexus surgery has been shaken in the last two decades by the emergence of nerve transfer techniques or neurotizations. This technique consists in sectioning a donor nerve, sacrificing its original function, to connect it with the distal stump of a receptor nerve, whose function was lost during the trauma. Neurotizations are indicated when direct repair is not possible, i.e. when a cervical root is avulsed at its origin in the spinal cord. In recent years, due to the positive results of some of these nerve transfer techniques, they have been widely used even in some cases where the roots of the plexus were preserved. In complete brachial plexus injuries, it is mandatory to determine the exact number of roots available (not avulsed) to perform a direct reconstruction. In case of absence of available roots, extraplexual nerve transfers are employed, such as the spinal accessory nerve, the phrenic nerve, the intercostal nerves, etc., to increase the amount of axons transferred to the injured plexus. In cases of avulsion of all the roots, extraplexal neurotizations are the only reinnervation option available to limit the long-term devastating effects of this injury. Given the large amount of reports that has been published in recent years regarding brachial plexus traumatic injuries, the present article has been written in order to clarify the concerned readers the indications, results and techniques available in the surgical armamentarium for this condition. Since the choice of either surgical technique is usually taken during the course of the procedure, all this knowledge should be perfectly embodied by the surgical team before the procedure. In this first part extraplexual nerve transfers are analyzed, while intraplexual nerve transfers will be analyzed in the second part of this presentation.

Robla-Costales J; Socolovsky M; Di Masi G; Domitrovic A Campero J Fernández-Fernández J Ibáñez-Plágaro J García-Cosamalón L; Campero A; Fernández-Fernández J; Ibáñez-Plágaro J; García-Cosamalón J

2011-12-01

11

Brachial muscles of dystrophic chick embryos atypically sustain interaction with thoracic nerves.  

UK PubMed Central (United Kingdom)

Previous analyses of experimental chick embryos of normal lineage demonstrate the inability of brachial muscles to sustain a successful union with foreign nerves derived from a thoracic neural tube segment transplanted to the brachial region at day 2 in ovo (day 2E). The present experiments were performed to determine if mutant chick embryos afflicted with hereditary muscular dystrophy would respond similarly to this experimental manipulation. Using the same criteria applied to our analysis of experimental normal embryos, our results demonstrated that dystrophic brachial muscles were capable of maintaining a compatible union with foreign thoracic nerves throughout the experimental period analysed. Significant muscle growth occurred, intramuscular nerve branches were maintained, motor endplates formed and wing motility was equivalent to that of unoperated dystrophic embryos. Thus, foreign nerves rejected by normal brachial muscles were accepted by brachial muscles of the mutant dystrophic embryo.

Butler J; Cosmos E

1987-01-01

12

Can bilateral bronchospasm be a sign of unilateral phrenic nerve palsy after supraclavicular brachial plexus block?  

UK PubMed Central (United Kingdom)

Ultrasound-guided peripheral nerve blocks facilitate ambulatory anesthesia for upper limb surgeries. Unilateral phrenic nerve blockade is a common complication after interscalene brachial plexus block, rather than the supraclavicular block. We report a case of severe respiratory distress and bilateral bronchospasm following ultrasound-guided supraclavicular brachial plexus block. Patient did not have clinical features of pneumothorax or drug allergy and was managed with oxygen therapy and salbutamol nebulization. Chest X-ray revealed elevated right hemidiaphragm confirming unilateral phrenic nerve paresis.

Chaudhuri S; Gopalkrishna M; Paul C; Kundu R

2012-04-01

13

Grafting the C5 root to the musculocutaneous nerve partially restores hand sensation in complete palsies of the brachial plexus.  

UK PubMed Central (United Kingdom)

BACKGROUND: In complete brachial plexus palsy, we have hypothesized that grafting to the musculocutaneous nerve should restore some hand sensation because the musculocutaneous nerve can drive hand sensation directly or via communication with the radial and median nerves. OBJECTIVE: To investigate sensory recovery in the hand and forearm after C5 root grafting to the musculocutaneous nerve in patients with a total brachial plexus injury. METHODS: Eleven patients who had recovered elbow flexion after musculocutaneous nerve grafting from a preserved C5 root and who had been followed for a minimum of 3 years were screened for sensory recovery in the hand and forearm. Six matched patients who had not undergone surgery served as controls. Methods of assessment included testing for pain sensation using Adson forceps, cutaneous pressure threshold measurements using Semmes-Weinstein monofilaments, and the static 2-point discrimination test. Deep sensation was evaluated by squeezing the first web space, and thermal sensation was assessed using warm and cold water. RESULTS: All grafted patients recovered sensation in a variable territory extending from just over the thenar eminence to the entire lateral forearm and hand. Seven patients were capable of perceiving 2-0 monofilament pressure on the thenar eminence, palm, and dorsoradial aspect of the hand. All could differentiate warm and cold water. None recovered 2-point discrimination. None of the patients in the control group recovered any kind of sensation in the affected limb. CONCLUSION: Grafting the musculocutaneous nerve can restore nociceptive sensation on the radial side of the hand.

Bertelli JA; Ghizoni MF

2012-08-01

14

Different Learning Curves for Axillary Brachial Plexus Block: Ultrasound Guidance versus Nerve Stimulation  

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Little is known about the learning of the skills needed to perform ultrasound- or nerve stimulator-guided peripheral nerve blocks. The aim of this study was to compare the learning curves of residents trained in ultrasound guidance versus residents trained in nerve stimulation for axillary brachial ...

Luyet, C.; Schüpfer, G.; Wipfli, M.; Greif, R.; Luginbühl, M.; Eichenberger, U.

15

A systematic review of nerve transfer and nerve repair for the treatment of adult upper brachial plexus injury.  

Science.gov (United States)

Nerve reconstruction for upper brachial plexus injury consists of nerve repair and/or transfer. Current literature lacks evidence supporting a preferred surgical treatment for adults with such injury involving shoulder and elbow function. We systematically reviewed the literature published from January 1990 to February 2011 using multiple databases to search the following: brachial plexus and graft, repair, reconstruction, nerve transfer, neurotization. Of 1360 articles initially identified, 33 were included in analysis, with 23 nerve transfer (399 patients), 6 nerve repair (99 patients), and 4 nerve transfer + proximal repair (117 patients) citations (mean preoperative interval, 6 ± 1.9 months). For shoulder abduction, no significant difference was found in the rates ratio (comparative probabilities of event occurrence) among the 3 methods to achieve a Medical Research Council (MRC) scale score of 3 or higher or a score of 4 or higher. For elbow flexion, the rates ratio for nerve transfer vs nerve repair to achieve an MRC scale score of 3 was 1.46 (P = .03); for nerve transfer vs nerve transfer + proximal repair to achieve an MRC scale score of 3 was 1.45 (P = .02) and an MRC scale score of 4 was 1.47 (P = .05). Therefore, for elbow flexion recovery, nerve transfer is somewhat more effective than nerve repair; however, no particular reconstruction strategy was found to be superior to recover shoulder abduction. When considering nerve reconstruction strategies, our findings do not support the sole use of nerve transfer in upper brachial plexus injury without operative exploration to provide a clear understanding of the pathoanatomy. Supraclavicular brachial plexus exploration plays an important role in developing individual surgical strategies, and nerve repair (when donor stumps are available) should remain the standard for treatment of upper brachial plexus injury except in isolated cases solely lacking elbow flexion. PMID:22811085

Yang, Lynda J-S; Chang, Kate W-C; Chung, Kevin C

2012-08-01

16

A systematic review of nerve transfer and nerve repair for the treatment of adult upper brachial plexus injury.  

UK PubMed Central (United Kingdom)

Nerve reconstruction for upper brachial plexus injury consists of nerve repair and/or transfer. Current literature lacks evidence supporting a preferred surgical treatment for adults with such injury involving shoulder and elbow function. We systematically reviewed the literature published from January 1990 to February 2011 using multiple databases to search the following: brachial plexus and graft, repair, reconstruction, nerve transfer, neurotization. Of 1360 articles initially identified, 33 were included in analysis, with 23 nerve transfer (399 patients), 6 nerve repair (99 patients), and 4 nerve transfer + proximal repair (117 patients) citations (mean preoperative interval, 6 ± 1.9 months). For shoulder abduction, no significant difference was found in the rates ratio (comparative probabilities of event occurrence) among the 3 methods to achieve a Medical Research Council (MRC) scale score of 3 or higher or a score of 4 or higher. For elbow flexion, the rates ratio for nerve transfer vs nerve repair to achieve an MRC scale score of 3 was 1.46 (P = .03); for nerve transfer vs nerve transfer + proximal repair to achieve an MRC scale score of 3 was 1.45 (P = .02) and an MRC scale score of 4 was 1.47 (P = .05). Therefore, for elbow flexion recovery, nerve transfer is somewhat more effective than nerve repair; however, no particular reconstruction strategy was found to be superior to recover shoulder abduction. When considering nerve reconstruction strategies, our findings do not support the sole use of nerve transfer in upper brachial plexus injury without operative exploration to provide a clear understanding of the pathoanatomy. Supraclavicular brachial plexus exploration plays an important role in developing individual surgical strategies, and nerve repair (when donor stumps are available) should remain the standard for treatment of upper brachial plexus injury except in isolated cases solely lacking elbow flexion.

Yang LJ; Chang KW; Chung KC

2012-08-01

17

[Chronic inflammatory demyelinating polyradiculoneuropathy with hypertrophy of spinal roots, brachial plexus and cranial nerves  

UK PubMed Central (United Kingdom)

We report two patients who presented an atypical chronic inflammatory demyelinating polyradiculoneuropathy with massive nerve root and brachial plexus hypertrophy, and pseudotumoral supraclavicular mass. They also presented an hypertrophy of oculomotor and trigeminal nerves causing an exophthalmos and ocular palsy. Spinal root enlargement and cranial nerve hypertrophy was demonstrated by CT scanner and MRI. Brachial plexus biopsy showed a similar aspect of sural nerve, with an extensive onion bulb formation and perivascular inflammatory cell infiltration. There was an excellent response to steroids in both patients.

Aïdi S; El Alaoui Faris M; Amarti A; Belaïdi H; Jiddane M; Guezzaz M; Medjel A; Chkili T

2002-09-01

18

Collateral branches of the brachial plexus as donors in nerve transfers  

Directory of Open Access Journals (Sweden)

Full Text Available Background/Aim. Nerve transfers in cases of directly irreparable, or high level extensive brachial plexus traction injuries are performed using a variety of donor nerves with various success but an ideal method has not been established. The purpose of this study was to analyze the results of nerve transfers in patients with traction injuries to the brachial plexus using the thoracodorsal and medial pectoral nerves as donors. Methods. This study included 40 patients with 25 procedures using the thoracodorsal nerve and 33 procedures using the medial pectoral nerve as donors for reinnervation of the musculocutaneous or axillary nerve. The results were analyzed according to the donor nerve, the age of the patient and the timing of surgery. Results. The total rate of recovery for elbow flexion was 94.1%, for shoulder abduction 89.3%, and for shoulder external rotation 64.3%. The corresponding rates of recovery using the thoracodorsal nerve were 100%, 93.7% and 68.7%, respectively. The rates of recovery with medial pectoral nerve transfers were 90.5%, 83.3% and 58.3%, respectively. Despite the obvious differences in the rates of recovery, statistical significance was found only between the rates and quality of recovery for the musculocutaneous and axillary nerve using the thoracodorsal nerve as donor. Conclusion. According to our findings, nerve transfers using collateral branches of the brachial plexus in cases with upper palsy offer several advantages and yield high rate and good quality of recovery.

Samardži? Miroslav; Rasuli? Lukas; Laki?evi? Novak; Baš?arevi? Vladimir; Cvrkota Irena; Mi?ovi? Mirko; Savi? Andrija

2012-01-01

19

Use of intercostal nerves for different target neurotization in brachial plexus reconstruction  

Directory of Open Access Journals (Sweden)

Full Text Available Intercostal nerve transfer is a valuable procedure in devastating plexopathies. Intercostal nerves are a very good choice for elbow flexion or extension and shoulder abduction when the intraplexus donor nerves are not available. The best results are obtained in obstetric brachial plexus palsy patients, when direct nerve transfer is performed within six months from the injury. Unlike the adult posttraumatic patients after median and ulnar nerve neurotization with intercostal nerves, almost all obstetric brachial plexus palsy patients achieve protective sensation in the hand and some of them achieve active wrist and finger flexion. Use in combination with proper muscles, intercostal nerve transfer can yield adequate power to the paretic upper limb. Reinnervation of native muscles (i.e., latissimus dorsi) should always be sought as they can successfully be transferred later on for further functional restoration.

Marios G Lykissas; Ioannis P Kostas-Agnantis; Ananstasios V Korompilias; Marios D Vekris; Alexandros E Beris

2013-01-01

20

Can bilateral bronchospasm be a sign of unilateral phrenic nerve palsy after supraclavicular brachial plexus block?  

Science.gov (United States)

Ultrasound-guided peripheral nerve blocks facilitate ambulatory anesthesia for upper limb surgeries. Unilateral phrenic nerve blockade is a common complication after interscalene brachial plexus block, rather than the supraclavicular block. We report a case of severe respiratory distress and bilateral bronchospasm following ultrasound-guided supraclavicular brachial plexus block. Patient did not have clinical features of pneumothorax or drug allergy and was managed with oxygen therapy and salbutamol nebulization. Chest X-ray revealed elevated right hemidiaphragm confirming unilateral phrenic nerve paresis. PMID:22557755

Chaudhuri, Souvik; Gopalkrishna, Md; Paul, Cherish; Kundu, Ratul

2012-04-01

 
 
 
 
21

Nerve injury complicating ultrasound/electrostimulation-guided supraclavicular brachial plexus block.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: Neurologic complications after peripheral nerve blocks (PNBs) are relatively uncommon. It has been postulated that real-time, needle-nerve visualization during ultrasound guided PNBs might further reduce the risk of neurologic or vascular complications. CASE REPORT: In this report, we describe the occurrence of a severe brachial plexus injury after combined ultrasound and nerve stimulator-guided supraclavicular brachial plexus block. CONCLUSIONS: Ultrasound guidance should not preclude development of additional monitoring and protocols to decrease the risk of complications with PNBs.

Reiss W; Kurapati S; Shariat A; Hadzic A

2010-07-01

22

Solitary neurolymphomatosis of the brachial plexus mimicking benign nerve sheath tumour: case report.  

UK PubMed Central (United Kingdom)

Neurolymphomatosis typically appears as a diffuse lesion with thickening of the affected nerves on magnetic resonance imaging (MRI). MRI in the present case revealed a well-defined, solitary lesion showing continuity with brachial plexus nerves. Findings including clinical symptoms resembled benign nerve sheath tumour rather than neurolymphomatosis. Intra-operatively, the C8 root was focally swollen, corresponding to a well-circumscribed lesion on MRI. The diagnosis of neurolymphomatosis was obtained only after resection biopsy. Post-operatively, (18)F-fluorodeoxyglucose positron emission tomography proved useful for follow-up evaluation. We offer the first description of the MRI characteristics of brachial plexopathy in neurolymphomatosis, along with the clinical course.

Okada M; Takamatsu K; Oebisu N; Nakamura H

2013-06-01

23

Can bilateral bronchospasm be a sign of unilateral phrenic nerve palsy after supraclavicular brachial plexus block?  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Ultrasound-guided peripheral nerve blocks facilitate ambulatory anesthesia for upper limb surgeries. Unilateral phrenic nerve blockade is a common complication after interscalene brachial plexus block, rather than the supraclavicular block. We report a case of severe respiratory distress and bilater...

Chaudhuri, Souvik; Gopalkrishna, MD; Paul, Cherish; Kundu, Ratul

24

Sensory nerves and nitric oxide contribute to reflex cutaneous vasodilation in humans.  

UK PubMed Central (United Kingdom)

We tested the hypothesis that inhibition of cutaneous sensory nerves would attenuate reflex cutaneous vasodilation in response to an increase in core temperature. Nine subjects were equipped with four microdialysis fibers on the forearm. Two sites were treated with topical anesthetic EMLA cream for 120 min. Sensory nerve inhibition was verified by lack of sensation to a pinprick. Microdialysis fibers were randomly assigned as 1) lactated Ringer (control); 2) 10 mM nitro-L-arginine methyl ester (L-NAME) to inhibit nitric oxide synthase; 3) EMLA + lactated Ringer; and 4) EMLA + L-NAME. Laser-Doppler flowmetry was used as an index of skin blood flow, and blood pressure was measured via brachial auscultation. Subjects wore a water-perfused suit, and oral temperature was monitored as an index of core temperature. The suit was perfused with 50°C water to initiate whole body heat stress to raise oral temperature 0.8°C above baseline. Cutaneous vascular conductance (CVC) was calculated and normalized to maximal vasodilation (%CVC(max)). There was no difference in CVC between control and EMLA sites (67 ± 5 vs. 69 ± 6% CVC(max)), but the onset of vasodilation was delayed at EMLA compared with control sites. The L-NAME site was significantly attenuated compared with control and EMLA sites (45 ± 5% CVC(max); P < 0.01). Combined EMLA + L-NAME site (25 ± 6% CVC(max)) was attenuated compared with control and EMLA (P < 0.001) and L-NAME only (P < 0.01). These data suggest cutaneous sensory nerves contribute to reflex cutaneous vasodilation during the early, but not latter, stages of heat stress, and full expression of reflex cutaneous vasodilation requires functional sensory nerves and NOS.

Wong BJ

2013-04-01

25

Sensory nerves and nitric oxide contribute to reflex cutaneous vasodilation in humans.  

Science.gov (United States)

We tested the hypothesis that inhibition of cutaneous sensory nerves would attenuate reflex cutaneous vasodilation in response to an increase in core temperature. Nine subjects were equipped with four microdialysis fibers on the forearm. Two sites were treated with topical anesthetic EMLA cream for 120 min. Sensory nerve inhibition was verified by lack of sensation to a pinprick. Microdialysis fibers were randomly assigned as 1) lactated Ringer (control); 2) 10 mM nitro-L-arginine methyl ester (L-NAME) to inhibit nitric oxide synthase; 3) EMLA + lactated Ringer; and 4) EMLA + L-NAME. Laser-Doppler flowmetry was used as an index of skin blood flow, and blood pressure was measured via brachial auscultation. Subjects wore a water-perfused suit, and oral temperature was monitored as an index of core temperature. The suit was perfused with 50°C water to initiate whole body heat stress to raise oral temperature 0.8°C above baseline. Cutaneous vascular conductance (CVC) was calculated and normalized to maximal vasodilation (%CVC(max)). There was no difference in CVC between control and EMLA sites (67 ± 5 vs. 69 ± 6% CVC(max)), but the onset of vasodilation was delayed at EMLA compared with control sites. The L-NAME site was significantly attenuated compared with control and EMLA sites (45 ± 5% CVC(max); P < 0.01). Combined EMLA + L-NAME site (25 ± 6% CVC(max)) was attenuated compared with control and EMLA (P < 0.001) and L-NAME only (P < 0.01). These data suggest cutaneous sensory nerves contribute to reflex cutaneous vasodilation during the early, but not latter, stages of heat stress, and full expression of reflex cutaneous vasodilation requires functional sensory nerves and NOS. PMID:23408029

Wong, Brett J

2013-02-13

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

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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)

Bhagat Hemant; Agarwa Anil; Sharma Manish S

2008-01-01

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Double nerve transfer for elbow flexion in obstetric brachial plexus injury: a case report.  

UK PubMed Central (United Kingdom)

We report a case of a 10-month-old boy with a left extended upper type (C5-C7) obstetric brachial plexus injury that was treated with double nerve transfer (partial ulnar and partial median nerve transfer) to restore elbow flexion and spinal accessory nerve transfer to the suprascapular nerve to restore shoulder abduction. At 60 months' follow-up, shoulder abduction was 0-150° (M4) and elbow flexion was 0-140° (M5). Elbow, wrist and finger extension improved to M5. However, shoulder external rotation was only 0-30° (from full internal rotation). No weakness on finger and wrist flexion was observed. Double nerve transfers to restore elbow flexion can be safely done in obstetric brachial plexus injuries with good results. Secondary surgeries may be needed to improve external rotation.

Estrella EP; Mella PM

2013-03-01

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Combined use of ultrasound guided infraclavicular block and lateral femoral cutaneous nerve block in upper extremity reconstruction requiring large skin graft: case report.  

UK PubMed Central (United Kingdom)

Combined nerve blocks of the upper extremity and lower limb in same operation rarely performed due to the risk of systemic toxicity of local anesthetics. Therefore, general anesthesia is generally preferred in this operations. However, use of ultrasound allows reliable deposition of the anesthetic around the nerves, potentially lowering the local anesthetic requirement. In this case report, we present a 44-year-old, ASA physical status I, male patient who was operated for upper extremity reconstruction requiring skin graft from anterolateral thigh region under ultrasound-guided infraclavicular brachial plexus block and lateral femoral cutaneous nerve block. The block was successful and no block-related complications were noted. We think that combining an ultrasound guided infraclavicular brachial plexus block and a lateral femoral cutaneous nerve block is a clinically useful and safe technique and an alternative anesthetic method for procedures requiring skin grafts for the upper extremity.

K?l?çaslan A; Erol A; Topal A; Selimo?lu MN; Otelcio?lu S

2013-07-01

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

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Full Text Available Abstract 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 blockade were assessed. The sensorial blockade, motor blockade time and quality of blockade were compared among the cases. Results The time needed to perform the axillary brachial plexus block averaged is similar in both groups (p > 0.05). Although not significant statistically, it was observed that the sensory block had formed earlier in Group 1 (p > 0.05). But the degree of motor blockade was intenser in Group 1 than in Group 2 (p Conclusions Ultrasound offers a new possibility for identifiying the nerves of the brachial plexus for regional anesthesia. The ultrasound-guided axillary brachial plexus block is a safe method with faster onset time and better quality of motor blockade compared to peripheral nerve stimulation technique.

Zencirci Beyazit

2011-01-01

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

UK PubMed Central (United Kingdom)

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 blockade were assessed. The sensorial blockade, motor blockade time and quality of blockade were compared among the cases. RESULTS: The time needed to perform the axillary brachial plexus block averaged is similar in both groups (p > 0.05). Although not significant statistically, it was observed that the sensory block had formed earlier in Group 1 (p > 0.05). But the degree of motor blockade was intenser in Group 1 than in Group 2 (p < 0.05). CONCLUSIONS: Ultrasound offers a new possibility for identifiying the nerves of the brachial plexus for regional anesthesia. The ultrasound-guided axillary brachial plexus block is a safe method with faster onset time and better quality of motor blockade compared to peripheral nerve stimulation technique.

Zencirci B

2011-01-01

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Posterior brachial plexus block with nerve stimulator and 0.5% ropivacaine.  

UK PubMed Central (United Kingdom)

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, scheduled for shoulder, clavicle and proximal humerus surgery, who were submitted to posterior brachial plexus block with the aid of a nerve stimulator starting at 1 mA. When adequate muscle contraction was obtained, the current was decreased to 0.5 mA. If the response persisted, 40 mL of 0.5% ropivacaine was injected. The following parameters were evaluated: block onset, analgesia and motor block duration, complications and side effects. RESULTS: Blockade was effective in 20 out of 22 patients, mean onset time was 15.52 min, mean surgical duration was 1.61 h. Mean analgesia duration was 15.85 h and mean motor block duration was 11.16 h. There were no clinical signs or symptoms of toxic effects of local anesthetics and no patient presented side effects. CONCLUSIONS: Posterior brachial plexus block with the aid of nerve stimulator provides effective anesthesia, is very comfortable for patients and easy to perform.

Beato L; Camocardi G; Imbelloni LE

2005-08-01

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[Nerve transfer in brachial plexus injuries--comparative analysis of surgical procedures  

UK PubMed Central (United Kingdom)

Nerve transfer is the only possibility for nerve repair in cases of the brachial plexus traction injuries with spinal roots avulsion. From 1980. until 2000. in Institute of Neurosurgery, Clinical Center of Serbia, nerve transfer has been performed in 127(79%) of 159 patients with traction injuries of brachial plexus, i.e., 204 reinnervation procedures has been performed using different donor nerves. We achieved good or satisfactory arm abduction and full range or satisfactory elbow flexion through reinnervation of the axillary and musculocutaneous nerve using different donor nerves in 143 of 204 reinnervations, which presents general rate of useful functional recovery in 70.1% of cases. Mean values of the rate of useful functional recovery in individual modalities of nerve transfer in our series are 50.1% for intercostal and/or spinal accessory nerve transfer, 64.5% for plexo-plexal nerve transfer, 81.7% for regional nerve transfer, and 87.1% for combine nerve transfer.

Rasuli? L; Samardzi? M; Grujici? D; Bascarevi? V

2003-01-01

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Brachial Neuritis Presenting with Isolated Long Thoracic Nerve Involvement  

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Full Text Available Brachial neuritis is a sudden onset disorder characterized by severe pain and weakness of the shoulder and upper extremities. Pain is followed by motor weakness, sensory and reflex impairments. Electroneuromyography is the most valuable method for the diagnosis of brachial neuritis. Early and definite diagnosis is important to prevent unnecessary procedures including surgical interventions. Here we report a patient admitted to our outpatient clinics with a 3-4 day history of sudden onset of severe pain and motor weakness of shoulder muscles. Due to his scapular winging and specific ENMG findings, he was diagnosed as brachial neuritis presenting with isolated nervus thoracicus longus neuropathy. Turk J Phys Med Rehab 2009;55:83-6.

Bar?? Nac?r; Hakan Genç; Burcu Duyur Çak?t; Aynur Karagöz; Hatice Rana Erdem

2009-01-01

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Lateral Antebrachial Cutaneous Nerve injury induced by phlebotomy  

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Full Text Available Abstract Background Phlebotomy is one of the routine procedures done in medical labs daily. Case presentation A 52 yr woman noted shooting pain and dysesthesia over her right side anterolateral aspect of forearm, clinical examination and electrodiagnostic studies showed severe involvement of right side lateral antebrachial cutaneous nerve. Conclusion Phlebotomy around lateral aspect of antecubital fossa may cause lateral antebrachial cutaneous nerve injury, electrodiagnostic studies are needed for definite diagnosis.

Rayegani S Mansoor; Azadi Arezoo

2007-01-01

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

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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 diagnosed as postganglionic lesion (Zone 2) intraoperatively. In the latter all roots except two roots were diagnosed as preganglionic lesion intraoperatively. ESCPs of low amplitude were recorded in the two roots. The sensitivity and the specificity of MR myelography were 100% and 97.1% respectively. MR myelography has several advantages compared with conventional myelography. It is non-invasive and quick. It provides imaging of full column in multiple projections. It delineates the deformity of a nerve sleeve and/or the defect of nerve rootlets. Therefore, MR myelography is now superior to conventional myelography for evaluation of nerve root avulsion in brachial plexus injury. (author)

2002-01-01

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

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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 diagnosed as postganglionic lesion (Zone 2) intraoperatively. In the latter all roots except two roots were diagnosed as preganglionic lesion intraoperatively. ESCPs of low amplitude were recorded in the two roots. The sensitivity and the specificity of MR myelography were 100% and 97.1% respectively. MR myelography has several advantages compared with conventional myelography. It is non-invasive and quick. It provides imaging of full column in multiple projections. It delineates the deformity of a nerve sleeve and/or the defect of nerve rootlets. Therefore, MR myelography is now superior to conventional myelography for evaluation of nerve root avulsion in brachial plexus injury. (author)

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

2002-10-01

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Supraclavicular brachial plexus block with the aid of a nerve stimulator.  

UK PubMed Central (United Kingdom)

Hundred supraclavicular brachial plexus blocks according to the subclavian perivascular technique were performed with the aid of a nerve stimulator Neutracer in order to verify the value of the technique and the acceptance by the patients. The technique is extensively described and the results and complications are presented. The rationale for the use of the supraclavicular approach and the advantages of the use of a nerve stimulator in regional anesthesia are discussed.

Eeckelaert JP; Filliers E; Alleman JJ; Hanegreefs G

1984-03-01

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Brachial plexus entrapment of interscalene nerve catheter after uncomplicated ultrasound-guided placement.  

UK PubMed Central (United Kingdom)

We report on the case of an entrapped interscalene nerve catheter in a 46-year-old male undergoing left shoulder arthroscopic lysis of adhesions for a frozen shoulder. The catheter was placed under ultrasound guidance without any apparent complications. The continuous interscalene nerve block was successfully used as the primary anesthetic and for postoperative pain management. Upon attempted catheter removal, the patient experienced severe pain and paresthesias. Fluoroscopy revealed possible brachial plexus involvement, and surgery was performed to extract the catheter, which had become hooked and entrapped around the C5 nerve root and sheath.

Bowens C Jr; Briggs ER; Malchow RJ

2011-07-01

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Brachial plexus entrapment of interscalene nerve catheter after uncomplicated ultrasound-guided placement.  

Science.gov (United States)

We report on the case of an entrapped interscalene nerve catheter in a 46-year-old male undergoing left shoulder arthroscopic lysis of adhesions for a frozen shoulder. The catheter was placed under ultrasound guidance without any apparent complications. The continuous interscalene nerve block was successfully used as the primary anesthetic and for postoperative pain management. Upon attempted catheter removal, the patient experienced severe pain and paresthesias. Fluoroscopy revealed possible brachial plexus involvement, and surgery was performed to extract the catheter, which had become hooked and entrapped around the C5 nerve root and sheath. PMID:21699651

Bowens, Clifford; Briggs, Eric R; Malchow, Randall J

2011-06-23

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

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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.

Bhagat Hemant; Agarwal Anil; Sharma Manish S

2008-01-01

 
 
 
 
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Comparison of Nerve Stimulator and Ultrasonography Application for Brachial Plexus Anesthesia  

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Full Text Available Objective: Axillary brachial plexus block can be achieved through various techniques in upper extremity operations. The purpose of our study was to compare the efficacy of axillary brachial plexus block using an ultrasound technique with peripheral nerve stimulation technique. Material and Methods: Sixty patients for whom elective forearm and hand surgery was planned were included in the study. Group 1 (n=30) was given an axillary block by using ultrasonography, Group 2 (n=30) was given axillary block by using a peripheral nerve stimulator. The quality and time of onset of the sensorial and motor blockade were assessed. Results: The average time needed to perform the axillary brachial plexus block was similar in both groups. Although not significant statistically, it was observed that the sensory block was achieved earlier in Group 1. However, the degree of motor blockade was more intense in Group 1 than in Group 2.Conclusion: The ultrasound-guided axillary brachial plexus block is a preferable method with faster onset time and better quality of motor blockade compared to the PNS technique.

Beyaz?t Zencirci; Hafize Öksüz

2012-01-01

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ANÁLISE DA ORIGEM E DISTRIBUIÇÃO DOS NERVOS PERIFÉRICOS DO PLEXO BRAQUIAL DA PACA (Agouti paca, LINNAEUS, 1766) ORIGIN AND DITRIBUTION ANALYSIS OF THE BRACHIAL PLEXUS PERIPHERAL NERVES OF PACA (Agouti paca, LINNAEUS, 1766)  

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Full Text Available O plexo braquial é um conjunto de nervos que surge na região medular cervicotorácica e que se distribui pelos membros torácicos e porção interna do tórax. O plexo braquial de oito pacas foi dissecado para evidenciação da origem e distribuição de seus nervos. O nervo supraescapular distribuía-se para os músculos supra e infra-espinhal, e o subescapular para o músculo subescapular. O nervo axilar ramificava-se para os músculos redondo maior, subescapular, redondo menor e deltóide. Os nervos ulnar e mediano ramificavam-se para a musculatura do antebraço, e o musculocutâneo para os músculos coracobraquial, bíceps braquial e braquial. O nervo radial abrangia o músculo tríceps braquial, tensor da fáscia do antebraço e ancôneo. O nervo torácico longo e o toracodorsal emitiam ramos para o músculo grande dorsal, e o torácico lateral para o músculo cutâneo do tronco. Os nervos peitorais craniais ramificavam-se no músculo peitoral profundo, e os nervos peitorais caudais distribuíam-se para o músculo peitoral superficial. O plexo braquial da paca é formado por doze pares de nervos com origens distintas, os quais surgem do quinto par de nervos cervicais até o segundo par de nervos torácicos, não havendo troncos ou cordões na formação destes.PALAVRAS-CHAVES: Agouti paca, distribuição, plexo braquial, sistema nervoso. The brachial plexus is a set of nerves originated in the cervicothoracic medular region and distributed in the thoracic limbs and inner thorax. The brachial plexus of eight pacas was dissected for study on the nerves origin and distribution. The suprascapular nerve went through the supra and infraspinal muscles and the subscapular gave off on the subscapular muscle. The axilar nerve was distributed on the teres major, subscapular, teres minor and deltoid muscles. The ulnar and the median nerves branched off on the forearm musculature, and the musculocutaneous branched on the coracobrachial, biceps brachial and brachial muscles. The radial nerve went through the triceps brachial, tensor fasciae latae and anconeus muscles. The long thoracic and the thoracodorsal nerves branched on the latissimus dorsi muscle, and the lateral thoracic gave off on the trunk cutaneous muscle. The cranial pectoral nerves branched on the deep pectoral muscle and the caudal pectoral nerves gave off on the superficial pectoral muscle. The brachial plexus of pacas is formed by 12 pairs of nerves presenting different origins, which arose from ventral roots from the fifth pair of cervical to the second pair of thoracic nerves, not occurring trunks or cords in those formation.KEY  WORDS: Agouti paca, brachial plexus, distribution, nervous system.

Alessandra Regina Freixo Scavone; Márcia Rita Fernandes Machado; Gregório Corrêa Guimarães; Fabrício Singaretti Oliveira; Sílvia Helena Brendolan Gerbasi

2008-01-01

43

[Transcutaneous electrical nerve stimulation (TENS) in the treatment of a peripheral lesion of the brachial plexus  

UK PubMed Central (United Kingdom)

This case report describes the clinical history of a patient on dialysis, who suffered from a lesion of the brachial plexus, secondary to a mechanical damage after attempted suicide. Therapy with transcutaneous electrical nerve stimulation (TENS) revealed both sufficient analgesia and a striking improvement of the functional situation. Possible causes of the therapeutic success are discussed. The analgesia of TENS therapy, which has almost no side-effects, with the secondarily improved psychic situation, is regarded as the major responsible factor. This method appears to be a rewarding alternative in the treatment of pain syndromes secondary to peripheral nerve lesions.

Pohl S; Masyk-Iversen T; Lips U; Pichlmayr I

1983-06-01

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[Transcutaneous electrical nerve stimulation (TENS) in the treatment of a peripheral lesion of the brachial plexus].  

Science.gov (United States)

This case report describes the clinical history of a patient on dialysis, who suffered from a lesion of the brachial plexus, secondary to a mechanical damage after attempted suicide. Therapy with transcutaneous electrical nerve stimulation (TENS) revealed both sufficient analgesia and a striking improvement of the functional situation. Possible causes of the therapeutic success are discussed. The analgesia of TENS therapy, which has almost no side-effects, with the secondarily improved psychic situation, is regarded as the major responsible factor. This method appears to be a rewarding alternative in the treatment of pain syndromes secondary to peripheral nerve lesions. PMID:6604466

Pohl, S; Masyk-Iversen, T; Lips, U; Pichlmayr, I

1983-06-01

45

PHRENIC NERVE PALSY AFTER SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK  

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Full Text Available A 67 year old male patient was scheduled for implant removal from right upper limb under supraclavicular block. During procedure patient develops right phrenic nerve palsy & complains of dyspnea which was managed conservatively and no intervention done except chest x-ray for confirming the diagnosis. Surgeons completed the implant removal without any invasive intervention or interruption.

Gupta A K; Divekar D S; Dhulkhed V K; Madhur; Shrivastav V

2009-01-01

46

Clinical and neuropathological study about the neurotization of the suprascapular nerve in obstetric brachial plexus lesions  

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Full Text Available Abstract Background The lack of recovery of active external rotation of the shoulder is an important problem in children suffering from brachial plexus lesions involving the suprascapular nerve. The accessory nerve neurotization to the suprascapular nerve is a standard procedure, performed to improve shoulder motion in patients with brachial plexus palsy. Methods We operated on 65 patients with obstetric brachial plexus palsy (OBPP), aged 5-35 months (average: 19 months). We assessed the recovery of passive and active external rotation with the arm in abduction and in adduction. We also looked at the influence of the restoration of the muscular balance between the internal and the external rotators on the development of a gleno-humeral joint dysplasia. Intraoperatively, suprascapular nerve samples were taken from 13 patients and were analyzed histologically. Results Most patients (71.5%) showed good recovery of the active external rotation in abduction (60°-90°). Better results were obtained for the external rotation with the arm in abduction compared to adduction, and for patients having only undergone the neurotization procedure compared to patients having had complete plexus reconstruction. The neurotization operation has a positive influence on the glenohumeral joint: 7 patients with clinical signs of dysplasia before the reconstructive operation did not show any sign of dysplasia in the postoperative follow-up. Conclusion The neurotization procedure helps to recover the active external rotation in the shoulder joint and has a good prevention influence on the dysplasia in our sample. The nerve quality measured using histopathology also seems to have a positive impact on the clinical results.

Schaakxs Dominique; Bahm Jörg; Sellhaus Bernd; Weis Joachim

2009-01-01

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A Variation of the Cords of the Brachial Plexus on the Right and a Communication between the Musculocutaneous and Median Nerves on the Left Upper Limb: A Unique Case.  

Science.gov (United States)

During routine anatomical dissection of the upper extremity of a 64-year-old cadaver for educational purposes, we observed variations in the brachial plexus on each side. On the right an anomaly of cord formation was present and on the left there was a communication between the musculocutaneous nerve (MCN) and median nerve (MN). On the right side the brachial plexus showed two trunks, superior (C5 and C6) and inferior (C7, C8, and T1); the middle trunk was absent. The superior trunk bifurcated into anterior and posterior divisions, the anterior division continued as the lateral cord forming the MCN. The posterior division gave off the subscapular branch. The inferior trunk trifurcated into radial, median, and ulnar nerves. The radial nerve gave off the axillary and thoracodorsal nerves. The ulnar nerve gave off the median cutaneous nerves of the arm and forearm. The median nerve received a small ascending branch from the MCN. On the right side, there was a communicating branch from the MCN to the MN in the lower third of the arm region. This communicating branch also gave rise to a muscular branch to the brachialis muscle and the lateral cutaneous nerve of forearm. No additional heads of the biceps brachii muscle were observed in either upper limb. Knowledge of the variations of the brachial plexus in humans can be valuable for operations of the shoulder joint and its repair for providing an effective block or treatment for anesthetists and also for explaining otherwise incomprehensible clinical signs for neurologists. PMID:23444130

Kirazl?, Ozlem; Tatarl?, Necati; Ceylan, Davut; Hac?o?lu, Hüsniye; Uygun, Seda; Seker, A?k?n; Kele?, Evren; Cavdar, Safiye

2013-02-26

48

Posterior femoral cutaneous nerve mononeuropathy: a case report.  

Science.gov (United States)

Isolated posterior femoral cutaneous nerve (PFCN) lesions are rare, with only six cases reported in the modern literature and one case documented with a nerve conduction study. A 25-year-old woman had sensory loss in the posterolateral thigh after two right gluteal intramuscular injections. Nerve conduction studies using Dumitru's technique showed a 9microV response on the asymptomatic side, but no response on the symptomatic side, and no abnormalities on needle examination of the back and lower extremities. Although a single case does not prove the validity of a technique, this case provides the rare opportunity to demonstrate the utility of Dumitru's technique. PMID:10943764

Tong, H C; Haig, A

2000-08-01

49

Posterior femoral cutaneous nerve mononeuropathy: a case report.  

UK PubMed Central (United Kingdom)

Isolated posterior femoral cutaneous nerve (PFCN) lesions are rare, with only six cases reported in the modern literature and one case documented with a nerve conduction study. A 25-year-old woman had sensory loss in the posterolateral thigh after two right gluteal intramuscular injections. Nerve conduction studies using Dumitru's technique showed a 9microV response on the asymptomatic side, but no response on the symptomatic side, and no abnormalities on needle examination of the back and lower extremities. Although a single case does not prove the validity of a technique, this case provides the rare opportunity to demonstrate the utility of Dumitru's technique.

Tong HC; Haig A

2000-08-01

50

Median nerve and brachial artery entrapment in the abnormal brachialis muscle – a case report  

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Full Text Available Knowledge of variation in the pattern of muscle insertion and possible neurovascular entrapment is importantfor orthopedic surgeons, plastic surgeons and physiotherapists. We found a variation in the insertion pattern of brachialis and entrapped median nerve and brachial artery dueto the superficial position of the muscle, in relation to the neurovascular bundle. The brachialis was found tohave an additional thick slip from the distal third of the muscle. The accessory slip partly merged with the originof superficial flexors of the forearm and partly inserted to the medial aspect of olecranon process. The mediannerve and brachial artery passed under this additional slip of brachialis. The abnormality reported here might result in neurovascular compression symptoms in upper limb and somemechanical advantages or disadvantage in the flexion of elbow joint.

George BM; Nayak SB

2008-01-01

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Brief reports: nerve stimulator evoked motor response predicting a successful supraclavicular brachial plexus block.  

UK PubMed Central (United Kingdom)

BACKGROUND: We examined the success rate of supraclavicular brachial plexus block after the different evoked motor responses to nerve stimulation. METHODS: This multicenter observational study included 377 patients. For each block, the evoked motor response elicited at 0.25 mA for 2 milliseconds was recorded, 30 mL bupivacaine 0.25% was injected, and the block was observed for success or failure. RESULTS: Complete anesthesia occurred in 317 cases (84.1%). The success rate was 100% when the evoked motor response was simultaneous flexion of the third and fourth digits or flexion of all 4 digits (digits 2-5) with or without thumb opposition. CONCLUSION: Simultaneous flexion of the third and fourth digits with or without other digits is associated with the highest success rate of supraclavicular brachial plexus block.

Haleem S; Siddiqui AK; Mowafi HA; Ismail SA; Ali QA

2010-06-01

52

[Adequate treatment of supracondylar fracture of the humerus with associated brachial artery and nerve injury in childhood (author's transl)  

UK PubMed Central (United Kingdom)

Injury to the brachial artery and the nerve trunks, accompanying supra- and peri-condylar humerus fractures, occurs in children particularly in seriously dislocated fractures of Baumann Type II and III. Prompt treatment aims at avoiding late sequelae, especially ischaemic muscle contracture. Based on 6 of our own cases, the significance of brachial artery angiogram when the pulse does not become palpable, and of operative investigation, is expounded.

Jaschke W; Stojanovic R

1981-04-01

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Isolated ulnar dorsal cutaneous nerve herpes zoster reactivation.  

UK PubMed Central (United Kingdom)

Herpes zoster is a viral disease presenting with vesicular eruptions that are usually preceded by pain and erythema. Herpes zoster can be seen in any dermatome of the body but most commonly appears in the thoracic region. Herpes zoster virus is typically transmitted from person to person through direct contact. The virus remains dormant in the dorsal ganglion of the affected individual throughout his or her lifetime. Herpes zoster reactivation commonly occurs in elderly people due to normal age-related decline in cell-mediated immunity. Postherpetic neuralgia is the most common complication and is defined as persistent pain or dysesthesia 1 month after resolution of the herpetic rash. This article describes a healthy 51-year-old woman who experienced a burning sensation and shooting pain along the ulnar dorsal cutaneous nerve. Ten days after the onset of pain, she developed cutaneous vesicular eruption and decreased light-touch sensation. Wrist and fourth and fifth finger range of motion were painful and slightly limited. Muscle strength was normal. Nerve conduction studies indicated an ulnar dorsal cutaneous nerve lesion. She was treated with anti-inflammatory and antibiotic drugs and the use of a short-arm resting splint. At 5-month follow-up, she reported no residual pain, numbness, or weakness. Herpes zoster in the upper extremity may be mistaken for entrapment neuropathies and diseases characterized by skin eruptions; ulnar nerve zoster reactivation is rarely seen. The authors report an uncommon ulnar dorsal cutaneous nerve herpes zoster reactivation. Clinicians should be aware of this virus during patients' initial evaluation.

Kayipmaz M; Basaran SH; Ercin E; Kural C

2013-09-01

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[Anatomical study on contralateral C7 nerve transfer via posterior spinal route for treatment of brachial plexus root avulsion injury].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To investigate the feasibility of contralateral C7 nerve transfer via posterior spinal route for treatment of brachial plexus root avulsion injury by anatomical study. METHODS: Ten cadaveric specimens of 7 men and 3 women were selected, who had no obvious deformity and no tissue defect in neck neutral position. By simulating surgical exploration of brachial plexus injury, the length of contralateral C7 nerve root was elongated by dissecting its anterior and posterior divisions to the distal end, while the length of C7 nerve from the intervertebral foramen to the branching point and the length of the anterior and posterior divisions were measured. By simulating cervical posterior approach, the C7 vertebral plate and T1 spinous process were fully exposed; the hole was made near vertebral body; and the C7 nerve root lengths by posterior vertebra path to the contralateral upper trunk and lower trunk were measured. RESULTS: C7 nerve root length was (58.62 +/- 8.70) mm; the length of C7 nerve root plus posterior or anterior division was (65.15 +/- 9.11) mm and (70.03 +/- 10.79) mm, respectively. By posterior spinal route, the distance was (72.12 +/- 10.22) mm from the end of C7 nerve to the contralateral upper trunk of brachial plexus, and was (95.21 +/- 12.50) mm to the contralateral lower trunk of brachial plexus. CONCLUSION: Contralateral C7 nerve can be transferred to the contralateral side through posterior spinal route and it only needs short bridge nerve or no. The posterior spinal route can effectively prevent from neurovascular injury, so it might be the best surgery approach for the treatment of brachial plexus root avulsion injury.

Xiang Q; Yang J; Liu G; Tan W; Li H; Zhang S

2012-02-01

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[Operative management in axillary brachial plexus blocks: comparison of ultrasound and nerve stimulation  

UK PubMed Central (United Kingdom)

Given a case-by-case accounting system, the analysis of medical performance becomes increasingly important. Quality of treatment and the time effort attached play an important role. Anaesthesia procedures require a high level of quality and safety. Moreover, they are personnel intensive. In the area of regional anaesthesia, new procedures such as the use of high definition ultrasonography for nerve blocks, allow a possible time gain as well as improved quality. The aim of this investigation was to analyze the impact on time and results when using ultrasonography or nerve stimulation for axillary brachial plexus blocks. Therefore, over a time period of 9 months, the ultrasound-guided plexus anaesthesia (Sono) and the neurostimulation methods (NStim) were investigated based upon the anaesthesia documentation of patients undergoing hand surgery. Only those cases were included where an axillary brachial plexus block had been performed, incomplete protocols were excluded and 1.5% mepivacaine was used as medication. Overall, a total of 130 cases fulfilled these criteria. The success rates, time consumption and timelines were evaluated. All data was stored on an Excel-sheet and statistically evaluated. The results revealed a significant increase in the success rate for the patient group where ultrasound was used (98.2% Sono vs 83.1% NStim) and the operation could begin 15 min earlier in the Sono group (5 min vs. 20 min, p<0.001). Furthermore, the duration of anaesthesia was significantly shorter (85 min vs. 120 min, p<0.001) and the necessity for post-operative observation was less (5.4% vs. 32.4%, p<0.001). The data provided in the study indicate that the use of ultrasound for the identification of the nerves can clearly improve quality and time-scales of axillary brachial plexus blocks.

Schwemmer U; Schleppers A; Markus C; Kredel M; Kirschner S; Roewer N

2006-04-01

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Supraclavicular brachial plexus block using a nerve stimulator and an insulated needle.  

UK PubMed Central (United Kingdom)

A technique employing a nerve stimulator and an insulated needle was used for supraclavicular brachial plexus block in 71 patients using 0.5% plain bupivacaine 15-20 ml. The mean minimal stimulating current to produce paraesthesia was 0.09 mA. The plexus was identified at a mean depth of 27 mm below the skin. The block was successful in 98% of patients when the stimulation was felt in the index, middle or ring finger, but was often incomplete when felt in the thumb or little finger.

Yasuda I; Hirano T; Ojima T; Ohira N; Kaneko T; Yamamuro M

1980-04-01

57

The use of a catheter to provide brachial plexus block in dogs.  

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The objective of the study was to devise a method to facilitate catheter placement to perform brachial plexus block in the dog. Lidocaine plus epinephrine was injected through a 3.5 French feeding tube secured in proximity of the brachial plexus. Cutaneous areas for the nerves of the distal forelimb...

Moens, N M; Caulkett, N A

58

Entrapment of the lateral cutaneous nerve of the calf.  

UK PubMed Central (United Kingdom)

Isolated lesion of lateral cutaneous nerve of the calf (LCNC), particularly due to entrapment, is rarely reported in the literature. Patients usually present with sensory symptoms in the lateral aspect of the calf. Treatment is usually by local applications or local steroid/anaesthetic injection. We report the first case of LCNC entrapment in a 35-year-old man which is documented by nerve conduction studies. The patient had a temporary improvement following a local anaesthetic/steroid injection. Owing to the recurrence of symptoms, the patient opted for surgery. About 1 year after surgery, the symptoms disappeared completely.

Khalil NM; Nicotra A; Kaplan C; O'Neill KS

2013-01-01

59

Entrapment of the lateral cutaneous nerve of the calf.  

Science.gov (United States)

Isolated lesion of lateral cutaneous nerve of the calf (LCNC), particularly due to entrapment, is rarely reported in the literature. Patients usually present with sensory symptoms in the lateral aspect of the calf. Treatment is usually by local applications or local steroid/anaesthetic injection. We report the first case of LCNC entrapment in a 35-year-old man which is documented by nerve conduction studies. The patient had a temporary improvement following a local anaesthetic/steroid injection. Owing to the recurrence of symptoms, the patient opted for surgery. About 1 year after surgery, the symptoms disappeared completely. PMID:23821626

Khalil, Nofal M; Nicotra, Alessia; Kaplan, Charles; O'Neill, Kevin S

2013-07-02

60

Posterior femoral cutaneous nerve neuropathy and somatosensory evoked potentials.  

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Isolated posterior femoral cutaneous nerve (PFCN) entrapment has only rarely been described in the literature and never documented electrophysiologically. We report an unusual occurrence of such an injury and use somatosensory evoked potentials (SSEP) to explore the extent of the lesion. A 40-year-old woman had localized numbness of the right posterior thigh after a left putamenal hemorrhage four years before this study. She made a complete recovery from her stroke within four months; however, she continued to experience decreased sensation in the right posterior thigh. Normal sural and peroneal nerve latencies, velocities, and amplitudes were obtained in the right leg. Electromyographic examination of right leg and related para spinal musculature was unremarkable. SSEP were then performed with CZ'-FZ (10-20 system) electrode placement. Normal sural, lateral femoral cutaneous, and posterior tibial responses were obtained bilaterally. Response differences consistent with an isolated right PFCN neuropathy were observed. The perfectly symmetric SSEP responses for the sural, lateral femoral cutaneous, and posterior tibial nerves obviate a central, and substantiate a peripheral, cause for the altered right PFCN evoked response. PMID:2827603

Dumitru, D; Marquis, S

1988-01-01

 
 
 
 
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Posterior femoral cutaneous nerve neuropathy and somatosensory evoked potentials.  

UK PubMed Central (United Kingdom)

Isolated posterior femoral cutaneous nerve (PFCN) entrapment has only rarely been described in the literature and never documented electrophysiologically. We report an unusual occurrence of such an injury and use somatosensory evoked potentials (SSEP) to explore the extent of the lesion. A 40-year-old woman had localized numbness of the right posterior thigh after a left putamenal hemorrhage four years before this study. She made a complete recovery from her stroke within four months; however, she continued to experience decreased sensation in the right posterior thigh. Normal sural and peroneal nerve latencies, velocities, and amplitudes were obtained in the right leg. Electromyographic examination of right leg and related para spinal musculature was unremarkable. SSEP were then performed with CZ'-FZ (10-20 system) electrode placement. Normal sural, lateral femoral cutaneous, and posterior tibial responses were obtained bilaterally. Response differences consistent with an isolated right PFCN neuropathy were observed. The perfectly symmetric SSEP responses for the sural, lateral femoral cutaneous, and posterior tibial nerves obviate a central, and substantiate a peripheral, cause for the altered right PFCN evoked response.

Dumitru D; Marquis S

1988-01-01

62

[Contribution of ultrasound guidance to the performance of the axillary brachial plexus block with multiple nerve stimulation  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate whether ultrasound imaging of vascular nerve structures improves anesthetic block quality and decreases the incidence of vascular puncture in the performance of an axillary brachial plexus block with multiple nerve stimulation. PATIENTS AND METHODS: Randomized trial enrolling 129 patients assigned to 2 groups. In group 1, axillary brachial plexus nerves were located by nerve stimulation with ultrasound guidance. In group 2, only conventional multiple nerve stimulation was used. We analyzed the number of nerves located, time required to perform the block, anesthetic quality, and the number of accidental vascular punctures. RESULTS: Four nerves were located in 43% of the patients in group 1 and 38% of those in group 2. More time was taken in performing the block in group 1 than in group 2 (mean [SD] of 350 [40] seconds vs. 291 [58] seconds, respectively; P < .05). The incidence of vascular puncture was significantly lower in group 1 (8%) than in group 2 (28%) (odds ratio, 4 [95% confidence interval, 2-13]; P < .01). Ten and 20 minutes after puncture, the quality of sensory and motor blockade was significantly better in group 1. Block success was similar in the 2 groups (98.5% and 94% respectively). CONCLUSIONS: Combining ultrasound guidance with nerve stimulation improves the anesthetic quality of an axillary brachial plexus block, decreases the likelihood of vascular puncture, and slightly increases the amount of time required to perform the procedure.

Morros C; Pérez-Cuenca MD; Sala-Blanch X; Cedó F

2009-02-01

63

Ultrasound-guided supraclavicular brachial plexus nerve block vs procedural sedation for the treatment of upper extremity emergencies.  

UK PubMed Central (United Kingdom)

BACKGROUND: Emergency physicians often treat patients who require procedural sedation for the management of upper extremity fractures, dislocations, and abscesses (upper extremity emergencies). Unfortunately, procedural sedation is associated with several rare but potentially serious adverse effects and requires continuous hemodynamic monitoring and several dedicated staff members. The purpose of this study was to determine the role of ultrasound-guided supraclavicular brachial plexus nerve blocks in the emergency department (ED) as an alternative to procedural sedation for the management of upper extremity emergencies. METHODS: In a prospective trial, a convenience sample of ED patients with upper extremity emergencies that would normally require procedural sedation were assigned to receive either procedural sedation or an ultrasound-guided supraclavicular brachial plexus nerve block. Emergency department length of stay (ED LOS) was the primary outcome measure and was analyzed using a paired 2-tailed Student t test. RESULTS: A total of 12 subjects were enrolled. Average ED LOS for subjects receiving the brachial plexus nerve block was 106 minutes (95% confidence interval, 57-155 minutes). Average ED LOS for subjects receiving procedural sedation was 285 minutes (95% confidence interval, 228-343 minutes). The ED LOS was significantly shorter in the nerve block group (P < .0005). Patient satisfaction was high in both groups, and no significant complications occurred in either group. CONCLUSIONS: In our population, ultrasound-guided brachial plexus nerve blocks resulted in shorter ED LOS compared to procedural sedation for patients with upper extremity fractures, dislocations, or abscesses.

Stone MB; Wang R; Price DD

2008-07-01

64

Dorsomedial cutaneous nerve syndrome: treatment with nerve transection and burial into bone.  

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Damage to the dorsomedial cutaneous nerve of the foot, which innervates the medial hallux, may occur with crush injury or iatrogenically with bunion surgery. Severe neuritic pain after bunion surgery may alert the surgeon that this small nerve has been damaged. The term "dorsomedial cutaneous nerve syndrome" is suggested for this condition, and nine patients with such forefoot presentations, all of which were unresponsive to nonoperative interventions, are described. The nerve had been either transected or bound in scar tissue; in these nine cases, the nerve was then resected and buried in the proximal aspect of the first metatarsal or the medial cuneiform. Most patients underwent an additional procedure (other than the nerve procedure), such as revision bunionectomy or arthrodesis, but all felt they could clearly delineate nerve pain from bone or joint pain. All patients experienced marked relief of their symptoms, usually within days after the surgery, and were satisfied with the results. The verbal analog pain score, on a scale of 0 (no pain) to 10 (pain requiring amputation), improved from a preoperative level of 8.6 to a postoperative level of 2.0. Resection and burial of this nerve appears to be a useful treatment for neuritis unresponsive to nonoperative measures. PMID:11310860

Miller, S D

2001-03-01

65

Nerve growth factor, neuropeptides and cutaneous nerves in atopic dermatitis  

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Full Text Available Introduction: Neurogenic components, as neurotrophic factors and neuropeptides, are probably involved in the pathogenesis of atopic dermatitis (AD) with the neuroimmunocutaneous system as they modify the functions of immunoactive cells in the skin. Nerve growth factor (NGF) is the best-characterized member of the neurotrophin family. Both NGF and neuropeptides (NPs) may be associated with the disease pathogenesis. Aim: This study aims to evaluate the plasma level of NGF and NPs in AD patients and correlate them with the disease activity and nerve changes in the skin by electron microscopy. Materials and Methods: Plasma levels of NGF and vasoactive intestinal peptide (+VIP) were measured by an immunoenzymatic assay while plasma levels of calcitonine gene related peptide (CGRP) and neuropeptide Y (NPY) were measured by radioimmunoassay in 30 AD patients in comparison to 10 normal non-atopic controls. Electron microscopic study was done in 10 AD patients. Results: It has been found that there is significant increase of plasma levels of NGF and NPs in AD patients compared with controls. There is a positive correlation between the plasma levels of NGF and disease activity (correlation coefficient = 0.750, P< 0.005). There is a significant correlation between the number of Schwann axon complex, evidenced by electron microscopic examination and plasma level of NGF in AD patients. Conclusion: It has been concluded that these neurogenic factors; NGF and NPs modulate the allergic response in AD, probably through interactions with cells of the immune-inflammatory component. NGF might be considered as a marker of the disease activity.

Hodeib Abeer; El-Samad Zeinab; Hanafy Hesham; El-Latief Amani; El-bendary Amal; Abu-Raya Azza

2010-01-01

66

Effect of ipsilateral C7 nerve root transfer on restoration of rat upper trunk muscle and nerve function after brachial plexus root avulsion.  

UK PubMed Central (United Kingdom)

The effects of ipsilateral cervical nerve root transfer on the restoration of the rat upper trunk muscle and nerve brachial plexus root avulsion were studied. After simulated root avulsion of the upper trunk brachial plexus, 120 rats were randomly divided into 4 groups: (A) ipsilateral C7 root transfer group; (B) Oberlin group; (C) phrenic nerve group; and (D) no axillary nerve restoration group. At 3, 6, and 12 weeks postoperatively, Ochiai score, Barth feet overreaching test, Terzis grooming test, and indices of neurotization were determined in 10 rats from each group. Twelve weeks postoperatively, nearly all the behavioral, neuroelectrophysiological, and histological outcomes of the axillary nerve and deltoid muscle and some of the indices of musculocutaneous nerve and biceps brachii function in the ipsilateral C7 group were superior to those in the other 3 groups. No significant difference was found between the ipsilateral C7 group and the other 3 groups in recovery rate of wet biceps muscle weight. No significant difference was found between the ipsilateral C7 group and the Oberlin group in the recovery of the axillary nerve compound muscle action potential and biceps brachii cell size. No significant difference was found between the ipsilateral C7 group and the phrenic nerve and no axillary nerve restoration groups in amplitude recovery rate of musculocutaneous nerve compound muscle action potential. No significant difference was found between the ipsilateral C7 and the Oberlin groups in the early recovery of musculocutaneous nerve compound muscle action potential, but recovery was significantly better in the ipsilateral C7 group at 12 weeks. Ipsilateral C7 root transfer can improve the quality of restoration of muscle and nerve function in the rat upper trunk after brachial plexus root avulsion.

Song J; Chen L; Gu Y

2010-12-01

67

The medial plantar and medial peroneal cutaneous nerve conduction studies for diabetic polyneuropathy.  

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Objective of this study was to determine which nerve conduction is more sensitive electrophysiologically in the diagnosis of polyneuropathy in diabetics by evaluating the sensory conduction in medial plantar nerve and medial peroneal (dorsal) cutaneous nerves. Additionally to investigate the relation between Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS) values used in the diagnosis of these conduction studies. Forty patients with diagnosis diabetic neuropathy were included into this study. In diabetic polyneuropathic patient group, both medial plantar and medial dorsal cutaneous nerve sensory action potential were not bilaterally obtained in 19 patients (47.5%). Sensitivity and specificity of medial dorsal cutaneous nerve and medial plantar nerve sensory conduction abnormalities in diagnosis of diabetic polyneuropathy were higher compared to sural nerve conduction abnormalities. This study showed that both medial plantar and medial dorsal cutaneous nerve conduction study performed bilaterally was a highly sensitive and specific method in diagnosis of diabetic neuropathy. PMID:21720897

Altun, Yasar; Demirkol, Ahmet; Tumay, Yener; Ekmekci, Kaz?m; Unsal, Ibrahim; Koyluoglu, Ahmet Candan; Ozkul, Yasar

2011-07-01

68

The medial plantar and medial peroneal cutaneous nerve conduction studies for diabetic polyneuropathy.  

UK PubMed Central (United Kingdom)

Objective of this study was to determine which nerve conduction is more sensitive electrophysiologically in the diagnosis of polyneuropathy in diabetics by evaluating the sensory conduction in medial plantar nerve and medial peroneal (dorsal) cutaneous nerves. Additionally to investigate the relation between Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS) values used in the diagnosis of these conduction studies. Forty patients with diagnosis diabetic neuropathy were included into this study. In diabetic polyneuropathic patient group, both medial plantar and medial dorsal cutaneous nerve sensory action potential were not bilaterally obtained in 19 patients (47.5%). Sensitivity and specificity of medial dorsal cutaneous nerve and medial plantar nerve sensory conduction abnormalities in diagnosis of diabetic polyneuropathy were higher compared to sural nerve conduction abnormalities. This study showed that both medial plantar and medial dorsal cutaneous nerve conduction study performed bilaterally was a highly sensitive and specific method in diagnosis of diabetic neuropathy.

Altun Y; Demirkol A; Tumay Y; Ekmekci K; Unsal I; Koyluoglu AC; Ozkul Y

2011-10-01

69

A novel strategy for repairing preganglionic cervical root avulsion in brachial plexus injury by sural nerve grafting.  

UK PubMed Central (United Kingdom)

OBJECT: In this study, the authors evaluated the efficacy of a new surgical strategy for reconnecting the injured brachial plexus with the spinal cord using fibrin glue containing acidic fibroblast growth factor as an adhesive and neurotrophic agent. METHODS: Eighteen patients with preganglionic brachial plexus injuries, each with varying degrees of upper limb dysfunction, underwent cervical laminectomy with or without sural nerve grafting. The treatment of each avulsed root varied according to the severity of the injury. Some patients also underwent a second-stage operation involving supraclavicular brachial plexus exploration for reconnection with the corresponding segment of cervical spinal cord at the trunk level. Muscle strength was graded both pre- and postoperatively with the British Medical Research Council scale, and the results were analyzed with the Friedman and Wilcoxon signed-rank tests. RESULTS: Muscle strength improvements were observed in 16 of the 18 patients after 24 months of follow-up. Significant improvements in mean muscle strength were observed in patients from all repair method groups at 12 and 24 months postoperatively (p < 0.05). Statistical significance was not reached in the groups with insufficient numbers of cases. CONCLUSIONS: The authors' new surgical strategy yielded clinical improvement in muscle strength after preganglionic brachial plexus injury, such that nerve regeneration may have taken place. Reconnection of the brachial plexus to the cervical spinal cord is possible. Functional motor recovery, observed through increases in Medical Research Council-rated muscle strength in the affected arm, is likewise possible.

Wu JC; Huang WC; Huang MC; Tsai YA; Chen YC; Shih YH; Cheng H

2009-04-01

70

Cross sectional area reference values for sonography of peripheral nerves and brachial plexus.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Ultrasound measurements of the cross sectional area (CSA) variability have been recently introduced to quantify pathological changes in peripheral nerves (PN). METHODS: Reference values from 75 healthy subjects and their correlation to age, height, weight and sex are reported. RESULTS: The mean values in PN were: (1) intranerve CSA-variability: median 1.05 (SD±0.13), ulnar 1.53 (SD±0.51), fibular 1.33 (SD±0.37), tibial 1.39 (SD±0.39), (2) internerve CSA-variability 1.76 (SD±0.37), (3) intraplexus CSA-variability 1.52 (SD±0.37), (4) side-to-side difference ratio of the CSA-variability: median 1.21 (SD±0.04), ulnar 1.2 (SD±0.25), fibular 1.19 (SD±0.23), tibial 1.28 (SD±0.24) and brachial plexus 1.19 (SD±0.23). CSA did not correlate with height in PN, but correlated with weight in the ulnar nerve [Guyon's canal, r=0.411, p=0.0237, elbow r=0.409, p=0.0248]. Significant changes between sex were found only in the ulnar (Guyon's canal, p=0.0265), fibular (popliteal fossa, p=0.0336) and sural nerve (p=0.048). CSA decreased with age in the median (axilla, p=0.0236), and radial nerve (spiral groove, p=0.0037) and increased in the tibial nerve (ankle, p<0.0001). CONCLUSIONS: The CSA reference values reported seem to correlate at certain sites with age, weight and sex but not with height. SIGNIFICANCE: The new CSA variability measures may be helpful in investigating pathologies of the PN.

Kerasnoudis A; Pitarokoili K; Behrendt V; Gold R; Yoon MS

2013-09-01

71

Unilateral variant origin of musculocutaneous nerve  

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Full Text Available Musculocutaneous nerve branch out from lateral cord of brachial plexus. It innervates coracobrachialis, biceps brachii and brachialis muscles and continues as the lateral cutaneous nerve of forearm without exhibiting any communication with median nerve or any other nerve. Here, unilateral variant origin of musculocutaneous nerve is reported. In an adult male cadaver, a branch of median nerve represents musculocutaneous nerve which supplies coracobrachialis, biceps brachii and brachialis muscles and continues as lateral cutaneous nerve of forearm. This branch does not pass through coracobrachialis muscle. Such several variations surgeons should keep in mind while performing surgeries of axilla and upper arm.

Sontakke YA; Fulzele RR; Tamgire DW; Joshi M; Gajbe UL; Marathe RR

2010-01-01

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Supraclavicular approach to brachial plexus block using fluoroscopic anatomic landmarks and nerve stimulation.  

Science.gov (United States)

Irritation of neural structures, specifically the brachial plexus outside of the cervical spine is capable of producing pain in the upper extremity. These pain patterns may be similar to pain originating from the cervical spine, presenting a diagnostic challenge. Brachial plexus block is performed at multiple levels, including interscalene, supraclavicular, infraclavicular, and axillary. Interscalene block is frequently utilized by interventional pain management physicians for diagnostic and therapeutic purposes to isolate and manage the brachial plexus as a pain generator. The traditional methods employed in performing interscalene or supraclavicular brachial plexus blocks are associated with multiple disadvantages. A new technique is described to meet five essential requirements encompassing safety, specificity, consistency, reproducibility and a high success rate. Relevant anatomy and proposed technique of brachial plexus block is described. The procedure is performed under fluoroscopy with contrast injection. It is concluded that the proposed technique of brachial plexus block is useful for brachial plexus blockade providing precision and specificity with minimal complications. PMID:16883379

Vilims, Bradley D; Wright, Robert E

2003-04-01

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Variations in brachial plexus and the relationship of median nerve with the axillary artery: a case report  

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Full Text Available Abstract Background Brachial Plexus innervates the upper limb. As it is the point of formation of many nerves, variations are common. Knowledge of these is important to anatomists, radiologists, anesthesiologists and surgeons. The presence of anatomical variations of the peripheral nervous system is often used to explain unexpected clinical signs and symptoms. Case Presentation On routine dissection of an embalmed 57 year old male cadaver, variations were found in the formation of divisions and cords of the Brachial Plexus of the right side. Some previously unreported findings observed were; direct branches to the muscles Pectoralis Minor and Latissimus dorsi from C6, innervation of deltoid by C6 and C7 roots and the origin of lateral pectoral nerve from the posterior division of upper trunk. The median nerve was present lateral to axillary artery. The left side brachial plexus was also inspected and found to have normal anatomy. Conclusion The probable cause for such variations and their embryological basis is discussed in the paper. It is also concluded that although these variations may not have affected the functioning of upper limb in this individual, knowledge of such variations is essential in evaluation of unexplained sensory and motor loss after trauma and surgical interventions to the upper limb.

Singhal Suruchi; Rao Vani; Ravindranath Roopa

2007-01-01

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Efficacy of Ultrasound-Guided Axillary Brachial Plexus Block: A Comparative Study with Nerve Stimulator-Guided Method  

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Full Text Available Background: The aim of this study was to compare the efficacy of axillary brachial plexusblock using an ultrasound-guided method with the nerve stimulator-guidedmethod. We also compared the efficacy of ultrasound-guided single-injectionwith those of double-injection for the quality of the block.Methods: Ninety patients scheduled for surgery of the forearm or hand were randomlyallocated into three groups (n = 30 per group), i.e., nerve stimulator-guidedand double-injection (ND) group, ultrasound-guided and double-injection(UD) group, and ultrasound-guided and single-injection (US) group. Eachpatient received 0.5 ml kg-1 of 1.5% lidocaine with 5 ?g kg-1 epinephrine.Patients in the ND group received half the volume of lidocaine injected nearthe median and radial nerves after identification using a nerve stimulator.Patients in the UD group received half the volume of lidocaine injectedaround the lateral and medial aspects of the axillary artery, while those in theUS group were given the entire volume near the lateral aspect of the axillaryartery. The extent of the sensory blockade of the seven nerves and motorblockades of the four nerves were assessed 40 min after the performance ofaxillary brachial plexus block.Results: Seventy percent of the patients in the ND and US groups as well as 73% ofthe patients in the UD group obtained satisfactory sensory and motor blockades.The success rate of performing the block was 90% in patients in theND and UD groups and 70% in the US group. The incidence of adverseevents was significantly higher in the ND group (20%) compared with that inthe US group and the UD group (0%; p = 0.03).Conclusions: Ultrasound-guided axillary brachial plexus block, using either single- or double-injection technique, provided excellent sensory and motor blockadeswith fewer adverse events.

Fu-Chao Liu; Jiin-Tarng Liou; Yung-Fong Tsai; Allen H. Li; Yuan-Yi Day; Yu-Ling Hui; Ping-Wing Lui

2005-01-01

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Posttraumatic pseudoaneurysm of the brachial artery and postsurgical retraction of median nerve: description of a case and ultrasonography findings.  

UK PubMed Central (United Kingdom)

We present the case of a 25-year-old man who developed a brachial artery pseudoaneurysm and a subsequent haematoma after a penetrating injury with a window glass. A surgical excision of the pseudoaneurysm (anterior access) and a drainage of the haematoma were performed. After surgery, the patient developed a median nerve paresis, secondary to the postsurgical scar located in the elbow flexure. The diagnosis of these two entities was performed with ultrasound. Ultrasonography is an excellent imaging tool to make the diagnosis of pseudoaneurysms and nerve pathology, determining the presence, localization and extent of neural damage.

Pelaz Esteban M; Beltrán de Otálora S; Landeras RM; Gallardo E; Fernández Echevarría MA; Pérez Aguilar D

2007-02-01

76

Nerve fibre composition of the palmar cutaneous branch of the median nerve and clinical implications.  

Science.gov (United States)

Fifteen fresh human cadaver hands were dissected, using x2.8 loupe magnification, to study the subcutaneous innervation at the site of the incision (in the line with the radial border of the ring finger) for standard open carpal tunnel decompression. Subcutaneous nerve branches were detected and traced proximally to determine their origin. Morphometric analysis of nerve cross sections from the site of the incision and from the main nerve trunk proximal to cutaneous arborisation was performed using light and transmission electron microscopy and a computer-based image analysis system. At the site of the incision, the ulnar sub-branch (US) of the palmar cutaneous branch of the median nerve (PCBMN), which innervates the skin over the hypothenar eminence, was found in 10 of 15 cases. Branches from the ulnar side were not detected. The main trunk of PCBMN consisted on average of 1000 (SD 229) myelinated axons arranged in 1-4 fascicles. In the US of the PCBMN there were on average 620 (SD 220) myelinated axons, 80% of them smaller than 40 microm(2) i.e. thin myelinated axons, and on average 2037 (SD 1106) unmyelinated axons, arranged in 1-3 fascicles. The ratio of the number of myelinated axons in the US and the main trunk of the PCBMN was on average 63% (SD 19%). Frequency distribution of cross-sectional areas of myelinated axons shows no significant difference between the US and the main nerve trunk of the PCBMN. The importance of incision trauma to subcutaneous innervation of palmar triangle is emphasised and possible mechanisms of scar discomfort are discussed. PMID:14615254

Ahcan, U; Arnez, Z M; Bajrovi?, F F; Hvala, A; Zorman, P

2003-12-01

77

Nerve fibre composition of the palmar cutaneous branch of the median nerve and clinical implications.  

UK PubMed Central (United Kingdom)

Fifteen fresh human cadaver hands were dissected, using x2.8 loupe magnification, to study the subcutaneous innervation at the site of the incision (in the line with the radial border of the ring finger) for standard open carpal tunnel decompression. Subcutaneous nerve branches were detected and traced proximally to determine their origin. Morphometric analysis of nerve cross sections from the site of the incision and from the main nerve trunk proximal to cutaneous arborisation was performed using light and transmission electron microscopy and a computer-based image analysis system. At the site of the incision, the ulnar sub-branch (US) of the palmar cutaneous branch of the median nerve (PCBMN), which innervates the skin over the hypothenar eminence, was found in 10 of 15 cases. Branches from the ulnar side were not detected. The main trunk of PCBMN consisted on average of 1000 (SD 229) myelinated axons arranged in 1-4 fascicles. In the US of the PCBMN there were on average 620 (SD 220) myelinated axons, 80% of them smaller than 40 microm(2) i.e. thin myelinated axons, and on average 2037 (SD 1106) unmyelinated axons, arranged in 1-3 fascicles. The ratio of the number of myelinated axons in the US and the main trunk of the PCBMN was on average 63% (SD 19%). Frequency distribution of cross-sectional areas of myelinated axons shows no significant difference between the US and the main nerve trunk of the PCBMN. The importance of incision trauma to subcutaneous innervation of palmar triangle is emphasised and possible mechanisms of scar discomfort are discussed.

Ahcan U; Arnez ZM; Bajrovi? FF; Hvala A; Zorman P

2003-12-01

78

[Paralysis of the brachial plexus caused by supraclavicular injuries in the adult. Long-term comparative results of nerve grafts and transfers  

UK PubMed Central (United Kingdom)

PURPOSE OF THE STUDY: Recovery of active elbow flexion constitutes the first priority in microsurgical repair after closed injuries of the supraclavicular brachial plexus in adults. However, there are many controversial issues between the proponents of nerve grafting from available roots, and the proponents of nerve transfer. MATERIAL AND METHODS: The results concerning elbow flexor muscle recovery following microsurgical nerve repair of supraclavicular brachial plexus lesions were analysed in 62 patients. The average age at operation was 23 years old and the average delay between trauma and nerve repair was 7 months. Nerve grafting from C5 or C6 was performed in 43 patients. Nerve transfer using 3 intercostal nerves was done in 10 patients and using the spinal accessory nerve in 7 patients. A combination of both techniques was performed in 2 patients. Conventional sural nerve grafts were used every time. Functional evaluation was based on the assessment of active range of motion including flexion and supination, and on the assessment of maximum isotonic strength of the elbow flexors. RESULTS: With an average follow up of 8.5 years (range from 3 to 16 years) the average functional score of the elbow flexors was 4.4 out of a possible 11. Sixty six percent of patients had a strength recovery of M3 or more. Nerve repair using nerve graft from a non avulsed root seems to give better functional scores than nerve transfer from intercostal nerves or spinal accessory nerve using interpositional nerve graft, even if the differences were not statistically significant. DISCUSSION: In order to restore elbow flexion in case of supraclavicular brachial plexus lesion, nerve graft from an available root should be preferred to nerve transfer with interpositional nerve graft, when no avulsion exists among C5 and C6. Nerve transfer with interpositional nerve graft to the musculocutaneous nerve is indicated in case of avulsion of one or more roots among C5 and C6.

Allieu Y; Chammas M; Picot MC

1997-01-01

79

Magnetic stimulation of the radial nerve in dogs and cats with brachial plexus trauma: a report of 53 cases.  

Science.gov (United States)

Brachial plexus trauma is a common clinical entity in small animal practice and prognostic indicators are essential early in the course of the disease. Magnetic stimulation of the radial nerve and consequent recording of the magnetic motor evoked potential (MMEP) was examined in 36 dogs and 17 cats with unilateral brachial plexus trauma. Absence of deep pain perception (DPP), ipsilateral loss of panniculus reflex, partial Horner's syndrome and a poor response to MMEP were related to the clinical outcome in 29 of the dogs and 13 of the cats. For all animals, a significant difference was found in MMEP between the normal and the affected limb. Absence of DPP and unilateral loss of the panniculus reflex were indicative of an unsuccessful outcome in dogs. Additionally, the inability to evoke a MMEP was associated with an unsuccessful outcome in all animals. It was concluded that magnetic stimulation of the radial nerve in dogs and cats with brachial plexus trauma may provide an additional diagnostic and prognostic tool. PMID:18602850

Van Soens, Iris; Struys, Michel M; Polis, Ingeborgh E; Bhatti, Sofie F; Van Meervenne, Sofie A; Martlé, Valentine A; Nollet, Heidi; Tshamala, Mulenda; Vanhaesebrouck, An E; Van Ham, Luc M

2008-07-07

80

Magnetic stimulation of the radial nerve in dogs and cats with brachial plexus trauma: a report of 53 cases.  

UK PubMed Central (United Kingdom)

Brachial plexus trauma is a common clinical entity in small animal practice and prognostic indicators are essential early in the course of the disease. Magnetic stimulation of the radial nerve and consequent recording of the magnetic motor evoked potential (MMEP) was examined in 36 dogs and 17 cats with unilateral brachial plexus trauma. Absence of deep pain perception (DPP), ipsilateral loss of panniculus reflex, partial Horner's syndrome and a poor response to MMEP were related to the clinical outcome in 29 of the dogs and 13 of the cats. For all animals, a significant difference was found in MMEP between the normal and the affected limb. Absence of DPP and unilateral loss of the panniculus reflex were indicative of an unsuccessful outcome in dogs. Additionally, the inability to evoke a MMEP was associated with an unsuccessful outcome in all animals. It was concluded that magnetic stimulation of the radial nerve in dogs and cats with brachial plexus trauma may provide an additional diagnostic and prognostic tool.

Van Soens I; Struys MM; Polis IE; Bhatti SF; Van Meervenne SA; Martlé VA; Nollet H; Tshamala M; Vanhaesebrouck AE; Van Ham LM

2009-10-01

 
 
 
 
81

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  

Directory of Open Access Journals (Sweden)

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.

Mônica Vicky Bahr Arias; Ana Paula Frederico Loureiro Bracarense; Ângelo João Stopiglia

1997-01-01

82

Chronic sciatic nerve injury impairs the local cutaneous neurovascular interaction in rats.  

UK PubMed Central (United Kingdom)

Most studies of chronic nerve compression focus on large nerve function in painful conditions, and only few studies have assessed potential changes in the function of small nerve fibers during chronic nerve compression and recovery from compression. Cutaneous pressure-induced vasodilation is a neurovascular phenomenon that relies on small neuropeptidergic fibers controlling the cutaneous microvasculature. We aimed to characterize potential changes in function of these small fibers and/or in cutaneous microvascular function following short-term (1-month) and long-term (6-month) nerve compression and after release of compression (ie, potential recovery of function). A compressive tube was left on one sciatic nerve for 1 or 6 months and then removed for 1-month recovery in Wistar rats. Cutaneous vasodilator responses were measured by laser Doppler flowmetry in hind limb skin innervated by the injured nerve to assess neurovascular function. Nociceptive thermal and low mechanical thresholds were evaluated to assess small and large nerve fiber functions, respectively. Pressure-induced vasodilation was impaired following nerve compression and restored following nerve release; both impairment and restoration were strongly related to duration of compression. Small and large nerve fiber functions were less closely related to duration of compression. Our data therefore suggest that cutaneous pressure-induced vasodilation provides a non-invasive and mechanistic test of neurovascular function that gives direct information regarding extent and severity of damage during chronic nerve compression and recovery, and may ultimately provide a clinically useful tool in the evaluation of nerve injury such as carpal tunnel syndrome.

Pelletier J; Fromy B; Morel G; Roquelaure Y; Saumet JL; Sigaudo-Roussel D

2012-01-01

83

Computerized tomography myelography with coronal and oblique coronal view for diagnosis of nerve root avulsion in brachial plexus injury  

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Full Text Available Abstract Background The authors describe a new computerized tomography (CT) myelography technique with coronal and oblique coronal view to demonstrate the status of the cervical nerve rootlets involved in brachial plexus injury. They discuss the value of this technique for diagnosis of nerve root avulsion compared with CT myelography with axial view. Methods CT myelography was performed with penetration of the cervical subarachnoid space by the contrast medium. Then the coronal and oblique coronal reconstructions were created. The results of CT myelography were evaluated and classified with presence of pseudomeningocele, intradural ventral nerve rootlets, and intradural dorsal nerve rootlets. The diagnosis was by extraspinal surgical exploration with or without spinal evoked potential measurements and choline acetyl transferase activity measurement in 25 patients and recovery by a natural course in 3 patients. Its diagnostic accuracy was compared with that of CT myelography with axial view, correlated with surgical findings or a natural course in 57 cervical roots in 28 patients. Results Coronal and oblique coronal views were superior to axial views in visualization of the rootlets and orientation of the exact level of the root. Sensitivity and specificity for coronal and oblique coronal views of unrecognition of intradural ventral and dorsal nerve root shadow without pseudomeningocele in determining pre-ganglionic injury were 100% and 96%, respectively. There was no statistically significant difference between coronal and oblique coronal views and axial views. Conclusion The information by the coronal and oblique coronal slice CT myelography enabled the authors to assess the rootlets of the brachial plexus and provided valuable data for helping to decide whether to proceed with exploration, nerve repair, primary reconstruction.

Yamazaki Hiroshi; Doi Kazuteru; Hattori Yasunori; Sakamoto Sotetsu

2007-01-01

84

Feline cutaneous nerve sheath tumours: Histological features and immunohistochemical evaluations.  

UK PubMed Central (United Kingdom)

Feline cutaneous nerve sheath tumours (CNSTs) are uncommonly reported in the skin, since they are underestimated relative to the more common spindle cell tumours of soft tissue. In this study, 26 nerve sheath tumours selected from 337 skin neoplasms of cats were examined. Histologically, they were classified into malignant (MPNSTs) and benign tumours (BPNSTs) based on degree of cellular atypia and polymorphism as well as mitotic rate and diffuse necrosis. CPNSTs were tipically characterised by Antoni A pattern, in some cases associated with Antoni B pattern. In the malignant peripheral nerve sheath tumours (MPNSTs) the polymorphism was marked, while it was mild to moderate in the benign forms (BPNSTs). In the MPNSTs the mitotic activity was generally higher than in the BPNSTs. In five cases, including three MPNSTs and two BPNSTs, there were multinucleated giant cells. Necrotic foci occurred in a BPNST and in two MPNSTs, while osseous/chondroid metaplasia was found in two cases. Immunohistochemically, all the tumours showed a marked diffuse vimentin expression. S-100 protein was expressed in 17 cases, including 81.8% of BPNSTs and 57.14% of MPNSTs. Twenty-five tumours expressed NSE and twenty-four cases showed immunoreaction for laminin. Thirteen tumours were positive for GFAP, while five tumours were positive for SMA. PGP 9.5 expression was detected in all cases, except for two MPNSTs. NGFR was expressed in eleven cases, including four MPNSTs and seven BPNSTs. Ki67 was expressed in twenty tumours without any relationship with morphologic malignancy of the neoplasm. In this case series we confirmed neoplastic spindloid cells with wavy cytoplasm arranged in compact areas, with occasional nuclear palisading or whirls, and interchanged with loosely arranged areas, as the morphological features supporting a diagnosis of CPNST. A constant concurrent expression of vimentin, NSE, and laminin might confirm the diagnosis of PNST in the absence of clear S-100 protein positivity, especially in the malignant forms. In this study, conclusive data were not obtained on the diagnostic relevance of NGFR- and PGP 9.5-expression in feline CPNSTs.

Mandara MT; Fabriani E; Pavone S; Pumarola M

2013-10-01

85

Feline cutaneous nerve sheath tumours: Histological features and immunohistochemical evaluations.  

Science.gov (United States)

Feline cutaneous nerve sheath tumours (CNSTs) are uncommonly reported in the skin, since they are underestimated relative to the more common spindle cell tumours of soft tissue. In this study, 26 nerve sheath tumours selected from 337 skin neoplasms of cats were examined. Histologically, they were classified into malignant (MPNSTs) and benign tumours (BPNSTs) based on degree of cellular atypia and polymorphism as well as mitotic rate and diffuse necrosis. CPNSTs were tipically characterised by Antoni A pattern, in some cases associated with Antoni B pattern. In the malignant peripheral nerve sheath tumours (MPNSTs) the polymorphism was marked, while it was mild to moderate in the benign forms (BPNSTs). In the MPNSTs the mitotic activity was generally higher than in the BPNSTs. In five cases, including three MPNSTs and two BPNSTs, there were multinucleated giant cells. Necrotic foci occurred in a BPNST and in two MPNSTs, while osseous/chondroid metaplasia was found in two cases. Immunohistochemically, all the tumours showed a marked diffuse vimentin expression. S-100 protein was expressed in 17 cases, including 81.8% of BPNSTs and 57.14% of MPNSTs. Twenty-five tumours expressed NSE and twenty-four cases showed immunoreaction for laminin. Thirteen tumours were positive for GFAP, while five tumours were positive for SMA. PGP 9.5 expression was detected in all cases, except for two MPNSTs. NGFR was expressed in eleven cases, including four MPNSTs and seven BPNSTs. Ki67 was expressed in twenty tumours without any relationship with morphologic malignancy of the neoplasm. In this case series we confirmed neoplastic spindloid cells with wavy cytoplasm arranged in compact areas, with occasional nuclear palisading or whirls, and interchanged with loosely arranged areas, as the morphological features supporting a diagnosis of CPNST. A constant concurrent expression of vimentin, NSE, and laminin might confirm the diagnosis of PNST in the absence of clear S-100 protein positivity, especially in the malignant forms. In this study, conclusive data were not obtained on the diagnostic relevance of NGFR- and PGP 9.5-expression in feline CPNSTs. PMID:23659741

Mandara, M T; Fabriani, E; Pavone, S; Pumarola, M

2013-05-06

86

The extent of blockade following axillary and infraclavicular approaches of brachial plexus block in uremic patients.  

UK PubMed Central (United Kingdom)

INTRODUCTION: This study was aimed to compare the axillary approach performed through multiple injection method and vertical infraclavicular approach performed through single injection method in terms of the sensory and motor block onset, quality, and extent of blocks of brachial plexus in uremic patients who underwent arteriovenous fistula surgery. METHODS: Forty patients scheduled for creation of arteriovenous fistula with axillary brachial plexus block (group AX, n = 20) or infraclavicular brachial plexus block (IC group, n = 20) were examined. The median, radial, ulnar, and musculocutaneous nerves were selectively localized by nerve stimulation. The volume of the local anesthetics was calculated based on the height of each patient, and the volume determined was prepared by mixing 2% lidocaine and 0.5% bupivacaine in equal proportions. Sensory and motor block were assessed at 3, 6, 9, 12, 15, 18, and 30th min and their durations were measured. RESULTS: While the adequate sensory and motor block rate with axillary approach was 100% in musculocutaneous, median, radial, ulnar and medial antebrachial cutaneous nerves, it was 65% in axillary nerve, 80% in intercostobrachial nerve and 95% in medial brachial cutaneous nerve. This rate was found to be 100% for all the nerves with infraclavicular approach. CONCLUSION: For arteriovenous fistula surgeries in uremic patients, both axillary approach performed through multiple injection method and vertical infraclavicular approach performed through single injection method can be used successfully; however, for the short performance of the procedure, infraclavicular block may be preferred. KEYWORDS: Brachial plexus block; Axillary; Infraclavicular; Uremic patients.

Sariguney D; Mahli A; Coskun D

2012-02-01

87

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.  

UK PubMed Central (United Kingdom)

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 Review Manager 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.

Yuan JM; Yang XH; Fu SK; Yuan CQ; Chen K; Li JY; Li Q

2012-05-01

88

Técnicas de reconstrucción nerviosa en cirugía del plexo braquial traumatizado (Parte 1): Transferencias nerviosas extraplexuales Nerve reconstruction techniques in traumatic brachial plexus surgery (Part 1): Extraplexal nerve transfers  

Directory of Open Access Journals (Sweden)

Full Text Available Tras el gran entusiasmo generado en las décadas de los años '70 y '80 del siglo pasado, como consecuencia entre otras de la incorporación de las técnicas de microcirugía, la cirugía del plexo braquial se ha visto sacudida en las últimas dos décadas por la aparición de las técnicas de transferencia nerviosa o neurotizaciones. Se denomina así a la sección de un nervio que llamaremos dador, sacrificando su función original, para unirlo con el cabo distal de un nervio receptor, cuya función se ha perdido durante el trauma y se busca restablecer. Las neurotizaciones se indican cuando un nervio lesionado no posee un cabo proximal que pueda ser unido, mediante injerto o sin él, con el extremo distal. La ausencia de cabo proximal se produce en el plexo braquial cuando una raíz cervical se avulsiona de su origen a nivel de la médula espinal. Sin embargo, en los últimos años, y dados los resultados francamente positivos de algunas de ellas, las técnicas de transferencia nerviosa se han estado empleando inclusive en algunos casos en los que las raíces del plexo estaban preservadas. En las lesiones completas del plexo braquial, se recurre al diagnóstico inicial de la existencia o no de raíces disponibles (C5 a D1) para utilizarlas como dadores de axones. De acuerdo a la cantidad viable de las mismas, se recurre a las transferencias de nervios que no forman parte del plexo (extraplexuales) como pueden ser el espinal accesorio, el frénico, los intercostales, etc, para incrementar la cantidad de axones transferidos al plexo lesionado. En los casos de avulsiones de todas las raíces, las neurotizaciones extraplexuales son el único método de reinervación disponible para limitar los efectos a largo plazo de una lesión tan devastadora. Dada la avalancha de trabajos que se han publicado en los últimos años sobre las lesiones traumáticas del plexo braquial, se ha escrito el presente trabajo de revisión con el objetivo de clarificar al interesado las indicaciones, resultados y técnicas quirúrgicas disponibles en el arsenal terapéutico quirúrgico de esta patología. Dado que la elección de una u otra se toma generalmente durante el transcurso del mismo procedimiento, todos estos conocimientos deben ser perfectamente incorporados por el equipo quirúrgico antes de realizar el procedimiento. En esta primera parte se analizan las transferencias nerviosas extraplexuales, para luego hacer lo propio con las intraplexuales, en una segunda entrega.After the great enthusiasm generated in the '70s and '80s in brachial plexus surgery as a result of the incorporation of microsurgical techniques and other advances, brachial plexus surgery has been shaken in the last two decades by the emergence of nerve transfer techniques or neurotizations. This technique consists in sectioning a donor nerve, sacrificing its original function, to connect it with the distal stump of a receptor nerve, whose function was lost during the trauma. Neurotizations are indicated when direct repair is not possible, i.e. when a cervical root is avulsed at its origin in the spinal cord. In recent years, due to the positive results of some of these nerve transfer techniques, they have been widely used even in some cases where the roots of the plexus were preserved. In complete brachial plexus injuries, it is mandatory to determine the exact numer of roots available (not avulsed) to perform a direct reconstruction. In case of absence of available roots, extraplexual nerve transfers are employed, such as the spinal accessory nerve, the phrenic nerve, the intercostal nerves, etc., to increase the amount of axons transferred to the injured plexus. In cases of avulsion of all the roots, extraplexal neurotizations are the only reinnervation option available to limit the long-term devastating effects of this injury. Given the large amount of reports that has been published in recent years regarding brachial plexus traumatic injuries, the present article has been written in order to clarify the concerned readers the indications, results

J. Robla-Costales; M. Socolovsky; G. Di Masi; L. Domitrovic; A. Campero; J. Fernández-Fernández; J. Ibáñez-Plágaro; J. García-Cosamalón

2011-01-01

89

Técnicas de reconstrucción nerviosa en cirugía del plexo braquial traumatizado (Parte 2): Transferencias nerviosas intraplexuales Nerve Reconstruction Techniques in Traumatic Brachial Plexus Surgery (Part 2): Intraplexal nerve transfers  

Directory of Open Access Journals (Sweden)

Full Text Available Tras el gran entusiasmo generado en las décadas de los '70 y '80 del siglo pasado, como consecuencia entre otras de la incorporación de las técnicas de microcirugía, la cirugía del plexo braquial se ha visto sacudida en las últimas dos décadas por la aparición de las técnicas de transferencia nerviosa o neurotizaciones. Se denomina así a la sección de un nervio que llamaremos dador, sacrificando su función original, para unirlo con el cabo distal de un nervio receptor, cuya función se ha perdido durante el trauma y se busca restablecer. Las neurotizaciones se indican cuando un nervio lesionado no posee un cabo proximal que pueda ser unido, mediante injerto o sin él, con el extremo distal. La ausencia de cabo proximal se produce en el plexo braquial cuando una raíz cervical se avulsiona de su origen a nivel de la médula espinal. Sin embargo, en los últimos años, y dados los resultados francamente positivos de algunas de ellas, las técnicas de transferencia nerviosa se han estado empleando inclusive en algunos casos en los que las raíces del plexo estaban preservadas. En las lesiones completas del plexo braquial, se recurre al diagnóstico inicial de la existencia o no de raíces disponibles (C5 a D1) para utilizarlas como dadores de axones. De acuerdo a la cantidad viable de las mismas, se recurre a las transferencias de nervios que no forman parte del plexo (extraplexuales) como pueden ser el espinal accesorio, el frénico, los intercostales, etc., para incrementar la cantidad de axones transferidos al plexo lesionado. En los casos de avulsiones de todas las raíces, las neurotizaciones extraplexuales son el único método de reinervación disponible para limitar los efectos a largo plazo de una lesión tan devastadora. Dada la avalancha de trabajos que se han publicado en los últimos años sobre las lesiones traumáticas del plexo braquial, se ha escrito el presente trabajo de revisión con el objetivo de clarificar al interesado las indicaciones, resultados y técnicas quirúrgicas disponibles en el arsenal terapéutico quirúrgico de esta patología. Dado que la elección de una u otra se toma generalmente durante el transcurso del mismo procedimiento, todos estos conocimientos deben ser perfectamente incorporados por el equipo quirúrgico antes de realizar el procedimiento. En una primera entrega se analizaron las transferencias nerviosas extraplexuales; este trabajo viene a complementar al anterior revisando las transferencias intraplexuales, y así completando el análisis de las transferencias nerviosas disponibles en la cirugía del plexo braquial.After the great enthusiasm generated in the '70s and '80s in brachial plexus surgery as a result of the incorporation of microsurgical techniques and other advances, brachial plexus surgery has been shaken in the last two decades by the emergence of nerve transfer techniques or neurotizations. This technique consists in sectioning a donor nerve, sacrificing its original function, to connect it with the distal stump of a receptor nerve, whose function was lost during the trauma. Neurotizations are indicated when direct repair is not possible, i.e. when a cervical root is avulsed at its origin in the spinal cord. In recent years, due to the positive results of some of these nerve transfer techniques, they have been widely used even in some cases where the roots of the plexus were preserved. In complete brachial plexus injuries, it is mandatory to determine the exact numer of roots available (not avulsed) to perform a direct reconstruction. In case of absence of available roots, extraplexual nerve transfers are employed, such as the spinal accessory nerve, the phrenic nerve, the intercostal nerves, etc., to increase the amount of axons transferred to the injured plexus. In cases of avulsion of all the roots, extraplexal neurotizations are the only reinnervation option available to limit the long-term devastating effects of this injury. Given the large amount of reports that has been published in recent years regarding brachial plexu

J. Robla-Costales; M. Socolovsky; G. Di Masi; D. Robla-Costales; L. Domitrovic; A. Campero; J. Fernández-Fernández; J. Ibáñez-Plágaro; J. García-Cosamalón

2011-01-01

90

Técnicas de reconstrucción nerviosa en cirugía del plexo braquial traumatizado (Parte 1): Transferencias nerviosas extraplexuales/ Nerve reconstruction techniques in traumatic brachial plexus surgery (Part 1): Extraplexal nerve transfers  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Tras el gran entusiasmo generado en las décadas de los años '70 y '80 del siglo pasado, como consecuencia entre otras de la incorporación de las técnicas de microcirugía, la cirugía del plexo braquial se ha visto sacudida en las últimas dos décadas por la aparición de las técnicas de transferencia nerviosa o neurotizaciones. Se denomina así a la sección de un nervio que llamaremos dador, sacrificando su función original, para unirlo con el cabo distal de un n (more) ervio receptor, cuya función se ha perdido durante el trauma y se busca restablecer. Las neurotizaciones se indican cuando un nervio lesionado no posee un cabo proximal que pueda ser unido, mediante injerto o sin él, con el extremo distal. La ausencia de cabo proximal se produce en el plexo braquial cuando una raíz cervical se avulsiona de su origen a nivel de la médula espinal. Sin embargo, en los últimos años, y dados los resultados francamente positivos de algunas de ellas, las técnicas de transferencia nerviosa se han estado empleando inclusive en algunos casos en los que las raíces del plexo estaban preservadas. En las lesiones completas del plexo braquial, se recurre al diagnóstico inicial de la existencia o no de raíces disponibles (C5 a D1) para utilizarlas como dadores de axones. De acuerdo a la cantidad viable de las mismas, se recurre a las transferencias de nervios que no forman parte del plexo (extraplexuales) como pueden ser el espinal accesorio, el frénico, los intercostales, etc, para incrementar la cantidad de axones transferidos al plexo lesionado. En los casos de avulsiones de todas las raíces, las neurotizaciones extraplexuales son el único método de reinervación disponible para limitar los efectos a largo plazo de una lesión tan devastadora. Dada la avalancha de trabajos que se han publicado en los últimos años sobre las lesiones traumáticas del plexo braquial, se ha escrito el presente trabajo de revisión con el objetivo de clarificar al interesado las indicaciones, resultados y técnicas quirúrgicas disponibles en el arsenal terapéutico quirúrgico de esta patología. Dado que la elección de una u otra se toma generalmente durante el transcurso del mismo procedimiento, todos estos conocimientos deben ser perfectamente incorporados por el equipo quirúrgico antes de realizar el procedimiento. En esta primera parte se analizan las transferencias nerviosas extraplexuales, para luego hacer lo propio con las intraplexuales, en una segunda entrega. Abstract in english After the great enthusiasm generated in the '70s and '80s in brachial plexus surgery as a result of the incorporation of microsurgical techniques and other advances, brachial plexus surgery has been shaken in the last two decades by the emergence of nerve transfer techniques or neurotizations. This technique consists in sectioning a donor nerve, sacrificing its original function, to connect it with the distal stump of a receptor nerve, whose function was lost during the t (more) rauma. Neurotizations are indicated when direct repair is not possible, i.e. when a cervical root is avulsed at its origin in the spinal cord. In recent years, due to the positive results of some of these nerve transfer techniques, they have been widely used even in some cases where the roots of the plexus were preserved. In complete brachial plexus injuries, it is mandatory to determine the exact numer of roots available (not avulsed) to perform a direct reconstruction. In case of absence of available roots, extraplexual nerve transfers are employed, such as the spinal accessory nerve, the phrenic nerve, the intercostal nerves, etc., to increase the amount of axons transferred to the injured plexus. In cases of avulsion of all the roots, extraplexal neurotizations are the only reinnervation option available to limit the long-term devastating effects of this injury. Given the large amount of reports that has been published in recent years regarding brachial plexus traumatic injuries, the present article has been written in order

Robla-Costales, J.; Socolovsky, M.; Di Masi, G.; Domitrovic, L.; Campero, A.; Fernández-Fernández, J.; Ibáñez-Plágaro, J.; García-Cosamalón, J.

2011-12-01

91

Comparison late cutaneous complications between exposure to sulfur mustard and nerve agents.  

UK PubMed Central (United Kingdom)

BACKGROUND: Iraq used chemical weapons against thousands of Iranian militaries and civilians. This study aimed to compare the chronic cutaneous side effects of exposure to sulfur mustard (SM) with nerve agents (NA). METHODS: The study enrolled 154 SM exposed cases and 175 (NA) exposed cases. Presence of any late cutaneous manifestations was evaluated by a dermatologist via prior history of acute cutaneous complications extracted from medical achieves. RESULTS: only 18.1% mustard exposed group was asymptomatic compared to 62.4% nerve agent exposures. Mustard and non-mustard scars, intertrigo, xerosis, cherry angioma, hyper pigmentation, pilar keratosis, poikiloderma, and malignant tumors were significantly more frequent in mustard exposed patients (p < 0.05). Nerve agent exposed patients experienced significantly more frequent occurrence of acne a seborrheic dermatitis and tinea versicolor. CONCLUSIONS: Mustard induced dermaltologic lesions were more common and specific than (NA) skin injuries. (NA) cause few psychocutaneous disorders like acne and seborrheic dermatitis in addition to psychological stress disorders.

Emadi SN; Aslani J; Poursaleh Z; Izadi M; Soroush M; Kafashi M; Alavinia SA; Bakhshi H; Karimi A; Momtaz-Manesh K; Babaei AA; Esmaili A; Raygan B; Emadi SE; Babamahmoodi F; Emadi SA

2012-09-01

92

A cobalt study of medullary sensory projections from lateral line nerves, associated cutaneous nerves, and the VIIIth nerve in adult Xenopus.  

UK PubMed Central (United Kingdom)

The medullary projections of the anterior lateral line nerve, dorsal branch (Alln.d), the posterior lateral line nerve, dorsal branch (PLLn.d), associated cutaneous nerves, and the VIIIth nerve in Xenopus laevis have been delineated by axonal infusion of cobalt chloride and silver intensification. The peripheral innervation of the posterior lateral line sense organs has also been traced. From wholemount and sectioned preparations, we describe three central projections, extending the length of the ipsilateral medulla but occupying distinct zones: lateral line afferents dorsomedially, stato-acoustic dorsolaterally, and cutaneous ventrolaterally. Arborizations of ALLn.d and PLLn.d afferents are morphologically similar, intermingling throughout the lateral line lobe. Each divides into ascending and descending limbs bearing collaterals, which terminate in the lateral line neuropile and nucleus. Evidence is presented for directional and positional mapping in the branching of individual PLLn.d afferents and for topography in the ALLn.d projection. Second-order neurones have been identified by transneuronal staining and their axons traced into the contralateral torus semicircularis. The morphology of efferent neurones is also described. Rostral branches of PLLn.d also contain cutaneous afferents which run through the medulla into the spinal cord, similar to the nerve V (cutaneous) projection. In nerve VIII preparations, the projection to the compact cochlear nucleus and the massive vestibular projection are identified. Cutaneous and vestibular but not lateral line afferents extend into the cerebellum. The separation of VIIIth nerve and lateral line afferents in Xenopus medulla is considered as evidence against the validity of the acousticolateralis concept. Information processing in the lateral line lobe is discussed in relation to connectivity patterns between first- and second-order neurones.

Altman JS; Dawes EA

1983-01-01

93

Cutaneous lesions sensory impairment recovery and nerve regeneration in leprosy patients  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english 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 (more) ) 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.

Illarramendi, Ximena; Rangel, Emanuel; Miranda, Alice Machado; Castro, Ana Claudia Ribeiro de; Magalhães, Giselle de Oliveira; Antunes, Sérgio Luiz Gomes

2012-12-01

94

A randomized comparative study of efficacy of axillary and infraclavicular approaches for brachial plexus block for upper limb surgery using peripheral nerve stimulator  

Directory of Open Access Journals (Sweden)

Full Text Available Brachial plexus block via the axillary approach is problematic in patients with limited arm mobility. In such cases, the infraclavicular approach may be a valuable alternative. The purpose of our study was to compare axillary and infraclavicular techniques for brachial plexus block in patients undergoing forearm and hand surgeries. After obtaining institutional approval and written informed consent, 60 patients of American Society of Anaesthesiologists grade I or II scheduled for forearm and hand surgeries were included in the study and were randomly allocated into two groups. Brachial plexus block was performed via the vertical infraclavicular approach (VIB) in patients of Group I and axillary approach in Group A using a peripheral nerve stimulator. Sensory block in the distribution of individual nerves supplying the arm, motor block, duration of sensory block, incidence of successful block and various complications were recorded. Successful block was achieved in 90% of the patients in group I and in 87% of patients in group A. Intercostobrachial nerve blockade was significantly higher in group I. No statistically significant difference was found in sensory and motor blockade of other nerves. Both the approaches are comparable, but the VIB scores ahead of axillary block in terms of its ability to block more nerves. The VIB because of its easily identifiable landmarks, a comfortable patient position during the block procedure and the ability to block a larger spectrum of nerves should thus be considered as an effective alternative to the axillary approach.

Lahori Vikram; Raina Anjana; Gulati Smriti; Kumar Dinesh; Gupta Satya

2011-01-01

95

Técnicas de reconstrucción nerviosa en cirugía del plexo braquial traumatizado (Parte 2): Transferencias nerviosas intraplexuales/ Nerve Reconstruction Techniques in Traumatic Brachial Plexus Surgery (Part 2): Intraplexal nerve transfers  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Tras el gran entusiasmo generado en las décadas de los '70 y '80 del siglo pasado, como consecuencia entre otras de la incorporación de las técnicas de microcirugía, la cirugía del plexo braquial se ha visto sacudida en las últimas dos décadas por la aparición de las técnicas de transferencia nerviosa o neurotizaciones. Se denomina así a la sección de un nervio que llamaremos dador, sacrificando su función original, para unirlo con el cabo distal de un nervio (more) receptor, cuya función se ha perdido durante el trauma y se busca restablecer. Las neurotizaciones se indican cuando un nervio lesionado no posee un cabo proximal que pueda ser unido, mediante injerto o sin él, con el extremo distal. La ausencia de cabo proximal se produce en el plexo braquial cuando una raíz cervical se avulsiona de su origen a nivel de la médula espinal. Sin embargo, en los últimos años, y dados los resultados francamente positivos de algunas de ellas, las técnicas de transferencia nerviosa se han estado empleando inclusive en algunos casos en los que las raíces del plexo estaban preservadas. En las lesiones completas del plexo braquial, se recurre al diagnóstico inicial de la existencia o no de raíces disponibles (C5 a D1) para utilizarlas como dadores de axones. De acuerdo a la cantidad viable de las mismas, se recurre a las transferencias de nervios que no forman parte del plexo (extraplexuales) como pueden ser el espinal accesorio, el frénico, los intercostales, etc., para incrementar la cantidad de axones transferidos al plexo lesionado. En los casos de avulsiones de todas las raíces, las neurotizaciones extraplexuales son el único método de reinervación disponible para limitar los efectos a largo plazo de una lesión tan devastadora. Dada la avalancha de trabajos que se han publicado en los últimos años sobre las lesiones traumáticas del plexo braquial, se ha escrito el presente trabajo de revisión con el objetivo de clarificar al interesado las indicaciones, resultados y técnicas quirúrgicas disponibles en el arsenal terapéutico quirúrgico de esta patología. Dado que la elección de una u otra se toma generalmente durante el transcurso del mismo procedimiento, todos estos conocimientos deben ser perfectamente incorporados por el equipo quirúrgico antes de realizar el procedimiento. En una primera entrega se analizaron las transferencias nerviosas extraplexuales; este trabajo viene a complementar al anterior revisando las transferencias intraplexuales, y así completando el análisis de las transferencias nerviosas disponibles en la cirugía del plexo braquial. Abstract in english After the great enthusiasm generated in the '70s and '80s in brachial plexus surgery as a result of the incorporation of microsurgical techniques and other advances, brachial plexus surgery has been shaken in the last two decades by the emergence of nerve transfer techniques or neurotizations. This technique consists in sectioning a donor nerve, sacrificing its original function, to connect it with the distal stump of a receptor nerve, whose function was lost during the t (more) rauma. Neurotizations are indicated when direct repair is not possible, i.e. when a cervical root is avulsed at its origin in the spinal cord. In recent years, due to the positive results of some of these nerve transfer techniques, they have been widely used even in some cases where the roots of the plexus were preserved. In complete brachial plexus injuries, it is mandatory to determine the exact numer of roots available (not avulsed) to perform a direct reconstruction. In case of absence of available roots, extraplexual nerve transfers are employed, such as the spinal accessory nerve, the phrenic nerve, the intercostal nerves, etc., to increase the amount of axons transferred to the injured plexus. In cases of avulsion of all the roots, extraplexal neurotizations are the only reinnervation option available to limit the long-term devastating effects of this injury. Given the large amount of reports that has

Robla-Costales, J.; Socolovsky, M.; Di Masi, G.; Robla-Costales, D.; Domitrovic, L.; Campero, A.; Fernández-Fernández, J.; Ibáñez-Plágaro, J.; García-Cosamalón, J.

2011-12-01

96

Recognition of local anesthetic maldistribution in axillary brachial plexus block guided by ultrasound and nerve stimulation.  

UK PubMed Central (United Kingdom)

Nerve stimulation may occur despite the presence of a fascial barrier between the needle tip and the nerve, which may prevent appropriate flow or distribution of local anesthetic solution. During an axillary nerve block, ultrasound (US) guidance was used to identify the median nerve. Insertion of a needle with US and nerve stimulator guidance resulted in the appearance of the needle tip in contact with the nerve. However, as local anesthetic injection was begun, it was clear that the injectate was accumulating superficial to the investing fascia of the neurovascular bundle. No injectate was seen below the fascia. With US guidance, the needle was repositioned at a greater depth. Repeat injection of local anesthetic clearly flowed around the nerve.

Veneziano GC; Rao VK; Orebaugh SL

2012-03-01

97

Recognition of local anesthetic maldistribution in axillary brachial plexus block guided by ultrasound and nerve stimulation.  

Science.gov (United States)

Nerve stimulation may occur despite the presence of a fascial barrier between the needle tip and the nerve, which may prevent appropriate flow or distribution of local anesthetic solution. During an axillary nerve block, ultrasound (US) guidance was used to identify the median nerve. Insertion of a needle with US and nerve stimulator guidance resulted in the appearance of the needle tip in contact with the nerve. However, as local anesthetic injection was begun, it was clear that the injectate was accumulating superficial to the investing fascia of the neurovascular bundle. No injectate was seen below the fascia. With US guidance, the needle was repositioned at a greater depth. Repeat injection of local anesthetic clearly flowed around the nerve. PMID:22414707

Veneziano, Giorgio C; Rao, Vidya K; Orebaugh, Steven L

2012-03-01

98

Ultrasound does not shorten the duration of procedure but provides a faster sensory and motor block onset in comparison to nerve stimulator in infraclavicular brachial plexus block.  

UK PubMed Central (United Kingdom)

BACKGROUND: Infraclaviculr Brachial plexus (ICBP) block is useful for upper extremity surgery. The aim of this study was to compare the ultrasound (US) technique with the nerve stimulation (NS) technique in their success rates and times to perform ICBP block. METHODS: 60 patients undergoing surgery of the upper limb were randomly allocated into two groups (n = 30 per group). Group 1; US, and Group 2; NS. Procedure time (including time for initial ultrasound examination), the success rate and the onset time of sensory and motor blockade were assessed. RESULTS: The time needed to perform the ICBP block is similar in both groups (220 seconds ± 130 in US group versus 281 ± 134 seconds in NS group; P = 0.74). The success rate of all the nerve blocks in the US group was 100%. The success rate in the NS group was 73.3%, 76.7%, 76.7% and 100% for radial, ulnar, medial, and musculocutaneous nerve, respectively. A significantly faster onset of sensory block for the radial, ulnar, median, musculocutaneous, and the four nerves considered together were observed. The onset of motor block for the radial, ulnar, and medial nerves was faster in the US group. However, the onset of motor block for the musculocutaneous nerve and the four nerves considered together was comparable between the two groups. CONCLUSIONS: The ultrasound-guided infraclavicular brachial plexus block is a significantly efficacious method with faster onset but similar procedure time compared to the nerve stimulation technique.

Trabelsi W; Amor MB; Lebbi MA; Romdhani C; Dhahri S; Ferjani M

2013-04-01

99

[Attenuation of phrenic nerve palsy associated with brachial plexus block by modified supra costal approach under fluoroscopic guidance].  

UK PubMed Central (United Kingdom)

BACKGROUND: Brachial plexus block (BPB) frequently accompanies phrenic nerve palsy (PNP). METHODS: Thirty six patients scheduled for upper-limb surgery were allocated to 2 groups; 14 patients undergoing BPB with the supra costal approach (i. e. placing the needle-tip at the middle of the 1st lib), and 22 patients undergoing BPB with the modified supra costal approach (i. e. placing the needle-tip in the visceral or dorsal area of the 1st lib). We evaluated analgesic effects of the block and changes in forced vital capacity (FVC). RESULTS: BPB with both approaches provided sufficient analgesia. After BPB with both approaches, a significant reductions in FVC was observed; however, the reduction after BPB with the modified supra costal approach was significantly lower than that with the supra costal approach. CONCLUSIONS: These results suggest that BPB with the modified supra costal approach provides sufficient analgesia with a significantly lower degree of PNP. We suppose that distribution of local anesthetics is altered by changing the location of the needle-tip on the 1st lib. Amounts of local anesthetics distributing around the phrenic nerve can be reduced by the modified supra costal approach, leading to the significantly less reduction in FVC after BPB.

Saito Y; Kitamura T; Otsuji M; Yamada Y

2010-06-01

100

The Correlation between Calcium Intensity and Histopathological Changes in Brachial Plexus Nerve Injuries.  

UK PubMed Central (United Kingdom)

Background After nerve injury, an influx of calcium exceeds the homeostatic capacity, which damages peripheral nerves. Previous studies identified that following nerve crush, function improves as calcium levels normalize.Methods Electrophysiological analysis was performed to measure the compound muscle action potential of 15 patients' damaged nerves. These samples were evaluated for calcium level and also stained with a Luxol fast blue and neurofilament antibodies to evaluate the myelin sheath and neurofilaments of the nerves. Based on the Sunderland scale, we identified three exclusive types of peripheral nerve injury groups.Results There was a correlation between histopathological damage and calcium levels of 0.81 (p < 0.005). The average relative fluorescence units (RFUs) was 235.28 ± 19, which corresponds to 5.3 × 10-7 M of calcium, five times the normal value.Conclusion Our study shows promising clinical implications via faster pathology results by the RFU technique. This approach of calcium staining, though still in clinical trials, offers significant clinical application, allowing physicians to get the clinically diagnostic nerve injury degree faster and will also facilitate better strategies for further treatment or future surgeries.

Davis J; O'Connor E; Zhang LL; Agresti M; Matloub HS; Sanger J; Jaradeh SS; Yan JG

2013-09-01

 
 
 
 
101

The Correlation between Calcium Intensity and Histopathological Changes in Brachial Plexus Nerve Injuries.  

Science.gov (United States)

Background After nerve injury, an influx of calcium exceeds the homeostatic capacity, which damages peripheral nerves. Previous studies identified that following nerve crush, function improves as calcium levels normalize.Methods Electrophysiological analysis was performed to measure the compound muscle action potential of 15 patients' damaged nerves. These samples were evaluated for calcium level and also stained with a Luxol fast blue and neurofilament antibodies to evaluate the myelin sheath and neurofilaments of the nerves. Based on the Sunderland scale, we identified three exclusive types of peripheral nerve injury groups.Results There was a correlation between histopathological damage and calcium levels of 0.81 (p < 0.005). The average relative fluorescence units (RFUs) was 235.28 ± 19, which corresponds to 5.3 × 10-7 M of calcium, five times the normal value.Conclusion Our study shows promising clinical implications via faster pathology results by the RFU technique. This approach of calcium staining, though still in clinical trials, offers significant clinical application, allowing physicians to get the clinically diagnostic nerve injury degree faster and will also facilitate better strategies for further treatment or future surgeries. PMID:23661333

Davis, John; O'Connor, Elizabeth; Zhang, Lin-Ling; Agresti, Michael; Matloub, Hani S; Sanger, James; Jaradeh, Safwan S; Yan, Ji-Geng

2013-05-09

102

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  

Directory of Open Access Journals (Sweden)

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. Level of Evidence: IV, Case Series.

Marcelo Rosa de Rezende; Neylor Teofilo Araújo Rabelo; Clóvis Castanho Silveira Júnior; Pedro Araújo Petersen; Emygdio José Leomil de Paula; Rames Mattar Júnior

2012-01-01

103

Noninvasive monitoring of diabetes-induced cutaneous nerve fiber loss and hypoalgesia in thy1-YFP transgenic mice  

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Progressive loss of pain perception and cutaneous nerve fibers are frequently observed in diabetic patients. We evaluated the feasibility of using thy1-YFP mice that express the yellowish-green fluorescent protein (YFP) in all of their sensory/motor neurons for noninvasive monitoring of cutaneous ne...

Yuk, SC; Chung, SSM; Chung, SK

104

Clinical comparisons of 0.5% and 0.375% levobupivacaine for ultrasound-guided axillary brachial plexus block with nerve stimulation.  

UK PubMed Central (United Kingdom)

BACKGROUND: In an axillary brachial plexus block (ABPB), where relatively large doses of local anesthetics are administered, levobupivacaine is preferred due to a greater margin of safety. However, the efficacy of levobupivacaine in ABPB has not been studied much. We performed a prospective, double-blinded study to compare the clinical effect of 0.375% levobupivacaine with 0.5% levobupivacaine for ultrasound (US)-guided ABPB with nerve stimulation. METHODS: FORTY PATIENTS UNDERGOING ELECTIVE UPPER LIMB SURGERY WERE RANDOMIZED INTO TWO GROUPS: Group I (0.375% levobupivacaine) and Group II (0.5% levobupivacaine). All four main terminal nerves of the brachial plexus were blocked separately with 7 ml of levobupivacaine using US guidance with nerve stimulation according to study group. A blinded observer recorded the onset time for sensory and motor block, elapsed time to be ready for surgery, recovery time for sensory and motor block, quality of anesthesia, patient satisfaction and complications. RESULTS: There were no significant differences in the time to find nerve locations, time to perform block and number of skin punctures between groups. Insufficient block was reported in one patient of Group I, but no failed block was reported in either group. There were no differences in the onset time for sensory and motor block, elapsed time to be ready for surgery, patient satisfaction and complications. CONCLUSIONS: 0.375% levobupivacaine produced adequate anesthesia for ABPB using US guidance with nerve stimulation, without any clinically significant differences compared to 0.5% levobupivacaine.

Kim W; Kim YJ; Kim JH; Kim DY; Chung RK; Kim CH; Heo S

2012-01-01

105

Clinical comparisons of 0.5% and 0.375% levobupivacaine for ultrasound-guided axillary brachial plexus block with nerve stimulation  

Science.gov (United States)

Background In an axillary brachial plexus block (ABPB), where relatively large doses of local anesthetics are administered, levobupivacaine is preferred due to a greater margin of safety. However, the efficacy of levobupivacaine in ABPB has not been studied much. We performed a prospective, double-blinded study to compare the clinical effect of 0.375% levobupivacaine with 0.5% levobupivacaine for ultrasound (US)-guided ABPB with nerve stimulation. Methods Forty patients undergoing elective upper limb surgery were randomized into two groups: Group I (0.375% levobupivacaine) and Group II (0.5% levobupivacaine). All four main terminal nerves of the brachial plexus were blocked separately with 7 ml of levobupivacaine using US guidance with nerve stimulation according to study group. A blinded observer recorded the onset time for sensory and motor block, elapsed time to be ready for surgery, recovery time for sensory and motor block, quality of anesthesia, patient satisfaction and complications. Results There were no significant differences in the time to find nerve locations, time to perform block and number of skin punctures between groups. Insufficient block was reported in one patient of Group I, but no failed block was reported in either group. There were no differences in the onset time for sensory and motor block, elapsed time to be ready for surgery, patient satisfaction and complications. Conclusions 0.375% levobupivacaine produced adequate anesthesia for ABPB using US guidance with nerve stimulation, without any clinically significant differences compared to 0.5% levobupivacaine.

Kim, Wonkyo; Kim, Jong-Hak; Kim, Dong Yeon; Chung, Rack Kyung; Kim, Chi Hyo; Heo, Seok

2012-01-01

106

High-resolution magnetic resonance-guided posterior femoral cutaneous nerve blocks.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess the feasibility, technical success, and effectiveness of high-resolution magnetic resonance (MR)-guided posterior femoral cutaneous nerve (PFCN) blocks. MATERIALS AND METHODS: A retrospective analysis of 12 posterior femoral cutaneous nerve blocks in 8 patients [6 (75%) female, 2 (25%) male; mean age, 47 years; range, 42-84 years] with chronic perineal pain suggesting PFCN neuropathy was performed. Procedures were performed with a clinical wide-bore 1.5-T MR imaging system. High-resolution MR imaging was utilized for visualization and targeting of the PFCN. Commercially available, MR-compatible 20-G needles were used for drug delivery. Variables assessed were technical success (defined as injectant surrounding the targeted PFCN on post-intervention MR images) effectiveness, (defined as post-interventional regional anesthesia of the target area innervation downstream from the posterior femoral cutaneous nerve block), rate of complications, and length of procedure time. RESULTS: MR-guided PFCN injections were technically successful in 12/12 cases (100%) with uniform perineural distribution of the injectant. All blocks were effective and resulted in post-interventional regional anesthesia of the expected areas (12/12, 100%). No complications occurred during the procedure or during follow-up. The average total procedure time was 45 min (30-70) min. CONCLUSIONS: Our initial results demonstrate that this technique of selective MR-guided PFCN blocks is feasible and suggest high technical success and effectiveness. Larger studies are needed to confirm our initial results.

Fritz J; Bizzell C; Kathuria S; Flammang AJ; Williams EH; Belzberg AJ; Carrino JA; Chhabra A

2013-04-01

107

Ultrasound anatomy of the brachial plexus nerves in the neurovascular bundle at the axilla in patients undergoing upper-extremity block anesthesia.  

UK PubMed Central (United Kingdom)

PURPOSE: Familiarity with the localization of the nerves in the neurovascular bundle that constitutes the axillary segment of the brachial plexus (BP) is important when applying ultrasound (US)-guided block anesthesia. Therefore in this study we aimed to delineate the anatomy of the median, radial, and ulnar nerves of the BP at the axilla with US and electrical stimulation. MATERIALS AND METHODS: The study included 60 patients who were scheduled to undergo upper-arm surgery with axillary block anesthesia. Prior to anesthesia, ulnar, radial, and median nerves were localized with US using a 12-h quadrant identification system that placed the axillary artery (AA) in the middle. The nerves were then functionally tested using a neurostimulator. RESULTS: The radial nerve was mainly located in the 4-6 o'clock arc (posterior and posteromedial to AA) in 50 (83 %) of patients. Ulnar nerve was mainly at the 12-3 o'clock arc (anteromedial to AA) in 51 (85 %) of patients. Ulnar nerve showed a second peak at 9-10 o'clock quadrant (anterolateral to AA) in 11 % (7) of patients. Median nerve location was most common in the 12 and 9 o'clock arc (anterior and anterolateral to AA) in 53 (88 %) of the patients. CONCLUSIONS: Ultrasound is a useful tool for depicting BP anatomy in the axillary fossa prior to block anesthesia. Median, ulnar, and radial nerves form a highly consistent triangular pattern around the axillary artery that is easily recognizable with US.

Ustuner E; Y?lmaz A; Özgencil E; Okten F; Turhan SC

2013-05-01

108

[Axillary brachial plexus anesthesia. How many nerve stimulation responses do we look for?  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine whether axillary block with nerve stimulation involving the location of four motor responses is more effective than other techniques using fewer locations, without increasing patient discomfort or the rate of complications. PATIENTS AND METHODS: Prospective, randomized single blind study enrolling 100 patients undergoing orthopedic surgery under axillary block with nerve stimulation. Patients were randomly assigned to five groups of 20 patients: in group A, 4 motor responses were located; in group B three were located (musculocutaneous nerve and two more); in group C two responses, the musculocutaneous nerve and one more; in group D two non-musculocutaneous responses; and in group E only one non-musculocutaneous response was located (medial, cubital or radial). We used 40 ml of 1% mepivacaine. Data collected were location of responses, duration of blockade, adverse events occurring during the technique; level of motor and sensory block; tolerance to the tourniquet; level of patient discomfort; and presence of complications. RESULTS: A full sensory block was achieved for 100% in group A, 90% in group B, 60% in group C, 75% in group D and 40% in group E. Patient discomfort was similar in all groups. One patient continued to suffer postoperative neurologic dysfunction three months after the block. CONCLUSIONS: Locating 4 responses gives the greatest degree of assurance of obtaining full sensory block without increasing patient discomfort or rate of complications.

Serradell Catalán A; Moncho Rodríguez JM; Santos Carnés JA; Herrero Carbó R; Villanueva Ferrer JA; Masdeu Castellví J

2001-10-01

109

Free gracilis transfer reinnervated by the nerve to the supinator for the reconstruction of finger and thumb extension in longstanding C7-T1 brachial plexus root avulsion.  

UK PubMed Central (United Kingdom)

PURPOSE: To report the clinical results of a free gracilis muscle transfer to finger and thumb extensors reinnervated by supinator muscle motor branches in patients with longstanding C7-T1 root avulsion. METHODS: Between January 2010 and January 2011, 3 young adult patients with traumatic C7-T1 brachial plexus palsies had gracilis transfer to the thumb and finger extensors at a mean of 38 months after injury. The muscle flap was connected to radial vessels and comitant veins and to nerve branches supplying the supinator muscle. RESULTS: All patients had recovery of active thumb and finger extension, scoring M3 and M4 on the Medical Research Council scale, respectively, at a mean of 12 months after surgery. CONCLUSIONS: Reconstruction of finger and thumb extension in lower-type brachial plexus injuries is a challenging problem that is most commonly addressed with an extensor tenodesis technique, which depends on wrist flexion. Free gracilis transfer innervated by nerve branches to the supinator provided the restoration of thumb and finger extension independent of wrist flexion. CLINICAL RELEVANCE: For those patients with lower brachial root injury more than a year old, transfer of a free functional gracilis muscle is an alternative for the reconstruction of thumb and finger extension. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Soldado F; Bertelli J

2013-05-01

110

Inhibition of micturition reflex by activation of somatic afferents in posterior femoral cutaneous nerve.  

UK PubMed Central (United Kingdom)

This study determined if activation of somatic afferents in posterior femoral cutaneous nerve (PFCN) could modulate the micturition reflex recorded under isovolumetric conditions in ?-chloralose anaesthetized cats. PFCN stimulation inhibited reflex bladder activity and significantly (P <0.05) increased bladder capacity during slow infusion of saline or 0.25% acetic acid (AA). The optimal frequency for PFCN stimulation-induced bladder inhibition was between 3 and 10 Hz, and a minimal stimulation intensity of half of the threshold for inducing anal twitching was required. Bilateral pudendal nerve transection eliminated PFCN stimulation-induced anal twitching but did not change the stimulation-induced bladder inhibition, excluding the involvement of pudendal afferent or efferent axons in PFCN afferent inhibition.Mechanical or electrical stimulation on the skin surface in the PFCN dermatome also inhibited bladder activity. Prolonged (2 × 30 min) PFCN stimulation induced a post-stimulation inhibition that persists for at least 2 h. This study revealed a new cutaneous-bladder reflex activated by PFCN afferents. Although the mechanisms and physiological functions of this cutaneous-bladder reflex need to be further studied, our data raise the possibility that stimulation of PFCN afferents might be useful clinically for the treatment of overactive bladder symptoms.

Tai C; Shen B; Mally AD; Zhang F; Zhao S; Wang J; Roppolo JR; de Groat WC

2012-10-01

111

Inhibition of micturition reflex by activation of somatic afferents in posterior femoral cutaneous nerve.  

Science.gov (United States)

This study determined if activation of somatic afferents in posterior femoral cutaneous nerve (PFCN) could modulate the micturition reflex recorded under isovolumetric conditions in ?-chloralose anaesthetized cats. PFCN stimulation inhibited reflex bladder activity and significantly (P PFCN stimulation-induced bladder inhibition was between 3 and 10 Hz, and a minimal stimulation intensity of half of the threshold for inducing anal twitching was required. Bilateral pudendal nerve transection eliminated PFCN stimulation-induced anal twitching but did not change the stimulation-induced bladder inhibition, excluding the involvement of pudendal afferent or efferent axons in PFCN afferent inhibition.Mechanical or electrical stimulation on the skin surface in the PFCN dermatome also inhibited bladder activity. Prolonged (2 × 30 min) PFCN stimulation induced a post-stimulation inhibition that persists for at least 2 h. This study revealed a new cutaneous-bladder reflex activated by PFCN afferents. Although the mechanisms and physiological functions of this cutaneous-bladder reflex need to be further studied, our data raise the possibility that stimulation of PFCN afferents might be useful clinically for the treatment of overactive bladder symptoms. PMID:22869011

Tai, Changfeng; Shen, Bing; Mally, Abhijith D; Zhang, Fan; Zhao, Shouguo; Wang, Jicheng; Roppolo, James R; de Groat, William C

2012-08-06

112

Brachial plexus variation involving the formation and branches of the cords  

Directory of Open Access Journals (Sweden)

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.

Fabian-Taylor FM; Varma KS

2010-01-01

113

Excitation of cutaneous sensory nerve endings in the rat by 4-aminopyridine and tetraethylammonium.  

UK PubMed Central (United Kingdom)

1. The effects of the potassium channel blockers 4-aminopyridine (4-AP) and tetraethylammonium (TEA) on cutaneous sensory nerve endings have been investigated with the use of an in vitro skin-nerve preparation from the rat. 2. Direct application of these compounds to the nerve endings, but not to the axons, induced continuous discharges in most A beta, A delta, and C fibers. There was no relationship between the fibers' responsiveness or the threshold concentration required to induce discharges and either the conduction velocity or sensory properties of the fibers. 3. The rate of induced discharges increased linearly with increasing concentrations of 4-AP. At threshold concentrations of 10(-6)-10(-5) M, low-frequency, irregular discharges developed; but at the highest concentration of 10(-3) M, a characteristic doublet or bursting discharges usually emerged. 4. During and after the induced discharges there did not appear to be an alteration in the sensitivity of the sensory nerve endings to mechanical or thermal stimuli. 5. It is concluded that the induced activity arises from an action of these potassium channel blockers at or near the action potential generator region at the nerve endings.

Kirchhoff C; Leah JD; Jung S; Reeh PW

1992-01-01

114

Cutaneous nerves in cafe au lait spots with white halos in infants with neurofibromatosis. An electron microscopic study.  

UK PubMed Central (United Kingdom)

BACKGROUND AND DESIGN: Although two cardinal skin manifestations of neurofibromatosis are cutaneous neurofibromas and cafe au lait spots, the pathogenesis of cafe au lait spots are very poorly known compared with that of cutaneous neurofibromas. Thus, the cafe au lait spots in two Japanese infants were clinically, histologically, and electron-microscopically investigated. OBSERVATIONS: Some of the cafe au lait spots in the mongolian spots were surrounded by white halos. Histologically, in the cafe au lait spots, the epidermal basal cells had abundant melanin pigment, but macromelanosomes were not seen throughout the epidermis. In the white halo, the epidermal basal cells had a small amount of melanin pigment. Electron microscopically, the cafe au lait spots and their white halos had many subepidermal and intraepidermal nerves that belonged to free nerve endings. All the cutaneous nerves were mature. Some of the intraepidermal nerves had partially or completely naked axons that contacted tightly with the cytomembranes of the basal keratinocytes. Some of the axons in the subepidermal nerves showed degenerative changes only in the white halos. No ultrastructural pathologic changes were observed in the melanocytes, the epidermal keratinocytes, or melanosomes in those cells in the cafe au lait spots and their white halos; also, dermal melanocytes were absent in the both areas. CONCLUSIONS: The increase of the cutaneous nerves and the absence of dermal melanocytes in the cafe au lait spots and their white halos may be considered as characteristic histologic cutaneous findings in infants with neurofibromatosis. However, no evidence indicates that the cutaneous nerves may participate closely in the pathogenesis of the white halos.

Mihara M; Nakayama H; Aki T; Inoue T; Shimao S

1992-07-01

115

Altered cutaneous nerve regeneration in a simian immunodeficiency virus / macaque intracutaneous axotomy model.  

UK PubMed Central (United Kingdom)

To characterize the regenerative pattern of cutaneous nerves in simian immunodeficiency virus (SIV)-infected and uninfected macaques, excisional axotomies were performed in nonglabrous skin at 14-day intervals. Samples were examined after immunostaining for the pan-axonal marker PGP 9.5 and the Schwann cell marker p75 nerve growth factor receptor. Collateral sprouting of axons from adjacent uninjured superficial dermal nerve bundles was the initial response to axotomy. Both horizontal collateral sprouts and dense vertical regeneration of axons from the deeper dermis led to complete, rapid reinnervation of the epidermis at the axotomy site. In contrast to the slower, incomplete reinnervation previously noted in humans after this technique, in both SIV-infected and uninfected macaques epidermal reinnervation was rapid and completed by 56 days postaxotomy. p75 was densely expressed on the Schwann cells of uninjured nerve bundles along the excision line and on epidermal Schwann cell processes. In both SIV-infected and uninfected macaques, Schwann cell process density was highest at the earliest timepoints postaxotomy and then declined at a similar rate. However, SIV-infection delayed epidermal nerve fiber regeneration and remodeling of new sprouts at every timepoint postaxotomy, and SIV-infected animals consistently had lower mean epidermal Schwann cell densities, suggesting that Schwann cell guidance and support of epidermal nerve fiber regeneration may account for altered nerve regeneration. The relatively rapid regeneration time and the completeness of epidermal reinnervation in this macaque model provides a useful platform for assessing the efficacy of neurotrophic or regenerative drugs for sensory neuropathies including those caused by HIV, diabetes mellitus, medications, and toxins.

Ebenezer GJ; Laast VA; Dearman B; Hauer P; Tarwater PM; Adams RJ; Zink MC; McArthur JC; Mankowski JL

2009-05-01

116

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  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese 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 te (more) mpo 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 Abstract in english 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 (more) 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

Rezende, Marcelo Rosa de; Rabelo, Neylor Teofilo Araújo; Silveira Júnior, Clóvis Castanho; Petersen, Pedro Araújo; Paula, Emygdio José Leomil de; Mattar Júnior, Rames

2012-12-01

117

Free inferior gluteal flap harvest with sparing of the posterior femoral cutaneous nerve.  

Science.gov (United States)

The free inferior gluteal flap is a major secondary choice of autologous tissue for breast reconstruction if the TRAM flap is not an option. Loss of posterior thigh and popliteal sensibility is a frequent sequela of harvesting the free inferior gluteal musculocutaneous flap and the inferior gluteal artery perforator (I-GAP) flap. The posterior femoral cutaneous nerve of the thigh lies directly on the deep surface of the gluteus maximus muscle, having a very close anatomic relationship with the inferior gluteal artery. The purpose of this study was to gain a better understanding of the anatomy of the posterior femoral cutaneous nerve (PFCN), its branches, and their relationship with the inferior gluteal artery (IGA). Eighteen fresh human pelvic halves were dissected for examination during harvesting of the inferior gluteal myocutaneous free flap, to determine if a nerve-sparing approach was possible and how this information might impact on I-GAP flap harvest. Seventeen of 18 pelvic halves had at least some of the PFCN branches intact after isolation of the IGA pedicle and flap elevation. Three of 18 of the pelvic halves had the entire PFCN and its branches intact after flap elevation. One of 18 pelvic halves required complete transection of the PFCN and its branches in order to isolate the IGA pedicle. In 94.5 percent of the pelvic halve dissections, it was possible to maintain at least a portion of the PFCN intact after isolation of the inferior gluteal artery pedicle while harvesting the free inferior gluteal myocutaneous flap. These findings support a nerve-sparing approach to inferior gluteal myocutaneous flap elevation to minimize the sequela of posterior thigh anesthesia. These data also emphasize the intimate relationship of the PFCN and the gluteal artery and the real possibility of injury to the PFCN during I-GAP harvest. PMID:17048132

Zenn, Michael R; Millard, John A

2006-10-01

118

Free inferior gluteal flap harvest with sparing of the posterior femoral cutaneous nerve.  

UK PubMed Central (United Kingdom)

The free inferior gluteal flap is a major secondary choice of autologous tissue for breast reconstruction if the TRAM flap is not an option. Loss of posterior thigh and popliteal sensibility is a frequent sequela of harvesting the free inferior gluteal musculocutaneous flap and the inferior gluteal artery perforator (I-GAP) flap. The posterior femoral cutaneous nerve of the thigh lies directly on the deep surface of the gluteus maximus muscle, having a very close anatomic relationship with the inferior gluteal artery. The purpose of this study was to gain a better understanding of the anatomy of the posterior femoral cutaneous nerve (PFCN), its branches, and their relationship with the inferior gluteal artery (IGA). Eighteen fresh human pelvic halves were dissected for examination during harvesting of the inferior gluteal myocutaneous free flap, to determine if a nerve-sparing approach was possible and how this information might impact on I-GAP flap harvest. Seventeen of 18 pelvic halves had at least some of the PFCN branches intact after isolation of the IGA pedicle and flap elevation. Three of 18 of the pelvic halves had the entire PFCN and its branches intact after flap elevation. One of 18 pelvic halves required complete transection of the PFCN and its branches in order to isolate the IGA pedicle. In 94.5 percent of the pelvic halve dissections, it was possible to maintain at least a portion of the PFCN intact after isolation of the inferior gluteal artery pedicle while harvesting the free inferior gluteal myocutaneous flap. These findings support a nerve-sparing approach to inferior gluteal myocutaneous flap elevation to minimize the sequela of posterior thigh anesthesia. These data also emphasize the intimate relationship of the PFCN and the gluteal artery and the real possibility of injury to the PFCN during I-GAP harvest.

Zenn MR; Millard JA

2006-10-01

119

Combined use of axillary block and lateral femoral cutaneous nerve block in upper-extremity injuries requiring large skin grafts.  

UK PubMed Central (United Kingdom)

An axillary block and lateral femoral cutaneous nerve block combination was used in 11 patients with upper-extremity injuries requiring large skin grafts. In our experience, this block combination was highly successful. All but one of the patients obtained excellent pain relief (mean visual analog pain scores, 0.2) that required no narcotic analgesics or sedatives. There were no systemic or neurologic side effects attributed to the local anesthetic drugs. We believe that combining an axillary block and a lateral femoral cutaneous nerve block is a clinically useful and effective technique and an excellent anesthetic alternative for procedures requiring large grafts for the upper extremity.

Karacalar A; Karacalar S; Uçkunkaya N; Sahin S; Ozcan B

1998-11-01

120

Successful treatment of testicular pain with peripheral nerve stimulation of the cutaneous branch of the ilioinguinal and genital branch of the genitofemoral nerves.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To assess the effect of peripheral nerve stimulation on neuropathic testicular pain. MATERIAL AND METHODS: A 30-year-old man with a four-year history of chronic testicular pain following scrotal hydrocele surgery had two percutaneous leads implanted in his groin and low-frequency stimulation of the cutaneous branch of the ilioinguinal and genital branch of the genitofemoral nerves. RESULT: At seven-month follow-up, the pain intensity had declined from 9/10 to 2/10 on the numeric rating scale. CONCLUSION: We report the successful implantation of an ilioinguinal and genitofemoral nerve stimulator for sustained suppression of intractable neuropathic testicular pain.

Rosendal F; Moir L; de Pennington N; Green AL; Aziz TZ

2013-03-01

 
 
 
 
121

[Functional recovery of tendons and nerves after early repair of electric burns of the extremities using cutaneous and myocutaneous flaps].  

Science.gov (United States)

A new operative treatment for the early repair of electric burn injuries by using cutaneous or myocutaneous flaps are recommended. The functional results of the burnt tendons and nerves were followed up. 174 operations among 134 cases were performed from 1964 to 1984, amputation rate were decreased to 9.7%. The percentage of functional recovery of the burnt tendons at wrist canal are 97.6% and which of the 21 burnt peripheral nerves are 80.9%. PMID:2517226

Chang, Z D

1989-12-01

122

[Functional recovery of tendons and nerves after early repair of electric burns of the extremities using cutaneous and myocutaneous flaps  

UK PubMed Central (United Kingdom)

A new operative treatment for the early repair of electric burn injuries by using cutaneous or myocutaneous flaps are recommended. The functional results of the burnt tendons and nerves were followed up. 174 operations among 134 cases were performed from 1964 to 1984, amputation rate were decreased to 9.7%. The percentage of functional recovery of the burnt tendons at wrist canal are 97.6% and which of the 21 burnt peripheral nerves are 80.9%.

Chang ZD

1989-12-01

123

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

Directory of Open Access Journals (Sweden)

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.

Ayse Tokcaer; Feride Gogus; Sumer Gullap; Isik Keles; Mustafa Gokce

2007-01-01

124

The application of brachial-femoral stretch guidewire in endovascular exclusion of abdominal aortic aneurysm  

International Nuclear Information System (INIS)

[en] Objective: To investigate the key technique and application value of brachial-femoral stretch guidewire in endovascular exclusion of abdominal aortic aneurysms. Methods: Since Mach 1997 to October 2002, endovascular exclusion for abdominal aortic aneurysm had been preformed on 136 patients. The main body short limb graft was used in 118 cases. (Vanguard 6, Talent 86, AneuRx 2, Zenith 3, domestic 21). 12 of these patients were undergone brachial-femoral guidewire technique for the procedure. Results: All of the 12 cases with brachial-femoral stretch guidewire technique had the stent-grafts introduced, connected and released successfully. One case suffered brachial artery thrombosis postoperatively. One case had left medial antebrachial cutaneous nerve injured, but no other artery or incision complications occurred. 9 cases with the brachial-femoral stretch guidewire technique showed obviously, shortening of the time for this procedure. Conclusions: For the patients with poor general condition or specific anatomic conditions, such as aneurysm diameter >6 cm and the angle between aneurysm and common iliac artery >45 degree, aneurysm necktwist > 30 degree or iliac artery twist > 45 degree, age over 75 years old and combination with more than one important organ disfunction, the brachial-femoral guidewire technique is the valuable method of choice

2003-01-01

125

Expression of vanilloid receptor subtype 1 in cutaneous sensory nerve fibers, mast cells, and epithelial cells of appendage structures.  

Science.gov (United States)

The vanilloid receptor subtype 1 (VR1)/(TRPV1), binding capsaicin, is a non-selective cation channel that recently has been shown in human keratinocytes in vitro and in vivo. However, a description of VR1 localization in other cutaneous compartments in particular cutaneous nerve fibers is still lacking. We therefore investigated VR1 immunoreactivity as well as mRNA and protein expression in a series (n = 26) of normal (n = 7), diseased (n = 13) [prurigo nodularis (PN) (n = 10), generalized pruritus (n = 1), and mastocytosis (n = 2)], and capsaicin-treated human skin (n = 6). VR1 immunoreactivity could be observed in cutaneous sensory nerve fibers, mast cells, epidermal keratinocytes, dermal blood vessels, the inner root sheet and the infundibulum of hair follicles, differentiated sebocytes, sweat gland ducts, and the secretory portion of eccrine sweat glands. Upon reverse transcriptase-polymerase chain reaction and Western blot analysis, VR1 was detected in mast cells and keratinocytes from human skin. In pruritic skin of PN, VR1 expression was highly increased in epidermal keratinocytes and nerve fibers, which was normalized after capsaicin application. During capsaicin therapy, a reduction of neuropeptides (substance P, calcitonin gene-related peptide) was observed. After cessation of capsaicin therapy, neuropeptides re-accumulated in skin nerves. In conclusion, VR1 is widely distributed in the skin, suggesting a major role for this receptor, e.g. in nociception and neurogenic inflammation. PMID:14987252

Ständer, Sonja; Moormann, Corinna; Schumacher, Mark; Buddenkotte, Jörg; Artuc, Metin; Shpacovitch, Victoria; Brzoska, Thomas; Lippert, Undine; Henz, Beate M; Luger, Thomas A; Metze, Dieter; Steinhoff, Martin

2004-03-01

126

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

Directory of Open Access Journals (Sweden)

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.

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

2006-01-01

127

Extradural malignancy simulating brachial neuritis.  

UK PubMed Central (United Kingdom)

A 57 year old man is described who presented with symptoms and signs suggestive of brachial neuritis. Sparing of the serratus anterior both clinically and on electromyography suggested that the lesion was in the brachial plexus, thus supporting the diagnosis. Subsequent investigation showed an extradural tumour at C5-C6 level. Sparing of serratus anterior does not definitively localize the pathology as distal to the nerve roots.

Gates PC; Kempster PA; Rischin D; Balla JI

1986-01-01

128

Anatomical relationships and branching patterns of the dorsal cutaneous branch of the ulnar nerve.  

UK PubMed Central (United Kingdom)

PURPOSE: To describe the variable branching patterns of the dorsal cutaneous branch of the ulnar nerve (DCBUN) relative to identifiable anatomical landmarks on the ulnar side of the wrist. METHODS: We dissected the ulnar nerve in 28 unmatched fresh-frozen cadavers to identify the DCBUN and its branches from its origin to the level of the metacarpophalangeal joints. The number and location of branches of the DCBUN were recorded relative to the distal ulnar articular surface. Relationships to the subcutaneous border of the ulna, the pisotriquetral joint, and the extensor carpi ulnaris tendon were defined in the pronated wrist. RESULTS: On average, 2 branches of the DCBUN were present at the level of the distal ulnar articular surface (range, 1-4). On average, 2.2 branches were present 2 cm distal to the ulnar articular surface (range, 1-4). At least 1 longitudinal branch crossed dorsal to the extensor carpi ulnaris tendon prior to its insertion at the base of the fifth metacarpal in 23 of 28 specimens (82%). In 27 of 28 specimens (96%), all longitudinal branches of the DCBUN coursed between the dorsal-volar midpoint of the subcutaneous border of the ulna and the pisotriquetral joint. In 20 of 28 specimens (71%), a transverse branch of the DCBUN to the distal radioulnar joint was present. CONCLUSIONS: During exposure of the dorsal and ulnar areas of the wrist, identification and protection of just a single branch of the DCBUN are unlikely to ensure safe dissection because multiple branches normally are present. The 6U, 6R, and ulnar midcarpal arthroscopy portals may place these branches at risk. In the pronated forearm, the area between the DCBUN and the pisotriquetral joint contained all longitudinal branches of the DCBUN in 96% of specimens. CLINICAL RELEVANCE: During surgery involving the dorsal and ulnar areas of the wrist, multiple longitudinal branches and a transverse branch of the DCBUN are normally present and must be respected.

Root CG; London DA; Schroeder NS; Calfee RP

2013-06-01

129

Randomized clinical trial of trigger point infiltration with lidocaine to diagnose anterior cutaneous nerve entrapment syndrome.  

UK PubMed Central (United Kingdom)

BACKGROUND: Anterior cutaneous nerve entrapment syndrome (ACNES) is hardly considered in the differential diagnosis of chronic abdominal pain. Some even doubt the existence of such a syndrome and attribute reported successful treatment results to a placebo effect. The objective was to clarify the role of local anaesthetic injection in diagnosing ACNES. The hypothesis was that pain attenuation following lidocaine injection would be greater than that after saline injection. METHODS: Patients aged over 18 years with suspected ACNES were randomized to receive an injection of 10 ml 1 per cent lidocaine or saline into the point of maximal abdominal wall pain just beneath the anterior fascia of the rectus abdominis muscle. Pain was recorded using a visual analogue scale (VAS; 1-100 mm) and a verbal rating scale (VRS; 0, no pain; 4, severe pain) during physical examination just before and 15-20 min after injection. A reduction of at least 50 per cent on the VAS and/or 2 points on the VRS was considered a successful response. RESULTS: Between August 2008 and December 2010, 48 patients were randomized equally (7 men and 41 women, median age 47 years). Four patients in the saline group reported a successful response compared with 13 in the lidocaine group (P = 0·007). CONCLUSION: Entrapped branches of intercostal nerves may contribute to the clinical picture in some patients with chronic abdominal pain. Pain reduction following local infiltration in these patients was based on an anaesthetic mechanism and not on a placebo or a mechanical (volume) effect. Registration number: NTR2016 (Nederlands Trial Register; http://www.trialregister.nl).

Boelens OB; Scheltinga MR; Houterman S; Roumen RM

2013-01-01

130

Variation in the termination of musculocutaneous nerve  

Directory of Open Access Journals (Sweden)

Full Text Available The present report describes a case of variation of the musculocutaneous nerve observed in a middle aged Indian male cadaver during routine educational dissection. We examined a variation in the termination of musculocutaneous nerve in right upper limb. After piercing coracobrachialis muscle musculocutaneous nerve divided into lateral cutaneous nerve of the forearm and another branch that joined with median nerve below the insertion of the coracobrachialis. This abnormal branch coming from the musculocutaneous nerve had a very close oblique course over the brachial artery. Precise knowledge of variations of this report may help to plan a surgery in the region of axilla and arm, traumatology of the shoulder joint and plastic and reconstructive repair operations.

Thomas HR; Potu BK; Bhat KM; Margaret B; Madhav V; Wersely S

2010-01-01

131

[Nerve transfers].  

UK PubMed Central (United Kingdom)

Nerve transfers are recent surgical techniques where an unaffected nerve or part of its fascicules is transferred onto another nerve and co-apted end-to-end, or sometimes end-to-side, in order to "reanimate", sensitive or motor deficits. The technique is indicated when the proximal nerve stump has been destroyed or is of bad histological quality (brachial plexus root avulsion, or stump hidden in an extended scar), far from the target (important loss of substance), or difficult to access. Nerve transfers may be indicated for the microsurgical repair of brachial or lumbo-sacral plexus lesions, and in specific upper and lower limb peripheral nerve injuries : rupture of the axillary nerve in the quadrilateral space, irreversible lesion of the upper trunk of the brachial plexus, and in facial nerve surgery.

Bahm J; El Kazzi W; Schuind F

2011-01-01

132

Evaluation of the proprioceptive influence of the cutaneous afferents to the ankle in patients after sural nerve harvesting.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Cutaneous afferent nerves contribute to joint proprioception. The aim of this study was to retrospectively analyze the proprioceptive influence of the cutaneous afferents to the ankle in patients after sural nerve harvesting in comparison to controls. METHODS: The proprioception of the ankle in 24 patients after sural nerve harvesting was investigated. The sural nerve was harvested bilaterally in Group 1 (n = 10), in the right leg in Group 2 (n = 6), and in the left leg in Group 3 (n = 8). The proprioception of the ankle was also tested in controls (Group 4, n = 24). The peroneal reaction time (PRT) was measured on a tilting platform. The position sense test was performed. Balance control was investigated with the Biodex Stability System (Biodex Medical Systems, Shirley, NY) at the stable Level 8 and unstable Level 2. RESULTS: No significant differences among the groups were seen in the position sense test, the PRT, and all scores of the Biodex Stability System. The PRT showed significant differences in comparison to the contralateral leg for the peroneus brevis muscle in Group 1 (P = 0.005) and Group 4 (P = 0.001) as well as for the peroneus longus muscle in Group 3 (P = 0.036) and Group 4 (P = 0.001). CONCLUSION: The proprioception of the ankle in patients after sural nerve harvesting is not reduced in comparison to controls. Significant differences of the PRT between the left and right legs are attributable to leg dominance in most cases and not to a loss of innervation. Harvesting of the sural nerve does not result in ankle instability.

Rein S; Fabian T; Krishnan K; Benesch S; Schackert G; Zwipp H; Lindner C; Weindel S

2009-03-01

133

Brachial plexopathy  

Science.gov (United States)

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.

Khadilkar, Satish V.; Khade, Snehaldatta S.

2013-01-01

134

Brachial plexopathy.  

UK PubMed Central (United Kingdom)

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.

Khadilkar SV; Khade SS

2013-01-01

135

Selective regulation of nerve growth factor expression in developing cutaneous tissue by early sensory innervation  

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Full Text Available Abstract Background In the developing vertebrate peripheral nervous system, the survival of sympathetic neurons and the majority of sensory neurons depends on a supply of nerve growth factor (NGF) from tissues they innervate. Although neurotrophic theory presupposes, and the available evidence suggests, that the level of NGF expression is completely independent of innervation, the possibility that innervation may regulate the timing or level of NGF expression has not been rigorously investigated in a sufficiently well-characterized developing system. Results To address this important question, we studied the influence of innervation on the regulation of NGF mRNA expression in the embryonic mouse maxillary process in vitro and in vivo. The maxillary process receives its innervation from predominantly NGF-dependent sensory neurons of the trigeminal ganglion and is the most densely innervated cutaneous territory with the highest levels of NGF in the embryo. When early, uninnervated maxillary processes were cultured alone, the level of NGF mRNA rose more slowly than in maxillary processes cultured with attached trigeminal ganglia. In contrast to the positive influence of early innervation on NGF mRNA expression, the levels of brain-derived neurotrophic factor (BDNF) mRNA and neurotrophin-3 (NT3) mRNA rose to the same extent in early maxillary processes grown with and without trigeminal ganglia. The level of NGF mRNA, but not BDNF mRNA or NT3 mRNA, was also significantly lower in the maxillary processes of erbB3-/- mice, which have substantially fewer trigeminal neurons than wild-type mice. Conclusions This selective effect of initial innervation on target field NGF mRNA expression provokes a re-evaluation of a key assertion of neurotrophic theory that the level of NGF expression is independent of innervation.

Wyatt Sean L; Spori Bodo; Vizard Tom N; Davies Alun M

2011-01-01

136

Obstetrical brachial plexus palsy.  

UK PubMed Central (United Kingdom)

Obstetrical brachial plexus palsy is considered to be the result of a trauma during the delivery, even if there remains some controversy surrounding the causes. Although most babies recover spontaneously in the first 3 months of life, a small number remains with poor recovery which requires surgical brachial plexus exploration. Surgical indications depend on the type of lesion (producing total or partial palsy) and particularly the nonrecovery of biceps function by the age of 3 months. In a global palsy, microsurgery will be mandatory and the strategy for restoration will focus first on hand reinnervation and secondarily on providing elbow flexion and shoulder stability. Further procedures may be necessary during growth in order to avoid fixed contractured deformities or to give or increase strength of important muscle functions like elbow flexion or wrist extension. The author reviews the history of obstetrical brachial plexus injury, epidemiology, and the specifics of descriptive and functional anatomy in babies and children. Clinical manifestations at birth are directly correlated with the anatomical lesion. Finally, operative procedures are considered, including strategies of reconstruction with nerve grafting in infants and secondary surgery to increase functional capacity at later ages. However, normal function is usually not recovered, particularly in total brachial plexus palsy.

Romaña MC; Rogier A

2013-01-01

137

Arterial and venous plasma levels of bupivacaine following peripheral nerve blocks.  

UK PubMed Central (United Kingdom)

Mean arterial plasma (MAP) and peripheral mean venous plasma (MVP) levels of bupivacaine were ascertained in 3 groups of 10 patients each for: (1) intercostal nerve block, 400 mg; (2) block of the sciatic, femoral, and lateral femoral cutaneous nerves, with or without block of the obturator nerve, 400 mg; and (3) supraclavicular brachial plexus block, 300 mg. MAP levels were consistently higher than simultaneously sampled MVP levels, the highest levels occurring from bilateral intercostal nerve block. No evidence of systemic toxicity was observed. The results suggest that bupivacaine has a much wider margin of safety in humans than is now stated.

Moore DC; Mather LE; Bridenbaugh LD; Balfour RI; Lysons DF; Horton WG

1976-11-01

138

Neurinomas of the brachial plexus: case report.  

Science.gov (United States)

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

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

139

Neurinomas of the brachial plexus: case report.  

UK PubMed Central (United Kingdom)

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.

Forte A; Gallinaro LS; Bertagni A; Montesano G; Prece V; Illuminati G

1999-01-01

140

Treatment of brachial plexus injury.  

UK PubMed Central (United Kingdom)

A brachial plexus injury is the most severe nerve injury of the extremities. To achieve good results from treatment, correct diagnosis and early nerve repair are mandatory. The brachial plexus should be explored as early as possible if there is an incised wound, if clinical findings or diagnostic imaging indicate that at least one root is avulsed, if there is damage to the subclavian artery, and if there is total-type injury. With an upper-type injury with no clinical signs of a preganglionic lesion, the patient should be treated conservatively for 3 months and if there are no signs of recovery, then the brachial plexus should be explored. During this exploration, recording of the spinal cord evoked potential (ESCP) or the somatosensory evoked potential (SEP) is mandatory to determine the site of injury. Nerve grafting is indicated for a rupture in the root demonstrating a positive ESCP or SEP potential, in the trunk or in the cord. Exploration of the brachial plexus should be extended distally as far as possible to achieve good results after nerve grafting; when this was done more than M3 (MRC grading) power of the infraspinatus, deltoid, and biceps was achieved in more than 70% of our 32, 30, 33 patients, respectively. Results of nerve grafting for the forearm muscles have been very poor. Intercostal nerve transfer is recommended to restore elbow flexion in root avulsion type of injury, with elbow flexion to more than M3 being regained in 70% of our 221 patients. The best results of intercostal nerve transfer were achieved in patients younger than 30 years who received the operation within 6 months after injury. Motor recovery of hand function after intercostal nerve transfer was poor but protective sensation was restored in fingers innervated by the median nerve. The recommended treatment for each type of injury is described according to the results achieved.

Nagano A

1998-01-01

 
 
 
 
141

Treatment of brachial plexus injury.  

Science.gov (United States)

A brachial plexus injury is the most severe nerve injury of the extremities. To achieve good results from treatment, correct diagnosis and early nerve repair are mandatory. The brachial plexus should be explored as early as possible if there is an incised wound, if clinical findings or diagnostic imaging indicate that at least one root is avulsed, if there is damage to the subclavian artery, and if there is total-type injury. With an upper-type injury with no clinical signs of a preganglionic lesion, the patient should be treated conservatively for 3 months and if there are no signs of recovery, then the brachial plexus should be explored. During this exploration, recording of the spinal cord evoked potential (ESCP) or the somatosensory evoked potential (SEP) is mandatory to determine the site of injury. Nerve grafting is indicated for a rupture in the root demonstrating a positive ESCP or SEP potential, in the trunk or in the cord. Exploration of the brachial plexus should be extended distally as far as possible to achieve good results after nerve grafting; when this was done more than M3 (MRC grading) power of the infraspinatus, deltoid, and biceps was achieved in more than 70% of our 32, 30, 33 patients, respectively. Results of nerve grafting for the forearm muscles have been very poor. Intercostal nerve transfer is recommended to restore elbow flexion in root avulsion type of injury, with elbow flexion to more than M3 being regained in 70% of our 221 patients. The best results of intercostal nerve transfer were achieved in patients younger than 30 years who received the operation within 6 months after injury. Motor recovery of hand function after intercostal nerve transfer was poor but protective sensation was restored in fingers innervated by the median nerve. The recommended treatment for each type of injury is described according to the results achieved. PMID:9654558

Nagano, A

1998-01-01

142

Obstetric brachial plexus injury.  

UK PubMed Central (United Kingdom)

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.

Thatte MR; Mehta R

2011-09-01

143

Obstetric brachial plexus injury.  

Science.gov (United States)

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. PMID:22279269

Thatte, Mukund R; Mehta, Rujuta

2011-09-01

144

Otfrid Foerster (1873-1941)--self-taught neurosurgeon and innovator of reconstructive peripheral nerve surgery.  

UK PubMed Central (United Kingdom)

Otfrid Foerster (1873-1941) became a self-taught neurosurgeon during and after WW I, playing a critical role in the development of peripheral nerve reconstruction. Although best known for describing dermatomes, he published over 300 articles on the nervous system. Confronted by thousands of nerve injuries during WW I, as well as poor results and disinterest from his surgical colleagues, Foerster began performing neurolysis and tension-free nerve repairs himself under emergency conditions. He pioneered grafting motor nerve defects by expendable cutaneous nerves (e.g., sural) and performed intraplexal neurotizations and various nerve transfers, such as the pectoral, subscapular, long thoracic, and thoracodorsal nerves in brachial plexus injuries. Foerster championed rehabilitation, recognizing the potential of electrostimulation and physiotherapy to influence cortical reorganization (brain plasticity) and improve recovery after nerve injury. Foerster died from tuberculosis in 1941, leaving a rich reconstructive peripheral nerve legacy; his innovative and visionary spirit serves as a role model.

Gohritz A; Dellon LA; Guggenheim M; Spies M; Steiert A; Vogt PM

2013-01-01

145

A randomized comparative study of efficacy of axillary and infraclavicular approaches for brachial plexus block for upper limb surgery using peripheral nerve stimulator  

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Brachial plexus block via the axillary approach is problematic in patients with limited arm mobility. In such cases, the infraclavicular approach may be a valuable alternative. The purpose of our study was to compare axillary and infraclavicular techniques for brachial plexus block in patients under...

Lahori Vikram; Raina Anjana; Gulati Smriti; Kumar Dinesh; Gupta Satya

146

[Continuous block of the brachial plexus with nerve stimulation. Intra and postoperative control in orthopedic surgery of the arm  

UK PubMed Central (United Kingdom)

A perivascular axillary plexus block was performed to 87 patients scheduled for orthopedic surgery of hand or arm using an electric nerve stimulator. A catheter was inserted for the postoperative pain control. The success rate was of 90.8% (79 cases); 65 patients (74.7%) presented a complete motor block. Complications were: arterial puncture (3), difficulty in inserting catheter (3), injection out of the sheath (1), pain at the electric stimulation (3). No allergic reactions nor neurologic complications were founded during a year of posterior control.

de Andrés JA; Bolinches R; Vila M; Serrano MT

1989-07-01

147

Differential presynaptic control of the synaptic effectiveness of cutaneous afferents evidenced by effects produced by acute nerve section.  

UK PubMed Central (United Kingdom)

In the anaesthetized cat, the acute section of the saphenous (Saph) and/or the superficial peroneal (SP) nerves was found to produce a long-lasting increase of the field potentials generated in the dorsal horn by stimulation of the medial branch of the sural (mSU) nerve. This facilitation was associated with changes in the level of the tonic primary afferent depolarization (PAD) of the mSU intraspinal terminals. The mSU afferent fibres projecting into Rexed's laminae III-IV were subjected to a tonic PAD that was reduced by the acute section of the SP and/or the Saph nerves. The mSU afferents projecting deeper into the dorsal horn (Rexed's laminae V-VI) were instead subjected to a tonic PAD that was increased after Saph and SP acute nerve section. A differential control of the synaptic effectiveness of the low-threshold cutaneous afferents according to their sites of termination within the dorsal horn is envisaged as a mechanism that allows selective processing of sensory information in response to tactile and nociceptive stimulation or during the execution of different motor tasks.

Rudomin P; Jiménez I; Chávez D

2013-05-01

148

Magnetic resonance imaging in brachial plexus injury.  

Science.gov (United States)

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

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

2013-08-15

149

Magnetic resonance imaging in brachial plexus injury.  

UK PubMed Central (United Kingdom)

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.

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

2013-08-01

150

Cutaneous epithelioid malignant nerve sheath tumor with rhabdoid features: a histologic, immunohistochemical, and ultrastructural study of three cases.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Malignant rhabdoid tumors are morphologically defined as sheets of loosely cohesive cells with eccentric nuclei and hyaline, paranuclear inclusions. Although originally described as a distinctive renal neoplasm of childhood, these tumors have since been described in all age groups and in a variety of extrarenal sites. In the latter setting, it is thought that the rhabdoid phenotype is comprised of histogenetically unrelated tumors, that regardless of histogenesis, pursue a biologically aggressive behavior. METHODS: We report on the clinical, histologic, immunophenotypic, and ultrastructural characteristics of three cases of cutaneous malignant rhabdoid tumor. RESULTS: Each of the cases arose on the trunk or the extremity of elderly men. None of the patients had neurofibromatosis. All of the lesions histologically showed sheets of loosely cohesive polygonal cells with eccentric nuclei and hyaline paranuclear inclusions. Each of the cases showed the following immunophenotype: S-100 (+), synaptophysin(+), vimentin (+), alpha smooth muscle actin (-), CD-30 (-), HMB-45 (-), and pankeratin(-). Ultrastructure of two of the cases yielded similar results showing paranuclear filamentous aggregates of intermediate filaments, cell membrane dense plaques, and rudimentary cell junctions consistent with nerve sheath differentiation. Tonofilaments, dense bodies, microtubules, neurosecretory granules, and melanosomes were not identified. Each of the patients died of widely metastatic disease within 1 year of diagnosis. CONCLUSIONS: Cutaneous epithelioid malignant nerve sheath tumor is a potentially aggressive tumor capable of showing rhabdoid differentiation thus simulating a variety of neoplasms. Immunophenotyping and ultrastructural analysis reliably discriminates these lesions from melanoma, de-differentiated carcinoma, lymphoma, and rhabdomyosarcoma.

Morgan MB; Stevens L; Patterson J; Tannenbaum M

2000-11-01

151

Multiple Variations of the Branches of the Brachial Plexus with Bilateral Connections between Ulnar and Radial Nerves/ Múltiples Variaciones de los Ramos del Plexo Braquial con Conexiones Bilaterales entre los Nervios Ulnar y Radial  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Fueron observadas durante una disección de rutina de los miembros superiores de un cadáver caucásico masculino, múltiples variaciones de los ramos del plexo braquial. En el lado izquierdo, el nervio musculocutáneo estaba ausente y los músculos del compartimento anterior del brazo estaban inervados por el nervio mediano. El nervio mediano se encontraba formado de tres raíces dos provenientes del fascículo lateral y uno del fascículo medial del plexo braquial. En e (more) l lado derecho, en la mitad distal del brazo, el nervio musculocutáneo generó un largo ramo comunicante con el nervio mediano. Además, en el brazo, en ambos miembros superiores existían ramos comunicantes entre los nervios ulnar y radial. La coexistencia de estas variaciones aparece ser única y no ha sido relatada en la literatura consultada. Son discutidas la significancia anatómica y clínica de estas variaciones. Abstract in english During routine dissection of the upper limbs of a Caucasian male cadaver, multiple variations of the branches of the brachial plexus were observed. On the left side, the musculocutaneous nerve was absent and the muscles of the anterior compartment of the arm were innervated by the median nerve. The median nerve was also formed from three roots viz; two from the lateral and one from the medial cord of the brachial plexus. On the right side, the musculocutaneous nerve contr (more) ibuted a long communicating branch to the median nerve in the distal half of the arm. There were also communicating branches between the ulnar and radial nerves in both limbs at the humeral level. The co-existence of these variations appears to be unique and has not been reported in the literature reviewed. The anatomic and clinical significance of these variations is discussed.

Ajayi, Nasirudeen Oladipupo; Lazarus, Lelika; Satyapal, Kapil Sewsaran

2012-06-01

152

Multiple Variations of the Branches of the Brachial Plexus with Bilateral Connections between Ulnar and Radial Nerves Múltiples Variaciones de los Ramos del Plexo Braquial con Conexiones Bilaterales entre los Nervios Ulnar y Radial  

Directory of Open Access Journals (Sweden)

Full Text Available During routine dissection of the upper limbs of a Caucasian male cadaver, multiple variations of the branches of the brachial plexus were observed. On the left side, the musculocutaneous nerve was absent and the muscles of the anterior compartment of the arm were innervated by the median nerve. The median nerve was also formed from three roots viz; two from the lateral and one from the medial cord of the brachial plexus. On the right side, the musculocutaneous nerve contributed a long communicating branch to the median nerve in the distal half of the arm. There were also communicating branches between the ulnar and radial nerves in both limbs at the humeral level. The co-existence of these variations appears to be unique and has not been reported in the literature reviewed. The anatomic and clinical significance of these variations is discussed.Fueron observadas durante una disección de rutina de los miembros superiores de un cadáver caucásico masculino, múltiples variaciones de los ramos del plexo braquial. En el lado izquierdo, el nervio musculocutáneo estaba ausente y los músculos del compartimento anterior del brazo estaban inervados por el nervio mediano. El nervio mediano se encontraba formado de tres raíces dos provenientes del fascículo lateral y uno del fascículo medial del plexo braquial. En el lado derecho, en la mitad distal del brazo, el nervio musculocutáneo generó un largo ramo comunicante con el nervio mediano. Además, en el brazo, en ambos miembros superiores existían ramos comunicantes entre los nervios ulnar y radial. La coexistencia de estas variaciones aparece ser única y no ha sido relatada en la literatura consultada. Son discutidas la significancia anatómica y clínica de estas variaciones.

Nasirudeen Oladipupo Ajayi; Lelika Lazarus; Kapil Sewsaran Satyapal

2012-01-01

153

Brachial plexus trauma: the morbidity of hemidiaphragmatic paralysis.  

Science.gov (United States)

Phrenic nerve palsy has previously been associated with brachial plexus root avulsion; severe unilateral phrenic nerve injury is not uncommonly associated with brachial plexus injury. Brachial plexus injuries can be traumatic (gunshot wounds, lacerations, stretch/contusion and avulsion injuries) or non-traumatic in aetiology (supraclavicular brachial plexus nerve block, subclavian vein catheterisation, cardiac surgeries, or obstetric complications such as birth palsy). Despite the known association, the incidence and morbidity of a phrenic nerve injury and hemidiaphragmatic paralysis associated with traumatic brachial plexus stretch injuries remains ill-defined. The incidence of an associated phrenic nerve injury with brachial plexus trauma ranges from 10% to 20%; however, because unilateral diaphragmatic paralysis often presents without symptoms at rest, a high number of phrenic nerve injuries are likely to be overlooked in the setting of brachial plexus injury. A case report is presented of a unilateral phrenic nerve injury associated with brachial plexus stretch injury presenting with a recalcitrant left lower lobe pneumonia. PMID:18723725

Franko, O I; Khalpey, Z; Gates, J

2008-09-01

154

The cutaneous cervical plexus nerves of the crab-eating macaque (Macaca fascicularis), eastern grey kangaroo (Macropus giganteus), and koala (Phascolarctos cinereus).  

Science.gov (United States)

The origin, course and distribution of the cutaneous nerves of the cervical plexus were examined in the crab-eating macaque (4 body-halves), the grey kangaroo (5 body-halves) and koala (3 body-halves). The cutaneous nerves, n. auricularis magnus, nn. supraclaviculares, n. transversus colli, and n. transversus cervicis, were recognized. Cranial and caudal branches were identified in the latter 2 nerves. Some intermediate, relatively small branches were recognized between these main nerves. The n. occipitalis minor was not recognized in all our specimens. Four segmental nerves, C2 to C5, gave rise to all the cutaneous nerves and branches of the cervical plexus described. However, between species there was some variation. In the crab-eating macaque the n. auricularis magnus and n. transversus colli tended to arise from a lower segment than in the grey kangaroo and koala. In the grey kangaroo the nn. supraclaviculares arose from a lower segment than in the crab-eating macaque and koala. PMID:2093157

Kato, K; Hopwood, P; Sato, T

1990-12-01

155

The cutaneous cervical plexus nerves of the crab-eating macaque (Macaca fascicularis), eastern grey kangaroo (Macropus giganteus), and koala (Phascolarctos cinereus).  

UK PubMed Central (United Kingdom)

The origin, course and distribution of the cutaneous nerves of the cervical plexus were examined in the crab-eating macaque (4 body-halves), the grey kangaroo (5 body-halves) and koala (3 body-halves). The cutaneous nerves, n. auricularis magnus, nn. supraclaviculares, n. transversus colli, and n. transversus cervicis, were recognized. Cranial and caudal branches were identified in the latter 2 nerves. Some intermediate, relatively small branches were recognized between these main nerves. The n. occipitalis minor was not recognized in all our specimens. Four segmental nerves, C2 to C5, gave rise to all the cutaneous nerves and branches of the cervical plexus described. However, between species there was some variation. In the crab-eating macaque the n. auricularis magnus and n. transversus colli tended to arise from a lower segment than in the grey kangaroo and koala. In the grey kangaroo the nn. supraclaviculares arose from a lower segment than in the crab-eating macaque and koala.

Kato K; Hopwood P; Sato T

1990-12-01

156

Surgery for abdominal wall pain caused by cutaneous nerve entrapment in children-a single institution experience in the last 5 years.  

UK PubMed Central (United Kingdom)

BACKGROUND: Chronic abdominal pain (CAP) is a serious medical condition which needs to be approached with great attention. Chronic abdominal pain may be caused by entrapment of cutaneous branches of intercostal nerves (ACNES). OBJECTIVES: The aim of this study is the surgery for abdominal wall pain which caused by cutaneous nerve entrapment in children during last 5 years. MATERIALS AND METHODS: In all children with ACNES, we tried conservative treatment with anesthetic and steroid injections. In children who were refractory to conservative treatment, we received surgical procedure like sectioning the entrapped nerve to obtain relief. RESULTS: In 12 pediatric patients with chronic abdominal pain, we diagnosed ACNES. Each presented with abdominal pain and a positive Carnett sign. Local nerve blocks using anesthetic and steroid injections are the treatment. In all patients, we tried with local nerve block. In 3 patients, pain improvement occurs in the few minutes, and they were without pain after 5 days. In other 4 patients required a reinjection for pain recurrence. In one patients pain was gone. The maximum reinjection was 3. In other 5 patients, we did operative treatment like sectioning the entrapped nerve. CONCLUSIONS: Some children with CAP have ACNES. In all children with ACNES, we recommended local nerve blocks. If the local block in 3 times is not helping, neurectomy of the peripheral nerve is method of choice.

Zganjer M; Boji? D; Bum?i I

2013-02-01

157

Perineural Invasion of Cutaneous Squamous Cell Carcinoma Along the Zygomaticotemporal Nerve.  

UK PubMed Central (United Kingdom)

The vast majority of periocular squamous cell carcinoma spreads intraorbitally along the supraorbital and infraorbital nerves into the cavernous sinus. A patient presented with a history of resected squamous cell carcinoma and pain in the zygomatic distribution. She was found to have temporalis involvement of the malignancy and invasion of the zygomaticotemporal nerve by histopathology. She underwent aggressive resection and adjuvant treatment with no evidence of recurrence at 8-month follow up. This case illustrates an uncommon route of squamous cell carcinoma spread through the zygomaticotemporal sensory nerve distribution.

Notz G; Cognetti D; Murchison AP; Bilyk JR

2013-08-01

158

ASPECTOS BIOMÉTRICOS DE LOS RAMOS MOTORES DEL NERVIO MUSCULOCUTÁNEO PARA EL MÚSCULO BRAQUIAL BIOMETRIC ASPECTS OF THE MOTOR BRANCHES OF THE MUSCULOCUTANEOUS NERVE TO THE BRACHIAL MUSCLE  

Directory of Open Access Journals (Sweden)

Full Text Available RESUMEN: Los puntos motores son el lugar de penetración de las fibras motoras en el músculo a través del epimisio por lo que su conocimiento es de importancia, sobretodo cuando se quiere electroestimular un músculo atrofiado. En relación a este tema, estudiamos la inervación del músculo braquial, describiendo con detalles los ramos que proceden del nervio musculocutáneo, considerando el nivel en que se originan, su distribución terminal y nivel de penetración en el tejido muscular. Para ello, estudiamos 46 miembros superiores de 23 cadáveres formolizados de individuos adultos, brasileños, de ambos sexos. Para determinar el punto de origen y el punto de penetración de los ramos musculares mencionados se consideró como referencia a la línea biepicondilar (LBE). El músculo braquial recibió ramos procedentes del nervio musculocutáneo en todos los casos (100%); un ramo fue encontrado en 15 casos (65,2%) en el lado derecho y en 18 casos (78,3%) en el izquierdo; con dos ramos se observaron 6 casos (26,1%) en el lado derecho y 2 casos (8,7%) en el izquierdo. También se presentaron 3 y 4 ramos. Cuando se presentó 1 ramo, su nivel de origen en el lado derecho fue en promedio de 130,1 ± 13,3 mm respecto de LBE y de 127,8 ± 12,0 mm en el izquierdo. Cuando se presentaron dos ramos, el nivel de origen de éstos, en el lado derecho fue en promedio de 126,2 ± 14,5 mm para el proximal y de100,2 ± 37,1 mm para el distal, siempre respecto de LBE. En el lado izquierdo, por tratarse de solo dos casos, no se calculó el promedio. Con respecto al punto de ingreso en el vientre muscular, la mayor parte de ellos lo hicieron por la parte medial del músculo, encontrando que cuando fue ramo único, 13 de ellos tuvieron esta característica en el lado derecho y 15 en el izquierdo. La casi totalidad de estos nervios se subdividieron en ramos menores (secundarios), encontrando 2, 3, 4 y 5 de ellos, los que penetraron en el tejido muscular a distintos niveles. Estos datos pueden servir de referencia a las cirugías de reinervación, bloqueo selectivo de puntos motores y tratamientos fisioterapéuticos en el brazoSUMMARY: The motor points are the penetration place of the motor fibers in the muscle through the epimisio, that is why its knowledge is of great importance, mainly when an atrophied muscle require to be electro-stimulated. In relation to this subject, we studied the innervation of the brachial muscle, describing in detail the branches coming from the musculocutaneous nerve, taking into account the levels where they originate, their final distribution and the penetration level in the muscular tissue. For this purpose, we have studied 46 upper limbs of 23 formolized corpses of Brazilian adult individuals of both sexes.In order to determine the origin and the penetration points of the mentioned muscular branches the biepicondilar line (LBE) was considered as reference. The brachial muscle received branches coming from the musculocutaneous nerve in all cases (100%); 1 branch was found in 15 cases (65.2%) at the right side and in 18 cases (78.3%) at the left side. With 2 branches, 6 cases (26.1%) were observed at the right side and 2 cases (8.7%) at the left side. There were also 3 and 4 branches. When there was only 1 branch, its origin level at the right side was of 130.1 ± 13.3 mm on average in respect to LBE and of 127.88 ± 12.0 mm at the left side. When there were 2 branches, their origin level was 126.2 ± 14.5 mm on average for the proximal and of 100.2 ± 37.1 mm for the distal, always in respect to LBE. At the left side, as there were only 2 cases, the average was not calculated. In relation to the entrance point in the muscular vientre, most of then did it through the medial portion of the muscle, finding that, when there was a single branch, 13 of then had this characteristic at the right side and 15 at the left side. Almost all these nerves subdivided in smaller branches (secondary) finding 2, 3, 4 and 5 of them, which penetrated in the muscul

E. Olave; C. Gabrielli; M. T. T. Braga; M. del Sol

2002-01-01

159

ASPECTOS BIOMÉTRICOS DE LOS RAMOS MOTORES DEL NERVIO MUSCULOCUTÁNEO PARA EL MÚSCULO BRAQUIAL/ BIOMETRIC ASPECTS OF THE MOTOR BRANCHES OF THE MUSCULOCUTANEOUS NERVE TO THE BRACHIAL MUSCLE  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish RESUMEN: Los puntos motores son el lugar de penetración de las fibras motoras en el músculo a través del epimisio por lo que su conocimiento es de importancia, sobretodo cuando se quiere electroestimular un músculo atrofiado. En relación a este tema, estudiamos la inervación del músculo braquial, describiendo con detalles los ramos que proceden del nervio musculocutáneo, considerando el nivel en que se originan, su distribución terminal y nivel de penetración en (more) el tejido muscular. Para ello, estudiamos 46 miembros superiores de 23 cadáveres formolizados de individuos adultos, brasileños, de ambos sexos. Para determinar el punto de origen y el punto de penetración de los ramos musculares mencionados se consideró como referencia a la línea biepicondilar (LBE). El músculo braquial recibió ramos procedentes del nervio musculocutáneo en todos los casos (100%); un ramo fue encontrado en 15 casos (65,2%) en el lado derecho y en 18 casos (78,3%) en el izquierdo; con dos ramos se observaron 6 casos (26,1%) en el lado derecho y 2 casos (8,7%) en el izquierdo. También se presentaron 3 y 4 ramos. Cuando se presentó 1 ramo, su nivel de origen en el lado derecho fue en promedio de 130,1 ± 13,3 mm respecto de LBE y de 127,8 ± 12,0 mm en el izquierdo. Cuando se presentaron dos ramos, el nivel de origen de éstos, en el lado derecho fue en promedio de 126,2 ± 14,5 mm para el proximal y de100,2 ± 37,1 mm para el distal, siempre respecto de LBE. En el lado izquierdo, por tratarse de solo dos casos, no se calculó el promedio. Con respecto al punto de ingreso en el vientre muscular, la mayor parte de ellos lo hicieron por la parte medial del músculo, encontrando que cuando fue ramo único, 13 de ellos tuvieron esta característica en el lado derecho y 15 en el izquierdo. La casi totalidad de estos nervios se subdividieron en ramos menores (secundarios), encontrando 2, 3, 4 y 5 de ellos, los que penetraron en el tejido muscular a distintos niveles. Estos datos pueden servir de referencia a las cirugías de reinervación, bloqueo selectivo de puntos motores y tratamientos fisioterapéuticos en el brazo Abstract in english SUMMARY: The motor points are the penetration place of the motor fibers in the muscle through the epimisio, that is why its knowledge is of great importance, mainly when an atrophied muscle require to be electro-stimulated. In relation to this subject, we studied the innervation of the brachial muscle, describing in detail the branches coming from the musculocutaneous nerve, taking into account the levels where they originate, their final distribution and the penetration (more) level in the muscular tissue. For this purpose, we have studied 46 upper limbs of 23 formolized corpses of Brazilian adult individuals of both sexes.In order to determine the origin and the penetration points of the mentioned muscular branches the biepicondilar line (LBE) was considered as reference. The brachial muscle received branches coming from the musculocutaneous nerve in all cases (100%); 1 branch was found in 15 cases (65.2%) at the right side and in 18 cases (78.3%) at the left side. With 2 branches, 6 cases (26.1%) were observed at the right side and 2 cases (8.7%) at the left side. There were also 3 and 4 branches. When there was only 1 branch, its origin level at the right side was of 130.1 ± 13.3 mm on average in respect to LBE and of 127.88 ± 12.0 mm at the left side. When there were 2 branches, their origin level was 126.2 ± 14.5 mm on average for the proximal and of 100.2 ± 37.1 mm for the distal, always in respect to LBE. At the left side, as there were only 2 cases, the average was not calculated. In relation to the entrance point in the muscular vientre, most of then did it through the medial portion of the muscle, finding that, when there was a single branch, 13 of then had this characteristic at the right side and 15 at the left side. Almost all these nerves subdivided in smaller branches (secondary) findin

Olave, E.; Gabrielli, C.; Braga, M. T. T.; del Sol, M.

2002-01-01

160

An immunohistochemical study on cutaneous sensory receptors after chronic median nerve compression in man.  

Science.gov (United States)

Carpal tunnel syndrome represents the most frequent chronic compressive neuropathy in man and hence may be investigated as a spontaneous model of peripheral nerve damage and repair. In the present report the fate of nerve fibers in the digital skin after long-lasting median nerve compression has been investigated immunohistochemically in comparison to normal digital skin, with special consideration to sensory endings and encapsulated receptors. The presence has been documented of the neurospecific marker PGP 9.5, the glia-associated protein S-100, and the neuropeptides CGRP and CPON which are mainly associated with the sensory and sympathetic nerve fibers respectively. The morphology and distribution of nerve fibers and corpuscles appeared comparable to that of normal digital skin; a reduction in the density of sensory receptors has, however, been observed, although not to the degree that was expected to explain the clinical deficits. It has been also demonstrated that at least part of the CGRP-containing sensory and CPON-containing sympathetic axons may survive unaltered even in patients with a long clinical history of profound sensorial impairment. An apparent discrepancy between the maintenance of nerve fibers and the sensory disturbances and the frequent observation of prompt postoperative recovery even after years of compression results from this investigation. The correlation of immunohistochemical observations and functional scores may not be considered conclusive. It must, however, be discussed if the sensorial impairment in this syndrome might have, at least in some cases, not only an anatomical but also an electrophysiological basis. PMID:7572032

Ramieri, G; Stella, M; Calcagni, M; Cellino, G; Panzica, G C

1995-01-01

 
 
 
 
161

An immunohistochemical study on cutaneous sensory receptors after chronic median nerve compression in man.  

UK PubMed Central (United Kingdom)

Carpal tunnel syndrome represents the most frequent chronic compressive neuropathy in man and hence may be investigated as a spontaneous model of peripheral nerve damage and repair. In the present report the fate of nerve fibers in the digital skin after long-lasting median nerve compression has been investigated immunohistochemically in comparison to normal digital skin, with special consideration to sensory endings and encapsulated receptors. The presence has been documented of the neurospecific marker PGP 9.5, the glia-associated protein S-100, and the neuropeptides CGRP and CPON which are mainly associated with the sensory and sympathetic nerve fibers respectively. The morphology and distribution of nerve fibers and corpuscles appeared comparable to that of normal digital skin; a reduction in the density of sensory receptors has, however, been observed, although not to the degree that was expected to explain the clinical deficits. It has been also demonstrated that at least part of the CGRP-containing sensory and CPON-containing sympathetic axons may survive unaltered even in patients with a long clinical history of profound sensorial impairment. An apparent discrepancy between the maintenance of nerve fibers and the sensory disturbances and the frequent observation of prompt postoperative recovery even after years of compression results from this investigation. The correlation of immunohistochemical observations and functional scores may not be considered conclusive. It must, however, be discussed if the sensorial impairment in this syndrome might have, at least in some cases, not only an anatomical but also an electrophysiological basis.

Ramieri G; Stella M; Calcagni M; Cellino G; Panzica GC

1995-01-01

162

Angiosomes of medial cord of brachial plexus  

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Full Text Available This anatomical study analyzed the neurovascular relationship of the brachial plexus. Ten formalized specimens of brachial plexuses were examined after injection of lead oxide in to the subclavian artery. The vascular, anatomical features of the brachial plexus were documented .The specimens were analyzed by dissection method, subjected for microscopic study. The vascular supply was markedly rich, often with true anastomotic channels found within the nerves. There was much variation in supply, depending on the branching pattern of subclavian artery. [Int J Res Med Sci 2013; 1(2.000): 79-82

D. Suseelamma; S. Deepthi; K. Krishna Chaitanya; H. R. Sharada

2013-01-01

163

A rare cause of forearm pain: anterior branch of the medial antebrachial cutaneous nerve injury: a case report  

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Full Text Available Abstract Introduction Medial antebrachial cutaneous nerve (MACN) neuropathy is reported to be caused by iatrogenic reasons. Although the cases describing the posterior branch of MACN neuropathy are abundant, only one case caused by lipoma has been found to describe the anterior branch of MACN neuropathy in the literature. As for the reason for the forearm pain, we report the only case describing isolated anterior branch of MACN neuropathy which has developed due to repeated minor trauma. Case presentation We report a 37-year-old woman patient with pain in her medial forearm and elbow following the shaking of a rug. Pain and symptoms of dysestesia in the distribution of the right MACN were found. Electrophysiological examination confirmed the normality of the main nerve trunks of the right upper limb and demonstrated abnormalities of the right MACN when compared with the left side. Sensory action potential (SAP) amplitude on the right anterior branch of the MACN was detected to be lower in proportion to the left. In the light of these findings, NSAI drug and physical therapy was performed. Dysestesia and pain were relieved and no recurrence was observed after a follow-up of 14 months. Conclusion MACN neuropathy should be taken into account for the differential diagnosis of the patients with complaints of pain and dysestesia in medial forearm and anteromedial aspect of the elbow.

Yildiz Necmettin; Ardic Füsun

2008-01-01

164

Specific paucity of unmyelinated C-fibers in cutaneous peripheral nerves of the African naked-mole rat: comparative analysis using six species of Bathyergidae.  

UK PubMed Central (United Kingdom)

In mammalian peripheral nerves, unmyelinated C-fibers usually outnumber myelinated A-fibers. By using transmission electron microscopy, we recently showed that the saphenous nerve of the naked mole-rat (Heterocephalus glaber) has a C-fiber deficit manifested as a substantially lower C:A-fiber ratio compared with other mammals. Here we determined the uniqueness of this C-fiber deficit by performing a quantitative anatomical analysis of several peripheral nerves in five further members of the Bathyergidae mole-rat family: silvery (Heliophobius argenteocinereus), giant (Fukomys mechowii), Damaraland (Fukomys damarensis), Mashona (Fukomys darlingi), and Natal (Cryptomys hottentotus natalensis) mole-rats. In the largely cutaneous saphenous and sural nerves, the naked mole-rat had the lowest C:A-fiber ratio (?1.5:1 compared with ?3:1), whereas, in nerves innervating both skin and muscle (common peroneal and tibial) or just muscle (lateral/medial gastrocnemius), this pattern was mostly absent. We asked whether lack of hair follicles alone accounts for the C-fiber paucity by using as a model a mouse that loses virtually all its hair as a consequence of conditional deletion of the ?-catenin gene in the skin. These ?-catenin loss-of function mice (?-cat LOF mice) displayed only a mild decrease in C:A-fiber ratio compared with wild-type mice (4.42 compared with 3.81). We suggest that the selective cutaneous C-fiber deficit in the cutaneous nerves of naked mole-rats is unlikely to be due primarily to lack of skin hair follicles. Possible mechanisms contributing to this unique peripheral nerve anatomy are discussed.

St John Smith E; Purfürst B; Grigoryan T; Park TJ; Bennett NC; Lewin GR

2012-08-01

165

Specific paucity of unmyelinated C-fibers in cutaneous peripheral nerves of the African naked-mole rat: comparative analysis using six species of Bathyergidae.  

Science.gov (United States)

In mammalian peripheral nerves, unmyelinated C-fibers usually outnumber myelinated A-fibers. By using transmission electron microscopy, we recently showed that the saphenous nerve of the naked mole-rat (Heterocephalus glaber) has a C-fiber deficit manifested as a substantially lower C:A-fiber ratio compared with other mammals. Here we determined the uniqueness of this C-fiber deficit by performing a quantitative anatomical analysis of several peripheral nerves in five further members of the Bathyergidae mole-rat family: silvery (Heliophobius argenteocinereus), giant (Fukomys mechowii), Damaraland (Fukomys damarensis), Mashona (Fukomys darlingi), and Natal (Cryptomys hottentotus natalensis) mole-rats. In the largely cutaneous saphenous and sural nerves, the naked mole-rat had the lowest C:A-fiber ratio (?1.5:1 compared with ?3:1), whereas, in nerves innervating both skin and muscle (common peroneal and tibial) or just muscle (lateral/medial gastrocnemius), this pattern was mostly absent. We asked whether lack of hair follicles alone accounts for the C-fiber paucity by using as a model a mouse that loses virtually all its hair as a consequence of conditional deletion of the ?-catenin gene in the skin. These ?-catenin loss-of function mice (?-cat LOF mice) displayed only a mild decrease in C:A-fiber ratio compared with wild-type mice (4.42 compared with 3.81). We suggest that the selective cutaneous C-fiber deficit in the cutaneous nerves of naked mole-rats is unlikely to be due primarily to lack of skin hair follicles. Possible mechanisms contributing to this unique peripheral nerve anatomy are discussed. PMID:22528859

St John Smith, Ewan; Purfürst, Bettina; Grigoryan, Tamara; Park, Thomas J; Bennett, Nigel C; Lewin, Gary R

2012-08-15

166

The excitation of cutaneous nerve endings in a neuroma by capsaicin.  

UK PubMed Central (United Kingdom)

Spontaneous electrophysiological activity and excitation by capsaicin of regenerating sensory fibers has been studied using 1 to 20-week-old neuromas induced in rats by ligating and transecting the saphenous nerve. Overall, spontaneous activity occurred in 12% of fibers, and capsaicin at concentrations up to 1.0 microM excited 3.8% of all the A delta-plus C-fibers examined. There was a slight increase in the incidence of spontaneous activity, but not excitation by capsaicin, with increasing age of the neuromas. The responses to capsaicin were similar to those seen with normal saphenous nerve endings, including bursting discharges and desensitization with repeated applications. The results are considered in the context of the requirements for reexpression of normal sensory capacities on regenerating sensory nerve endings.

Hartung M; Leah J; Zimmerman M

1989-10-01

167

[Risk management in brachial plexus block].  

UK PubMed Central (United Kingdom)

Peripheral nerve block has many advantages in surgical anesthesia with or without general anesthesia; postoperative analgesia, faster postoperative rehabilitation, and chronic pain management. However, serious adverse complications after peripheral nerve block can happen. Therefore, anesthetists should obtain full informed consent for possible complications, and require scrupulous attention to this procedure. This review focuses on complications of brachial plexus block because it is the most popular peripheral nerve block.

Kurita A; Yamamoto K

2011-11-01

168

Brachial plexus injuries in scapulothoracic dissociation.  

UK PubMed Central (United Kingdom)

The rare condition of scapulothoracic dissociation (STD) is characterized by a lateral displacement of the scapula from the thoracic cage following severe trauma to the scapular girdle. This study presents an analysis of five STDs. There were three supraclavicular brachial plexus palsies and two retro- and infraclavicular palsies. Recovery of elbow flexion was obtained in only two cases. Nerve damage dominates the prognosis and nerve recovery only rarely occurs. Nerve surgery should attempt to reestablish elbow flexion.

Masmejean EH; Asfazadourian H; Alnot JY

2000-08-01

169

Brachial plexus injuries in scapulothoracic dissociation.  

Science.gov (United States)

The rare condition of scapulothoracic dissociation (STD) is characterized by a lateral displacement of the scapula from the thoracic cage following severe trauma to the scapular girdle. This study presents an analysis of five STDs. There were three supraclavicular brachial plexus palsies and two retro- and infraclavicular palsies. Recovery of elbow flexion was obtained in only two cases. Nerve damage dominates the prognosis and nerve recovery only rarely occurs. Nerve surgery should attempt to reestablish elbow flexion. PMID:11057999

Masmejean, E H; Asfazadourian, H; Alnot, J Y

2000-08-01

170

Malignant brachial plexopathy: A pictorial essay of MRI findings  

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Full Text Available 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.

Iyer Veena; Sanghvi Darshana; Merchant Nikhil

2010-01-01

171

High-frequency transcutaneous peripheral nerve stimulation induces a higher increase of heat pain threshold in the cutaneous area of the stimulated nerve when confronted to the neighbouring areas.  

Science.gov (United States)

Background. TENS (transcutaneous electrical nerve stimulation) is probably the most diffused physical therapy used for antalgic purposes. Although it continues to be used by trial and error, correct targeting of paresthesias evoked by the electrical stimulation on the painful area is diffusely considered very important for pain relief. Aim. To investigate if TENS antalgic effect is higher in the cutaneous area of the stimulated nerve when confronted to neighbouring areas. Methods. 10 volunteers (4 males, 6 females) underwent three different sessions: in two, heat pain thresholds (HPTs) were measured on the dorsal hand skin before, during and after electrical stimulation (100?Hz, 0.1?msec) of superficial radial nerve; in the third session HPTs, were measured without any stimulation. Results. Radial nerve stimulation induced an increase of HPT significantly higher in its cutaneous territory when confronted to the neighbouring ulnar nerve territory, and antalgic effect persisted beyond the stimulation time. Conclusions. The location of TENS electrodes is crucial for obtaining the strongest pain relief, and peripheral nerve trunk stimulation is advised whenever possible. Moreover, the present study indicates that continuous stimulation could be unnecessary, suggesting a strategy for avoiding the well-known tolerance-like effect of prolonged TENS application. PMID:24027756

Buonocore, M; Camuzzini, N; Cecini, M; Dalla Toffola, E

2013-08-06

172

High-frequency transcutaneous peripheral nerve stimulation induces a higher increase of heat pain threshold in the cutaneous area of the stimulated nerve when confronted to the neighbouring areas.  

UK PubMed Central (United Kingdom)

Background. TENS (transcutaneous electrical nerve stimulation) is probably the most diffused physical therapy used for antalgic purposes. Although it continues to be used by trial and error, correct targeting of paresthesias evoked by the electrical stimulation on the painful area is diffusely considered very important for pain relief. Aim. To investigate if TENS antalgic effect is higher in the cutaneous area of the stimulated nerve when confronted to neighbouring areas. Methods. 10 volunteers (4 males, 6 females) underwent three different sessions: in two, heat pain thresholds (HPTs) were measured on the dorsal hand skin before, during and after electrical stimulation (100?Hz, 0.1?msec) of superficial radial nerve; in the third session HPTs, were measured without any stimulation. Results. Radial nerve stimulation induced an increase of HPT significantly higher in its cutaneous territory when confronted to the neighbouring ulnar nerve territory, and antalgic effect persisted beyond the stimulation time. Conclusions. The location of TENS electrodes is crucial for obtaining the strongest pain relief, and peripheral nerve trunk stimulation is advised whenever possible. Moreover, the present study indicates that continuous stimulation could be unnecessary, suggesting a strategy for avoiding the well-known tolerance-like effect of prolonged TENS application.

Buonocore M; Camuzzini N; Cecini M; Dalla Toffola E

2013-01-01

173

Avaliação clínica da dor e sensibilidade cutânea de pacientes submetidas à dissecção axilar com preservação do nervo intercostobraquial para tratamento cirúrgico do câncer de mama Clinical evaluation of pain and cutaneous sensitivity in patients with preservation of intercostobrachial nerve during the axillary dissection for breast cancer treatment  

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Full Text Available OBJETIVO: avaliar a dor e a sensibilidade cutânea superficial no dermátomo do nervo intercostobraquial (NICB) em pacientes submetidas à dissecção axilar com preservação do NICB para tratamento cirúrgico do câncer de mama. MÉTODOS: realizamos estudo tipo coorte prospectivo de 77 pacientes divididas em Grupo NP (n=34), sem preservação do NICB, e Grupo ICB (n=43), com preservação do NICB. A sensibilidade cutânea foi avaliada um ano após a cirurgia, empregando-se: 1) questionário modificado de McGill; 2) exame clínico incluindo perimetria braquial, pesquisa de sensibilidade táctil e dolorosa; 3) aplicação dos monofilamentos de Semmes-Weinsten que permitem avaliar de forma objetiva, qualitativa e quantitativamente, lesões de nervo periférico. Para análise estatística, foram usados os testes do chi2, Kruskal-Wallis e exato de Fisher. RESULTADOS: a dor foi relatada com maior freqüência pelas pacientes do Grupo NP (23/33) do que pelas pacientes do Grupo ICB (17/42); p=0,012. A sensibilidade dolorosa estava preservada na maioria das pacientes do Grupo ICB (38/42) e em apenas 11/33 do Grupo NP (pPURPOSE: loss of cutaneous sensitivity has been related to lesions of the intercostobrachial nerve (ICBN) during the axillary lymph node dissection for breast cancer treatment. We evaluated pain and cutaneous sensitivity in the ICBN dermatome of patients in which the nerve was preserved during the axillary dissection. METHODS: we carried out a prospective cohort study of 77 patients divided into: NP group (n=34), patients without ICBN preservation, and ICB group (n=43), patients in which the nerve was preserved. Cutaneous sensitivity was evaluated one year after surgery using 1) a modified McGill Pain Questionnaire; 2) clinical examination including brachial perimetry and evaluation of pain and tactile sensitivity; 3) Semmes-Weinstein monofilaments which allow an objective, qualitative, and quantitative evaluation of peripheral nerve lesions. RESULTS: pain was more frequently reported in the NP group (23/33) than in patients from the ICB group (17/42); p=0,012. Painful sensitivity was preserved in the majority of patients from the ICB group (38/42) but in only 11/33 patients from the NP group (p<0,01). There was no significant difference in the number of lymph nodes dissected between the two groups (p=0,06). CONCLUSIONS: patients with ICBN preservation had less pain and more preservation of cutaneous sensitivity, with no decreased number of axillary lymph nodes removed during the axillary dissection.

Mônica Duarte Pimentel; Luiz Cláudio dos Santos; Helenice Gobbi

2007-01-01

174

División Alta del Nervio Fibular Superficial: Origen Precoz de los Nervios Cutáneos Dorsales del Pie/ High Division of Superficial Fibular Nerve: Early Origin of the Dorsal Cutaneous Nerves of the Foot  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Los nervios cutáneos dorsales del pie se originan a partir del nervio fibular superficial (NFS), después que éste pasa desde el compartimiento lateral de la pierna a través de la fascia profunda, para luego distribuirse superficialmente en el dorso del pie. A veces, el nervio fibular superficial se divide precozmente, por lo que estos nervios se originan profundamente y con una disposición diferente. Con el propósito de dar a conocer en estos casos, los niveles de o (more) rigen de los nervios cutáneos dorsales del pie y el punto de penetración en la fascia profunda de la pierna, se estudiaron 16 muestras de individuos, chilenos, adultos, fijadas en formaldehido al 10%. En 2 de ellas, su origen se observó a un nivel alto, cerca de la parte proximal de la fíbula. En el primer caso, el nervio cutáneo dorsal intermedio se originó directamente de la división posterior del NFS; la división anterior del NFS se subdividió en dos ramos, los que después de un corto trayecto se unieron y formaron el nervio cutáneo dorsal medial. En el segundo caso, los nervios cutáneos dorsales intermedio y medial se originaron directamente del NFS, que después de un corto trayecto se dividió en estos dos nervios. El origen de los nervios cutáneos dorsales del pie se registró en relación al epicóndilo lateral del fémur y el paso de éstos a través de la fascia profunda de la pierna hacia su distribución cutánea fue relacionado al maléolo lateral. Aunque el origen de los nervios cutáneos dorsales del pie ocurra a un nivel próximo a la cabeza de la fíbula, perforan la fascia mencionada, en su tercio distal. Un conocimiento detallado del NFS y de sus ramos y variaciones anatómicas puede reducir lesiones iatrogénicas en éstos durante los procedimientos quirúrgicos realizados en el compartimiento lateral de la pierna. Abstract in english The dorsal cutaneous nerves of the foot originate from the superficial fibular nerve (SFN), then pass from the lateral compartment of the leg piercing the deep fascia, thus distributed superficially in the dorsum of the foot. Sometimes SFN splits early, so these nerves originate deeply and with a different arrangement. The objective of this research was to study in these cases, the origin of the dorsal cutaneous nerves of the foot and pierce point level in the deep fascia (more) of the leg. We studied 16 formolized samples of Chilean adult individuals. In two of them its origin was observed at a high level, near the proximal epiphysis of the fibula. In the first case the intermediate dorsal cutaneous nerve arose directly from the posterior division of SFN, of short course; the anterior division of SFN was subdivided into two branches, which after a short course, both branches joined to form the medial dorsal cutaneous nerve. In the second case the medial and intermediate dorsal cutaneous nerves originated directly from the SFN, which after a short course, it divided in these two nerves. The origin level was recorded in relation to the lateral epicondyle of the femur and the passage of these nerves through the deep fascia of the leg for its skin distribution was located in relation to the lateral malleolus. Although the origin of the dorsal cutaneous nerves of the foot occur very close to the proximal epiphysis of the fibula, passing through the mentioned fascia in its distal third. A detailed knowledge of the branches of the SFN and variations can reduce injuries in these nerves during surgical procedures in the lateral compartment of the leg.

Olave, E; Galaz, C; Retamal, P; Cruzat, C

2011-06-01

175

División Alta del Nervio Fibular Superficial: Origen Precoz de los Nervios Cutáneos Dorsales del Pie High Division of Superficial Fibular Nerve: Early Origin of the Dorsal Cutaneous Nerves of the Foot  

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Full Text Available Los nervios cutáneos dorsales del pie se originan a partir del nervio fibular superficial (NFS), después que éste pasa desde el compartimiento lateral de la pierna a través de la fascia profunda, para luego distribuirse superficialmente en el dorso del pie. A veces, el nervio fibular superficial se divide precozmente, por lo que estos nervios se originan profundamente y con una disposición diferente. Con el propósito de dar a conocer en estos casos, los niveles de origen de los nervios cutáneos dorsales del pie y el punto de penetración en la fascia profunda de la pierna, se estudiaron 16 muestras de individuos, chilenos, adultos, fijadas en formaldehido al 10%. En 2 de ellas, su origen se observó a un nivel alto, cerca de la parte proximal de la fíbula. En el primer caso, el nervio cutáneo dorsal intermedio se originó directamente de la división posterior del NFS; la división anterior del NFS se subdividió en dos ramos, los que después de un corto trayecto se unieron y formaron el nervio cutáneo dorsal medial. En el segundo caso, los nervios cutáneos dorsales intermedio y medial se originaron directamente del NFS, que después de un corto trayecto se dividió en estos dos nervios. El origen de los nervios cutáneos dorsales del pie se registró en relación al epicóndilo lateral del fémur y el paso de éstos a través de la fascia profunda de la pierna hacia su distribución cutánea fue relacionado al maléolo lateral. Aunque el origen de los nervios cutáneos dorsales del pie ocurra a un nivel próximo a la cabeza de la fíbula, perforan la fascia mencionada, en su tercio distal. Un conocimiento detallado del NFS y de sus ramos y variaciones anatómicas puede reducir lesiones iatrogénicas en éstos durante los procedimientos quirúrgicos realizados en el compartimiento lateral de la pierna.The dorsal cutaneous nerves of the foot originate from the superficial fibular nerve (SFN), then pass from the lateral compartment of the leg piercing the deep fascia, thus distributed superficially in the dorsum of the foot. Sometimes SFN splits early, so these nerves originate deeply and with a different arrangement. The objective of this research was to study in these cases, the origin of the dorsal cutaneous nerves of the foot and pierce point level in the deep fascia of the leg. We studied 16 formolized samples of Chilean adult individuals. In two of them its origin was observed at a high level, near the proximal epiphysis of the fibula. In the first case the intermediate dorsal cutaneous nerve arose directly from the posterior division of SFN, of short course; the anterior division of SFN was subdivided into two branches, which after a short course, both branches joined to form the medial dorsal cutaneous nerve. In the second case the medial and intermediate dorsal cutaneous nerves originated directly from the SFN, which after a short course, it divided in these two nerves. The origin level was recorded in relation to the lateral epicondyle of the femur and the passage of these nerves through the deep fascia of the leg for its skin distribution was located in relation to the lateral malleolus. Although the origin of the dorsal cutaneous nerves of the foot occur very close to the proximal epiphysis of the fibula, passing through the mentioned fascia in its distal third. A detailed knowledge of the branches of the SFN and variations can reduce injuries in these nerves during surgical procedures in the lateral compartment of the leg.

E Olave; C Galaz; P Retamal; C Cruzat

2011-01-01

176

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

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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).

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

2003-01-01

177

Brachial plexus morphology and vascular supply in the wistar rat.  

UK PubMed Central (United Kingdom)

INTRODUCTION: The rat is probably the animal species most widely used in experimental studies on nerve repair. The aim of this work was to contribute to a better understanding of the morphology and blood supply of the rat brachial plexus. MATERIAL AND METHODS: Thirty adult rats were studied regarding brachial plexus morphology and blood supply. Intravascular injection and dissection under an operating microscope, as well as light microscopy and scanning electron microscopy techniques were used to define the microanatomy of the rat brachial plexus and its vessels. RESULTS: The rat brachial plexus was slightly different from the human brachial plexus. The arterial and venous supply to the brachial plexus plexus was derived directly or indirectly from neighboring vessels. These vessels formed dense and interconnected plexuses in the epineurium, perineurium, and endoneurium. Several brachial plexus components were accompanied for a relatively long portion of their length by large and constant blood vessels that supplied their epineural plexus, making it possible to raise these nerves as flaps. DISCUSSION: The blood supply to the rat brachial plexus is not very different from that reported in humans, making the rat a useful animal model for the experimental study of peripheral nerve pathophysiology and treatment. CONCLUSION: Our results support the homology between the rat and the human brachial plexus in terms of morphology and blood supply. This work suggests that several components of the rat brachial plexus can be used as nerve flaps, including predominantly motor, sensory or mixed nerve fibers. This information may facilitate new experimental procedures in this animal model.

Angélica-Almeida M; Casal D; Mafra M; Mascarenhas-Lemos L; Martins-Ferreira J; Ferraz-Oliveira M; Amarante J; Goyri-O'Neill J

2013-05-01

178

[Surgical treatment of children with brachial plexus paralysis].  

UK PubMed Central (United Kingdom)

OBJECTIVE AND METHODS: A variety of surgical procedures exist for early repair of the nerve injury in obstetrical brachial plexus palsy, including neuroma excision and nerve grafting, neurolysis and neurotization. Secondary deformities of the shoulder, forearm, and hand can similarly be reconstructed using soft tissue and skeletal procedures. This review describes our surgical approach to maximize the ultimate functional outcome in infants and children with obstetrical brachial plexus palsy.

Grossman JA; Ramos LE; Tidwell M; Price A; Papazian O; Alfonso I

1998-08-01

179

Dorsal ulnar cutaneous nerve conduction: reference values Condução nervosa do nervo cutâneo ulnar dorsal: valores de referência  

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Full Text Available We investigated the reference values of the dorsal ulnar cutaneous nerve (DUC) sensory nerve conduction (SNC) in 66 healthy individuals. Measurements were processed using stimulating electrodes positioned between the ulnar bone and the flexor carpi ulnaris muscle, 11-13 cm proximal to the active electrode recording. Superficial recording electrodes were placed on the fourth intermetacarpal space. The mean sensory conduction velocity (SCV) in males was 63.7 -- 0.16 x age ± 3.36 m/s and in females was 57.7 ± 3.37 m/s. The mean sensory nerve action potential (SNAP) amplitude in males was 19.5 ± 10.7 µV and in females was 24.6 ± 5.8 µV. The mean SNAP duration was 0.96 ± 0.13 ms. No significant differences regarding the DUC-SCV, distal latency, and SNAP duration or amplitude were found between both sides of the same subject. The amplitude of the SNAP was higher in females than males. The effects of age on DUC-SCV were distinct for each gender.Investigamos os valores de referência da condução nervosa sensitiva do nervo cutâneo ulnar dorsal em 66 indivíduos normais, por técnica de condução nervosa antidrômica. A velocidade de condução sensitiva (VCS) média, em homens foi 63,7 -- 0,16 x idade ± 3,36 m/s e nas mulheres 57,7 ± 3,37 m/s. A amplitude média do potencial de ação nervoso sensitivo (PANS) em homens foi 19,5 ± 10,7 µV e nas mulheres foi 24,6 ± 5,8 µV. A duração média do PANS foi 0,96 ± 0,13 ms. A dominância manual não interferiu nos valores da VCS, latência distal, amplitude e duração do PANS. Nas mulheres a amplitude do PANS foi maior do que nos homens. Os efeitos da idade na VCS foram distintos para cada sexo.

Solange G. Garibaldi; Anamarli Nucci

2002-01-01

180

Avaliação clínica da dor e sensibilidade cutânea de pacientes submetidas à dissecção axilar com preservação do nervo intercostobraquial para tratamento cirúrgico do câncer de mama/ Clinical evaluation of pain and cutaneous sensitivity in patients with preservation of intercostobrachial nerve during the axillary dissection for breast cancer treatment  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese OBJETIVO: avaliar a dor e a sensibilidade cutânea superficial no dermátomo do nervo intercostobraquial (NICB) em pacientes submetidas à dissecção axilar com preservação do NICB para tratamento cirúrgico do câncer de mama. MÉTODOS: realizamos estudo tipo coorte prospectivo de 77 pacientes divididas em Grupo NP (n=34), sem preservação do NICB, e Grupo ICB (n=43), com preservação do NICB. A sensibilidade cutânea foi avaliada um ano após a cirurgia, empregando (more) -se: 1) questionário modificado de McGill; 2) exame clínico incluindo perimetria braquial, pesquisa de sensibilidade táctil e dolorosa; 3) aplicação dos monofilamentos de Semmes-Weinsten que permitem avaliar de forma objetiva, qualitativa e quantitativamente, lesões de nervo periférico. Para análise estatística, foram usados os testes do chi2, Kruskal-Wallis e exato de Fisher. RESULTADOS: a dor foi relatada com maior freqüência pelas pacientes do Grupo NP (23/33) do que pelas pacientes do Grupo ICB (17/42); p=0,012. A sensibilidade dolorosa estava preservada na maioria das pacientes do Grupo ICB (38/42) e em apenas 11/33 do Grupo NP (p Abstract in english PURPOSE: loss of cutaneous sensitivity has been related to lesions of the intercostobrachial nerve (ICBN) during the axillary lymph node dissection for breast cancer treatment. We evaluated pain and cutaneous sensitivity in the ICBN dermatome of patients in which the nerve was preserved during the axillary dissection. METHODS: we carried out a prospective cohort study of 77 patients divided into: NP group (n=34), patients without ICBN preservation, and ICB group (n=43), p (more) atients in which the nerve was preserved. Cutaneous sensitivity was evaluated one year after surgery using 1) a modified McGill Pain Questionnaire; 2) clinical examination including brachial perimetry and evaluation of pain and tactile sensitivity; 3) Semmes-Weinstein monofilaments which allow an objective, qualitative, and quantitative evaluation of peripheral nerve lesions. RESULTS: pain was more frequently reported in the NP group (23/33) than in patients from the ICB group (17/42); p=0,012. Painful sensitivity was preserved in the majority of patients from the ICB group (38/42) but in only 11/33 patients from the NP group (p

Pimentel, Mônica Duarte; Santos, Luiz Cláudio dos; Gobbi, Helenice

2007-06-01

 
 
 
 
181

Brachial plexus variations during the fetal period.  

UK PubMed Central (United Kingdom)

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.

Wo?niak J; K?dzia A; Dudek K

2012-12-01

182

Brachial plexus variations during the fetal period.  

Science.gov (United States)

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

Wo?niak, Jowita; K?dzia, Alicja; Dudek, Krzysztof

2012-09-04

183

Ankle-Brachial Index  

Science.gov (United States)

Ankle-brachial index Basics Multimedia Resources Reprints A single copy of this article may be reprinted for personal, noncommercial use only. Ankle-brachial index By Mayo Clinic staff Original Article: http://www. ...

184

Ultrasound-guided supraclavicular brachial plexus block.  

UK PubMed Central (United Kingdom)

UNLABELLED: In this study, we evaluated state-of-the-art ultrasound technology for supraclavicular brachial plexus blocks in 40 outpatients. Ultrasound imaging was used to identify the brachial plexus before the block, guide the block needle to reach target nerves, and visualize the pattern of local anesthetic spread. Needle position was further confirmed by nerve stimulation before injection. The block technique we describe aligned the needle path with the ultrasound beam. The block was successful after one attempt in 95% of the cases, with one failure attributable to subcutaneous injection and one to partial intravascular injection. Pneumothorax did not occur. Our preliminary data suggest that a high-resolution ultrasound probe can reliably identify the brachial plexus and its neighboring structures in the supraclavicular region. The technique of real-time guidance during needle advancement can quickly localize nerves. Distinct patterns of local anesthetic spread observed on ultrasound can further confirm accurate needle location. IMPLICATIONS: Real-time ultrasound imaging during supraclavicular brachial plexus blocks can facilitate nerve localization and needle placement and examine the pattern of local anesthetic spread.

Chan VW; Perlas A; Rawson R; Odukoya O

2003-11-01

185

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

Energy Technology Data Exchange (ETDEWEB)

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% CO{sub 2}. 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 10{sup 4} 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 by run). The analysis was done on at least 100 images from two comet slides (one per Petri dish) for each cellular model and exposure condition. Results The analysis of the slides is ongoing. Once the data analysis is completed, I.T.I.S. will break the blinding codes, and the results will be presented at the meeting. Acknowledgement: This work was supported by France Telecom R and D, Bouygues Telecom, the Cnrs and the Aquitaine Council for Research. (authors)

Sanchez, S.; Poulletier De Gannes, F.; Haro, E.; Ruffie, G.; Lagroye, I.; Billaudel, B.; Veyret, B. [PIOM laboratory, UMR 5501 CNRS, ENSCPB, 33 -Pessac (France)

2006-07-01

186

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

International Nuclear Information System (INIS)

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 by run). The analysis was done on at least 100 images from two comet slides (one per Petri dish) for each cellular model and exposure condition. Results The analysis of the slides is ongoing. Once the data analysis is completed, I.T.I.S. will break the blinding codes, and the results will be presented at the meeting. Acknowledgement: This work was supported by France Telecom R and D, Bouygues Telecom, the Cnrs and the Aquitaine Council for Research. (authors)

2006-01-01

187

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

International Nuclear Information System (INIS)

[en] 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)

1982-01-01

188

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

Energy Technology Data Exchange (ETDEWEB)

The release of /sup 3/H-dopamine (DA) continuously synthesized from /sup 3/H-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 /sup 3/H-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 reestablish sufficient release of DA when the dopaminergic function is impaired as in Parkinson's disease.

Nieoullon, A.; Dusticier, N. (Centre National de la Recherche Scientifique, 13 - Marseille (France). Inst. de Neurophysiologie et Psychophysiologie)

1982-01-01

189

Facial nerve reconstruction using a vascularized lateral femoral cutaneous nerve graft based on the superficial circumflex iliac artery system: an application of the inferolateral extension of the groin flap.  

Science.gov (United States)

The use of an inferolateral extension technique of a groin flap has previously been reported. This technique involves harvesting an extended portion from the anterolateral thigh, including the lateral femoral cutaneous nerve (LFCN) and its accompanying vessels, attached to a groin flap via communications between the LFCN-accompanying vessels and the superficial circumflex iliac artery (SCIA) system. In this study, we used this technique involving a vascularized LFCN combined with a groin flap to reconstruct a facial nerve defect. The patient was a 58-year-old man with a salivary duct carcinoma in the left parotid gland. Tumor ablation resulted in a defect of the skin and soft tissue including all branches of the facial nerve. A free groin flap was harvested based on the SCIA system, composed of the LFCN and a small monitoring flap, which were nourished by the LFCN-accompanying vessels and by communication with the SCIA system. The LFCN was transplanted into the gaps in the facial nerve branches as a cable graft, and the skin flap was used to cover and fill the soft tissue defect. The postoperative course was uneventful and satisfactory facial animation was obtained. This represents a possible technique for nerve reconstruction using a vascularized nerve graft. PMID:20697990

Kashiwa, Katsuhiko; Kobayashi, Seiichiro; Nasu, Wakako; Kuroda, Takashi; Higuchi, Hirofumi

2010-08-09

190

Facial nerve reconstruction using a vascularized lateral femoral cutaneous nerve graft based on the superficial circumflex iliac artery system: an application of the inferolateral extension of the groin flap.  

UK PubMed Central (United Kingdom)

The use of an inferolateral extension technique of a groin flap has previously been reported. This technique involves harvesting an extended portion from the anterolateral thigh, including the lateral femoral cutaneous nerve (LFCN) and its accompanying vessels, attached to a groin flap via communications between the LFCN-accompanying vessels and the superficial circumflex iliac artery (SCIA) system. In this study, we used this technique involving a vascularized LFCN combined with a groin flap to reconstruct a facial nerve defect. The patient was a 58-year-old man with a salivary duct carcinoma in the left parotid gland. Tumor ablation resulted in a defect of the skin and soft tissue including all branches of the facial nerve. A free groin flap was harvested based on the SCIA system, composed of the LFCN and a small monitoring flap, which were nourished by the LFCN-accompanying vessels and by communication with the SCIA system. The LFCN was transplanted into the gaps in the facial nerve branches as a cable graft, and the skin flap was used to cover and fill the soft tissue defect. The postoperative course was uneventful and satisfactory facial animation was obtained. This represents a possible technique for nerve reconstruction using a vascularized nerve graft.

Kashiwa K; Kobayashi S; Nasu W; Kuroda T; Higuchi H

2010-11-01

191

Brachial plexus injury following brachial plexus block.  

UK PubMed Central (United Kingdom)

A patient developed paralysis over the left upper limb 2 days after an otherwise uneventful supraclavicular brachial plexus block. Symptoms continued for 8 weeks after the block. The various possible causes for this complication are discussed. Although brachial plexus injury following the block is rare, some recommendations are made to reduce the incidence of this complication.

Lim EK; Pereira R

1984-07-01

192

Angiosomes of the brachial plexus: an anatomical study.  

UK PubMed Central (United Kingdom)

This anatomical study analyzed the neurovascular relationships of the brachial plexus. Ten fresh cadaveric brachial plexuses were examined after injection of the arterial system. The vascular anatomical features of the brachial plexus were documented with microdissection after lead oxide/gelatin injection. The specimens were analyzed by using radiography (including digital subtraction techniques) and light-microscopic, macroscopic, and digital photography. Four angiosomes, based on the subclavian, axillary, vertebral, and dorsal scapular arteries, were observed. As noted in previous angiosome studies, connections between angiosome territories lay within tissues, in this case, nerve trunks. Nutrient vessels penetrated nerve trunks at points of branching within the brachial plexus, with a Y-shaped mode of division on entry. The vascular supply was markedly rich, often with true anastomotic connections occurring within the nerves. There was much variation in supply, depending on the vascular anatomical features of the subclavian artery.

Levy SM; Taylor GI; Baudet J; Guérin J; Casoli V; Pan WR; Houseman ND

2003-12-01

193

Evoked spinal cord potentials for diagnosis during brachial plexus surgery.  

Science.gov (United States)

We used evoked spinal cord potentials (ESCP) for intraoperative diagnosis in 17 cases of traumatic brachial plexus palsy. Forty spinal nerves were directly stimulated during exploration of the brachial plexus and ESCP recorded from the cervical epidural space were compared with simultaneously observed somatosensory evoked potentials (SEP) and myelographic findings. Both SEP and ESCP could be evoked in 21 spinal nerves but ESCP were always more distinct and five to ten times greater in amplitude than SEP. In four nerves, ESCP but no SEP were produced, suggesting that there was continuity from the nerves to the spinal cord. ESCP were obtained from two spinal nerves which appeared to be abnormal on the myelogram. The results show that intraoperative electrodiagnosis by epidural ESCP recordings can provide useful information on the lesions of traumatic brachial plexus palsy. PMID:8376438

Murase, T; Kawai, H; Masatomi, T; Kawabata, H; Ono, K

1993-09-01

194

Evoked spinal cord potentials for diagnosis during brachial plexus surgery.  

UK PubMed Central (United Kingdom)

We used evoked spinal cord potentials (ESCP) for intraoperative diagnosis in 17 cases of traumatic brachial plexus palsy. Forty spinal nerves were directly stimulated during exploration of the brachial plexus and ESCP recorded from the cervical epidural space were compared with simultaneously observed somatosensory evoked potentials (SEP) and myelographic findings. Both SEP and ESCP could be evoked in 21 spinal nerves but ESCP were always more distinct and five to ten times greater in amplitude than SEP. In four nerves, ESCP but no SEP were produced, suggesting that there was continuity from the nerves to the spinal cord. ESCP were obtained from two spinal nerves which appeared to be abnormal on the myelogram. The results show that intraoperative electrodiagnosis by epidural ESCP recordings can provide useful information on the lesions of traumatic brachial plexus palsy.

Murase T; Kawai H; Masatomi T; Kawabata H; Ono K

1993-09-01

195

Anatomical and Biometric Aspects of the Cutaneous Distribution of the Superficial Fibular Nerve Aspectos Anatómicos y Biométricos de la Distribución Cutánea del Nervio Fibular Superficial  

Directory of Open Access Journals (Sweden)

Full Text Available The objective of this research was to study the cutaneous branching of the superficial fibular nerve (SFN), with a topographic and biometric focus, aiming to provide further anatomical details for foot and ankle surgery in general. There were analyzed 30 right and left lower limbs of 15 corpses of male adult Brazilian individuals. The cutaneous branching of the nerve was dissected and measurements taken with a tape measure and digital caliper. The nerve emerged at the surface as a single trunk in 66.7% and divided into two branches in 33.3% of the cases. When a single trunk emerged, it appeared at the level of the third distal of the leg in 75%, at the boundary between the middle and distal thirds in 20%, and, in the middle third in 5%. When divided, in most cases (60%), the two branches had the same topography, in general, in the distal third of the leg. The average width of the nerve, at its emergence, when single, was 3.1 ± 0.8 mm, when divided, one of its branches, the medial dorsal cutaneous nerve (MDCn) of the foot, measured 2.4 ± 0.9 mm, and the other, the intermediate dorsal cutaneous nerve (IDCn) of the foot 2.1 ± 0.6 mm. The MDCn communicated with the deep fibular nerve in 53.3%, and the IDCn with the sural nerve in 33.3%. In its distribution in the dorsum of the foot, the MDCn was related mainly with the first metatarsal bone and the first and second interosseous spaces, and the IDCn, in general, with the fourth metatarsal bone and the third and fourth interosseous spaces. There are important variations in the emergence and cutaneous branching of the SFN, which must be known in order to avoid iatrogenic injury during surgical procedures on the foot and ankleEl propósito de esta investigación fue estudiar la ramificación cutánea del nervio fibular superficial (NFS), con enfoques topográfico y biométrico, para proveer mayores detalles anatómicos a las cirugías del pie y tobillo. Fueron analizados 30 miembros inferiores, derechos e izquierdos, de 15 cadáveres de individuos brasileños adultos, de sexo masculino. La ramificación cutánea del nervio fue disecada y las medidas fueron tomadas con cinta métrica y paquímetro digital. El nervio se observó en la superficie como tronco único en 66,7% de los casos y dividido en dos ramos en 33,3%. Cuando se presentó como tronco único, emergió a nivel del tercio distal de la pierna en 75%, en el límite entre los tercios medio y distal en 20%, y, en el tercio medio en 5%. Cuando se presentó dividido, los dos ramos tuvieron la misma topografía en 60% de los casos, en general, el tercio distal de la pierna. Al salir a la superficie, el promedio del diámetro externo del nervio, cuando era único, fue de 3,1 ± 0,8 mm, y cuando estaba dividido, uno de sus ramos, el nervio cutáneo dorsal medial (nCDM) del pie, midió 2,4 ± 0,9 mm, y el otro, el nervio cutáneo dorsal intermedio (nCDI) del pie, 2,1 ± 0,6 mm. El nCDM se comunicó con el nervio fibular profundo en 53,3% y el nCDI con el nervio sural en 33,3%. En su distribución en el dorso del pie, el nCDM estuvo relacionado principalmente con el 1er hueso metatarsiano y los dos primeros espacios interóseos, mientras que el nCDI, se relacionó en general, con el cuarto hueso metatarsiano y el tercero y cuarto espacios interóseos. La emergencia y ramificación cutánea del NFS presentan importantes variaciones que deben ser conocidas para evitar lesiones iatrogénicas durante procedimientos quirúrgicos el en pie y tobillo

Carla Gabrielli; Ilário Froehner Junior; Maria Terezinha Teixeira Braga

2005-01-01

196

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

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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.

Elenara B. Araújo; Ana R. Lima; Luane L. Pinheiro; José A.P.C. Muniz; Aline Imbeloni; Érika Branco

2012-01-01

197

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  

Directory of Open Access Journals (Sweden)

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.

Mônica Vicky Bahr Arias; Ângelo João Stopiglia

1997-01-01

198

Brachial plexus lesions associated with dislocated shoulders.  

UK PubMed Central (United Kingdom)

We reviewed 28 patients with brachial plexus lesions caused by shoulder dislocation. Contrary to most other reports, we found that the neurological lesions involved the infraclavicular and the supraclavicular brachial plexus. With supraclavicular lesions the involvement was always of the suprascapular nerve, and this always recovered spontaneously. Isolated axillary nerve lesions had the poorest prognosis for spontaneous recovery. We explored all lesions that showed no recovery after three to five months and performed either grafting or neurolysis. We discuss the combinations of nerve lesions, their recovery, the surgical indications, and the operations. We also suggest a new classification for these injuries which is more clinically relevant than the anatomical classification of Leffert and Seddon (1965).

Travlos J; Goldberg I; Boome RS

1990-01-01

199

Infraclavicular Brachial Plexus Blockade in a Case with Ulnar Shaft Fracture  

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Full Text Available The brachial plexus is a peripheral nerve system that is responsible for motor, sympathetic and sensorial innervations of upper extremity. Brachial plexus lies between neck and shoulder next to great vessels and lungs. The anesthesia of upper extremities and shoulder can be achieved by blockade of brachial plexus in different places. Brachial plexus can be blocked using interscalene, supraclavicular, infraclavicular and axillary methods. In this case report, we presented an infraclavicular brachial plexus blockade for a patient with ulnar shaft fracture.

Mehmet Turan Inal; Canan Inal; Sermet Inal

2008-01-01

200

Distribution of evoked paraesthesiae and effectiveness of brachial plexus block.  

UK PubMed Central (United Kingdom)

The distribution of paraesthesiae evoked by a low power nerve stimulator during performance of supraclavicular brachial plexus block was studied in 120 patients. Evoked paraesthesiae in the distribution of the median nerve was associated with a significant improvement in effectiveness of the block when compared with evoked paraesthesiae in the ulnar and radial distributions. A possible explanation for this finding is proposed.

Smith BE

1986-11-01

 
 
 
 
201

Distribuição do nervo cutâneo lateral da coxa na área de injeção intramuscular/ Distribution of the lateral cutaneous nerve of the thigh in the area of intramuscular injection  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese A técnica de injeção intramuscular (IM) na região ântero-lateral da coxa é prática médica muito utilizada. Entretanto, apesar desta área ser apontada como segundo melhor local para esta prática, tanto em adultos como em crianças, a técnica ainda mostra-se muito dolorosa em ambos. OBJETIVO: Estudar a localização, distribuição, trajeto e relação topográfica do nervo cutâneo lateral da coxa com a área recomendada para prática da injeção intramuscular, (more) relacionando-os à dor decorrente de tal procedimento. MÉTODO: Através da exposição da região ântero-lateral por dissecção clássica, o nervo cutâneo lateral da coxa foi identificado e isolado em 20 cadáveres adultos masculinos fixados, dando-se ênfase à visualização de seus ramos nervosos sobre o tracto iliotibial. RESULTADOS: Após emergir medialmente em relação à espinha ilíaca ântero-superior, em 100% dos casos, o nervo cutâneo lateral da coxa emite três ramos calibrosos em 70% dos espécimes, sendo que em 30% emite apenas dois. No terço superior, e na porção superior do terço médio da coxa, observa-se uma rede de numerosos ramúsculos nervosos envoltos por quantidade variável de tecido adiposo. Todavia, na porção inferior do terço médio da coxa e no terço inferior, não se visualizam ramos nervosos importantes. CONCLUSÃO: Baseados em nossos dados, recomendamos a utilização da porção inferior do terço médio da coxa como local de escolha para prática de injeção IM na região ântero-lateral da coxa, por se tratar de uma região menos inervada, o que acarretará menos dor nesta área durante tal procedimento, trazendo maior conforto ao paciente. Abstract in english The technique of intramuscular injection (IM) into the antero-lateral region of the thigh is widely used. Nevertheless, despite this area being indicated as the second best location for this practice, the technique is still observed to be very painful for both adult and child patients. OBJECTIVE: To study the localization, distribution and course of the lateral cutaneous nerve of the thigh, and its topographic relationship with the area recommended for the practice of int (more) ramuscular injection, relating these characteristics to the pain resulting from such procedures. METHOD: By means of exposing the antero-lateral region by classical dissection, the lateral cutaneous nerve of the thigh was identified and isolated in 20 fixed adult male cadavers, giving emphasis to the viewing of its nerve rami across the iliotibial tract. RESULTS: In 100% of the cases, the lateral cutaneous nerve emerged medially in relation to the upper anterior iliac spine. After this, it issued three wide-caliber rami in 70% of the specimens and only two in the remaining 30%. In the upper third and in the upper portion of the middle third of the thigh, a network of numerous small nerve rami was observed, enveloped in a variable quantity of adipose tissue. However, in the lower portion of the middle third of the thigh and in the lower third, no significant nerve rami were seen. CONCLUSION: Based on our data, we recommend whenever possible that the distal half of the region displayed by the classical technique be utilized as the location of choice for the practice of intramuscular injection into the antero-lateral region of the thigh. This is because this region is less innervated by the lateral cutaneous nerve of the thigh, which will cause less pain in this area during such procedures, thereby affording greater comfort to the patient.

ROCHA, ROGÉRIO PORTO DA; FERNANDES, GERALDO JOSÉ MEDEIROS; VENGJER, ALESSANDRO; MONGON, MAURÍCIO LEAL DIAS; RIBEIRO, FÁBIO PIZZO; SILVA, RODRIGO BARBOSA LONGUINHO E

2002-12-01

202

Distribuição do nervo cutâneo lateral da coxa na área de injeção intramuscular Distribution of the lateral cutaneous nerve of the thigh in the area of intramuscular injection  

Directory of Open Access Journals (Sweden)

Full Text Available A técnica de injeção intramuscular (IM) na região ântero-lateral da coxa é prática médica muito utilizada. Entretanto, apesar desta área ser apontada como segundo melhor local para esta prática, tanto em adultos como em crianças, a técnica ainda mostra-se muito dolorosa em ambos. OBJETIVO: Estudar a localização, distribuição, trajeto e relação topográfica do nervo cutâneo lateral da coxa com a área recomendada para prática da injeção intramuscular, relacionando-os à dor decorrente de tal procedimento. MÉTODO: Através da exposição da região ântero-lateral por dissecção clássica, o nervo cutâneo lateral da coxa foi identificado e isolado em 20 cadáveres adultos masculinos fixados, dando-se ênfase à visualização de seus ramos nervosos sobre o tracto iliotibial. RESULTADOS: Após emergir medialmente em relação à espinha ilíaca ântero-superior, em 100% dos casos, o nervo cutâneo lateral da coxa emite três ramos calibrosos em 70% dos espécimes, sendo que em 30% emite apenas dois. No terço superior, e na porção superior do terço médio da coxa, observa-se uma rede de numerosos ramúsculos nervosos envoltos por quantidade variável de tecido adiposo. Todavia, na porção inferior do terço médio da coxa e no terço inferior, não se visualizam ramos nervosos importantes. CONCLUSÃO: Baseados em nossos dados, recomendamos a utilização da porção inferior do terço médio da coxa como local de escolha para prática de injeção IM na região ântero-lateral da coxa, por se tratar de uma região menos inervada, o que acarretará menos dor nesta área durante tal procedimento, trazendo maior conforto ao paciente.The technique of intramuscular injection (IM) into the antero-lateral region of the thigh is widely used. Nevertheless, despite this area being indicated as the second best location for this practice, the technique is still observed to be very painful for both adult and child patients. OBJECTIVE: To study the localization, distribution and course of the lateral cutaneous nerve of the thigh, and its topographic relationship with the area recommended for the practice of intramuscular injection, relating these characteristics to the pain resulting from such procedures. METHOD: By means of exposing the antero-lateral region by classical dissection, the lateral cutaneous nerve of the thigh was identified and isolated in 20 fixed adult male cadavers, giving emphasis to the viewing of its nerve rami across the iliotibial tract. RESULTS: In 100% of the cases, the lateral cutaneous nerve emerged medially in relation to the upper anterior iliac spine. After this, it issued three wide-caliber rami in 70% of the specimens and only two in the remaining 30%. In the upper third and in the upper portion of the middle third of the thigh, a network of numerous small nerve rami was observed, enveloped in a variable quantity of adipose tissue. However, in the lower portion of the middle third of the thigh and in the lower third, no significant nerve rami were seen. CONCLUSION: Based on our data, we recommend whenever possible that the distal half of the region displayed by the classical technique be utilized as the location of choice for the practice of intramuscular injection into the antero-lateral region of the thigh. This is because this region is less innervated by the lateral cutaneous nerve of the thigh, which will cause less pain in this area during such procedures, thereby affording greater comfort to the patient.

ROGÉRIO PORTO DA ROCHA; GERALDO JOSÉ MEDEIROS FERNANDES; ALESSANDRO VENGJER; MAURÍCIO LEAL DIAS MONGON; FÁBIO PIZZO RIBEIRO; RODRIGO BARBOSA LONGUINHO E SILVA

2002-01-01

203

Arachnoid cyst masquerading as obstetric brachial plexus palsy.  

UK PubMed Central (United Kingdom)

Obstetric brachial plexus palsy is not uncommon. However, lesions masquerading as obstetric brachial plexus palsy are rare. A child with a cervicothoracic arachnoid cyst masquerading as obstetric brachial plexus palsy is presented, and the relevant literature is reviewed. A girl born by vaginal delivery at full term without any antecedent risk factors for obstetric brachial plexus palsy was noted to have decreased movements of the right upper extremity. After 7 months, there was no improvement. An MRI scan was obtained, which revealed a cervicothoracic spinal extradural arachnoid cyst. During surgery, the cyst was found to communicate with the dura at the axilla of the C-7 nerve root. The cyst was excised in toto. Six months later, there was improvement in the infant's neurological status. This case illustrates that spinal arachnoid cysts should be entertained in the differential diagnosis when a child presents with obstetric brachial plexus palsy without known antecedent risk factors for obstetric palsy.

Muthukumar N; Santhanakrishnan AG; Sivakumar K

2012-07-01

204

[Brachial plexus sleep palsy].  

UK PubMed Central (United Kingdom)

INTRODUCTION: Brachial plexus is rarely involved in "Saturday night palsy". CASE REPORT: A young man was admitted for numbness and weakness of his right upper limb after awaking from sleep. Neurophysiological studies, consistent with brachial plexopathy, revealed presence of proximal conduction blocks. Patient presented spontaneous clinical and neurophysiological improvement. DISCUSSION: Diagnosis of compressive brachial plexopathy needs to eliminate other causes of neuropathy with conduction block.

Fourcade G; Taieb G; Renard D; Labauge P; Pradal-Prat D

2011-06-01

205

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 ...

Ayse Tokcaer; Feride Gogus; Sumer Gullap; Isik Keles; Mustafa Gokce

206

Estudo eletrofisiológico do nervo cutâneo dorsal lateral: aplicabilidade técnica e valores de referência Electrophysiological study of the lateral dorsal cutaneous nerve: technical applicability and normal values  

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Full Text Available O estudo da condução neural dos segmentos mais distais dos nervos mais longos pode ser capaz de reconhecer mais precocemente as alterações oriundas da maioria das polineuropatias. O objetivo deste estudo, foi verificar a aplicabilidade técnica do exame de condução ortodrômica do ramo cutâneo dorsal do nervo sural (nervo cutâneo dorsal lateral) em pessoas saudáveis, padronizar os valores normais para serem utilizados como referência e comparar seus valores com os do nervo sural na perna. Quarenta e cinco pessoas com idade média de 41,56 anos (19-75) foram avaliadas, com registro de potenciais de ação de nervo sensitivo nos noventa pés. O eletrodo de captação foi colocado inferior e posteriormente ao maléolo lateral e a estimulação realizada 10 cm distalmente na face dorso-lateral dos pés. O valor médio para a velocidade de condução do nervo sural cutâneo dorsal encontrado foi 47,35 ± 4,8 m/s e para a amplitude, 4,19 ± 1,9 miV. A velocidade de condução do segmento distal foi 14% inferior à do proximal. A amplitude média dos potenciais de ação sensitivos do segmento distal foi 73% aquém daquela obtida no segmento proximal. Os resultados confirmam a possibilidade técnica de se estudar o ramo cutâneo dorsal do nervo sural e sugerem que o limite mínimo de normalidade para sua velocidade de condução, após correção para a temperatura de 34ºC, seja 38 m/s. Diferenças na amplitude e velocidade de condução devem ser consideradas entre grupos etários.The distal nerve conduction study of the long nerve in the leg is more efficient to work with so that it can stablish the early diagnosis of the majority of polyneuropathies. The main purpose of this study is the technical applicability of the orthodromic neural conduction examination of the dorsal cutaneous branch of the sural nerve (lateral dorsal cutaneous nerve) on healthy people, and define the normal values used as references to compare with the proximal segment. Forty five persons mean age 41.56 years old (range 19-75) were examined, and the sensory nerve action potentials were registered from ninety feet. The active recording superficial electrode was placed below and behind the lateral malleolus and the estimulating electrode was placed 10 cm distal to the recording superficial electrode at the dorsal lateral aspect of the feet. The mean value for the lateral dorsal cutaneous nerve conduction velocity was 47.35 ± 4.8 m/s and for amplitudes 4.19 ± 1.9 muV. The sensory conduction velocity in the distal segment was 14% lower than the proximal one. The sensory nerve action potencial amplitude of the distal segment was 73% lower than the proximal one. The lower normal limit recomended for conduction velocity of this nerve plus correction for skin temperature of 34ºC is 38 m/s. Some diferences in amplitude and conduction velocity among group ages are to be considered.

RAFAEL JOSÉ SOARES DIAS; ARMANDO PEREIRA CARNEIRO

2000-01-01

207

Estudo eletrofisiológico do nervo cutâneo dorsal lateral: aplicabilidade técnica e valores de referência/ Electrophysiological study of the lateral dorsal cutaneous nerve: technical applicability and normal values  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese O estudo da condução neural dos segmentos mais distais dos nervos mais longos pode ser capaz de reconhecer mais precocemente as alterações oriundas da maioria das polineuropatias. O objetivo deste estudo, foi verificar a aplicabilidade técnica do exame de condução ortodrômica do ramo cutâneo dorsal do nervo sural (nervo cutâneo dorsal lateral) em pessoas saudáveis, padronizar os valores normais para serem utilizados como referência e comparar seus valores com (more) os do nervo sural na perna. Quarenta e cinco pessoas com idade média de 41,56 anos (19-75) foram avaliadas, com registro de potenciais de ação de nervo sensitivo nos noventa pés. O eletrodo de captação foi colocado inferior e posteriormente ao maléolo lateral e a estimulação realizada 10 cm distalmente na face dorso-lateral dos pés. O valor médio para a velocidade de condução do nervo sural cutâneo dorsal encontrado foi 47,35 ± 4,8 m/s e para a amplitude, 4,19 ± 1,9 miV. A velocidade de condução do segmento distal foi 14% inferior à do proximal. A amplitude média dos potenciais de ação sensitivos do segmento distal foi 73% aquém daquela obtida no segmento proximal. Os resultados confirmam a possibilidade técnica de se estudar o ramo cutâneo dorsal do nervo sural e sugerem que o limite mínimo de normalidade para sua velocidade de condução, após correção para a temperatura de 34ºC, seja 38 m/s. Diferenças na amplitude e velocidade de condução devem ser consideradas entre grupos etários. Abstract in english The distal nerve conduction study of the long nerve in the leg is more efficient to work with so that it can stablish the early diagnosis of the majority of polyneuropathies. The main purpose of this study is the technical applicability of the orthodromic neural conduction examination of the dorsal cutaneous branch of the sural nerve (lateral dorsal cutaneous nerve) on healthy people, and define the normal values used as references to compare with the proximal segment. Fo (more) rty five persons mean age 41.56 years old (range 19-75) were examined, and the sensory nerve action potentials were registered from ninety feet. The active recording superficial electrode was placed below and behind the lateral malleolus and the estimulating electrode was placed 10 cm distal to the recording superficial electrode at the dorsal lateral aspect of the feet. The mean value for the lateral dorsal cutaneous nerve conduction velocity was 47.35 ± 4.8 m/s and for amplitudes 4.19 ± 1.9 muV. The sensory conduction velocity in the distal segment was 14% lower than the proximal one. The sensory nerve action potencial amplitude of the distal segment was 73% lower than the proximal one. The lower normal limit recomended for conduction velocity of this nerve plus correction for skin temperature of 34ºC is 38 m/s. Some diferences in amplitude and conduction velocity among group ages are to be considered.

DIAS, RAFAEL JOSÉ SOARES; CARNEIRO, ARMANDO PEREIRA

2000-06-01

208

Axillary brachial plexus blockade in moyamoya disease?  

Directory of Open Access Journals (Sweden)

Full Text Available Moyamoya disease is characterized by steno-occlusive changes of the intracranial internal carotid arteries. Cerebral blood flow and metabolism are strictly impaired. The goal in perioperative anaesthetic management is to preserve the stability between oxygen supply and demand in the brain. Peripheral nerve blockade allows excellent neurological status monitoring and maintains haemodynamic stability which is very important in this patient group. Herein, we present an axillary brachial plexus blockade in a moyamoya patient operated for radius fracture.

Yalcin Saban; Cece Hasan; Nacar Halil; Karahan Mahmut

2011-01-01

209

[The microsurgical treatment of traumatic lesions of the brachial plexus  

UK PubMed Central (United Kingdom)

The article deals with the results of examination and surgical treatment of 213 patients with various forms and levels of traumatic damage of the branchial plexus. Five levels of damages are suggested: I--preganglionic; II--postganglionic damage of the spinal nerves and primary trunks of the brachial plexus; III--damage of the secondary trunks in the clavicular region; IV--damage of the distal parts of the brachial plexus; V--isolated damages of the initial parts of the peripheral nerves. The authors describe surgical management by the method of differentiated neurotization with nerves arising from different segments of the spinal cords, by-passing the brachial plexus. Pathological changes in the region of the trauma, the character and level of the damage, the condition of the circulatory system, the presence or absence of pain, the applied rehabilitation therapy, the duration of the disease, the patient's age, and other factors have a marked influence on the outcome of the operation. Charts of distribution of the nerve fibres of the brachial plexus in the nerve trunks were compiled more exactly on the basis of data obtained during the operative intervention and autopsy.

Shevelev IN; Safronov VA; Lykoshina LE; Grokhovski? NP

1989-11-01

210

[Ultrasound images of the brachial plexus in the axillary region.].  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: The axillary artery is the anatomical reference, in the surface, for axillary brachial plexus block. Anatomic studies suggest variability in the location of the structures in the brachial plexus in relation to the axillary artery. These variations can hinder blocks by neurostimulation. The ultrasound allows the identification of the structures within the brachial plexus(1). The objective of this report was to describe the position of the nerves in the brachial plexus in relation to the axillary artery. METHODS: Thirty volunteers of both genders were studied. They were in the supine position with 90 degrees abduction and external rotation of the shoulder and 90 masculine flexion of the elbow. Using a 5 cm and 5-10 MHz digital transducer, median, ulnar and radial nerves were identified and their position in relation to the artery were recorded in an 8-sector sectional graphic chart, numbered in crescent order starting at the 12-hour position (medial), whose center represented the axillary artery. RESULTS: The median nerve was located mainly in sectors 8 (55%) and 1 (28%) (medial); the radial nerve was predominantly in sectors 4 (59%) and 5 (34%) (lateral); and the ulnar nerve in sectors 2 and 3 (inferior) in 69% and 24% of the cases, respectively. There was a considerable variation in the location of the nerves in relation to the superior and inferior aspects of the artery. CONCLUSIONS: Real-time ultrasound inspection of the neurovascular structures of the brachial plexus in the axilla demonstrated that the median, ulnar and radial nerves have different relations with the axillary artery.

Conceição DB; Helayel PE; Carvalho FA; Wollmeister J; Oliveira Filho GR

2007-12-01

211

Reduced intraepidermal nerve fibre density in lesional and nonlesional prurigo nodularis skin as a potential sign of subclinical cutaneous neuropathy.  

UK PubMed Central (United Kingdom)

BACKGROUND: Prurigo nodularis (PN) is a highly pruritic condition characterized by multiple hyperkeratotic nodules. Previous immunohistochemical studies demonstrated increased numbers of dermal nerve fibres. OBJECTIVES: Given that the sensation of pruritus is transmitted mainly by thin, unmyelinated epidermal nerves, the aim of our study was to investigate the intraepidermal nerve fibre (IENF) density. METHODS: Biopsies taken from lesional and nonlesional skin of 53 patients (37 women and 16 men; mean ± SD age 60·6 ± 14·9 years) with PN of diverse origin were immunostained for protein gene product 9·5. According to the guideline of the European Federation of Neurological Societies, the IENF density per millimetre was determined and compared with that in 20 healthy volunteers. RESULTS: Lesional and uninvolved PN skin biopsies showed significantly decreased IENF density (P < 0·001) regardless of patient age, origin of PN, intensity or quality of pruritus. CONCLUSIONS: Hypoplasia of epidermal sensory nerves independently of clinical parameters is a new finding in PN and suggests involvement of epidermal nerves in PN pathophysiology. To date, it cannot be ruled out that reduced IENF density is due to repeated scratching. However, the presence of hypoplasia in nonlesional PN skin suggests the presence of a subclinical small fibre neuropathy.

Schuhknecht B; Marziniak M; Wissel A; Phan NQ; Pappai D; Dangelmaier J; Metze D; Ständer S

2011-07-01

212

Ultrasound-guided supraclavicular brachial plexus block in pediatric patients -A report of four cases-.  

UK PubMed Central (United Kingdom)

Supraclavicular brachial plexus blocks are not common in pediatric patients due to the risk of pneumothorax. Ultrasonography is an important tool for identifying nerves during regional anesthesia. Directly visualizing the target nerves and monitoring the distribution of the local anesthetic are potentially significant. In addition, ultrasound monitoring helps avoid complications, such as inadvertent intravascular injection or pneumothorax. This paper reports four cases of pediatric patients who received ultrasound-guided supraclavicular brachial plexus block for upper limb surgery.

Yang CW; Cho CK; Kwon HU; Roh JY; Heo YM; Ahn SM

2010-12-01

213

Ultrasound-guided supraclavicular brachial plexus block in pediatric patients -A report of four cases-.  

Science.gov (United States)

Supraclavicular brachial plexus blocks are not common in pediatric patients due to the risk of pneumothorax. Ultrasonography is an important tool for identifying nerves during regional anesthesia. Directly visualizing the target nerves and monitoring the distribution of the local anesthetic are potentially significant. In addition, ultrasound monitoring helps avoid complications, such as inadvertent intravascular injection or pneumothorax. This paper reports four cases of pediatric patients who received ultrasound-guided supraclavicular brachial plexus block for upper limb surgery. PMID:21286471

Yang, Chun Woo; Cho, Choon-Kyu; Kwon, Hee Uk; Roh, Jae Young; Heo, Youn Moo; Ahn, Sung-Min

2010-12-31

214

Should supraclavicular brachial plexus block be avoided in pregnancy?  

UK PubMed Central (United Kingdom)

Unilateral phrenic nerve block is common after supraclavicular brachial plexus block techniques, although it is rarely symptomatic in patients without respiratory disease. A 24-weeks-pregnant woman was scheduled for a carpal tunnel release because of intractable pain. After a perivascular subclavian brachial plexus block with 30 ml of 0.33% plain bupivacaine was performed, the patient developed a right phrenic nerve block manifested by acute dyspnea and cough. No deleterious consequences followed, but surgery was canceled. Respiratory changes produced by pregnancy might compromise ventilatory reserve. Thus, we suggest avoiding supraclavicular approaches to brachial plexus block in pregnant women, since they may be as prone to developing respiratory embarrassment, secondary to phrenic block, as patients with pulmonary pathology.

Gazmuri RR; Torregrosa SA; Dagnino JA; Iniguez FG

1992-07-01

215

Should supraclavicular brachial plexus block be avoided in pregnancy?  

Science.gov (United States)

Unilateral phrenic nerve block is common after supraclavicular brachial plexus block techniques, although it is rarely symptomatic in patients without respiratory disease. A 24-weeks-pregnant woman was scheduled for a carpal tunnel release because of intractable pain. After a perivascular subclavian brachial plexus block with 30 ml of 0.33% plain bupivacaine was performed, the patient developed a right phrenic nerve block manifested by acute dyspnea and cough. No deleterious consequences followed, but surgery was canceled. Respiratory changes produced by pregnancy might compromise ventilatory reserve. Thus, we suggest avoiding supraclavicular approaches to brachial plexus block in pregnant women, since they may be as prone to developing respiratory embarrassment, secondary to phrenic block, as patients with pulmonary pathology. PMID:1419016

Gazmuri, R R; Torregrosa, S A; Dagnino, J A; Iniguez, F G

216

[Portable ultrasound devices in regional anesthesia: the brachial plexus block].  

UK PubMed Central (United Kingdom)

Ultrasonography has received increasing attention in regional anesthesia in recent years because it allows visualization of the nerves, the needle, and the surrounding structures and makes it possible to monitor distribution of the local anesthetic. Ultrasound technology is unfamiliar to most anesthesiologists, unless they work with transesophageal echocardiography. Ultrasound-guided regional anesthesia relies entirely on the expertise of the person performing the technique and how that person interprets the images, though the latest portable ultrasound devices are ergonomically designed for fast, easy use, even by less experienced personnel. The high-frequency probes can identify the brachial plexus and produce excellent images of considerable educational value that differ only slightly from those provided by larger, more expensive equipment. Ultrasonography makes it possible to identify the brachial plexus, from the roots to the peripheral nerves of the arm. We describe the main approaches used in providing an ultrasound-guided brachial plexus block and explain the basic principles of ultrasound imaging.

Romero AO; de Isasa DD; Rodríguez Cdel O; Ramos EM; Gil RR

2008-05-01

217

Nerve grafting.  

UK PubMed Central (United Kingdom)

By avoiding tension and securing anatomical neurorrhaphy, regeneration of nerve is obtainable. When the gap exceeds a certain limit, the only way to avoid tension is the use of grafts. Experience in animal experiments and clinical practice has demonstrated that regenerating axons can cross 2 optimal suture lines much more easily than one sub-standard one. For bridging a gap autografts are used, because in autografts the fascicular pattern is preserved and its Swann cells survive. With the interfascicular technique the dissection of the nerve stumps proceeds from normal to abnormal tissues and the epineurium is resected. The coaptation must be exact so that the grafts cover the whole cross sectional area of the fascicle. All this can be achieved by the use of one 10--0 or 11--0 nylon suture. The clinical results show that in the median nerve 82%, in the ulnar 80% and in the radial nerve 92% of good functional results can be obtained. Also in brachial plexus injuries the interfascicular nerve grafting procedure opened new ways. Therefore interfascicular nerve grafting, using autografts in cases of nerve repair, where a gap may occur, currently is the method of choice.

Berger A; Millesi H

1978-06-01

218

Clinical research of comprehensive rehabilitation in treating brachial plexus injury patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: Brachial plexus injury is one of the difficult medical problems in the world. The aim of this study was to observe the clinical therapeutic effect of comprehensive rehabilitation in treating dysfunction after brachial plexus injury. METHODS: Forty-three cases of dysfunction after brachial plexus injury were divided into two groups randomly. The treatment group, which totaled 21 patients (including 14 cases of total brachial plexus injury and seven cases of branch brachial plexus injury), was treated with comprehensive rehabilitation including transcutaneous electrical nerve stimulation, mid-frequency electrotherapy, Tuina therapy, and occupational therapy. The control group, which totaled 22 patients (including 16 cases of total brachial plexus injury and six cases of branch brachial plexus injury), was treated with home-based electrical nerve stimulation and occupational therapy. Each course was of 30 days duration and the patients received four courses totally. After four courses, the rehabilitation effect was evaluated according to the brachial plexus function evaluation standard and electromyogram (EMG) assessment. RESULTS: In the treatment group, there was significant difference in the scores of brachial plexus function pre- and post-treatment (P < 0.01) in both "total" and "branch" injury. The scores of two "total injury" groups had statistical differences (P < 0.01), while the scores of two "branch injury" groups had statistical differences (P < 0.05) after four courses. EMG suggested that the appearance of regeneration potentials of the recipient nerves in the treatment group was earlier than the control group and had significant differences (P < 0.05). CONCLUSION: Comprehensive rehabilitation was more effective in treating dysfunction after brachial plexus injury than nonintegrated rehabilitation.

Zhou JM; Gu YD; Xu XJ; Zhang SY; Zhao X

2012-07-01

219

Ultrasound-guided supraclavicular brachial plexus block in pediatric patients -A report of four cases-  

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Supraclavicular brachial plexus blocks are not common in pediatric patients due to the risk of pneumothorax. Ultrasonography is an important tool for identifying nerves during regional anesthesia. Directly visualizing the target nerves and monitoring the distribution of the local anesthetic are pote...

Yang, Chun Woo; Cho, Choon-Kyu; Kwon, Hee Uk; Roh, Jae Young; Heo, Youn Moo; Ahn, Sung-Min

220

Imaging tumours of the brachial plexus  

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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.)

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

2003-07-01

 
 
 
 
221

COMPLICATIONS DURING A SUPRACLAVICULAR ANESTHESIA OF THE BRACHIAL PLEXUS WITH INTERSCALENE APPROACH  

Directory of Open Access Journals (Sweden)

Full Text Available A hemidiaphragmatic paresis is one of the most frequently observed complications following the supraclavicular anesthesia of the brachial plexus with interscalene approach. In patients, crucially dependant on adequate diaphragmatic function, hemidiaphragmatic paresis may provoke acute respiratory disturbances. The aim of this study was to analyze the anatomical features the brachial plexus with regard of the anesthesia of specific areas of the shoulder and the upper limb.A dissection of the cervical and the brachial plexuses was done in human cadavers. We established that in some cases the phrenic nerve and the accessory phrenic nerve arise from the superior trunk of the brachial plexus. This type of anatomical arrangement significantly increases the risk of hemidiaphragmatic paresis during supraclavicular anesthesia with interscalene approach because the anesthetic tends to invade the supraclavicular space.

Minko Minkov; Maria Vankova; Radoslav Minkov; Stefaniya Terzieva; Toni Dimitrov; Iskren Velikov

2012-01-01

222

A rare variation in the formation of the upper trunk of the brachial plexus - a case report  

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Full Text Available Brachial plexus is the plexus of nerves that supplies the upper limb. Variations in the origin and distribution of the branches of brachial plexus are common but variation in the roots and trunks are very rare. Here, we report one of such rare variations in the formation of the upper trunk of the brachial plexus. In this case, the upper trunk was formed by the union of ventral rami of C5, C6 and C7 nerves. The middle trunk was absent and lower trunk was normal.

Nayak S; Somayaji N; Vollala VR; Raghunathan D; Rodrigues V; Samuel VP; Alathady Malloor P

2005-01-01

223

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

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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.)

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

224

Supraclavicular brachial plexus blocks: review and current practice.  

Science.gov (United States)

This article reviews the possible revival of the supraclavicular brachial plexus blockade due to the use of ultrasound guidance. The brachial plexus is a complex network of nerves, extending from the neck to the axilla, which supplies motor and sensory fibers to the upper extremity. Understanding the complexities of the formation and structure of the brachial plexus remains a cornerstone for effective regional anaesthesia. On the level of the supraclavicular fossa, the plexus is most compactly arranged. The supraclavicular approach of the brachial plexus has a high success rate including blockade of the ulnar and musculocutaneous nerve, which can be missed respectively with the interscalene and axillary approach. However, because of the proximity of the pleura, most anaesthesiologists have been reluctant to perform this supraclavicular approach. The introduction of ultrasound guidance techniques not only reduces the possible risk of pneumothorax but also allows a faster onset time of the block with a reduction of the local anaesthetic dose. This makes the supraclavicular approach a valuable alternative to the axillary, interscalene and infraclavicular approach for upper limb surgery. PMID:22783706

Vermeylen, K; Engelen, S; Sermeus, L; Soetens, F; Van de Velde, M

2012-01-01

225

Supraclavicular brachial plexus blocks: review and current practice.  

UK PubMed Central (United Kingdom)

This article reviews the possible revival of the supraclavicular brachial plexus blockade due to the use of ultrasound guidance. The brachial plexus is a complex network of nerves, extending from the neck to the axilla, which supplies motor and sensory fibers to the upper extremity. Understanding the complexities of the formation and structure of the brachial plexus remains a cornerstone for effective regional anaesthesia. On the level of the supraclavicular fossa, the plexus is most compactly arranged. The supraclavicular approach of the brachial plexus has a high success rate including blockade of the ulnar and musculocutaneous nerve, which can be missed respectively with the interscalene and axillary approach. However, because of the proximity of the pleura, most anaesthesiologists have been reluctant to perform this supraclavicular approach. The introduction of ultrasound guidance techniques not only reduces the possible risk of pneumothorax but also allows a faster onset time of the block with a reduction of the local anaesthetic dose. This makes the supraclavicular approach a valuable alternative to the axillary, interscalene and infraclavicular approach for upper limb surgery.

Vermeylen K; Engelen S; Sermeus L; Soetens F; Van de Velde M

2012-01-01

226

[Schwannoma of the brachial plexus resembling a breast adenocarcinoma metastasis].  

UK PubMed Central (United Kingdom)

Schwanomas 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 function. Histological findings indicated a schwannoma thus ruling out the presence of metastasis. The postoperative development was uneventful and six years after surgery, the patient is to date tumour-free. To the best of our knowledge, this is the first report of a brachial plexus schwannoma arising from the ulnar branch. Intraoperative electrophysiological monitoring is essential for a good surgical outcome.

Rodríguez Boto G; Moreno-Gutiérrez A; Gutiérrez-González R; Villar-Martín A; Arraez-Aybar LA; Serrano Hernando J

2011-01-01

227

Adult traumatic brachial plexus injury  

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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.

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

2004-09-01

228

Brachial artery injuries in children.  

UK PubMed Central (United Kingdom)

Treatment of brachial artery injuries in children, particularly those resulting from supracondylar humeral fractures, is controversial when distal pulses are absent yet the hand remains warm and pink. This article presents a retrospective study of eight children, ages 3 to 13, who underwent brachial arterial exploration because of absent distal pulses following arm trauma. Absent pulses indicate diminished blood flow, and in all eight cases brachial artery obstruction or severance was confirmed at surgery. In four of the children, who presented with cold, devascularized hands as a result of posterior elbow dislocations, supracondylar humeral fracture, or dog bites, there is no debate regarding revascularization. The other four children, with type III supracondylar humerus fractures, had pulseless, pink hands as a result of brachial artery thrombosis or arterial tethering. Brachial artery flow was reestablished in all cases with return of distal pulses, and no vascular complications. The authors believe that artery exploration is indicated when distal pulses are not present.

Snyder A; Crick JC

2013-01-01

229

[Comparative study of 0.5% racemic bupivacaine versus enantiomeric mixture (S75-R25) of 0.5% bupivacaine in brachial plexus block for orthopedic surgery.].  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: Several studies were performed with bupivacaine isomers in the attempt to find a safer drug than racemic bupivacaine. This study aimed at evaluating the efficacy of 0.5% bupivacaine enantiomeric mixture (MEE50%) as compared to 0.5% racemic bupivacaine in brachial plexus block for upper limb orthopedic surgery. METHODS: Participated of this randomized double-blind study 40 patients aged 18 to 90 years, physical status ASA I and II, submitted to upper limb orthopedic surgeries, who were divided in two groups: Group R received 0.5% racemic bupivacaine; and Group L received 0.5% enantiomeric mixture (S75-R25) of bupivacaine both with 1:200,000 epinephrine, in a volume of 0.6 mL.kg-1 (3 mg.kg-1), limited to 40 mL. Motor and/or sensory characteristics of each nerve involved (musculocutaneous, radial, median, ulnar and medial cutaneous nerve of forearm), as well as the incidence of side effects were evaluated. RESULTS: There were no statistical differences in demographics. Hemodynamic parameters were similar between groups but systolic pressure was higher for Group R. There were no statistically significant differences in time to reach the greatest intensity of sensory and motor blocks. With one exception, the onset of motor block within the muscles innervated by the ulnar nerve was longer for Group L (10.75 versus 14.25 minutes). CONCLUSIONS: There were adequate sensory and motor blocks in both groups, with few side effects, suggesting that the 0.5% enantiomeric mixture (S75-R25) of bupivacaine with epinephrine is safe and effective for brachial plexus block of upper limb orthopedic surgeries.

Sato RT; Porsani DF; Amaral AG; Schulz Júnior OV; Carstens AM

2005-04-01

230

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

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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.

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

231

Cervical myelographic findings of brachial plexus injury by trauma  

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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.

Moon, Yang In; Lee, Jong Duk; Lim, Se Hwan; Lee, Cheorl Woo; Chung, Young Sun; Won, Jong Jin [Wonkwang University School of Medicine, Iksan (Korea, Republic of)

1989-12-15

232

[C5-C6 and C5-C6-C7 traumatic paralysis of the brachial plexus of the adult caused by supraclavicular lesions  

UK PubMed Central (United Kingdom)

PURPOSE OF THE STUDY: In C5-C6 and C5-C6-C7 brachial plexus palsies, prognoses was based on the recovery of a useful shoulder and elbow in order to control a normal or partially impaired hand. Treatment was an integrated procedure combining direct nerve surgery and muscle transfers. MATERIAL: Our study was performed on 27 cases of C5-C6 plexus palsy and 43 cases of C5-C6-C7 plexus palsy operated between 1984 and 1994, with an average delay between trauma and surgery of 8 months. METHODS: Elbow flexion was obtained by nerve surgery on the anterior part of the primary trunk or directly on the musculo-cutaneous nerve and after muscle transfer. Nerve surgery on supra-scapular nerve, on posterior part of primary trunk or directly on axillary nerve was also performed. RESULTS: The results were analyzed separately for shoulder and elbow flexion and globally. In C5-C6 palsies, elbow flexion was a goal which has been reached in 100 per cent of cases. Only 56 per cent of cases obtained a stable shoulder with active external rotation. In C5-C6-C7 palsies, elbow flexion was reached in 86 per cent of cases and stable shoulder with active external rotation only in 26 per cent. Reinnervation of the elbow flexors was reached by direct nerve surgery in 60 per cent of C5-C6 and 52 per cent of C5-C6-C7. Active external rotation was reached by spinal-suprascapularis nerve neurotization in 60 per cent of C5-C6 and 54 per cent of C5-C6-C7. DISCUSSION: No significant difference after nerve surgery for elbow flexion was found between C5-C6 and C5-C6-C7 plexus palsies. Failures of nerve surgery will undergo muscle transfer. When C7 is damaged, less muscles are transferable and results are less good. For shoulder, best results were obtained after spinal suprascapularis nerve neurotization with direct suture. In case of failure, a derotation osteotomy was performed. If shoulder was still unstable, transposition of the coracoacromial ligament to the humerus was also performed. CONCLUSION: In C5-C6 palsies, elbow flexion is a goal which must be reached in 100 per cent of cases. Prognosis depends of shoulder function. In C5-C6-C7 palsies, results are less good. 6 patients did not recover elbow flexion, no active mobility of the shoulder was observed in 63 per cent of them. The results obtained for elbow flexion are satisfactory if the program does not separate nerve surgery and muscle transfers.

Alnot JY; Rostoucher P; Oberlin C; Touam C

1998-04-01

233

Thickening of peripheral nerves in neurofibromatosis  

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A 14-year-old boy presented with multiple asymptomatic swellings all over the body. Cutaneous findings were classical for neurofibromatosis. Interesting and unusual finding was generalised thickening of peripheral nerve trunks. Biopsy from thickened nerve had features of neurofibromatosis.

Mittal Asit; Masuria B; Gupta L; Sharma M; Bansal N

234

A brachial plexus variation characterized by the absence of the superior trunk  

Directory of Open Access Journals (Sweden)

Full Text Available During routine dissection of a 55-year-old female cadaver, a variation of the brachial plexus characterizedby the absence of the superior trunk on the left side was observed. The ventral rami of the C5 and C6 nerveroots, without joining to form the superior trunk, independently divided into anterior and posterior divisions,which joined the lateral and posterior cords, respectively. Additionally, the suprascapular nerve that normallyoriginates from the superior trunk initiated exclusively from the C5 nerve root in this variation. Similarvariations in the brachial plexus were not observed on the contralateral side. The details of this variation and itsclinical significance are discussed herein.

Villamere J; Goodwin S; Hincke M; Jalali A

2009-01-01

235

A rare variation in the mode of termination of posterior cord of brachial plexus  

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Full Text Available Anatomical variations in the formation of brachial plexus and its terminal branches have been reported in the literature. During the routine dissection of embalmed adult cadavers in the Institute of Anatomy, MMC, Madurai, a rare variation in the mode of termination of the posterior cord of the brachial plexus was noted. The posterior cord was terminating into two divisions, and the radial nerve was formed by the union of those divisions and the axillary nerve was arising from one of those divisions. The clinical implications of this variation are discussed.

Jamuna M

2010-01-01

236

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

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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 consistently the presence or absence of avulsion of nerve roots. The MRI finding of post-traumatic neuroma has a high sensitivity and specificity in determining the side of the brachial plexus injury but cannot reveal the exact anatomic area (i.e. trunk or division) involved. The information obtained is, however, useful to the surgeon during intraoperative evaluation of spinal nerve integrity for reconstruction. (orig.)

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

237

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

International Nuclear Information System (INIS)

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 consistently the presence or absence of avulsion of nerve roots. The MRI finding of post-traumatic neuroma has a high sensitivity and specificity in determining the side of the brachial plexus injury but cannot reveal the exact anatomic area (i.e. trunk or division) involved. The information obtained is, however, useful to the surgeon during intraoperative evaluation of spinal nerve integrity for reconstruction. (orig.)

2006-01-01

238

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

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Full Text Available 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 fascicles were formed. All the nerves from the brachial plexus were originated from these two fascicles, except the thoracic, long pectoral and suprascapular nerves, which arose before the formation of the common trunk. The organization of the brachial plexus into trunks and fascicles, and subsequent origin of peripheral nerves, demonstrates that most of the spinal nerves contribute to the composition of the peripheral nerves and the possibility that lesions or traumatic injuries would damage most of the thoracic member.

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

2013-01-01

239

Sep diagnosing neurophaty of the lateral cutaneous branch of the iliohypogastric nerve: case report Neuropatia do ramo cutâneo lateral do nervo ílio-hipogástrico diagnosticada por PES: relato de caso  

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Full Text Available The article pertains to the uncommon clinical case of a patient with a proximal neuropathy of the lower extremity. It outlines the electrophysiological evaluation and reviews the medical literature. The electrophysiologic test that most accurately revealed the neuropathy was the segmental somatosensory evoked potential (SEP) of the lateral cutaneous branch of the iliohypogastric nerve. It showed well-defined and replicable cortical waveforms following the excitation of the lateral cutaneous branch of the iliohypogastric nerve in the asymptomatic lower extremity, but failed to present somatosensory evoked potentials arising from the excitation of the contralateral nerve in the symptomatic lower extremity. We did not find any previous reports diagnosing that particular pathology by the use of segmental SEP. In conclusion, it is important to remember that the accurate diagnosis of patients complaining of pain and dysesthesia in the proximal part of the lower extremities can possibly be achieved through the use of electrophysiologic tests such as the segmental SEP.O presente artigo relata caso clínico incomum de neuropatia proximal de membro inferior, demonstra eletrofisiologicamente o comprometimento neural e revisa a literatura médica sobre o assunto. O teste neurofisiológico que demonstrou a patologia foi o potencial evocado somato-sensitivo (PES) segmentar do ramo cutâneo lateral do nervo ílio-hipogástrico. Ele revelou potenciais corticais bem definidos e replicáveis à estimulação do membro inferior assintomático, mas falhou em produzir respostas corticais do membro inferior sintomático. Na revisão da literatura não foi encontrado nenhum relato anterior de diagnóstico dessa patologia por PES segmentar. Conclui-se que é importante ter em mente ao avaliar pacientes com queixas de dor e disestesia na base dos membros inferiores que o acometimento de pequenos ramos cutâneos, como o cutâneo lateral do ílio-hipogástrico, pode ter confirmação eletrofisiológica da patologia por testes neurofisiológicos como o potencial evocado somato-sensitivo segmentar.

Rafael José Soares Dias; Lancaster de Souza; Wanderley Freitas de Morais; Armando Pereira Carneiro

2004-01-01

240

Sep diagnosing neurophaty of the lateral cutaneous branch of the iliohypogastric nerve: case report/ Neuropatia do ramo cutâneo lateral do nervo ílio-hipogástrico diagnosticada por PES: relato de caso  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese O presente artigo relata caso clínico incomum de neuropatia proximal de membro inferior, demonstra eletrofisiologicamente o comprometimento neural e revisa a literatura médica sobre o assunto. O teste neurofisiológico que demonstrou a patologia foi o potencial evocado somato-sensitivo (PES) segmentar do ramo cutâneo lateral do nervo ílio-hipogástrico. Ele revelou potenciais corticais bem definidos e replicáveis à estimulação do membro inferior assintomático, ma (more) s falhou em produzir respostas corticais do membro inferior sintomático. Na revisão da literatura não foi encontrado nenhum relato anterior de diagnóstico dessa patologia por PES segmentar. Conclui-se que é importante ter em mente ao avaliar pacientes com queixas de dor e disestesia na base dos membros inferiores que o acometimento de pequenos ramos cutâneos, como o cutâneo lateral do ílio-hipogástrico, pode ter confirmação eletrofisiológica da patologia por testes neurofisiológicos como o potencial evocado somato-sensitivo segmentar. Abstract in english The article pertains to the uncommon clinical case of a patient with a proximal neuropathy of the lower extremity. It outlines the electrophysiological evaluation and reviews the medical literature. The electrophysiologic test that most accurately revealed the neuropathy was the segmental somatosensory evoked potential (SEP) of the lateral cutaneous branch of the iliohypogastric nerve. It showed well-defined and replicable cortical waveforms following the excitation of th (more) e lateral cutaneous branch of the iliohypogastric nerve in the asymptomatic lower extremity, but failed to present somatosensory evoked potentials arising from the excitation of the contralateral nerve in the symptomatic lower extremity. We did not find any previous reports diagnosing that particular pathology by the use of segmental SEP. In conclusion, it is important to remember that the accurate diagnosis of patients complaining of pain and dysesthesia in the proximal part of the lower extremities can possibly be achieved through the use of electrophysiologic tests such as the segmental SEP.

Dias, Rafael José Soares; Souza, Lancaster de; Morais, Wanderley Freitas de; Carneiro, Armando Pereira

2004-09-01

 
 
 
 
241

Tramadol use for axillary brachial plexus blockade.  

UK PubMed Central (United Kingdom)

BACKGROUND: We investigated the effects of tramadol added to the mixture of local anesthetic for axillary brachial plexus blockade (ABB) in patients to have undergone hand and forearm surgery. MATERIALS AND METHODS: Forty patients from the ASA classification I and II, between 18 and 60 y of age, were included in this randomized double-blind study. Group C: levobupivacaine (150 mg) + lidocaine (200 mg) (n = 20), Group T: levobupivacaine (150 mg), + lidocaine (200 mg) + tramadol (100 mg) (n = 20). Intravenous midazolam of 0.02 mg/kg was given for premedication. ABB was performed with 42 mL mixture of local anesthetic, using peripheral nerve stimulator. The duration of onset of motor and sensory blockades was recorded. The postoperative first analgesic need, sedation, and satisfaction score and side effects were recorded. RESULTS: There was no significant difference between the groups regarding intraoperative visual analog scale (VAS), hemodynamics, adverse effects, sedative and analgesic requirement, and the patient satisfaction. The development of motor block at the median nerve on the 5th min (P = 0.03) and at the ulnar nerve on 10th and 15th min in Group T were (P = 0.01, P = 0.03, respectively) considerably longer than that in Group C. CONCLUSIONS: Adding 100 mg of tramadol to the combination of levobupivacaine and lidocaine during ABB could not provide an important clinical effect in patients undergoing hand and forearm surgery.

Sarsu S; Mizrak A; Karakurum G

2011-01-01

242

[Effect of enhanced ultrasound guiding on brachial plexus block].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess whether the enhanced imaging technology can improve the needle visibility during ultrasound-guided auxillary brachial plexus block. METHODS: After obtaining informed consent, 60 ASA (American Society of Anesthesiologists) I-II patients undergoing forearm or hand surgery were enrolled in this prospective, randomized, double-blind study. The patients were randomly assigned to two groups, the common image group (n=30) and enhanced image group (n=30). Ultrasound was used in guiding the block of the four branches of brachial plexus, i.e. the median, radial, ulnar and musculocutaneous nerves. In the enhanced image group a special function key "Multi-beam enhance" (MBe) was turned on during the needle insertion. After the nerve stimulator identification of the median, radial, ulnar and musculocutaneous nerves, 10 mL of 0.5% ropivacaine was injected near each nerve. The operating time, the visibility of the needle, the depth of each nerve, the onset time of the block, and the complications related to the block were assessed and recorded. RESULTS: The operating time was significantly shorter in the enhanced image group compared with the common image group [(2.63±0.81) min vs. (5.07±1.89) min, P=0.01]. The visibility of the needle was better in enhanced image group when the radial and musculocutaneous nerve blocks were performed (P<0.05). CONCLUSION: The enhanced image technology can reduce the operating time and improve the visibility of the needle during the peripheral nerve block for the nerve which is relatively deep.

Rong YL; Li M; Guo XY

2012-06-01

243

Superficial course of brachial and ulnar arteries and high origin of common interosseous artery  

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Full Text Available Knowledge of variations in the course and branching pattern of the arteries of upper limb is important for clinicians. We report the variations of the branches of brachial artery. The brachial artery was superficial throughout its course. It divided into radial and ulnar arteries in the cubital fossa. The ulnar artery passed superficial to the flexor muscles of the forearm as it leaved the cubital fossa. The common interosseous artery was large in size and it was a direct branch of brachial artery. It took its origin from brachial artery approximately 5 cm below the lower border of teres major muscle and followed the median nerve till the cubital fossa and divided into anterior and posterior interosseous branches.

Cherian SB; Nayak SB; Somayaji N

2009-01-01

244

Anatomical Structure of the Brachial Plexus in the Merlin (Falco columbarius).  

UK PubMed Central (United Kingdom)

This study aimed to document the detailed features of the morphological structure and the innervation areas of the brachial plexus in Merlin (Falco columbarius). The skin and muscles of five adult male Merlins were dissected under the stereo microscope. The Merlin had two plexus trunks. The accessory brachial plexus consisted of ventral rami C10 and C11. C11 was divided into two branches: the cranial and caudal. The brachial plexus was composed of a rather complex network involving the ventral rami of C11-C13, T1 and T2. In addition, a thin branch from the last two cervical sympathetic nerves participated in the plexus formation. C12, C13 and T1 had rather thick trunk. C12, C13 and T1 were also involved in the formation of the brachial plexus emerging after 1 cm from the foramen inter-vertebrale as three trunk roots.

Cevik-Demirkan A

2013-03-01

245

Neural sheath tumors of the brachial plexus: a multidisciplinary team-based approach.  

Science.gov (United States)

Peripheral tumors of the brachial plexus, although rare, provide an opportunity for the plastic surgeon to coordinate a multidisciplinary team and achieve excellent outcomes. Most of the case series are reported from the neurosurgical literature. We report on the experience of the Kaiser Permanente Brachial Plexus Clinic over a recent 2-year period. A retrospective review was conducted to examine the medical records, radiographic images, operative reports, and pathologic findings of 13 consecutive patients with peripheral nerve sheath tumors of brachial plexus origin. Of the 10 patients requiring surgical exploration, 90% had significant improvement or resolution of pain, with sensory and motor recovery showing mixed results. Average follow-up consisted of 2 years with occupational therapy beginning shortly after operative intervention. Our results are similar to or better than those published in the literature. The plastic surgeon with subspecialty training can safely and successfully treat tumors of the brachial plexus by implementing a multidisciplinary approach. PMID:23392262

Soltani, Ali M; Francis, Cameron S; Kane, Justin T; Kazimiroff, Paul B; Edgerton, Bradford W

2013-07-01

246

High-resolution MRI demonstrates detailed anatomy of the axillary brachial plexus. A pilot study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Axillary block is the most commonly performed brachial plexus block and may be guided by nerve stimulation or ultrasound. Magnetic resonance imaging (MRI) has proven to be beneficial in presenting anatomy of interest for regional anaesthesia and in demonstrating spread of local anaesthetic. The aim of this pilot study was to demonstrate the anatomy as shown by MRI of the brachial plexus in the axillary region. METHODS: Nine volunteers and nine patients were examined in a 3.0 Tesla MR. The patients had two different brachial plexus blocks. Subsequently, they were scanned by MRI and finally tested clinically for block efficacy before operation. Axial images, with and without local anaesthetics injected, were viewed in a sequence loop to identify the anatomy. RESULTS: With the high-resolution MRI, we obtained images of good quality, and cords and all terminal nerves could be identified. When local anaesthetics are injected, neurovascular structures are displaced, and the vein is compressed. Viewing the images in a sequence loop facilitates identification of the different nerves and has high instructive value (links S1-3 to these loops are enclosed). CONCLUSION: Clinical high-field 3.0 Tesla MRI scanner gives good visualization of brachial plexus in the axilla. The superior ability to detect local anaesthetics after it has been injected and the multiplanar imaging capability make MRI a useful tool in studies of the brachial plexus.

Kjelstrup T; Courivaud F; Klaastad Ø; Breivik H; Hol PK

2012-08-01

247

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

UK PubMed Central (United Kingdom)

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 brachial plexus block was performed using the plumb bob technique with 30 ml of 0.5% ropivacaine. The block performance-related pain was evaluated. This study observed which nerve type was stimulated, and scored the sensory and motor block. The quality of the block was assessed intra-operatively. The duration of the sensory and motor block as well as the complications were assessed. The patient's satisfaction with the anesthetic technique was assessed after surgery. RESULTS: There were no significant differences in the block performance-related pain, frequency of the stimulated nerve type, evolution of sensory and motor block quality, or the success of the block. There were no significant differences in the duration of the sensory and motor block. There was a significant difference in the incidence of Horner's syndrome. Two patients had a pneumothorax in the supraclavicular approach. There were no significant differences in the patient's satisfaction. CONCLUSIONS: Both infraclavicular and supraclavicular brachial plexus block had similar effects. The infraclavicular approach may be preferred to the supraclavicular approach when considering the complications.

Yang CW; Kwon HU; Cho CK; Jung SM; Kang PS; Park ES; Heo YM; Shinn HK

2010-03-01

248

Specific paucity of unmyelinated C-fibers in cutaneous peripheral nerves of the African naked-mole rat: comparative analysis using six species of bathyergidae  

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In mammalian peripheral nerves, unmyelinated C-fibers usually outnumber myelinated A-fibers. Using transmission electron microscopy we recently showed that the saphenous nerve of the naked mole-rat (Heterocephalus glaber) has a C-fiber deficit manifested as a substantially lower C:A-fiber ratio comp...

Smith, E.S.J.; Purfuerst, B.; Grigoryan, T.; Park, T.J.; Bennett, N.C.; Lewin, G.R.

249

Entrapment of the Median Nerves and Brachial Arteries in the Lower Arms Bilaterally and Additional Origin of Biceps brachii Muscle: Case Report Compresión Bilateral del Nervio Mediano y de la Arteria Braquial en la Parte Distal del Brazo y Origen Adicional del Músculo Bíceps Braquial: Reporte de Caso  

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Full Text Available Neuro-vascular entrapments associated with variations observed in the origins of muscles in the arm are not uncommon. Though additional heads of biceps brachii muscle and extra fibres of brachialis muscles have been demonstrated earlier, bilateral additional heads of the biceps are rarely seen, especially with entrapment of the median nerve and the brachial arteries in both the arms. The present study reports conspicuous heads of the biceps brachii originating extensively from the medial inter-muscular septum, sharing its origin with the brachialis muscle. The extra origins of the muscle formed long musculo-aponeurotic tunnels. The tunnels measured eight centimeters in length extending from the lower arm to the cubital-fossa. Both the median nerve and the brachial arteries passed through the tunnel. The lower aspect of the left tunnel exhibited origins of fibres belonging to the superficial flexors of the forearm. The neuro-vascular structures did not give any branches in the tunnel. Awareness of such variations can aid clinicians in diagnosing and treating such neuropathies and vascular compromise.No es infrecuente observar atrapamientos neuro-vasculares asociados con variaciones en el origen de los músculos del brazo. A pesar de haberse observado cabezas adicionales del músculo bíceps braquial y fibras extra del músculo braquial raramente estas cabezas adicionales bilaterales han sido causantes de la compresión del nervio mediano y de la arteria braquial. En este trabajo presentamos las cabezas del músculo bíceps braquial originándose en gran parte en el tabique intermuscular medial compartiendo su origen con el músculo braquial. Los orígenes adicionales del músculo forman largos túneles músculo fasciales. Los túneles miden 8 cm de longitud, y se extienden desde la parte inferior del brazo hasta la fosa cubital. Tanto el nervio mediano como la arteria braquial pasan por el túnel. La parte inferior del túnel izquierdo dio origen a fibras pertenecientes al músculo flexor superficial del antebrazo. Las estructuras neurovasculares no otorgaron colaterales en el túnel. El conocimiento de estas variaciones puede ayudar a los clínicos en el diagnóstico y el tratamiento de neuropatías y compromiso vascular.

Niladri Kumar Mahato

2010-01-01

250

Acute brachial diplegia due to Lyme disease.  

UK PubMed Central (United Kingdom)

OBJECTIVE: to describe acute brachial diplegia as the initial manifestation of Lyme disease. BACKGROUND: bilateral, predominantly motor, cervical radiculoplexus neuropathy, the "dangling arm syndrome," has not been reported as a complication of acute Lyme infection. METHODS: retrospective series of 5 patients from 2 tertiary neuromuscular centers. RESULTS: there were 4 men and 1 woman with an average age of 69 years. One recalled a tick bite, and preceding constitutional symptoms included headache (2) and fever, arthralgias, and fatigue in 1 patient each. Proximal arm weakness and acute pain developed within 3 weeks from onset; pain was bilateral in 3 patients and unilateral in 2 patients, and was described as severe throbbing. Arm weakness was bilateral at onset in 3 patients, and right sided in 2 patients followed by spread to the left arm within days. All the patients had weakness in the deltoid and biceps that was 3/5 or less (Medical Research Council scale), with variable weakness of the triceps and wrist extensors; 1 patient had a flail right arm and moderate (4/5) weakness of the proximal left arm muscles. Light touch was normal in the regions of weakness, and 1 patient had mildly reduced pin sensation over the forearm. Serum IgM Lyme titers were elevated in all the patients and were detected in the cerebrospinal fluid in 4 tested patients. The cerebrospinal fluid protein ranged between 135 and 176 mg/dL with lymphocytic pleocytosis (range, 42 to 270 cells). Electrodiagnostic studies showed normal median and ulnar motor potentials with asymmetrically reduced sensory amplitudes in the median (4), ulnar (3), and radial, and lateral antebrachial cutaneous potentials in 1 patient each. Two patients had acute denervation in the cervical or proximal arm muscles. There was full recovery after antibiotic therapy in 4 patients and considerable improvement in 1 patient after 2 months. CONCLUSION: acute brachial diplegia is a rare manifestation of acute Lyme infection and responds promptly to antibiotic therapy.

Gorson KC; Kolb DA; Marks DS; Hayes MT; Baquis GD

2011-01-01

251

An analysis of 124 surgically managed brachial artery injuries.  

UK PubMed Central (United Kingdom)

BACKGROUND: A 3-year review of surgically managed brachial artery injuries is presented. METHODS: The medical records were analyzed for demographic data, mechanism of injury, associated injuries, treatment, and outcome. RESULTS: There were 113 males and 11 females with a mean age of 28.7 years. The majority of the injuries were caused by stab and gunshot wounds in 57.3% and 29%, respectively. Primary anastomosis was possible in 47 patients, whereas 73 patients required vein interposition grafting. Lower arm fasciotomy was performed in 15 patients (12.1%). Associated injuries included peripheral nerve lesions in 77 (62.1%), nonpaired brachial vein injuries in 17 (13.7%), and concomitant humerus fracture in 12 (9.7%) patients. Thirty-nine patients (31.5%) had remote injuries. CONCLUSIONS: The primary repair of penetrating brachial artery injuries was possible in approximately one third of the patients. Approximately two thirds of the patients had associated nerve lesions. Critical limb ischemia rarely occurred.

Zellweger R; Hess F; Nicol A; Omoshoro-Jones J; Kahn D; Navsaria P

2004-09-01

252

Entrapment neuropathy contributing to dysfunction after birth brachial plexus injuries.  

UK PubMed Central (United Kingdom)

Although surgical treatment of brachial plexus birth palsy has yielded encouraging results, persistent inability to abduct and elevate the shoulder is common even in children with excellent return of arm and hand function. The reason for deltoid weakness in the afflicted children is not completely understood and may be multifactorial. Clinical observations, including a pattern of position-dependent weakness, suggest that primary nerve damage may not be the sole cause. The authors performed a retrospective chart study to investigate the outcome of surgical treatment to augment shoulder function in a series of 10 children (ages 9 months to 8 years) with inadequate external rotation of the shoulder and inability to actively raise the arm beyond 90 degrees from a birth brachial plexus injury. At follow-up 6 months after surgery, increased shoulder range of motion was noticed in all, with significantly increased abduction/elevation in 8 of the 10 children. Analysis of data, including pre- and postoperative functional testing and intraoperative electrophysiologic monitoring, led to the conclusion that secondary compression of the axillary nerve in the quadrangular space is a separate and common reason for impairment in children with brachial plexus birth palsy and persistent weakness of the deltoid muscle and may provide an important reason for early intervention.

Adelson PD; Nystrom NA; Sclabassi R

2005-09-01

253

Entrapment neuropathy contributing to dysfunction after birth brachial plexus injuries.  

Science.gov (United States)

Although surgical treatment of brachial plexus birth palsy has yielded encouraging results, persistent inability to abduct and elevate the shoulder is common even in children with excellent return of arm and hand function. The reason for deltoid weakness in the afflicted children is not completely understood and may be multifactorial. Clinical observations, including a pattern of position-dependent weakness, suggest that primary nerve damage may not be the sole cause. The authors performed a retrospective chart study to investigate the outcome of surgical treatment to augment shoulder function in a series of 10 children (ages 9 months to 8 years) with inadequate external rotation of the shoulder and inability to actively raise the arm beyond 90 degrees from a birth brachial plexus injury. At follow-up 6 months after surgery, increased shoulder range of motion was noticed in all, with significantly increased abduction/elevation in 8 of the 10 children. Analysis of data, including pre- and postoperative functional testing and intraoperative electrophysiologic monitoring, led to the conclusion that secondary compression of the axillary nerve in the quadrangular space is a separate and common reason for impairment in children with brachial plexus birth palsy and persistent weakness of the deltoid muscle and may provide an important reason for early intervention. PMID:16199937

Adelson, P David; Nystrom, N Ake; Sclabassi, Robert

254

Cutaneous vasculitis.  

Science.gov (United States)

Cutaneous vasculitis comprises a wide spectrum of clinical syndromes and histopathologic findings that share the common theme of vascular inflammation and blood vessel damage. Clinical pattern and proper histopathologic studies are essential to the proper classification and evaluation of vasculitis. This article discusses the major types of cutaneous vasculitis typified by necrotizing or leukocytoclastic vasculitis and includes discussions of Henoch-Schönlein purpura, urticarial vasculitis, erythema elevatum diutinum, cutaneous polyarteritis nodosa, livedoid vasculitis, and cutaneous granulomatous vasculitis. PMID:8592739

Gibson, L E; Su, W P

1995-11-01

255

Cutaneous vasculitis.  

UK PubMed Central (United Kingdom)

Cutaneous vasculitis comprises a wide spectrum of clinical syndromes and histopathologic findings that share the common theme of vascular inflammation and blood vessel damage. Clinical pattern and proper histopathologic studies are essential to the proper classification and evaluation of vasculitis. This article discusses the major types of cutaneous vasculitis typified by necrotizing or leukocytoclastic vasculitis and includes discussions of Henoch-Schönlein purpura, urticarial vasculitis, erythema elevatum diutinum, cutaneous polyarteritis nodosa, livedoid vasculitis, and cutaneous granulomatous vasculitis.

Gibson LE; Su WP

1995-11-01

256

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

Science.gov (United States)

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

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

2012-06-07

257

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

UK PubMed Central (United Kingdom)

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.

Iwamoto J; Yamagishi N; Sasaki K; Kim D; Devkota B; Furuhama K

2012-12-01

258

Hemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: Supraclavicular brachial plexus block is associated with 50% to 67% incidence of hemidiaphragmatic paresis as a result of phrenic nerve block. We examined whether ultrasound-guided compared with nerve stimulation supraclavicular brachial plexus block using 0.75% ropivacaine results in a lower incidence of hemidiaphragmatic paresis. METHODS: In a prospective randomized observer-blinded controlled trial, 60 patients scheduled for elective elbow, forearm, wrist, or hand surgery under supraclavicular brachial plexus block without sedation were included. Supraclavicular brachial plexus block was performed with 20 mL of 0.75% ropivacaine using either ultrasound or nerve stimulation guidance. Ventilatory function was assessed by ultrasound examination of hemidiaphragmatic movement and spirometry. RESULTS: None of the 30 patients in the ultrasound group showed complete or partial paresis of the hemidiaphragm (95% confidence interval, 0.00-0.14), whereas in the nerve stimulation group, 15 patients showed complete paresis of the hemidiaphragm and 1 patient showed partial paresis of the hemidiaphragm (0% versus 53%, respectively; P < 0.0001). Ventilatory function (forced expiratory volume 1, forced vital capacity, peak expiratory flow) was significantly reduced in the nerve stimulation group compared with the ultrasound-guided group (P < 0.05). Two block failures occurred in the nerve stimulation group compared with none in the ultrasound group (P = 0.49). No adverse effects occurred in either group. Conclusions: Ultrasound-guided supraclavicular brachial plexus block, using 20 mL of 0.75% ropivacaine with the described technique, is not associated with hemidiaphragmatic paresis.

Renes SH; Spoormans HH; Gielen MJ; Rettig HC; van Geffen GJ

2009-11-01

259

Ultrasound-guided interscalene brachial plexus block in a pediatric patient with acute hepatitis -A case report-.  

UK PubMed Central (United Kingdom)

The interscalene brachial plexus block is not commonly used in pediatric regional anesthesia. The increasing popularity of ultrasound has allowed more anesthesiologists to perform regional anesthesia with high success rates in pediatric patients with the direct visualization of the target nerve and spread of local anesthetics. We present a case of interscalene brachial plexus block under ultrasound guidance in a 17-month-old child with acute drug-induced hepatitis who required fixation of a fracture of the lateral humeral condyle.

Lee JH; Kim YR; Yu HK; Cho SH; Kim SH; Chae WS

2012-06-01

260

Anomalous phrenic nerve – A case report  

Directory of Open Access Journals (Sweden)

Full Text Available In this paper we report a variation in the formation of phrenic nerve and mention its clinical implications. Phrenic nerve arises chiefly from the fourth cervical ventral ramus, but also the ventral rami of the third and fifth cervical spinal nerves contribute to its formation. A 60-year-old male cadaver presented bilateral variations in the origin of the phrenic nerve. Phrenic nerve was arising from supraclavicular nerve on both sides and receiving a communicating branch from the superior trunk of the brachial plexus. The same cadaver also presented an early division of the superior trunk of the brachial plexus. The clinical significance of such variations during regional anaesthesia is of considerable interest.

Madyastha S; Bhat SM

2006-01-01

 
 
 
 
261

Ankle Brachial Index  

Energy Technology Data Exchange (ETDEWEB)

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

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

262

Cutaneous mechanisms of isometric ankle force control  

DEFF Research Database (Denmark)

The sense of force is critical in the control of movement and posture. Multiple factors influence our perception of exerted force, including inputs from cutaneous afferents, muscle afferents and central commands. Here, we studied the influence of cutaneous feedback on the control of ankle force output. We used repetitive electrical stimulation of the superficial peroneal (foot dorsum) and medial plantar nerves (foot sole) to disrupt cutaneous afferent input in 8 healthy subjects. We measured the effects of repetitive nerve stimulation on (1) tactile thresholds, (2) performance in an ankle force-matching and (3) an ankle position-matching task. Additional force-matching experiments were done to compare the effects of transient versus continuous stimulation in 6 subjects and to determine the effects of foot anesthesia using lidocaine in another 6 subjects. The results showed that stimulation decreased 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 of transient stimulation on force error were greater when compared to continuous stimulation and lidocaine injection. Position-matching performance was unaffected by peroneal nerve or plantar nerve stimulation. Our results show that cutaneous feedback plays a role in the control of force output at the ankle 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.

Choi, Julia T; Jensen, Jesper Lundbye

2013-01-01

263

Incidence of diaphragmatic paralysis following supraclavicular brachial plexus block and its effect on pulmonary function  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Thirty unpremedicated ASA physical status 1-3 patients aged between 18 and 69 years, scheduled for upper limb surgery, received a conventional supraclavicular brachial plexus block using a nerve stimulator and bupivacaine 0.375% 0.5 ml.kg-1. Spirometric measurements of pulmonary function and ultraso...

Mak, PHK; Irwin, MG; Ooi, CGC; Chow, BFM

264

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 ...

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

265

Bilateral Obstetric Palsy of Brachial Plexus  

Directory of Open Access Journals (Sweden)

Full Text Available Obstetric Brachial Plexus Palsy (OBPP) is one of the devastating complications of difficult or assisted deliveries. Brachial plexus palsy with upper root involvement most commonly affects the external rotators and abductors. Twenty percent of obstetrical brachial plexus palsies are bilateral and they represent a more severe condition. An eight-year-old girl patient with bilateral brachial plexus palsy was described and discussed in this report. Turk J Phys Med Rehab 2009;55:126-7.

Özlem Alt?nda?; Sava? Gürsoy; Ahmet Mete

2009-01-01

266

Angiosomes of medial cord of brachial plexus  

Digital Repository Infrastructure Vision for European Research (DRIVER)

This anatomical study analyzed the neurovascular relationship of the brachial plexus. Ten formalized specimens of brachial plexuses were examined after injection of lead oxide in to the subclavian artery. The vascular, anatomical features of the brachial plexus were documented .The specimens were an...

D. Suseelamma; S. Deepthi; K. Krishna Chaitanya; H. R. Sharada

267

Results and current approach for Brachial Plexus reconstruction.  

UK PubMed Central (United Kingdom)

We review our experience treating 335 adult patients with supraclavicular brachial plexus injuries over a 7-year period at the University of Southern Santa Catarina, in Brazil. Patients were categorized into 8 groups, according to functional deficits and roots injured: C5-C6, C5-C7, C5-C8 (T1 Hand), C5-T1 (T2 Hand), C8-T1, C7-T1, C6-T1, and total palsy. To restore function, nerve grafts, nerve transfers, and tendon and muscle transfers were employed. Patients with either upper- or lower-type partial injuries experienced considerable functional return. In total palsies, if a root was available for grafting, 90% of patients had elbow flexion restored, whereas this rate dropped to 50% if no roots were grafted and only nerve transfers performed. Pain resolution should be the first priority, and root exploration and grafting helped to decrease or eliminate pain complaints within a short time of surgery.

Bertelli JA; Ghizoni MF

2011-01-01

268

Management of desmoid-type fibromatosis involving peripheral nerves Tratamento da fibromatose tipo desmoide envolvendo nervos periféricos  

Directory of Open Access Journals (Sweden)

Full Text Available Desmoid-type fibromatosis is an uncommon and aggressive neoplasia, associated with a high rate of recurrence. It is characterized by an infiltrative but benign fibroblastic proliferation occurring within the deep soft tissues. There is no consensus about the treatment of those tumors. We present a surgical series of four cases, involving the brachial plexus (two cases), the median nerve and the medial brachial cutaneous nerve. Except for the last case, they were submitted to multiple surgical procedures and showed repeated recurrences. The diagnosis, the different ways of treatment and the prognosis of these tumoral lesions are discussed. Our results support the indication of radical surgery followed by radiotherapy as probably one of the best ways to treat those controversial lesions.A fibromatose do tipo desmoide é uma lesão tumoral agressiva e rara, associada a alto índice de recorrência. É caracterizada pela fibroblástica infiltrativa, porém benigna, que ocorre no interior de tecidos moles profundos. Não existe consenso com relação ao tratamento desses tumores. Apresentamos uma série cirúrgica de quatro casos comprometendo o plexo braquial (dois casos), o nervo mediano e o nervo cutâneo medial do braço. Com exceção do último caso, todos foram submetidos a múltiplos procedimentos cirúrgicos e apresentaram recorrências repetidas. São discutidos o diagnóstico, as diferentes formas de tratamento e o prognóstico dessas lesões tumorais. Nossos resultados apoiam o conceito de que cirurgia radical seguida por radioterapia é uma das melhores formas de se tratar essas controvertidas lesões.

Mario G. Siqueira; Paulo L. Tavares; Roberto S. Martins; Carlos O. Heise; Luciano H.L. Foroni; Marcelo Bordalo; Roberto Falzoni

2012-01-01

269

Management of desmoid-type fibromatosis involving peripheral nerves/ Tratamento da fibromatose tipo desmoide envolvendo nervos periféricos  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese A fibromatose do tipo desmoide é uma lesão tumoral agressiva e rara, associada a alto índice de recorrência. É caracterizada pela fibroblástica infiltrativa, porém benigna, que ocorre no interior de tecidos moles profundos. Não existe consenso com relação ao tratamento desses tumores. Apresentamos uma série cirúrgica de quatro casos comprometendo o plexo braquial (dois casos), o nervo mediano e o nervo cutâneo medial do braço. Com exceção do último caso, (more) todos foram submetidos a múltiplos procedimentos cirúrgicos e apresentaram recorrências repetidas. São discutidos o diagnóstico, as diferentes formas de tratamento e o prognóstico dessas lesões tumorais. Nossos resultados apoiam o conceito de que cirurgia radical seguida por radioterapia é uma das melhores formas de se tratar essas controvertidas lesões. Abstract in english Desmoid-type fibromatosis is an uncommon and aggressive neoplasia, associated with a high rate of recurrence. It is characterized by an infiltrative but benign fibroblastic proliferation occurring within the deep soft tissues. There is no consensus about the treatment of those tumors. We present a surgical series of four cases, involving the brachial plexus (two cases), the median nerve and the medial brachial cutaneous nerve. Except for the last case, they were submitted (more) to multiple surgical procedures and showed repeated recurrences. The diagnosis, the different ways of treatment and the prognosis of these tumoral lesions are discussed. Our results support the indication of radical surgery followed by radiotherapy as probably one of the best ways to treat those controversial lesions.

Siqueira, Mario G.; Tavares, Paulo L.; Martins, Roberto S.; Heise, Carlos O.; Foroni, Luciano H.L.; Bordalo, Marcelo; Falzoni, Roberto

2012-07-01

270

Comunicación Masiva del Ramo Superficial del Nervio Radial con el Nervio Cutáneo Antebraquial Lateral, un Análisis Morfométrico. 1+1 ? 2/ Massive Communication Between the Superficial Branch of Radial Nerve and the Lateral Cutaneous Nerve of the Forearm, a Morphometric Study. 1+1 ? 2  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish La distribución de los ramos nerviosos sensitivos en el borde lateral y en el dorso de la mano han sido descritos con mayor exactitud en las últimas décadas, debido al avance de nuevas técnicas de diagnóstico, las cuales han permitido detectar que alrededor del 40% de la población examinada presenta algún grado de variación anatómica en el territorio de distribución de los nervios involucrados. Conocer el número de fibras que componen un ramo nervioso cutáneo (more) de la región de la mano, ha adquirido mayor relevancia con el desarrollo de técnicas de microcirugía y de ultrasonografía, procedimientos que han demostrado la utilidad de este conocimiento en el diagnóstico y tratamiento de las lesiones nerviosas. Así, la arquitectura fascicular, el área adiposa y el área vascular de un ramo nervioso determinado constituyen datos que se ha demostrado se modifican con la edad y, en consecuencia, van condicionar la conducta terapéutica y el pronóstico de las lesiones nerviosas. En este caso presentamos una variación anatómica bilateral extremadamente rara, que involucra al ramo superficial del nervio radial y al nervio cutáneo lateral antebraquial; situación que aparece descrita en la literatura especializada sólo una vez y que modifica notablemente la inervación sensitiva del borde radial de la mano. Abstract in english The distribution of sensory nerve branches in the lateral and the back of the hand have been described more accurately in recent decades due to advances in new diagnostic techniques, which have identified that about 40% of the population examined have some degree of anatomical variation in the distribution area of the sensitive nerves involved. The knowledge of the number of fibers forming a sensitive nerve of the hand has become more important with the development of mic (more) rosurgical techniques and ultrasonography; procedures that have demonstrated the usefulness of this information in the diagnosis and treatment of nerve injuries. Thus, the fascicular architecture, adipose tissue area and the vascular area of a nerve branch, data that has been demonstrated that change with age, will determine the therapeutic and prognosis of nerve injuries. In this case we present an extremely rare and bilateral anatomical variation, involving the superficial branch of radial nerve and the lateral antebrachial cutaneous nerve, a situation that is described in the literature only once and which notably alter the sensory innervations of the radial edge of the hand.

Salgado A, Guillermo; Inzunza A, Martin; Cruzat C, Claudio; Inzunza H, Oscar

2012-09-01

271

Endoscopic exploration and repair of brachial plexus with telerobotic manipulation: a cadaver trial.  

UK PubMed Central (United Kingdom)

OBJECT: The aim of this paper was to develop an effective minimally invasive approach to brachial plexus surgery and to determine the feasibility of using telerobotic manipulation to perform a diagnostic dissection and microsurgical repair of the brachial plexus utilizing an entirely endoscopic approach. METHODS: The authors performed an endoscopic approach using 3 supraclavicular portals in 2 fresh human cadaver brachial plexuses with the aid of the da Vinci telemanipulation system. Dissection was facilitated inflating the area with CO(2) at 4 mm Hg pressure. The normal supraclavicular plexus was dissected in its entirety to confirm the feasibility of a complete supraclavicular brachial plexus diagnostic exploration. Subsequently, an artificial lesion to the upper trunk was created, and nerve graft reconstruction was performed. Images and video of the entire procedure were obtained and edited to illustrate the technique. RESULTS: All supraclavicular structures of the brachial plexus could be safely dissected and identified, similar to the experience in open surgery. The reconstruction of the upper trunk with nerve graft was successfully completed using an epineural microsurgical suture technique performed exclusively with the aid of the robot. There were no instances of inadvertent macroscopic damage to the vascular and nervous structures involved. CONCLUSIONS: An endoscopic approach to the brachial plexus is feasible. The use of the robot makes it possible to perform microsurgical procedures in a very small space with telemanipulation and minimally invasive techniques. The ability to perform a minimally invasive procedure to explore and repair a brachial plexus injury may provide a new option in the acute management of these injuries.

Mantovani G; Liverneaux P; Garcia JC Jr; Berner SH; Bednar MS; Mohr CJ

2011-09-01

272

Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler: a case report.  

Science.gov (United States)

Objective: To present the unique case of a collegiate wrestler with C7 neurologic symptoms due to T1-T2 disc herniation. Background: A 23-year-old male collegiate wrestler injured his neck in a wrestling tournament match and experienced pain, weakness, and numbness in his left upper extremity. He completed that match and 1 additional match that day with mild symptoms. Evaluation by a certified athletic trainer 6 days postinjury showed radiculopathy in the C7 distribution of his left upper extremity. He was evaluated further by the team physician, a primary care physician, and a neurosurgeon. Differential Diagnosis: Cervical spine injury, stinger/burner, peripheral nerve injury, spinal cord injury, thoracic outlet syndrome, brachial plexus radiculopathy. Treatment: The patient initially underwent nonoperative management with ice, heat, massage, electrical stimulation, shortwave diathermy, and nonsteroidal anti-inflammatory drugs without symptom resolution. Cervical spine radiographs were negative for bony pathologic conditions. Magnetic resonance imaging showed evidence of T1-T2 disc herniation. The patient underwent surgery to resolve the symptoms and enable him to participate for the remainder of the wrestling season. Uniqueness: Whereas brachial plexus radiculopathy commonly is seen in collision sports, a postfixed brachial plexus in which the T2 nerve root has substantial contribution to the innervation of the upper extremity is a rare anatomic variation with which many health care providers are unfamiliar. Conclusions: The injury sustained by the wrestler appeared to be C7 radiculopathy due to a brachial plexus traction injury. However, it ultimately was diagnosed as radiculopathy due to a T1-T2 thoracic intervertebral disc herniation causing impingement of a postfixed brachial plexus and required surgical intervention. Athletic trainers and physicians need to be aware of the anatomic variations of the brachial plexus when evaluating and caring for patients with suspected brachial plexus radiculopathies. PMID:23952042

Kuzma, Scott A; Doberstein, Scott T; Rushlow, David R

2013-08-16

273

Our experience on brachial plexus blockade in upper extremity surgery  

Directory of Open Access Journals (Sweden)

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

Feyzi Çelik; Adnan Tüfek; Zeynep B.Y?ld?r?m; Orhan Tokgöz; Haktan Karaman; Celil Alemdar; Taner Çiftçi; Ömer Uslukaya; Gönül Ölmez Kavak

2012-01-01

274

[Neurophysiological assessment of children with obstetric brachial plexus palsy].  

UK PubMed Central (United Kingdom)

INTRODUCTION: The objectives of the neurophysiological evaluation of infants with brachial plexus palsy are to determine the time of occurrence of the lesion, to locate the lesion and to determine its course. METHODS AND CONCLUSIONS: These objectives are achieved by studying affected upper extremity muscles by needle electromiography (EMG) and affected nerves by motor and sensory conduction studies. EMG is performed in the first week of life in those patients with brachial plexus palsy of unknown etiology to determine the age of the lesion for medico-legal reasons. EMG is performed before surgery for tendon transfer in the selected muscles to assure that they are normal. EMG and motor and sensory conduction studies are performed at the age of 3 and 6 months in infants with less than 4 muscle weakness to determine candidates for surgical exploration. Motor and sensory nerve conduction studies are performed intraoperative to determine the functional status of the affected axons and the best surgical procedure (neurotization, neurolysis and/or neuroma resection and homologous nerve graft).

Papazian O; Alfonso I; Grossman JA

1998-08-01

275

[Schwannoma of brachial plexus: report of two cases].  

UK PubMed Central (United Kingdom)

Schwannomas, neurinomas or neurilemmomas are benign peripheral nerve tumors. The literature report some cases associated with neurofibromatosis 2. We report two cases of cervical schwannoma originating from the brachial plexus unassociated with neurofibromatosis. A 31-year-old woman presented with a mass in the right supraclavicular region, irradiating pain and distal tingling to percussion (Tinel's sign) for 6 months. And a 52-year-old woman presented with pain in the cervical region and right arm for one year. Both the patients underwent to a microsurgery with total resection of the lesion. Histology of the surgical specimen confirmed the diagnosis of schwannoma. Postoperatively, the patients had a good recovery.

Leal Filho MB; Aguiar Ade A; de Almeida BR; Dantas Kda S; Vieira MA; de Morais RK; da Silva RG Jr

2004-03-01

276

Changes of cutaneous sensory thresholds induced by non-painful transcutaneous electrical nerve stimulation in normal subjects and in subjects with chronic pain.  

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Transcutaneous electrical nerve stimulation (TENS) of the nervi cutaneus surae medialis was applied to 59 healthy subjects and 30 patients suffering from chronic myofascial pain in one lower limb, with an intensity of current that induced a well tolerated tingling sensation. Each period of stimulati...

Zoppi, M; Francini, F; Maresca, M; Procacci, P

277

[Management of obstetrical brachial plexus palsy--own experience with the primary operative technique  

UK PubMed Central (United Kingdom)

Obstetrical brachial plexus palsy occurs at a frequency of 0.6 to 2.5 per 1000 births. 80 to 95% of these lesions recover spontaneously. If spontaneous recovery does not occur within the first six months of life, investigations like electrophysiology, and CT-myelography and surgical exploration of the brachial plexus are recommended. During the last ten years 73 children with obstetrical brachial plexus lesions were examined in our department. 29 newborns underwent surgery on the brachial plexus. In 20 out of 29 children nerve root avulsions were diagnosed preoperatively. We performed in 16 cases nerve grafting after neuroma excision, in four cases nerve grafting combined with neurotization, in seven cases external or internal neurolysis, and in the remaining two cases neurotization and plexo-plexal transfer, respectively. The children were followed up between 18 and 50 months (range 27 months) in 18 cases. Elbow function according to Gilbert scale achieved one half of the patients four to five points and the other half two to three points. We found shoulder function with abduction between 45 degrees to 128 degrees and external rotation in 61% (Grade II to V, according to Gilbert scale). In 31% hand function showed Grade III and IV (Gilbert and Raimondi scale). We recommend decision for surgery at the age of six months. Operation should be planned between six to nine months of life. In addition, physical therapy and options including muscle transfers and orthopaedic procedures must be available to ensure the optimal outcome for these children.

Antoniadis G; König RW; Mohr K; Kretschmer T; Richter HP

2003-03-01

278

Early post-operative results after repair of traumatic brachial plexus palsy.  

UK PubMed Central (United Kingdom)

AIM: Treatment options for traumatic brachial plexus injuries include nerve grafting, or neurotization. The type of lesion and the reconstructive procedures affect functional results and postoperative pain relief. MATERIAL and METHODS: A total number of twenty five patients suffering from post-traumatic brachial plexus injury were included in the study. The patients underwent exploration and primary repair of the affected plexus, based on case by case policy. RESULTS: Spinal accessory nerve transfer to suprascapular nerve procedure regained 78.95% of functional muscle power, 10.50% of non functional muscle power and only 10.5 % of non innervated muscle. The Oberlin procedure regained 83.33% with elbow flexion muscle power, 16.67% with non functional muscle power. Intercostal nerve transfer to musculocutaneous nerve regained 62.5% with functional muscle power, 25% with non functional muscle power and only 12.5 % with non innervated muscle. The shoulder, elbow and wrist extension functions were significantly improved early post-operatively. In addition, the post-operative improvement of shoulder, elbow and wrist extension functions had significant negative correlations with the pre-operative elapsed time, and accompanied by a significant positive correlation with post-operative follow up period. CONCLUSION: Early intervention for traumatic brachial plexus palsy is recommended to get good results with pain relief.

Mohammad-Reda A

2013-01-01

279

A novel technique for teaching the brachial plexus.  

UK PubMed Central (United Kingdom)

BACKGROUND: The brachial plexus has posed problems for both students and teachers throughout generations of medical education. The anatomy is intricate, and traditional pictorial representations can be difficult to understand and learn. Few innovative teaching methods have been reported. CONTEXT: The basic anatomy of the brachial plexus is core knowledge required by medical students to aid clinical examination and diagnosis. A more detailed understanding is necessary for a variety of specialists, including surgeons, anaesthetists and radiologists. INNOVATION: Here, we present a novel, cheap and interactive method of teaching the brachial plexus. Using coloured pipe cleaners, teachers and students can construct three-dimensional models using different colours to denote the origin and outflow of each nerve. The three-dimensional nature of the model also allows for a better understanding of certain intricacies of the plexus. Students may use these models as adjuncts for self study, didactic lectures and tutorials. IMPLICATIONS: Compared with traditional textbooks and whiteboards, the pipe-cleaner model was preferred by medical students, and provided a higher level of student satisfaction. This was demonstrated and analysed using student feedback forms. Our model could be incorporated into current curricula to provide an effective and enjoyable way of rapidly teaching a difficult concept. Other such novel methods for teaching complex anatomical principles should be encouraged and explored.

Lefroy H; Burdon-Bailey V; Bhangu A; Abrahams P

2011-09-01

280

Parecoxib added to ropivacaine prolongs duration of axillary brachial plexus blockade and relieves postoperative pain.  

UK PubMed Central (United Kingdom)

BACKGROUND: Cyclooxygenase (COX)-2 antagonist is widely used for intravenous postoperative pain relief. Recent studies reported COX-2 in the spinal dorsal horn could modulate spinal nociceptive processes. Epidural parecoxib in rats showed no neurotoxicity. These findings suggested applying a COX-2 antagonist directly to the central or peripheral nerve might provide better analgesia. QUESTIONS/PURPOSES: We therefore determined: (1) whether the addition of parecoxib to ropivacaine injected locally on the nerve block affected the sensory and motor block times of the brachial plexus nerve block; and (2) whether parecoxib injected locally on the nerve or intravenously had a similar analgesic adjuvant effect. METHODS: We conducted a randomized controlled trial from January 2009 to November 2010 with 150 patients scheduled for elective forearm surgery, using a multiple-nerve stimulation technique. Patients were randomly allocated into one of three groups: Group A (n = 50) received ropivacaine 0.25% alone on the brachial plexus nerve; Group B (n = 50) received ropivacaine together with 20 mg parecoxib locally on the nerve block; and Group C (n = 50) received 20 mg parecoxib intravenously. We recorded the duration of the sensory and motor blocks, and the most severe pain score during a 24-hour postoperative period. RESULTS: Parecoxib added locally on the nerve block prolonged the motor and sensory block times compared with Group A. However, parecoxib injected intravenously had no such effect. Pain intensity scores in Group B were lower than those in Groups A and C. CONCLUSIONS: Parecoxib added to ropivacaine locally on the nerve block prolonged the duration of the axillary brachial plexus blockade and relieved postoperative pain for patients having forearm orthopaedic surgery. LEVEL OF EVIDENCE: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Liu X; Zhao X; Lou J; Wang Y; Shen X

2013-02-01

 
 
 
 
281

Cutaneous amyloidosis.  

Science.gov (United States)

Amyloidosis is generally classified as either systemic or cutaneous, with both primary and secondary forms. There are also heredofamilial and hemodialysis-associated varieties of amyloidosis, all with specific amyloid fibril derivatives. Nodular cutaneous amyloidosis is the most rare form of primary cutaneous amyloidosis. Lesions typically present as a crusted nodule on the face, extremities, or acral sites. The amyloid fibrils are immunoglobulin-derived and either kappa or lambda light chains. Systemic involvement is dependent on plasma cell amyloid protein deposition. Lesions may otherwise be classified as a local plasma cell clone or cutaneous plasmacytoma. Recent reports state that there is cutaneous amyloidosis is challenging, as there is no consistently effective treatment and local recurrence is common. PMID:21548513

Borowicz, Jessica; Gillespie, Michelle; Miller, Richard

282

Cutaneous amyloidosis.  

UK PubMed Central (United Kingdom)

Amyloidosis is generally classified as either systemic or cutaneous, with both primary and secondary forms. There are also heredofamilial and hemodialysis-associated varieties of amyloidosis, all with specific amyloid fibril derivatives. Nodular cutaneous amyloidosis is the most rare form of primary cutaneous amyloidosis. Lesions typically present as a crusted nodule on the face, extremities, or acral sites. The amyloid fibrils are immunoglobulin-derived and either kappa or lambda light chains. Systemic involvement is dependent on plasma cell amyloid protein deposition. Lesions may otherwise be classified as a local plasma cell clone or cutaneous plasmacytoma. Recent reports state that there is <10% risk of systemic progression. Workup should include at least a full history and physical examination; serum protein electrophoresis and urine protein electrophoresis; and gingival, rectal, or abdominal fat pad biopsies to rule out the presence of extracutaneous amyloid deposition. Management of nodular cutaneous amyloidosis is challenging, as there is no consistently effective treatment and local recurrence is common.

Borowicz J; Gillespie M; Miller R

2011-03-01

283

Nerve involvement in granuloma annulare.  

UK PubMed Central (United Kingdom)

BACKGROUND: Nerve involvement developed in a patient with granuloma annulare, as evidenced by a perineural infiltrate of histiocytes in the dermis. The histopathologic pattern was suggestive of leprosy. No mycobacteria were observed, and neurologic testing was normal. OBJECTIVE: To determine whether inflammation of the nerves or perineural tissue is common in granuloma annulare, we studied the cutaneous nerves in skin biopsy specimens from 14 patients with granuloma annulare. METHODS: Sections were stained with hematoxylin-eosin to highlight inflammatory cells and with S-100 to identify cutaneous nerves. RESULTS: No inflammation around nerves was found in 12 specimens, abutting granulomatous inflammation was found in 1 specimen, and enveloping granulomatous inflammation was found in 1 specimen. No nerves were infiltrated by inflammatory cells. CONCLUSION: Perineural granulomatous inflammation resembling the perineural infiltrate of leprosy appears to be an uncommon characteristic of granuloma annulare. Clinical correlation and acid-fast stains can assist in establishing the correct diagnosis.

Longmire M; DiCaudo DJ; Dahl MV

2012-11-01

284

Ultrasound-guided brachial plexus block: a study on 30 patients  

Directory of Open Access Journals (Sweden)

Full Text Available "n Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Successful brachial plexus blocks rely on proper techniques of nerve localization, needle placement, and local anesthetic injection. Standard approaches used today (elicitation of paresthesia or nerve-stimulated muscle contraction), unfortunately, are all "blind" techniques resulting in procedure-related pain and complications. Ultrasound guidance for brachial plexus blocks can potentially improve success and complication rates. This study presents the ultrasound-guided brachial plexus blocks for the first time in Iran in adults and pediatrics. "n"n Methods: In this study ultrasound-guided brachial plexus blocks in 30 patients (25 adults & 5 pediatrics) scheduled for an elective upper extremity surgery, are introduced. Ultrasound imaging was used to identify the brachial plexus before the block, guide the block needle to reach target nerves, and visualize the pattern of local anesthetic spread. Needle position was further confirmed by nerve stimulation before injection. Besides basic variables, block approach, block time, postoperative analgesia duration (VAS<3 was considered as target pain control) opioid consumption during surgery, patient satisfaction and block related complications were reported."n"n Results: Mean adult age was 35.5±15 and in pediatric group was 5.2±4. Frequency of interscalene, supraclavicular, axillary approaches to brachial plexus in adults was 5, 7, 13 respectively. In pediatrics, only supraclavicular approach was accomplished. Mean postoperative analgesia time in adults was 8.5±4 and in pediatrics was 10.8±2. No block related complication were observed and no supplementary, were needed.        "nConclusions: Real-time ultrasound imaging during brachial plexus blocks can facilitate nerve localization and needle placement and examine the pattern and extend of local anesthetic spread.

Amiri HR; Makarem J

2009-01-01

285

Radiation-induced brachial plexopathy: Neurological follow-up in 161 recurrence-free breast cancer patients  

International Nuclear Information System (INIS)

[en] The purpose was to assess the incidence and clinical manifestations of radiation-induced brachial plexopathy in breast cancer patients, treated according to the Danish Breast Cancer Cooperative Group protocols. One hundred and sixty-one recurrence-free breast cancer patients were examined for radiation-induced brachial plexopathy after a median follow-up period of 50 months (13-99 months). After total mastectomy and axillary node sampling, high-risk patients were randomized to adjuvant therapy. One hundred twenty-eight patients were treated with postoperative radiotherapy with 50 Gy in 25 daily fractions over 5 weeks. In addition, 82 of these patients received cytotoxic therapy (cyclophosphamide, methotrexate, and 5-fluorouracil) and 46 received tamoxifen. Five percent and 9% of the patients receiving radiotherapy had disabling and mild radiation-induced brachial plexopathy, respectively. Radiation-induced brachial plexopathy was more frequent in patients receiving cytotoxic therapy (p = 0.04) and in younger patients (p = 0.04). The clinical manifestations were paraesthesia (100%), hypaesthesia (74%), weakness (58%), decreased muscle stretch reflexes (47%), and pain (47%). The brachial plexus is more vulnerable to large fraction size. Fractions of 2 Gy or less are advisable. Cytotoxic therapy adds to the damaging effect of radiotherapy. Peripheral nerves in younger patients seems more vulnerable. Radiation-induced brachial plexopathy occurs mainly as diffuse damage to the brachial plexus. 24 refs., 9 tabs

1993-04-30

286

Radiation-induced brachial plexopathy: Neurological follow-up in 161 recurrence-free breast cancer patients  

Energy Technology Data Exchange (ETDEWEB)

The purpose was to assess the incidence and clinical manifestations of radiation-induced brachial plexopathy in breast cancer patients, treated according to the Danish Breast Cancer Cooperative Group protocols. One hundred and sixty-one recurrence-free breast cancer patients were examined for radiation-induced brachial plexopathy after a median follow-up period of 50 months (13-99 months). After total mastectomy and axillary node sampling, high-risk patients were randomized to adjuvant therapy. One hundred twenty-eight patients were treated with postoperative radiotherapy with 50 Gy in 25 daily fractions over 5 weeks. In addition, 82 of these patients received cytotoxic therapy (cyclophosphamide, methotrexate, and 5-fluorouracil) and 46 received tamoxifen. Five percent and 9% of the patients receiving radiotherapy had disabling and mild radiation-induced brachial plexopathy, respectively. Radiation-induced brachial plexopathy was more frequent in patients receiving cytotoxic therapy (p = 0.04) and in younger patients (p = 0.04). The clinical manifestations were paraesthesia (100%), hypaesthesia (74%), weakness (58%), decreased muscle stretch reflexes (47%), and pain (47%). The brachial plexus is more vulnerable to large fraction size. Fractions of 2 Gy or less are advisable. Cytotoxic therapy adds to the damaging effect of radiotherapy. Peripheral nerves in younger patients seems more vulnerable. Radiation-induced brachial plexopathy occurs mainly as diffuse damage to the brachial plexus. 24 refs., 9 tabs.

Olsen, N.K.; Pfeiffer, P.; Johannsen, L.; Schroder, H.; Rose, C. (Odense Univ. Hospital (Denmark))

1993-04-30

287

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  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish 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 v (more) arias 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. Abstract in english 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 concentr (more) ates (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.

López, C; Carmona, JU; Samudio, I

2010-01-01

288

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  

Directory of Open Access Journals (Sweden)

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.

C López; JU Carmona; I Samudio

2010-01-01

289

Mapping sensory nerve communications between peripheral nerve territories.  

UK PubMed Central (United Kingdom)

The human cutaneous sensory map has been a work in progress over the past century, depicting sensory territories supplied by both the spinal and cranial nerves. Two critical discoveries, which shaped our understanding of cutaneous innervation, were sensory dermatome overlap between contiguous spinal levels and axial lines across areas where no sensory overlap exists. These concepts define current dermatome maps. We wondered whether the overlap between contiguous sensory territories was even tighter: if neural communications were present in the peripheral nerve territories consistently connecting contiguous spinal levels? A literature search using peer-reviewed articles and established anatomy texts was performed aimed at identifying the presence of communications between sensory nerves in peripheral nerve territories and their relationship to areas of adjacent and non-adjacent spinal or cranial nerves and axial lines (lines of discontinuity) in the upper and lower limbs, trunk and perineum, and head and neck regions. Our findings demonstrate the consistent presence of sensory nerve communications between peripheral nerve territories derived from spinal nerves within areas of axial lines in the upper and lower limbs, trunk and perineum, and head and neck. We did not find examples of communications crossing axial lines in the limbs or lines of discontinuity in the face, but did find examples crossing axial lines in the trunk and perineum. Sensory nerve communications are common. They unify concepts of cutaneous innervation territories and their boundaries, and refine our understanding of the sensory map of the human skin. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.

Ladak A; Tubbs RS; Spinner RJ

2013-07-01

290

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

Directory of Open Access Journals (Sweden)

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.

Luane Lopes Pinheiro; Damázio Campos de Souza; Érika Branco; Ana Rita de Lima; Ana Carla Barros de Souza; Luiza Corrêa Pereira

2013-01-01

291

Brief report: identification of the great auricular nerve by ultrasound imaging and transcutaneous nerve stimulation.  

UK PubMed Central (United Kingdom)

Superficial cervical plexus neuropathy after interscalene brachial plexus block affects about 8% of patients postoperatively. One of the nerves involved in superficial cervical plexus neuropathy is the great auricular nerve. We report success in identification of the great auricular nerve with ultrasound and transcutaneous nerve stimulation in a clinical setting in the majority of cases (95% lower confidence limit 63%). Identification of the nerve is significantly more difficult in female and in obese patients. Further studies will allow determination of whether this information will help to reduce the incidence of superficial cervical plexus neuropathy.

Christ S; Kaviani R; Rindfleisch F; Friederich P

2012-05-01

292

Brief report: identification of the great auricular nerve by ultrasound imaging and transcutaneous nerve stimulation.  

Science.gov (United States)

Superficial cervical plexus neuropathy after interscalene brachial plexus block affects about 8% of patients postoperatively. One of the nerves involved in superficial cervical plexus neuropathy is the great auricular nerve. We report success in identification of the great auricular nerve with ultrasound and transcutaneous nerve stimulation in a clinical setting in the majority of cases (95% lower confidence limit 63%). Identification of the nerve is significantly more difficult in female and in obese patients. Further studies will allow determination of whether this information will help to reduce the incidence of superficial cervical plexus neuropathy. PMID:22312123

Christ, Saskia; Kaviani, Reza; Rindfleisch, Franziska; Friederich, Patrick

2012-02-06

293

Cutaneous Deposits.  

UK PubMed Central (United Kingdom)

ABSTRACT:: The cutaneous deposition disorders are a group of unrelated conditions characterized by the accumulation of either endogenous or exogenous substances within the skin. These cutaneous deposits are substances that are not normal constituents of the skin and are laid down usually in the dermis, but also in the subcutis, in a variety of different circumstances. There are 5 broad categories of cutaneous deposits. The first group includes calcium salts, bone, and cartilage. The second category includes the hyaline deposits that may be seen in the dermis in several metabolic disorders, such as amyloidosis, gout, porphyria, and lipoid proteinosis. The third category includes various pigments, heavy metals, and complex drug pigments. The fourth category, cutaneous implants, includes substances that are inserted into the skin for cosmetic purposes. The fifth category includes miscellaneous substances, such as oxalate crystals and fiberglass. In this article, the authors review the clinicopathologic characteristics of cutaneous deposition diseases, classify the different types of cutaneous deposits, and identify all the histopathologic features that may assist in diagnosing the origin of a cutaneous deposit.

Molina-Ruiz AM; Cerroni L; Kutzner H; Requena L

2013-01-01

294

Brachial Amyotrophic Diplegia: Case Report  

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Full Text Available Two forms of Amyotrophic lateral sclerosis (ALS) subtypes have been recognized since the late 19th and early 20th centuries but relatively inadequately studied, these being the flail arm (FA) and flail leg (FL) syndromes. The FA phenotype was described by Vulpian in 1886 as a syndrome of proximal weakness and wasting of the upper limbs (scapulohumeral variant of progressive muscular atrophy or forme scapulo-hume´rale). The condition has been variously termed as Vulpian-Bernhardt syndrome, hanging-arm syndrome, neurogenic man-in-a-barrel syndrome, brachial amyotrophic diplegia, or the FA syndrome. The syndrome typically presents with progressive upper limb weakness and wasting that is often symmetric and proximal, without significant functional involvement of lower limbs or bulbar muscles. Here we presented a patient with complaints of difficulty in lifting his right arm in his medical history. Brachial amyotrophic diplegia was diagnosed with neurological examination and EMG findings. It is presented because of rarity.

Mehmet YÜCEL; O?uzhan ÖZ; Hakan AKGÜN; Muammer KORKMAZ; Ümit H. ULA?; ?eref DEM?RKAYA; Ya?ar KÜTÜKÇÜ; Zeki ODABA?I

2011-01-01

295

Finger movement at birth in brachial plexus birth palsy  

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Full Text Available AIM: To investigate whether the finger movement at birth is a better predictor of the brachial plexus birth injury. METHODS: We conducted a retrospective study reviewing pre-surgical records of 87 patients with residual obstetric brachial plexus palsy in study 1. Posterior subluxation of the humeral head (PHHA), and glenoid retroversion were measured from computed tomography or Magnetic resonance imaging, and correlated with the finger movement at birth. The study 2 consisted of 141 obstetric brachial plexus injury patients, who underwent primary surgeries and/or secondary surgery at the Texas Nerve and Paralysis Institute. Information regarding finger movement was obtained from the patient’s parent or guardian during the initial evaluation. RESULTS: Among 87 patients, 9 (10.3%) patients who lacked finger movement at birth had a PHHA > 40%, and glenoid retroversion 40%, and retroversion < -8° in study 1. The improvement in glenohumeral deformity (PHHA, 31.8% ± 14.3%; and glenoid retroversion 22.0° ± 15.0°) was significantly higher in patients, who have not had any primary surgeries and had finger movement at birth (group 1), when compared to those patients, who had primary surgeries (nerve and muscle surgeries), and lacked finger movement at birth (group 2), (PHHA 10.7% ± 15.8%; Version -8.0° ± 8.4°, P = 0.005 and P = 0.030, respectively) in study 2. No finger movement at birth was observed in 55% of the patients in this study group. CONCLUSION: Posterior subluxation and glenoid retroversion measurements indicated significantly severe shoulder deformities in children with finger movement at birth, in comparison with those lacked finger movement. However, the improvement after triangle tilt surgery was higher in patients who had finger movement at birth.

Rahul K Nath; Mohamed Benyahia; Chandra Somasundaram

2013-01-01

296

Primary brachial plexus neoplasia in cats.  

UK PubMed Central (United Kingdom)

Conditions affecting the brachial plexus and its branches can cause lameness and/or neurological deficits. There are few reports of schwannomas in cats. In reported cases, the tumours arose from the dermis or subcutis of the limbs, head and neck and thorax, but there are no reports of primary tumours that arose from the brachial plexus itself. The purpose of this study is to present the clinical, radiological, ultrasonographical and pathological findings of primary brachial plexus tumour in three cats.

Hanna FY

2013-04-01

297

[Anatomical basis for infraclavicular brachial plexus block].  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: This study shows the constant infraclavicular fossa presence, aiming at using it as a pathway for infraclavicular brachial plexus block. Determining the point where brachial plexus fascicles may be located within the fossa, the authors have proposed measurements from the anterior surface of the clavicle and the angle formed by the deltoid muscle and the clavicle (deltoclavicular angle). The first measurement allows the in-depth location of the site crossed by the brachial plexus. The second determines fascicles projection within the fossa, corresponding to the needle insertion point on the skin. METHODS: Measurements were made between the anterior surface of the clavicle and brachial plexus fascicles, and from the deltoclavicular angle to superficial fascicles projection. Based on the anatomic findings a technique of infraclavicular brachial plexus approach was proposed. RESULTS: A hundred infraclavicular regions in cadavers were analyzed. Infraclavicular fossa was detected in 96 cases where brachial plexus fascicles were totally or partially (97.9%) located. The distance between the anterior surface of the clavicle and brachial plexus fascicles was in average of 2.49 cm and from the deltoclavicular angle to superficial fascicles projection was 2.21 cm. CONCLUSIONS: Values obtained allow for the precise location of the needle insertion point which, when perpendicular to the skin, reaches brachial plexus without danger of causing pneumothorax or vascular injury, providing more safety to anesthesiologists and allowing the return to the practice of brachial plexus block below the clavicle.

Gusmão LC; Lima JS; Prates JC

2002-06-01

298

Cutaneous Leishmaniasis.  

Science.gov (United States)

The cutaneous leishmaniases include a spectrum of self healing and chronic disease forms caused by protozoan parasites of the genus Leishmania. Clinical presentations differ according to parasite burden and host immune response. Although there can be cons...

A. J. Magill M. K. Klassen- Fischer R. C. Neafie W. M. Meyers

2011-01-01

299

Cutaneous rhinosporidiosis  

Directory of Open Access Journals (Sweden)

Full Text Available Rhinosporidiosis is a chronic granulomatous disease of the mucocutaneous tissue, which clinically presents as polypoidal growths. Cutaneous lesions are infrequent and are generally associated with mucosal lesions. We present a case of cutaneous rhinosporidiosis in association with recurrent nasopharyngeal rhinosporidiosis in a 65-year-old male patient. He presented with dysphagia for solid foods and skin growth on the left side of jaw of 2 years duration. Histopathology of cutaneous and nasopharyngeal lesions revealed numerous thick walled sporangia in a vascular connective tissue along with a granulomatous inflammation confirming the diagnosis of cutaneous and nasopharyngeal rhinosporidiosis. Endoscopic removal of nasopharyngeal polyp was done and he was started on dapsone therapy.

Shenoy Manjunath; Girisha B; Bhandari Sathish; Peter Ranjit

2007-01-01

300

Cutaneous vasculitis.  

UK PubMed Central (United Kingdom)

Cutaneous vasculitis comprises a wide spectrum of clinical syndromes and histopathologic findings which share the common theme of vascular inflammation and changes in the adjacent tissue. This article discusses several types of cutaneous vasculitides including leukocytoclastic vasculitis, Henoch-Schönlein purpura, urticarial vasculitis, livedoid vasculitis, and granulomatous vasculitides. The clinical patterns of these types of vasculitic syndromes as well as associated diseases and histopathology are discussed.

Gibson LE; Su WP

1990-05-01

 
 
 
 
301

The upper brachial plexus defect model in rhesus monkeys: a cadaveric feasibility study.  

Science.gov (United States)

To establish a model for nerve grafts and determine the anatomic characteristics of the brachial plexus in rhesus monkeys. Ten specimens of the brachial plexus were obtained from five rhesus monkey cadavers. Anatomic dissection of the brachial plexus was systemically performed. The length of each root, trunk, and each division was measured using a Vernier caliper proximodistally. The anatomic distributions of the suprascapular, axillary, and musculocutaneous nerve were documented. The brachial plexus of rhesus monkeys included the spinal nerves or roots of C5, C6, C7, C8, and T1 (80%, 8/10), with a small contribution from the C4 root (20%, 2/10) occasionally. The upper trunk was not measurable because of their irregular structures. The lower trunk had a mean length of 1.62 (range, 0.96-2.1 mm) and a mean diameter of 2.29 (range, 1.9-2.94 mm). For the upper trunk, the C5 and C6 roots either divided into two very short divisions or sent out very long divisions before they joined together. For the middle trunk, the C7 root had a straight course after leaving the foramen and blended imperceptibly into the middle trunk before dividing into the anterior and posterior divisions. The lower trunk was noted in almost all the specimens (80%, 8/10), which was formed by C8 and T1. The brachial plexus in rhesus monkeys varies from that of humans, and defects can be made at the level of C5 and C6 roots and the C7 root should also be cut off and ligated. PMID:24025797

Lu, Qingsen; Gu, Liqiang; Jiang, Li; Qin, Bengang; Fu, Guo; Li, Xiangming; Yang, Jiangtao; Huang, Xijun; Yang, Yi; Zhu, Qingtang; Liu, Xiaolin; Zhu, Jiakai

2013-11-13

302

The upper brachial plexus defect model in rhesus monkeys: a cadaveric feasibility study.  

UK PubMed Central (United Kingdom)

To establish a model for nerve grafts and determine the anatomic characteristics of the brachial plexus in rhesus monkeys. Ten specimens of the brachial plexus were obtained from five rhesus monkey cadavers. Anatomic dissection of the brachial plexus was systemically performed. The length of each root, trunk, and each division was measured using a Vernier caliper proximodistally. The anatomic distributions of the suprascapular, axillary, and musculocutaneous nerve were documented. The brachial plexus of rhesus monkeys included the spinal nerves or roots of C5, C6, C7, C8, and T1 (80%, 8/10), with a small contribution from the C4 root (20%, 2/10) occasionally. The upper trunk was not measurable because of their irregular structures. The lower trunk had a mean length of 1.62 (range, 0.96-2.1 mm) and a mean diameter of 2.29 (range, 1.9-2.94 mm). For the upper trunk, the C5 and C6 roots either divided into two very short divisions or sent out very long divisions before they joined together. For the middle trunk, the C7 root had a straight course after leaving the foramen and blended imperceptibly into the middle trunk before dividing into the anterior and posterior divisions. The lower trunk was noted in almost all the specimens (80%, 8/10), which was formed by C8 and T1. The brachial plexus in rhesus monkeys varies from that of humans, and defects can be made at the level of C5 and C6 roots and the C7 root should also be cut off and ligated.

Lu Q; Gu L; Jiang L; Qin B; Fu G; Li X; Yang J; Huang X; Yang Y; Zhu Q; Liu X; Zhu J

2013-11-01

303

Radiation-induced malignant and atypical peripheral nerve sheath tumors  

Energy Technology Data Exchange (ETDEWEB)

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.

Foley, K.M.; Woodruff, J.M.; Ellis, F.T.; Posner, J.B.

1980-04-01

304

Ultrasound-guided interscalene brachial plexus block in a pediatric patient with acute hepatitis -A case report-  

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The interscalene brachial plexus block is not commonly used in pediatric regional anesthesia. The increasing popularity of ultrasound has allowed more anesthesiologists to perform regional anesthesia with high success rates in pediatric patients with the direct visualization of the target nerve and ...

Lee, Joon-Ho; Kim, Young-Rok; Yu, Ho-Kyung; Cho, Sung-Hwan; Kim, Sang-Hyun; Chae, Won Seok

305

Application of magnetic motor stimulation for measuring conduction time across the lower part of the brachial plexus  

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Abstract Objective The objective of this study was to calculate central motor conduction time (CMCT) of median and ulnar nerves in normal volunteers. Conduction time across the lower part of the brachial plexus was measured by using magnetic stimulation over the motor cortex and bra...

Rayegani Seyed; Hollisaz Mohammad; Hafezi Rahmatollah; Nassirzadeh Shahriar

306

Modified Pathological Classification of Brachial Plexus Root Injury and Its MR Imaging Characteristics.  

UK PubMed Central (United Kingdom)

The authors described a modified pathological classification (PC) of brachial plexus injury (BPI) and its magnetic resonance (MR) imaging characteristics. The reliability and diagnostic accuracy of MR imaging for detecting nerve injury was discussed. Between 2006 and 2010, 86 patients with BPI were managed surgically in our department. Their preoperative MR images and surgical findings were analyzed retrospectively. The PC of BPI was classified into five types: (I) nerve root injury in continuity (including Sunderland grade I-IV injury); (II) postganglionic spinal nerve rupture with or without proximal stump; (III) preganglionic root injury (visible); (IV) preganglionic nerve root injury and postganglionic spinal nerves injury; (V) preganglionic root injury (invisible). The main MR imaging characteristics of BPI included traumatic meningocele, displacement of spinal cord, the absence of nerve root, "Black line" sign, nerve root/trunk injury in continuity, and thickening and edema of nerve root. The accuracy of MR imaging for detecting C5, C6, C7, C8, and T1 nerve roots injury were 93.3, 95.2, 92.3, 84, and 74.4%, respectively. The modified PC provides a detailed description of nerve root injury in BPI, and MR imaging technique is a reliable method for detecting nerve root injury.

Yang J; Qin B; Fu G; Li P; Zhu Q; Liu X; Zhu J; Gu L

2013-10-01

307

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

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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 produce...

Kajander, Keith C.

308

Brachial plexus anesthesia: an analysis of options.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

There are multiple sites at which the brachial plexus block can be induced in selecting regional anesthesia for upper extremity surgical patients. The most frequently used blocks are axillary, infraclavicular, supraclavicular, and interscalene. One must understand brachial plexus anatomy to use thes...

Brown, D. L.

309

Palpation- and ultrasound-guided brachial plexus blockade in Hispaniolan Amazon parrots (Amazona ventralis).  

UK PubMed Central (United Kingdom)

OBJECTIVE: To compare palpation-guided with ultrasound-guided brachial plexus blockade in Hispaniolan Amazon parrots. STUDY DESIGN: Prospective randomized experimental trial. ANIMALS: Eighteen adult Hispaniolan Amazon parrots (Amazona ventralis) weighing 252-295 g. METHODS: After induction of anesthesia with isoflurane, parrots received an injection of lidocaine (2 mg kg(-1)) in a total volume of 0.3 mL at the axillary region. The birds were randomly assigned to equal groups using either palpation or ultrasound as a guide for the brachial plexus block. Nerve evoked muscle potentials (NEMP) were used to monitor effectiveness of brachial plexus block. The palpation-guided group received the local anesthetic at the space between the pectoral muscle, triceps, and supracoracoideus aticimus muscle, at the insertion of the tendons of the caudal coracobrachial muscle, and the caudal scapulohumeral muscle. For the ultrasound-guided group, the brachial plexus and the adjacent vessels were located with B-mode ultrasonography using a 7-15 MHz linear probe. After location, an 8-5 MHz convex transducer was used to guide injections. General anesthesia was discontinued 20 minutes after lidocaine injection and the birds recovered in a padded cage. RESULTS: Both techniques decreased the amplitude of NEMP. Statistically significant differences in NEMP amplitudes, were observed within the ultrasound-guided group at 5, 10, 15, and 20 minutes after injection and within the palpation-guided group at 10, 15, and 20 minutes after injection. There was no statistically significant difference between the two groups. No effect on motor function, muscle relaxation or wing droop was observed after brachial plexus block. CONCLUSIONS AND CLINICAL RELEVANCE: The onset of the brachial plexus block tended to be faster when ultrasonography was used. Brachial plexus injection can be performed in Hispaniolan Amazon parrots and nerve evoked muscle potentials were useful to monitor the effects on nerve conduction in this avian species. Neither technique produced an effective block at the doses of lidocaine used and further study is necessary to develop a useful block for surgical analgesia.

da Cunha AF; Strain GM; Rademacher N; Schnellbacher R; Tully TN

2013-01-01

310

Bilateral Brachial Plexus Home Going Catheters After Digital Amputation for Patient With Upper Extremity Digital Gangrene  

Science.gov (United States)

Peripheral nerve catheter placement is used to control surgical pain. Performing bilateral brachial plexus block with catheters is not frequently performed; and in our case sending patient home with bilateral brachial plexus catheters has not been reported up to our knowledge. Our patient is a 57 years old male patient presented with bilateral upper extremity digital gangrene on digits 2 through 4 on both sides with no thumb involvement. The plan was to do the surgery under sequential axillary blocks. On the day of surgery a right axillary brachial plexus block was performed under ultrasound guidance using 20 ml of 0.75% ropivacaine. Patient was taken to the OR and the right fingers amputation was carried out under mild sedation without problems. Left axillary brachial plexus block was then done as the surgeon was closing the right side, two hours after the first block was performed. The left axillary block was done also under ultrasound using 20 ml of 2% mepivacaine. The brachial plexus blocks were performed in a sequential manner. Surgery was unremarkable, and patient was transferred to post anesthetic care unit in stable condition. Over that first postoperative night, the patient complained of severe pain at the surgical sites with minimal pain relief with parentral opioids. We placed bilateral brachial plexus catheters (right axillary and left infra-clavicular brachial plexus catheters). Ropivacaine 0.2% infusion was started at 7 ml per hour basal rate only with no boluses on each side. The patient was discharged home with the catheters in place after receiving the appropriate education. On discharge both catheters were connected to a single ON-Q (I-flow Corporation, Lake Forest, CA) ball pump with a 750 ml reservoir using a Y connection and were set to deliver a fixed rate of 7 ml for each catheter. The brachial plexus catheters were removed by the patient on day 5 after surgery without any difficulty. Patient's postoperative course was otherwise unremarkable. We concluded that home going catheters are very effective in pain control postoperatively and they shorten the period of hospital stay. Keywords Brachial plexus; Home going catheters; Post-operative pain

Abd-Elsayed, Alaa A; Seif, John; Guirguis, Maged; Zaky, Sherif; Mounir-Soliman, Loran

2011-01-01

311

Bilateral brachial plexus home going catheters after digital amputation for patient with upper extremity digital gangrene.  

UK PubMed Central (United Kingdom)

UNLABELLED: Peripheral nerve catheter placement is used to control surgical pain. Performing bilateral brachial plexus block with catheters is not frequently performed; and in our case sending patient home with bilateral brachial plexus catheters has not been reported up to our knowledge. Our patient is a 57 years old male patient presented with bilateral upper extremity digital gangrene on digits 2 through 4 on both sides with no thumb involvement. The plan was to do the surgery under sequential axillary blocks. On the day of surgery a right axillary brachial plexus block was performed under ultrasound guidance using 20 ml of 0.75% ropivacaine. Patient was taken to the OR and the right fingers amputation was carried out under mild sedation without problems. Left axillary brachial plexus block was then done as the surgeon was closing the right side, two hours after the first block was performed. The left axillary block was done also under ultrasound using 20 ml of 2% mepivacaine. The brachial plexus blocks were performed in a sequential manner. Surgery was unremarkable, and patient was transferred to post anesthetic care unit in stable condition. Over that first postoperative night, the patient complained of severe pain at the surgical sites with minimal pain relief with parentral opioids. We placed bilateral brachial plexus catheters (right axillary and left infra-clavicular brachial plexus catheters). Ropivacaine 0.2% infusion was started at 7 ml per hour basal rate only with no boluses on each side. The patient was discharged home with the catheters in place after receiving the appropriate education. On discharge both catheters were connected to a single ON-Q (I-flow Corporation, Lake Forest, CA) ball pump with a 750 ml reservoir using a Y connection and were set to deliver a fixed rate of 7 ml for each catheter. The brachial plexus catheters were removed by the patient on day 5 after surgery without any difficulty. Patient's postoperative course was otherwise unremarkable. We concluded that home going catheters are very effective in pain control postoperatively and they shorten the period of hospital stay. KEYWORDS: Brachial plexus; Home going catheters; Post-operative pain.

Abd-Elsayed AA; Seif J; Guirguis M; Zaky S; Mounir-Soliman L

2011-12-01

312

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

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: Existem várias maneiras de abordar o plexo braquial dependendo da experiência do anestesiologista e da região a ser operada. O bloqueio do plexo braquial pela via posterior pode representar uma alternativa para cirurgias de ombro, clavícula e úmero proximal. O objetivo deste estudo foi mostrar os resultados observados em pacientes submetidos a bloqueio do plexo braquial pela via posterior com uso de neuroestimulador e ropivacaína a 0,5%. M (more) ÉTODO: Vinte e dois pacientes com idade entre 17 e 76 anos, estado físico ASA I e II, submetidos a cirurgias ortopédicas envolvendo o ombro, clavícula e úmero proximal foram anestesiados com bloqueio de plexo braquial pela via posterior utilizando neuroestimulador a partir de 1 mA. Obtida a contração desejada, a corrente foi diminuída para 0,5 mA e, permanecendo a resposta contrátil, foram injetados 40 mL de ropivacaína a 0,5%. Foram avaliados os seguintes parâmetros: latência, analgesia, duração da cirurgia, duração da analgesia e do bloqueio motor, complicações e efeitos colaterais. RESULTADOS: O bloqueio foi efetivo em 20 dos 22 pacientes; a latência média foi de 15,52 min; a duração média da cirurgia foi de 1,61 hora. A média de duração da analgesia foi de 15,85 horas e do bloqueio motor 11,16 horas. Não foram observados sinais e sintomas clínicos de toxicidade do anestésico local e nenhum paciente apresentou efeitos adversos do bloqueio. CONCLUSÕES: Nas condições deste estudo o bloqueio de plexo braquial pela via posterior com o uso do neuroestimulador e ropivacaína a 0,5% demonstrou ser uma técnica efetiva, confortável para o paciente e de fácil realização. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: Existen varios modos de abordar el plexo braquial dependiendo de la experiencia del anestesiologista y de la región que será operada. El bloqueo del plexo braquial por la vía posterior puede representar una alternativa para cirugías de hombro, clavícula 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 neuroestimulado (more) r 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. Abstract in english 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 (more) to 76 years, physical status ASA I and II, schedule

Beato, Lúcia; Camocardi, Gustavo; Imbelloni, Luiz Eduardo

2005-08-01

313

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  

Directory of Open Access Journals (Sweden)

Full Text Available JUSTIFICATIVA E OBJETIVOS: Existem várias maneiras de abordar o plexo braquial dependendo da experiência do anestesiologista e da região a ser operada. O bloqueio do plexo braquial pela via posterior pode representar uma alternativa para cirurgias de ombro, clavícula e úmero proximal. O objetivo deste estudo foi mostrar os resultados observados em pacientes submetidos a bloqueio do plexo braquial pela via posterior com uso de neuroestimulador e ropivacaína a 0,5%. MÉTODO: Vinte e dois pacientes com idade entre 17 e 76 anos, estado físico ASA I e II, submetidos a cirurgias ortopédicas envolvendo o ombro, clavícula e úmero proximal foram anestesiados com bloqueio de plexo braquial pela via posterior utilizando neuroestimulador a partir de 1 mA. Obtida a contração desejada, a corrente foi diminuída para 0,5 mA e, permanecendo a resposta contrátil, foram injetados 40 mL de ropivacaína a 0,5%. Foram avaliados os seguintes parâmetros: latência, analgesia, duração da cirurgia, duração da analgesia e do bloqueio motor, complicações e efeitos colaterais. RESULTADOS: O bloqueio foi efetivo em 20 dos 22 pacientes; a latência média foi de 15,52 min; a duração média da cirurgia foi de 1,61 hora. A média de duração da analgesia foi de 15,85 horas e do bloqueio motor 11,16 horas. Não foram observados sinais e sintomas clínicos de toxicidade do anestésico local e nenhum paciente apresentou efeitos adversos do bloqueio. CONCLUSÕES: Nas condições deste estudo o bloqueio de plexo braquial pela via posterior com o uso do neuroestimulador e ropivacaína a 0,5% demonstrou ser uma técnica efetiva, confortável para o paciente e de fácil realização.JUSTIFICATIVA Y OBJETIVOS: Existen varios modos de abordar el plexo braquial dependiendo de la experiencia del anestesiologista y de la región que será operada. El bloqueo del plexo braquial por la vía posterior puede representar una alternativa para cirugías de hombro, clavícula 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, scheduled for shoulder, clavicle and proximal humerus surgery, who were submitted to posterior b

Lúcia Beato; Gustavo Camocardi; Luiz Eduardo Imbelloni

2005-01-01

314

Non-Stimulation Needle with External Indwelling Cannula for Brachial Plexus Block and Pain Management in 62 Patients Undergoing Upper-Limb Surgery  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: To investigate the feasibility of a non-stimulation needle with an external indwelling cannula for upper-limb surgery and acute postoperative pain management. Methods: 62 patients undergoing either scheduled or emergency upper-limb surgery received brachial plexus block of modified interscalene or axillary brachial and then postoperative patient-controlled analgesia (PCA) with local analgesics using a specially designed non-stimulation needle with an external indwelling cannula. The outcome measurements included anesthetic effect, acute or chronic complications, postoperative analgesic effect and patient's satisfaction. Results: The success rate of anesthesia was 96.8%. The single attempt placement with the external indwelling cannula was achieved in 85.2% of patients with axillary brachial plexus block and 78.8% with modified interscalene brachial plexus block. The incidence of severe intoxication was 3.7% with axillary brachial plexus block and 3.0% with modified interscalene brachial plexus block. No hematoma at the injection site, Horner's syndrome, hoarseness or dyspnea was observed. Postoperative analgesic effect was achieved in 100% and activities were slightly lowered in 91.7%. The incidence of nausea and vomit was 8.3%; patient's satisfaction was 9.1 on a 10-point scale system. Infection, nerve injury and respiratory depression were absent during the catheter indwelling. The indwelling time of external indwelling cannula was 30.5 h on average. There was no nerve injury related complication after withdrawing the external indwelling catheter. Conclusions: Brachial plexus block using a non-stimulation needle with an external indwelling cannula has favorable intra-operative anesthetic benefit and provides an excellent postoperative analgesic outcome. The low incidence of complications and favorable patient's satisfaction suggest that non-stimulation needle with an external indwelling cannula is a useful and safe anesthetic tool in brachial nerve block and acute postoperative pain management.

Bin Yu, Xiaoqing Zhang, Peili Sun, Shuqi Xie, Qiying Pang

2012-01-01

315

Non-Stimulation Needle with External Indwelling Cannula for Brachial Plexus Block and Pain Management in 62 Patients Undergoing Upper-Limb Surgery  

Science.gov (United States)

Objective: To investigate the feasibility of a non-stimulation needle with an external indwelling cannula for upper-limb surgery and acute postoperative pain management. Methods: 62 patients undergoing either scheduled or emergency upper-limb surgery received brachial plexus block of modified interscalene or axillary brachial and then postoperative patient-controlled analgesia (PCA) with local analgesics using a specially designed non-stimulation needle with an external indwelling cannula. The outcome measurements included anesthetic effect, acute or chronic complications, postoperative analgesic effect and patient's satisfaction. Results: The success rate of anesthesia was 96.8%. The single attempt placement with the external indwelling cannula was achieved in 85.2% of patients with axillary brachial plexus block and 78.8% with modified interscalene brachial plexus block. The incidence of severe intoxication was 3.7% with axillary brachial plexus block and 3.0% with modified interscalene brachial plexus block. No hematoma at the injection site, Horner's syndrome, hoarseness or dyspnea was observed. Postoperative analgesic effect was achieved in 100% and activities were slightly lowered in 91.7%. The incidence of nausea and vomit was 8.3%; patient's satisfaction was 9.1 on a 10-point scale system. Infection, nerve injury and respiratory depression were absent during the catheter indwelling. The indwelling time of external indwelling cannula was 30.5 h on average. There was no nerve injury related complication after withdrawing the external indwelling catheter. Conclusions: Brachial plexus block using a non-stimulation needle with an external indwelling cannula has favorable intra-operative anesthetic benefit and provides an excellent postoperative analgesic outcome. The low incidence of complications and favorable patient's satisfaction suggest that non-stimulation needle with an external indwelling cannula is a useful and safe anesthetic tool in brachial nerve block and acute postoperative pain management.

Yu, Bin; Zhang, Xiaoqing; Sun, Peili; Xie, Shuqi; Pang, Qiying

2012-01-01

316

Non-stimulation needle with external indwelling cannula for brachial plexus block and pain management in 62 patients undergoing upper-limb surgery.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To investigate the feasibility of a non-stimulation needle with an external indwelling cannula for upper-limb surgery and acute postoperative pain management. METHODS: 62 patients undergoing either scheduled or emergency upper-limb surgery received brachial plexus block of modified interscalene or axillary brachial and then postoperative patient-controlled analgesia (PCA) with local analgesics using a specially designed non-stimulation needle with an external indwelling cannula. The outcome measurements included anesthetic effect, acute or chronic complications, postoperative analgesic effect and patient's satisfaction. RESULTS: The success rate of anesthesia was 96.8%. The single attempt placement with the external indwelling cannula was achieved in 85.2% of patients with axillary brachial plexus block and 78.8% with modified interscalene brachial plexus block. The incidence of severe intoxication was 3.7% with axillary brachial plexus block and 3.0% with modified interscalene brachial plexus block. No hematoma at the injection site, Horner's syndrome, hoarseness or dyspnea was observed. Postoperative analgesic effect was achieved in 100% and activities were slightly lowered in 91.7%. The incidence of nausea and vomit was 8.3%; patient's satisfaction was 9.1 on a 10-point scale system. Infection, nerve injury and respiratory depression were absent during the catheter indwelling. The indwelling time of external indwelling cannula was 30.5 h on average. There was no nerve injury related complication after withdrawing the external indwelling catheter. CONCLUSIONS: Brachial plexus block using a non-stimulation needle with an external indwelling cannula has favorable intra-operative anesthetic benefit and provides an excellent postoperative analgesic outcome. The low incidence of complications and favorable patient's satisfaction suggest that non-stimulation needle with an external indwelling cannula is a useful and safe anesthetic tool in brachial nerve block and acute postoperative pain management.

Yu B; Zhang X; Sun P; Xie S; Pang Q

2012-01-01

317

Traumatic injuries of brachial plexus  

International Nuclear Information System (INIS)

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

1988-01-01

318

Cutaneous solitary neural hamartoma: report of an unusual case.  

Science.gov (United States)

Cutaneous hamartomas are tumor-like proliferations of tissue indigenous to the organ but arranged abnormally. There are examples in the literature of cutaneous hamartomas composed of a variety of different components. To our knowledge, there is no previous report of such cutaneous solitary neural hamartoma. Our case occurred in a 51-year-old man with pain and paresthesia in the right shoulder associated with a nodule that was surgically removed. There was no history of trauma, other skin nodules, neurofibromatosis, or tuberous sclerosis. Histologically, there was an unencapsulated nodule, composed of mature nerve bundles noted abnormally high within the papillary dermis, extending to the reticular dermis with periadnexal distribution. Immunohistochemically, the nerve bundles were positive for S-100, including the smaller nerve twigs, and the perineurium was highlighted by epithelial membrane antigen, reminiscent of normal peripheral nerves. Although, neural components including mature nerve bundles have been described in various cutaneous hamartomas, this represents a peculiar case of a cutaneous mature peripheral nerve hamartoma. Whether this is related to other entities of cutaneous hamartomas (ie, neurofollicular hamartoma, folliculosebaceous cystic hamartoma) is not yet apparent, although it is probably a unique entity. PMID:19542927

Al Habeeb, Ayman; Alkhalidi, Hisham; Idikio, Halliday; Ghazarian, Danny

2009-07-01

319

Brachial plexus root injection in a human cadaver model: injectate distribution and effects on the neuraxis.  

UK PubMed Central (United Kingdom)

BACKGROUND: The potential for injection into the brachial plexus root at cervical levels must be considered during interscalene block or chronic pain interventions in the neck, but this phenomenon has not been well studied. In this investigation, we performed injections into the brachial plexus roots of unembalmed cadavers, with real-time ultrasound guidance, to evaluate the proximal and distal spread of the injected fluids, the potential of the injectate to reach the neuraxis, and whether the injectate could migrate into the actual substance of the spinal cord itself. METHODS: A solution of particulate dye mixed with local anesthetic was injected into 8 brachial plexus roots at a lower cervical level, in unembalmed cadaver specimens, utilizing an automated pump and pressure monitor. Two injections were made adjacent to nerve roots as controls. The specimens were then dissected, and gross and microscopic analysis utilized to determine the distribution of the dye and the structures affected. RESULTS: The mean peak pressure achieved during plexus root injections was 48.9 psi. After injections into the plexus root, dye was evident within the neural tissue at the level of injection and spread primarily distally in the plexus. In 1 of 8 injections into the brachial plexus root, the dye in the injectate spread proximally into the spinal canal, but in none of the injections was the spinal cord affected by the dye. CONCLUSIONS: Injection directly into the neural tissue of a brachial plexus root in a cadaver model produced high pressures suggestive of intrafascicular injection and widespread flow of the injectate through the distal brachial plexus. However, proximal movement of the dye-containing injectate was more restricted, with only 1 of the injections leading to epidural spread and no apparent effects on the spinal cord.

Orebaugh SL; Mukalel JJ; Krediet AC; Weimer J; Filip P; McFadden K; Bigeleisen PE

2012-09-01

320

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  

Directory of Open Access Journals (Sweden)

Full Text Available JUSTIFICATIVA E OBJETIVOS: Bloqueio do nervo frênico é um evento adverso do bloqueio do plexo braquial; entretanto, na sua maioria, sem repercussões clínicas importantes. O objetivo deste relato foi apresentar um caso em que ocorreu bloqueio do nervo frênico, com comprometimento ventilatório, em paciente com insuficiência renal crônica submetido a instalação de fístula arteriovenosa extensa, sob bloqueio do plexo braquial pela via perivascular interescalênica. RELATO DO CASO: Paciente do sexo masculino, 50 anos, tabagista, portador de insuficiência renal crônica em regime de hemodiálise, hipertensão arterial, hepatite C, diabetes mellitus, doença pulmonar obstrutiva crônica, a ser submetido à instalação de fístula arteriovenosa extensa no membro superior direito sob bloqueio de plexo braquial pela via interescalênica. O plexo braquial foi localizado com utilização do estimulador de nervo periférico. Foram injetados 35 mL de uma solução de anestésico local, constituída de uma mistura de lidocaína a 2% com epinefrina a 1:200.000 e ropivacaína a 0,75% em partes iguais. Ao final da injeção o paciente apresentava-se lúcido, porém com dispnéia e predomínio de incursão respiratória intercostal ipsilateral ao bloqueio. Não havia murmúrio vesicular na base do hemitórax direito. A SpO2 manteve-se em 95%, com cateter nasal de oxigênio. Não foi necessária instalação de métodos de auxílio ventilatório invasivo. Radiografia do tórax revelou que o hemidiafragma direito ocupava o 5° espaço intercostal. O quadro clínico foi revertido em três horas. CONCLUSÕES: O caso mostrou que houve paralisia total do nervo frênico com sintomas respiratórios. Apesar de não ter sido necessária terapêutica invasiva para o tratamento, fica o alerta para a restrição da indicação da técnica nesses casos.JUSTIFICATIVA Y OBJETIVOS: El bloqueo del nervio frénico es un evento adverso del bloqueo del plexo braquial, sin 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 of this work was to report a case with phrenic nerve block with respiratory repercus

Luis Henrique Cangiani; Luis Augusto Edwards Rezende; Armando Giancoli Neto

2008-01-01

 
 
 
 
321

Ultrasound-guided interscalene brachial plexus block in a pediatric patient with acute hepatitis -A case report-.  

Science.gov (United States)

The interscalene brachial plexus block is not commonly used in pediatric regional anesthesia. The increasing popularity of ultrasound has allowed more anesthesiologists to perform regional anesthesia with high success rates in pediatric patients with the direct visualization of the target nerve and spread of local anesthetics. We present a case of interscalene brachial plexus block under ultrasound guidance in a 17-month-old child with acute drug-induced hepatitis who required fixation of a fracture of the lateral humeral condyle. PMID:22778895

Lee, Joon-Ho; Kim, Young-Rok; Yu, Ho-Kyung; Cho, Sung-Hwan; Kim, Sang-Hyun; Chae, Won Seok

2012-06-19

322

A variation of the phrenic nerve: case report and review.  

UK PubMed Central (United Kingdom)

During routine dissection in the department of anatomy, the following anatomical variations of the phrenic nerve were observed on the right side of the neck of a 30-year-old male cadaver. The phrenic nerve, in its early course close to its origin, gave a communicating branch to the C5 root of the brachial plexus. At the level of the root of neck just before entering the thorax, the phrenic nerve was located anterior to the subclavian vein. This unique case of phrenic nerve variation gains tremendous importance in the context of subclavian vein cannulation, implanted venous access portals, and supraclavicular nerve block for regional anaesthesia.

Prakash; Prabhu LV; Madhyastha S; Singh G

2007-12-01

323

A systematic review of peripheral nerve injury following laparoscopic colorectal surgery.  

UK PubMed Central (United Kingdom)

AIM: The risk of peripheral nerve injury associated with laparoscopic colorectal surgery has not been well established. We aimed to identify the number and type of peripheral nerve injuries associated with patient positioning in laparoscopic surgery. METHOD: A systematic review of MEDLINE and Embase was undertaken of English and non-English language articles. Search terms included the key words: laparoscopic, colorectal, nerve injury, nerve damage, brachial plexus, peripheral neuropathy, peripheral nerve injury, nerve and colonic injury. Articles were included where at least one peripheral nerve injury had been documented related to patient positioning at laparoscopic colorectal surgery. Data extraction for articles was conducted by two authors, using predefined data fields. RESULTS: Ten cases have been reported in the literature. All injuries involved the brachial plexus. They were associated with a lengthy procedure and abduction of the arm. CONCLUSION: Although rare, the surgeon and theatre team must be aware of the risk of peripheral nerve injury when positioning patients for laparoscopic colorectal procedures.

Codd RJ; Evans MD; Sagar PM; Williams GL

2013-03-01

324

Ultrasound-guided nerve blocks.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: Ultrasound-guided nerve blocks are based on the direct visualization of nerve structures, needle, and adjacent anatomic structures. Thus, it is possible to place the local anesthetic precisely around the nerves and follow its dispersion in real time, obtaining, therefore, more effective blockades, reduced dependency on anatomic references, decreased anesthetic volume, and increased safety. CONTENTS: The aim of this paper was to review the physical mechanisms of image formation, ultrasound anatomy of the neuro axis and of the brachial and lumbosacral plexuses, equipment and materials used in the blockades, settings of the ultrasound equipment to improve the image, planes of visualization of the needles, the techniques, and training in ultrasound-guided nerve blocks. CONCLUSIONS: The steps for a successful regional block include the identification of the exact position of the nerves, the precise localization of the needle, without causing injuries to adjacent structures, and, finally, the careful administration of the local anesthetic close to the nerves. Although neurostimulation is very useful in identifying nerves, it does not fulfill all those requirements. Therefore, it is believed that ultrasound-guided nerve blocks will be the technique of choice in regional anesthesia in a not too distant future.

Helayel PE; da Conceição DB; de Oliveira Filho GR

2007-02-01

325

Results and current approach for Brachial Plexus reconstruction  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract We review our experience treating 335 adult patients with supraclavicular brachial plexus injuries over a 7-year period at the University of Southern Santa Catarina, in Brazil. Patients were categorized into 8 groups, according to functional deficits and roots injured: C5-C6, C5-C7, C5-C8 (T1 Hand), C5-T1 (T2 Hand), C8-T1, C7-T1, C6-T1, and total palsy. To restore function, nerve grafts, nerve transfers, and tendon and muscle transfers were employed. Patients with either upper- or lower-type partial injuries experienced considerable functional return. In total palsies, if a root was available for grafting, 90% of patients had elbow flexion restored, whereas this rate dropped to 50% if no roots were grafted and only nerve transfers performed. Pain resolution should be the first priority, and root exploration and grafting helped to decrease or eliminate pain complaints within a short time of surgery.

Bertelli Jayme A; Ghizoni Marcos F

2011-01-01

326

Results and current approach for Brachial Plexus reconstruction.  

Science.gov (United States)

We review our experience treating 335 adult patients with supraclavicular brachial plexus injuries over a 7-year period at the University of Southern Santa Catarina, in Brazil. Patients were categorized into 8 groups, according to functional deficits and roots injured: C5-C6, C5-C7, C5-C8 (T1 Hand), C5-T1 (T2 Hand), C8-T1, C7-T1, C6-T1, and total palsy. To restore function, nerve grafts, nerve transfers, and tendon and muscle transfers were employed. Patients with either upper- or lower-type partial injuries experienced considerable functional return. In total palsies, if a root was available for grafting, 90% of patients had elbow flexion restored, whereas this rate dropped to 50% if no roots were grafted and only nerve transfers performed. Pain resolution should be the first priority, and root exploration and grafting helped to decrease or eliminate pain complaints within a short time of surgery. PMID:21676269

Bertelli, Jayme A; Ghizoni, Marcos F

2011-06-16

327

A giant plexiform schwannoma of the brachial plexus: case report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract We report the case of a patient who noticed muscle weakness in his left arm 5 years earlier. On examination, a biloculate mass was observed in the left supraclavicular area, and Tinel's sign caused paresthesia in his left arm. Magnetic resonance imaging showed a continuous, multinodular, plexiform tumor from the left C5 to C7 nerve root along the course of the brachial plexus to the left brachia. Tumor excision was attempted. The median and musculocutaneous nerves were extremely enlarged by the tumor, which was approximately 40 cm in length, and showed no response to electric stimulation. We resected a part of the musculocutaneous nerve for biopsy and performed latissimus dorsi muscle transposition in order to repair elbow flexion. Morphologically, the tumor consisted of typical Antoni A areas, and immunohistochemistry revealed a Schwann cell origin of the tumor cells moreover, there was no sign of axon differentiation in the tumor. Therefore, the final diagnosis of plexiform Schwannoma was confirmed.

Kohyama Sho; Hara Yuki; Nishiura Yasumasa; Hara Tetsuya; Nakagawa Tanefumi; Ochiai Naoyuki

2011-01-01

328

Nerve entrapments associated with postmastectomy lymphedema  

International Nuclear Information System (INIS)

[en] Ninety females underwent mastectomy for breast cancer and were thereafter investigated to determine whether nerve entrapments were responsible for some of the disabling symptoms in their arms. The majority of these patients suffered from fullness (edema), numbness, paraesthesia, weakness and pain of the arm on the mastectomized side. Lymphedema of varying degrees found in 50% of these patients was associated with brachial plexus entrapment and carpal tunnel syndrome (CTS). 28% of the patients has CTS, and 28% suffered from brachial plexus entrapment of the arm on the mastectomized side, as compared with 8% and 5%, respectively, on the nonoperated side. 12% of the patients suffered from both types of entrapment. Thus we consider that brachial plexus entrapment and carpal tunnel syndrome should be added to the list of complications following mastectomy, with lymphedema playing an active part in their development

1979-01-01

329

Thickening of peripheral nerves in neurofibromatosis  

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Full Text Available A 14-year-old boy presented with multiple asymptomatic swellings all over the body. Cutaneous findings were classical for neurofibromatosis. Interesting and unusual finding was generalised thickening of peripheral nerve trunks. Biopsy from thickened nerve had features of neurofibromatosis.

Mittal Asit; Masuria B; Gupta L; Sharma M; Bansal N

1997-01-01

330

Radiodiagnosis of closed fractures of brachial plexus  

International Nuclear Information System (INIS)

[en] 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

1989-01-01

331

Acute brachial neuritis following influenza vaccination.  

Science.gov (United States)

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. PMID:23192585

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

2012-11-28

332

Acute brachial neuritis following influenza vaccination.  

UK PubMed Central (United Kingdom)

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.

Shaikh MF; Baqai TJ; Tahir H

2012-01-01

333

Cutaneous ectoparasites.  

UK PubMed Central (United Kingdom)

Parasites inhabit many places in the world. Some of these can inhabit the human skin or body. Many of these have been eradicated in the developed countries but persist in some tropical environments that are fun places to visit. Visitors can bring such parasites home with them such as scabies, cutaneous larva migrans, tungiasis and myiasis. Their clinical manifestations and treatment are presented for physicians evaluating and treating travelers from exotic places.

Nordlund JJ

2009-11-01

334

Cutaneous ectoparasites.  

Science.gov (United States)

Parasites inhabit many places in the world. Some of these can inhabit the human skin or body. Many of these have been eradicated in the developed countries but persist in some tropical environments that are fun places to visit. Visitors can bring such parasites home with them such as scabies, cutaneous larva migrans, tungiasis and myiasis. Their clinical manifestations and treatment are presented for physicians evaluating and treating travelers from exotic places. PMID:19889135

Nordlund, James J

335

Cutaneous Listeriosis.  

UK PubMed Central (United Kingdom)

Cutaneous infection due to Listeria monocytogenes is rare. Typically, it manifests as a non-painful, non-pruritic, self-limited, localized, papulopustular or vesiculopustular eruption in healthy persons. Most cases follow direct inoculation of the skin in veterinarians and farmers who have exposure to animal products of conception. Less commonly, skin lesions may arise from hematogenous dissemination in compromised hosts with invasive disease. Here we report the first case in a gardener that followed exposure to soil and vegetation.

Godshall CE; Suh G; Lorber B

2013-08-01

336

Cutaneous listeriosis.  

Science.gov (United States)

Cutaneous infections due to Listeria monocytogenes are rare. Typically, infections manifest as nonpainful, nonpruritic, self-limited, localized, papulopustular or vesiculopustular eruptions in healthy persons. Most cases follow direct inoculation of the skin in veterinarians or farmers who have exposure to animal products of conception. Less commonly, skin lesions may arise from hematogenous dissemination in compromised hosts with invasive disease. Here, we report the first case in a gardener that occurred following exposure to soil and vegetation. PMID:23966491

Godshall, Casey E; Suh, Gina; Lorber, Bennett

2013-08-21

337

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

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: Bloqueio do nervo frênico é um evento adverso do bloqueio do plexo braquial; entretanto, na sua maioria, sem repercussões clínicas importantes. O objetivo deste relato foi apresentar um caso em que ocorreu bloqueio do nervo frênico, com comprometimento ventilatório, em paciente com insuficiência renal crônica submetido a instalação de fístula arteriovenosa extensa, sob bloqueio do plexo braquial pela via perivascular interescalênica. (more) RELATO DO CASO: Paciente do sexo masculino, 50 anos, tabagista, portador de insuficiência renal crônica em regime de hemodiálise, hipertensão arterial, hepatite C, diabetes mellitus, doença pulmonar obstrutiva crônica, a ser submetido à instalação de fístula arteriovenosa extensa no membro superior direito sob bloqueio de plexo braquial pela via interescalênica. O plexo braquial foi localizado com utilização do estimulador de nervo periférico. Foram injetados 35 mL de uma solução de anestésico local, constituída de uma mistura de lidocaína a 2% com epinefrina a 1:200.000 e ropivacaína a 0,75% em partes iguais. Ao final da injeção o paciente apresentava-se lúcido, porém com dispnéia e predomínio de incursão respiratória intercostal ipsilateral ao bloqueio. Não havia murmúrio vesicular na base do hemitórax direito. A SpO2 manteve-se em 95%, com cateter nasal de oxigênio. Não foi necessária instalação de métodos de auxílio ventilatório invasivo. Radiografia do tórax revelou que o hemidiafragma direito ocupava o 5° espaço intercostal. O quadro clínico foi revertido em três horas. CONCLUSÕES: O caso mostrou que houve paralisia total do nervo frênico com sintomas respiratórios. Apesar de não ter sido necessária terapêutica invasiva para o tratamento, fica o alerta para a restrição da indicação da técnica nesses casos. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: El bloqueo del nervio frénico es un evento adverso del bloqueo del plexo braquial, sin 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 i (more) nterescalénica. 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. Abstract in english 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 of t

Cangiani, Luis Henrique; Rezende, Luis Augusto Edwards; Giancoli Neto, Armando

2008-04-01

338

Brachial plexus variations in its formation and main branches  

Directory of Open Access Journals (Sweden)

Full Text Available 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 and side of the body. METHODS: Twenty-seven adult cadavers separated into sex and color had their brachial plexuses evaluated on the right and left sides. RESULTS: Our results are extensive and describe a large number of variations, including some that have not been reported in the literature. Our results showed that the phrenic nerve had a complete origin from the plexus in 20% of the cases. In this way, a lesion of the brachial plexus roots could result in diaphragm palsy. It is not usual that the long thoracic nerve pierces the scalenus medius muscle but it occurred in 63% of our cases. Another observation was that the posterior cord was formed by the posterior divisions of the superior and middle trunks in 9%. In these cases, the axillary and the radial nerves may not receive fibers from C7 and C8, as usually described. CONCLUSION: Finally, the plexuses studied did not show that sex, color or side of the body had much if any influence upon the presence of variations.OBJETIVOS: O plexo braquial apresenta uma estrutura anatômica complexa, desde sua origem, no pescoço, até sua ramificação terminal, na região axilar. Ele também apresenta relações importantes com outras estruturas anatômicas locais, o que o torna vulnerável ao aparecimento de uma série de variações anatômicas, marcando sua importância clínica e cirúrgica. Os objetivos desse estudo foram de descrever as variações anatômicas do plexo braquial, desde sua origem até seus ramos terminais e correlacionar essas variações com o sexo e a cor dos indivíduos, bem como com o lado do corpo estudado. MÉTODOS: Vinte e sete cadáveres adultos, separados em sexo e cor, tiveram seus plexos braquiais avaliados à direita e à esquerda. RESULTADOS: Nossos resultados são extensos e descrevem um grande número de variações, incluindo algumas ainda não descritas na literatura. Nossos resultados mostram que o nervo frênico apresentou sua origem diretamente no plexo braquial em 20% dos casos. Assim, uma lesão das raízes do plexo braquial poderia resultar em uma inexplicada paralisia diafragmática. Não é esperado que o nervo torácico longo passe através do músculo escaleno médio entretanto, esse fato foi observado em 63% de nossos casos. Outra observaçõa foi a formação do fascículo posterior pelas divisões posteriores dos troncos superior e médio em 9% dos casos. Nesses casos, os nervos axilar e radial poderão não receber fibras de C7 e C8, como normalmente descrito na literatura. CONCLUSÃO: Os plexos braquiais estudados não mostraram que o sexo, a cor ou o lado do corpo influenciam de maneira importante na presença de variações anatômicas dessa estrutura.

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

2003-01-01

339

Brachial plexus variations in its formation and main branches  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese OBJETIVOS: O plexo braquial apresenta uma estrutura anatômica complexa, desde sua origem, no pescoço, até sua ramificação terminal, na região axilar. Ele também apresenta relações importantes com outras estruturas anatômicas locais, o que o torna vulnerável ao aparecimento de uma série de variações anatômicas, marcando sua importância clínica e cirúrgica. Os objetivos desse estudo foram de descrever as variações anatômicas do plexo braquial, desde sua (more) origem até seus ramos terminais e correlacionar essas variações com o sexo e a cor dos indivíduos, bem como com o lado do corpo estudado. MÉTODOS: Vinte e sete cadáveres adultos, separados em sexo e cor, tiveram seus plexos braquiais avaliados à direita e à esquerda. RESULTADOS: Nossos resultados são extensos e descrevem um grande número de variações, incluindo algumas ainda não descritas na literatura. Nossos resultados mostram que o nervo frênico apresentou sua origem diretamente no plexo braquial em 20% dos casos. Assim, uma lesão das raízes do plexo braquial poderia resultar em uma inexplicada paralisia diafragmática. Não é esperado que o nervo torácico longo passe através do músculo escaleno médio entretanto, esse fato foi observado em 63% de nossos casos. Outra observaçõa foi a formação do fascículo posterior pelas divisões posteriores dos troncos superior e médio em 9% dos casos. Nesses casos, os nervos axilar e radial poderão não receber fibras de C7 e C8, como normalmente descrito na literatura. CONCLUSÃO: Os plexos braquiais estudados não mostraram que o sexo, a cor ou o lado do corpo influenciam de maneira importante na presença de variações anatômicas dessa estrutura. Abstract in english 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, c (more) olor of the subjects and side of the body. METHODS: Twenty-seven adult cadavers separated into sex and color had their brachial plexuses evaluated on the right and left sides. RESULTS: Our results are extensive and describe a large number of variations, including some that have not been reported in the literature. Our results showed that the phrenic nerve had a complete origin from the plexus in 20% of the cases. In this way, a lesion of the brachial plexus roots could result in diaphragm palsy. It is not usual that the long thoracic nerve pierces the scalenus medius muscle but it occurred in 63% of our cases. Another observation was that the posterior cord was formed by the posterior divisions of the superior and middle trunks in 9%. In these cases, the axillary and the radial nerves may not receive fibers from C7 and C8, as usually described. CONCLUSION: Finally, the plexuses studied did not show that sex, color or side of the body had much if any influence upon the presence of variations.

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

2003-01-01

340

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

UK PubMed Central (United Kingdom)

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.

Sharma D; Srivastava N; Pawar S; Garg R; Nagpal VK

2013-04-01

 
 
 
 
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Schwannomatosis of the sciatic nerve  

Energy Technology Data Exchange (ETDEWEB)

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.)

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

2001-02-01

342

Cutaneous angiomyolipoma  

Directory of Open Access Journals (Sweden)

Full Text Available Cutaneous angiomyolipomas are rare. We report a case in a 45-year-old male with a well circumscribed lesion located on the chin. This lesion, probably hamartomatous in nature, differs from renal angiomyolipoma in terms of nonassociation with tuberous sclerosis, circumscription, and male predominance. Another characteristic feature is the absence of epithelioid cells. Differential diagnosis includes angiolipoma, angioleiomyoma, hemangioma, and myolipoma. It is distinguished from the abovementioned entities by the presence of a combination of thick-walled blood vessels, smooth muscle, and fat.

Singh Kulwant; Pai Radha; Kini Hema; Kini Ullal

2009-01-01

343

[Cutaneous amyloidosis].  

UK PubMed Central (United Kingdom)

Amyloids are common protein aggregates in nature. Some amyloids fulfill important biological tasks while others are known to cause diseases. Despite the fact that the ultrastructure of amyloid is highly conserved, the mechanism of amyloidogenesis remains a challenging research topic. In humans, amyloidoses may develop in the skin or lead to skin signs due to secondary cutaneous involvement. An accurate diagnostic procedure is crucial for planning the therapy of this heterogeneous group of diseases. Therefore, the aim of this paper is to give an overview on the different kinds of amyloidoses as well as on diagnostic and therapeutic approaches. Furthermore, the discrimination between functional and disease-causing amyloid is briefly presented.

Schreml S; Szeimies RM; Landthaler M; Babilas P

2011-01-01

344

Convulsion due to levobupivacaine in axillary brachial plexus block: Case report  

Directory of Open Access Journals (Sweden)

Full Text Available Axillary brachial plexus block is an effective method of anaesthesia for the surgeries performed on the hand, forearm and distal third of the arm. However it has the risk of serious complications such as cardiovascular and central nervous system toxicity. Levobupivacaine is a long acting amide local anaesthetic used for epidural, caudal, spinal, infiltration and peripheral nerve blocks. Levobupivacaine is the S (-) isomer of racemic bupivacaine and has a lower risk of cardiovascular, central nervous system toxicity than bupivacaine. However central system toxicity cases due to absorption of the drug into the systemic circulation has been reported. Here, we report a case having no vascular puncture during axillary brachial plexus block performance but developing convulsion due to levobupivacain after the intervention.

Cevdet Düger; Ahmet Cemil ?sbir; ?clal Özdemir Kol,; Kenan Kaygusuz; Sinan Gürsoy; Caner Mimaro?lu

2013-01-01

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Incidence of diaphragmatic paralysis following supraclavicular brachial plexus block and its effect on pulmonary function.  

UK PubMed Central (United Kingdom)

Thirty unpremedicated ASA physical status 1-3 patients aged between 18 and 69 years, scheduled for upper limb surgery, received a conventional supraclavicular brachial plexus block using a nerve stimulator and bupivacaine 0.375% 0.5 ml.kg-1. Spirometric measurements of pulmonary function and ultrasonographic assessments of diaphragmatic function were made before the block and at 10-min intervals after injection until full motor block of the brachial plexus had developed. Complete paralysis of the ipsilateral hemidiaphragm occurred in 50% of patients. Seventeen per cent of patients had reduced diaphragmatic movement and the rest (33%) had no change in diaphragmatic movement. Those with complete paralysis all showed significant decreases in pulmonary function, whereas those with reduced or normal movement had minimal change. All patients remained asymptomatic throughout, with normal oxygen saturation on room air.

Mak PH; Irwin MG; Ooi CG; Chow BF

2001-04-01

346

Incidence of diaphragmatic paralysis following supraclavicular brachial plexus block and its effect on pulmonary function.  

Science.gov (United States)

Thirty unpremedicated ASA physical status 1-3 patients aged between 18 and 69 years, scheduled for upper limb surgery, received a conventional supraclavicular brachial plexus block using a nerve stimulator and bupivacaine 0.375% 0.5 ml.kg-1. Spirometric measurements of pulmonary function and ultrasonographic assessments of diaphragmatic function were made before the block and at 10-min intervals after injection until full motor block of the brachial plexus had developed. Complete paralysis of the ipsilateral hemidiaphragm occurred in 50% of patients. Seventeen per cent of patients had reduced diaphragmatic movement and the rest (33%) had no change in diaphragmatic movement. Those with complete paralysis all showed significant decreases in pulmonary function, whereas those with reduced or normal movement had minimal change. All patients remained asymptomatic throughout, with normal oxygen saturation on room air. PMID:11284823

Mak, P H; Irwin, M G; Ooi, C G; Chow, B F

2001-04-01

347