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Sample records for brachial plexus injury

  1. Brachial Plexus Injuries

    Science.gov (United States)

    ... sensation in the arm or hand Brachial plexus injuries can happen because of shoulder trauma, tumors, or ... the nerves stretch or tear. Some brachial plexus injuries may heal without treatment. Many children who are ...

  2. Obstetric brachial plexus injury

    Directory of Open Access Journals (Sweden)

    Mukund R Thatte

    2011-01-01

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

  3. Management of Brachial Plexus Injuries

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2005-02-01

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

  4. Brachial Plexus Injuries

    Science.gov (United States)

    ... as a result of shoulder trauma, tumors, or inflammation. There is a rare syndrome called Parsonage-Turner Syndrome, or brachial plexitis , which ... as a result of shoulder trauma, tumors, or inflammation. There is a rare syndrome called Parsonage-Turner Syndrome, or brachial plexitis , which ...

  5. Severe Brachial Plexus Injuries in American Football.

    Science.gov (United States)

    Daly, Charles A; Payne, S Houston; Seiler, John G

    2016-11-01

    This article reports a series of severe permanent brachial plexus injuries in American football players. The authors describe the mechanisms of injury and outcomes from a more contemporary treatment approach in the form of nerve transfer tailored to the specific injuries sustained. Three cases of nerve transfer for brachial plexus injury in American football players are discussed in detail. Two of these patients regained functional use of the extremity, but 1 patient with a particularly severe injury did not regain significant function. Brachial plexus injuries are found along a spectrum of brachial plexus stretch or contusion that includes the injuries known as "stingers." Early identification of these severe brachial plexus injuries allows for optimal outcomes with timely treatment. Diagnosis of the place of a given injury along this spectrum is difficult and requires a combination of imaging studies, nerve conduction studies, and close monitoring of physical examination findings over time. Although certain patients may be at higher risk for stingers, there is no evidence to suggest that this correlates with a higher risk of severe brachial plexus injury. Unfortunately, no equipment or strengthening program has been shown to provide a protective effect against these severe injuries. Patients with more severe injuries likely have less likelihood of functional recovery. In these patients, nerve transfer for brachial plexus injury offers the best possibility of meaningful recovery without significant morbidity. [ Orthopedics. 2016; 39(6):e1188-e1192.]. Copyright 2016, SLACK Incorporated.

  6. Lumbosacral Plexus Injury and Brachial Plexus Injury Following Prolonged Compression

    Directory of Open Access Journals (Sweden)

    Chung-Lan Kao

    2006-11-01

    Full Text Available We report the case of a 36-year-old woman who developed right upper and lower limb paralysis with sensory deficit after sedative drug overdose with prolonged immobilization. Due to the initial motor and sensory deficit pattern, brachial plexus injury or C8/T1 radiculopathy was suspected. Subsequent nerve conduction study/electromyography proved the lesion level to be brachial plexus. Painful swelling of the right buttock was suggestive of gluteal compartment syndrome. Elevation of serum creatine phosphokinase and urinary occult blood indicated rhabdomyolysis. The patient received medical treatment and rehabilitation; 2 years after the injury, her right upper and lower limb function had recovered nearly completely. As it is easy to develop complications such as muscle atrophy and joint contracture during the paralytic period of brachial plexopathy and lumbosacral plexopathy, early intervention with rehabilitation is necessary to ensure that the future limb function of the patient can be recovered. Our patient had suspected gluteal compartment syndrome that developed after prolonged compression, with the complication of concomitant lumbosacral plexus injury and brachial plexus injury, which is rarely reported in the literature. A satisfactory outcome was achieved with nonsurgical management.

  7. Long-Term Outcome of Brachial Plexus Reimplantation After Complete Brachial Plexus Avulsion Injury.

    Science.gov (United States)

    Kachramanoglou, Carolina; Carlstedt, Thomas; Koltzenburg, Martin; Choi, David

    2017-07-01

    Complete brachial plexus avulsion injury is a severe disabling injury due to traction to the brachial plexus. Brachial plexus reimplantation is an emerging surgical technique for the management of complete brachial plexus avulsion injury. We assessed the functional recovery in 15 patients who underwent brachial plexus reimplantation surgery after complete brachial plexus avulsion injury with clinical examination and electrophysiological testing. We included all patients who underwent brachial plexus reimplantation in our institution between 1997 and 2010. Patients were assessed with detailed motor and sensory clinical examination and motor and sensory electrophysiological tests. We found that patients who had reimplantation surgery demonstrated an improvement in Medical Research Council power in the deltoid, pectoralis, and infraspinatous muscles and global Medical Research Council score. Eight patients achieved at least grade 3 MRC power in at least one muscle group of the arm. Improved reinnervation by electromyelography criteria was found in infraspinatous, biceps, and triceps muscles. There was evidence of ongoing innervation in 3 patients. Sensory testing in affected dermatomes also showed better recovery at C5, C6, and T1 dermatomes. The best recovery was seen in the C5 dermatome. Our results demonstrate a definite but limited improvement in motor and sensory recovery after reimplantation surgery in patients with complete brachial plexus injury. We hypothesize that further improvement may be achieved by using regenerative cell technologies at the time of repair. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  8. MR evaluation of brachial plexus injuries

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    Gupta, R.K.; Jain, R.K. (Institute of Nuclear Medicine and Allied Sciences, New Delhi (India). NMR Research Center); Mehta, V.S.; Banerji, A.K. (All India Inst. of Medical Sciences, New Delhi (India). Dept. of Neurosurgery)

    1989-11-01

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

  9. Direct electrical injury to brachial plexus

    Directory of Open Access Journals (Sweden)

    Maksud Mubarak Devale

    2017-01-01

    Full Text Available Electrical current can cause neurological damage directly or by conversion to thermal energy. However, electrical injury causing isolated brachial plexus injury without cutaneous burns is extremely rare. We present a case of a 17-year-old boy who sustained accidental electrical injury to left upper extremity with no associated entry or exit wounds. Complete motor and sensory loss in upper limb were noted immediately after injury. Subsequently, the patient showed partial recovery in muscles around the shoulder and in ulnar nerve distribution at 6 months. However, there was no improvement in muscles supplied by musculocutaneous, median and radial nerves. On exploration at 6 months after trauma, injury to the infraclavicular plexus was identified. Reconstruction of musculocutaneous, median and radial nerves by means of sural nerve cable grafts was performed. The patient has shown excellent recovery in musculocutaneous nerve function with acceptable recovery of radial nerve function at 1-year post-injury.

  10. Brachial plexus (image)

    Science.gov (United States)

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

  11. Electroacupuncture attenuates neuropathic pain after brachial plexus injury

    OpenAIRE

    Zhang, Shenyu; Tang, Hailiang; Zhou, Junming; Gu, Yudong

    2014-01-01

    Electroacupuncture has traditionally been used to treat pain, but its effect on pain following brachial plexus injury is still unknown. In this study, rat models of an avulsion injury to the left brachial plexus root (associated with upper-limb chronic neuropathic pain) were given electroacupuncture stimulation at bilateral Quchi (LI11), Hegu (LI04), Zusanli (ST36) and Yanglingquan (GB34). After electroacupuncture therapy, chronic neuropathic pain in the rats’ upper limbs was significantly at...

  12. Traction injury of the brachial plexus confused with nerve injury due to interscalene brachial block: A case report

    Directory of Open Access Journals (Sweden)

    Francisco Ferrero-Manzanal

    2016-01-01

    Conclusion: When postoperative brachial plexus palsy appears, nerve block is a confusing factor that tends to be attributed as the cause of palsy by the orthopedic surgeon. The beach chair position may predispose brachial plexus traction injury. The head and neck position should be regularly checked during long procedures, as intraoperative maneuvers may cause eventual traction of the brachial plexus.

  13. Brachial plexus

    Science.gov (United States)

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

  14. Shoulder contracture and osseous deformity in obstetrical brachial plexus injuries

    NARCIS (Netherlands)

    Hoeksma, Agnes F.; ter Steeg, Anne Marie; Dijkstra, Piet; Nelissen, Rob G. H. H.; Beelen, Anita; de Jong, Bareld A.

    2003-01-01

    The purposes of this study were to determine the prevalence of and the association between shoulder contracture and osseous deformity in a cohort of children with an obstetrical brachial plexus injury and to identify the risk factors for these complications. In a retrospective cohort study, all

  15. Obstetrical brachial plexus injuries: incidence, natural course and shoulder contracture

    NARCIS (Netherlands)

    Hoeksma, A. F.; Wolf, H.; Oei, S. L.

    2000-01-01

    The incidence of obstetric brachial plexus injury (OBPI) was investigated and the natural course of this disorder and the frequency of shoulder contracture described. Between 1988 and 1997 13,366 children with a gestational age of 30 weeks or more, were born at the Academic Medical Center,

  16. Spontaneous recovery of non-operated traumatic brachial plexus injury.

    Science.gov (United States)

    Lim, S H; Lee, J S; Kim, Y H; Kim, T W; Kwon, K M

    2017-06-27

    We investigated the spontaneous recovery of non-operated traumatic brachial plexus injury (BPI). A total of 25 cases of non-operated traumatic BPI were analysed by retrospective review of medical records; in all cases, consecutive electrodiagnostic studies (ES) were conducted from 1 to 4 months and 18 to 24 months post-trauma. Injury severity was assessed using a modified version of Dumitru and Wilbourn's scale (DWS) based on ES. Spontaneous recovery of brachial plexus components per subject was analysed using Wilcoxon's signed-rank test. A two-tailed Fisher's exact or Pearson's Chi-square test was used to examine the associations between initial injury severity (DWS grade 2 vs. 3, complete vs. incomplete), accompanying injury type (open vs. closed), main lesion location (supraclavicular vs. infraclavicular lesion), and spontaneous recovery. The most common cause of BPI was traffic accident (TA) (15 cases, 60%), and the most common type of TA-induced BPI was a motorcycle TA (5 cases), accounting for 20% of all injuries. The second most common type of injury was an occupational injury (6 cases, 24%). Thirty-eight (69%) of 55 injured brachial components in 25 cases had DWS grade 3 and 17 brachial components (31%) had grade 2. The DWS grade of brachial plexus components per subject significantly differed between the first and follow-up ES (p = 0.000). However, initial injury severity, accompanying injury type, and main lesion location were not statistically associated with spontaneous recovery (p > 0.05). Spontaneous recovery may be possible even in severe traumatic BPI. Multiple factors should be considered when predicting the clinical course of traumatic BPI.

  17. Intrapartum risk factors for permanent brachial plexus injury.

    Science.gov (United States)

    Poggi, Sarah H; Stallings, Shawn P; Ghidini, Alessandro; Spong, Catherine Y; Deering, Shad H; Allen, Robert H

    2003-09-01

    The purpose of this study was to compare maternal, neonatal, and second stage of labor characteristics in shoulder dystocia deliveries that result in permanent brachial plexus injury with shoulder dystocia deliveries that result in no injury. Our cases were culled from a database of deliveries that resulted in permanent brachial plexus injuries and matched to control cases that were taken from a database of consecutive shoulder dystocia deliveries from one hospital. Deliveries that resulted in injury were excluded from the control cases; those cases with no recorded shoulder dystocia were excluded from the cases. Matching was for birth weight (+/-250 g), parity, and diabetic status. Rates of precipitous and prolonged second stage, operative delivery, neonatal depression, and average number of shoulder dystocia maneuvers used were compared between the two groups with chi(2) test, Fisher exact test, and the Student t test; a probability value of precipitous second stage rate, and sex were not significant between groups. The rates of precipitous second stage for both groups (28.0% injured and 35.0% uninjured) were more than triple the rates of prolonged second stage (9.5% injured and 11.3% uninjured). No characteristic of second-stage of labor predicts permanent brachial plexus injury. Precipitous second stage is the most prevalent labor abnormality that is associated with shoulder dystocia.

  18. Outcome following nonoperative treatment of brachial plexus birth injuries.

    Science.gov (United States)

    DiTaranto, Patricia; Campagna, Liliana; Price, Andrew E; Grossman, John A I

    2004-02-01

    Ninety-one infants who sustained a brachial plexus birth injury were treated with only physical and occupational therapy. The children were evaluated at 3-month intervals and followed for a minimum of 2 years. Sixty-three children with an upper or upper-middle plexus injury recovered good to excellent shoulder and hand function. In all of these children, critical marker muscles recovered M4 by 6 months of age. Twelve infants sustained a global palsy, with critical marker muscles remaining at M0-M1 at 6 months, resulting in a useless extremity. Sixteen infants with upper and upper-middle plexus injuries failed to recover greater than M1-M2 deltoid and biceps by 6 months, resulting in a very poor final outcome. These data provide useful guidelines for selection of infants for surgical reconstruction to improve ultimate outcome.

  19. Obstetrical brachial plexus injury (OBPI): Canada's national clinical practice guideline

    OpenAIRE

    Coroneos, Christopher J.; Voineskos, Sophocles H; Christakis, Marie K; Thoma, Achilleas; Bain, James R.; Brouwers, Melissa C

    2017-01-01

    Objective The objective of this study was to establish an evidence-based clinical practice guideline for the primary management of obstetrical brachial plexus injury (OBPI). This clinical practice guideline addresses 4 existing gaps: (1) historic poor use of evidence, (2) timing of referral to multidisciplinary care, (3) Indications and timing of operative nerve repair and (4) distribution of expertise. Setting The guideline is intended for all healthcare providers treating infants and childr...

  20. Reoperation for failed shoulder reconstruction following brachial plexus birth injury

    Science.gov (United States)

    2013-01-01

    Background Various approaches have been developed to treat the progressive shoulder deformity in patients with brachial plexus birth palsy. Reconstructive surgery for this condition consists of complex procedures with a risk for failure. Case presentations This is a retrospective case review of the outcome in eight cases referred to us for reoperation for failed shoulder reconstructions. In each case, we describe the initial attempt(s) at surgical correction, the underlying causes of failure, and the procedures performed to rectify the problem. Results were assessed using pre- and post-operative Mallet shoulder scores. All eight patients realized improvement in shoulder function from reoperation. Conclusions This case review identifies several aspects of reconstructive shoulder surgery for brachial plexus birth injury that may cause failure of the index procedure(s) and outlines critical steps in the evaluation and execution of shoulder reconstruction. PMID:23883413

  1. A Review of Brachial Plexus Birth Palsy: Injury and Rehabilitation.

    Science.gov (United States)

    Raducha, Jeremy E; Cohen, Brian; Blood, Travis; Katarincic, Julia

    2017-11-01

    Brachial plexus injuries during the birthing process can leave infants with upper extremity deficits corresponding to the location of the lesion within the complex plexus anatomy. Manifestations can range from mild injuries with complete resolution to severe and permanent disability. Overall, patients have a high rate of spontaneous recovery (66-92%).1,2 Initially, all lesions are managed with passive range motion and observation. Prevention and/or correction of contractures with occupational therapy and serial splinting/casting along with encouraging normal development are the main goals of non-operative treatment. Surgical intervention may be war- ranted, depending on functional recovery. [Full article available at http://rimed.org/rimedicaljournal-2017-11.asp].

  2. Brachial plexus injury in adults: Diagnosis and surgical treatment strategies

    Directory of Open Access Journals (Sweden)

    Mukund R Thatte

    2013-01-01

    Full Text Available Adult post traumatic Brachial plexus injury is unfortunately a rather common injury in young adults. In India the most common scenario is of a young man injured in a motorcycle accident. Exact incidence figures are not available but of the injuries presenting to us about 90% invole the above combination This article reviews peer-reviewed publications including clinical papers, review articles and Meta analysis 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. Results have been discussed and analysed to get an idea of factors influencing final recovery. It appears that time from injury and number of roots involved are most crucial.

  3. Brachial plexus injury in adults: Diagnosis and surgical treatment strategies

    Science.gov (United States)

    Thatte, Mukund R.; Babhulkar, Sonali; Hiremath, Amita

    2013-01-01

    Adult post traumatic Brachial plexus injury is unfortunately a rather common injury in young adults. In India the most common scenario is of a young man injured in a motorcycle accident. Exact incidence figures are not available but of the injuries presenting to us about 90% invole the above combination This article reviews peer-reviewed publications including clinical papers, review articles and Meta analysis 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. Results have been discussed and analysed to get an idea of factors influencing final recovery. It appears that time from injury and number of roots involved are most crucial. PMID:23661959

  4. Concomitant Traumatic Spinal Cord and Brachial Plexus Injuries in Adult Patients

    Science.gov (United States)

    Rhee, Peter C.; Pirola, Elena; Hébert-Blouin, Marie-Noëlle; Kircher, Michelle F.; Spinner, Robert J.; Bishop, Allen T.; Shin, Alexander Y.

    2011-01-01

    Background: Combined injuries to the spinal cord and brachial plexus present challenges in the detection of both injuries as well as to subsequent treatment. The purpose of this study is to describe the epidemiology and clinical factors of concomitant spinal cord injuries in patients with a known brachial plexus injury. Methods: A retrospective review was performed on all patients who were evaluated for a brachial plexus injury in a tertiary, multidisciplinary brachial plexus clinic from January 2000 to December 2008. Patients with clinical and/or imaging findings for a coexistent spinal cord injury were identified and underwent further analysis. Results: A total of 255 adult patients were evaluated for a traumatic traction injury to the brachial plexus. We identified thirty-one patients with a combined brachial plexus and spinal cord injury, for a prevalence of 12.2%. A preganglionic brachial plexus injury had been sustained in all cases. The combined injury group had a statistically greater likelihood of having a supraclavicular vascular injury (odds ratio [OR] = 22.5; 95% confidence interval [CI] = 1.9, 271.9) and a cervical spine fracture (OR = 3.44; 95% CI = 1.6, 7.5). These patients were also more likely to exhibit a Horner sign (OR = 3.2; 95% CI = 1.5, 7.2) and phrenic nerve dysfunction (OR = 2.5; 95% CI = 1.0, 5.8) compared with the group with only a brachial plexus injury. Conclusion: Heightened awareness for a combined spinal cord and brachial plexus injury and the presence of various associated clinical and imaging findings may aid in the early recognition of these relatively uncommon injuries. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. PMID:22258773

  5. Restoration and protection of brachial plexus injury: hot topics in the last decade

    Science.gov (United States)

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

    2014-01-01

    Brachial plexus injury is frequently induced by injuries, accidents or birth trauma. Upper limb function may be partially or totally lost after injury, or left permanently disabled. With the development of various medical technologies, different types of interventions are used, but their effectiveness is wide ranging. Many repair methods have phasic characteristics, i.e., repairs are done in different phases. This study explored research progress and hot topic methods for protection after brachial plexus injury, by analyzing 1,797 articles concerning the repair of brachial plexus injuries, published between 2004 and 2013 and indexed by the Science Citation Index database. Results revealed that there are many methods used to repair brachial plexus injury, and their effects are varied. Intervention methods include nerve transfer surgery, electrical stimulation, cell transplantation, neurotrophic factor therapy and drug treatment. Therapeutic methods in this field change according to the hot topic of research. PMID:25374596

  6. Brachial plexus injury in Thailand: a report of 520 cases.

    Science.gov (United States)

    Songcharoen, P

    1995-01-01

    Between October 1984 and October 1993, 520 patients with traumatic brachial plexus injuries were treated at the Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok. There were 486 male and 34 female patients. Eighty-two percent of the injuries were caused by motorcycle accidents, 9% by other traffic accidents, and 9% by gunshot, stabbing, and other means. The initial physical examination revealed 332 (63.8%) complete paralyses and 88 (36.2%) incomplete paralyses. One hundred twenty-seven patients were treated conservatively, 43 patients were observed before definitive treatment was given, and 350 patients were treated by operative means. Four hundred and twenty-one surgical procedures were performed, consisting of 314 neurotisations (250 spinal accessory, 14 plexo-plexal, 21 intercostal, 21 phrenic, 4 cervical plexus, 1 long thoracic, and 3 neuromuscular), 38 neurolyses, 23 nerve grafting, 16 free muscle transfers combined with neurotisations, and 30 musculotendinous transfers. Motor functional recovery of patients followed up for more than 2 years was evaluated. Nerve grafting gave 82% good (more than MRC grade 3) and 18% fair and poor recovery. Neurolysis gave 69% good and 31% fair and poor recovery. In patients with neurotisation, the spinal accessory (to suprascapular, axillary, and musculotaneous) intercostal (to musculotaneous), phrenic (to suprascapular, axillary, and musculocutaneous), and plexo- plexal methods gave a significant number of good results.

  7. Obstetrical brachial plexus injury (OBPI): Canada's national clinical practice guideline.

    Science.gov (United States)

    Coroneos, Christopher J; Voineskos, Sophocles H; Christakis, Marie K; Thoma, Achilleas; Bain, James R; Brouwers, Melissa C

    2017-01-27

    The objective of this study was to establish an evidence-based clinical practice guideline for the primary management of obstetrical brachial plexus injury (OBPI). This clinical practice guideline addresses 4 existing gaps: (1) historic poor use of evidence, (2) timing of referral to multidisciplinary care, (3) Indications and timing of operative nerve repair and (4) distribution of expertise. The guideline is intended for all healthcare providers treating infants and children, and all specialists treating upper extremity injuries. The evidence interpretation and recommendation consensus team (Canadian OBPI Working Group) was composed of clinicians representing each of Canada's 10 multidisciplinary centres. An electronic modified Delphi approach was used for consensus, with agreement criteria defined a priori. Quality indicators for referral to a multidisciplinary centre were established by consensus. An original meta-analysis of primary nerve repair and review of Canadian epidemiology and burden were previously completed. 7 recommendations address clinical gaps and guide identification, referral, treatment and outcome assessment: (1) physically examine for OBPI in newborns with arm asymmetry or risk factors; (2) refer newborns with OBPI to a multidisciplinary centre by 1 month; (3) provide pregnancy/birth history and physical examination findings at birth; (4) multidisciplinary centres should include a therapist and peripheral nerve surgeon experienced with OBPI; (5) physical therapy should be advised by a multidisciplinary team; (6) microsurgical nerve repair is indicated in root avulsion and other OBPI meeting centre operative criteria; (7) the common data set includes the Narakas classification, limb length, Active Movement Scale (AMS) and Brachial Plexus Outcome Measure (BPOM) 2 years after birth/surgery. The process established a new network of opinion leaders and researchers for further guideline development and multicentre research. A structured

  8. Traction injury of the brachial plexus confused with nerve injury due to interscalene brachial block: A case report.

    Science.gov (United States)

    Ferrero-Manzanal, Francisco; Lax-Pérez, Raquel; López-Bernabé, Roberto; Betancourt-Bastidas, José Ramiro; Iñiguez de Onzoño-Pérez, Alvaro

    2016-01-01

    Shoulder surgery is often performed with the patient in the so called "beach-chair position" with elevation of the upper part of the body. The anesthetic procedure can be general anesthesia and/or regional block, usually interscalenic brachial plexus block. We present a case of brachial plexus palsy with a possible mechanism of traction based on the electromyographic and clinical findings, although a possible contribution of nerve block cannot be excluded. We present a case of a 62 year-old female, that suffered from shoulder fracture-dislocation. Open reduction and internal fixation were performed in the so-called "beach-chair" position, under combined general-regional anesthesia. In the postoperative period complete motor brachial plexus palsy appeared, with neuropathic pain. Conservative treatment included analgesic drugs, neuromodulators, B-vitamin complex and physiotherapy. Spontaneous recovery appeared at 11 months. DISCUSION: in shoulder surgery, there may be complications related to both anesthetic technique and patient positioning/surgical maneuvers. Regional block often acts as a confusing factor when neurologic damage appears after surgery. Intraoperative maneuvers may cause eventual traction of the brachial plexus, and may be favored by the fixed position of the head using the accessory of the operating table in the beach-chair position. When postoperative brachial plexus palsy appears, nerve block is a confusing factor that tends to be attributed as the cause of palsy by the orthopedic surgeon. The beach chair position may predispose brachial plexus traction injury. The head and neck position should be regularly checked during long procedures, as intraoperative maneuvers may cause eventual traction of the brachial plexus. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. Timing of surgical reconstruction for closed traumatic injury to the supraclavicular brachial plexus.

    Science.gov (United States)

    Birch, R

    2015-07-01

    While it is widely accepted that cases of traumatic injury to the brachial plexus benefit from early surgical exploration and repair, with results deteriorating with long delays, policies vary regarding the exact timing of intervention. This is one of a pair of review articles considering the clinical issues, investigations, and surgical factors relating to management of injuries to the supraclavicular brachial plexus, as well evidence from experimental work and clinical outcomes.In this article Professor Birch argues for early exploration of the brachial plexus as the optimum both to delineate the pathology and undertake reconstructive surgery. © The Author(s) 2014.

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

    Directory of Open Access Journals (Sweden)

    Bhandari P

    2009-01-01

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

  11. Neonatal brachial plexus injury: comparison of incidence and antecedents between 2 decades.

    LENUS (Irish Health Repository)

    Walsh, Jennifer M

    2011-04-01

    We sought to compare the incidence and antecedents of neonatal brachial plexus injury (BPI) in 2 different 5-year epochs a decade apart following the introduction of specific staff training in the management of shoulder dystocia.

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

    Science.gov (United States)

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

    2016-05-01

    This article reviews the assessment and management of obstetrical brachial plexus palsy. The potential role of distal nerve transfers in the treatment of infants with Erb's palsy is discussed. Current evidence for motor outcomes after traditional reconstruction via interpositional nerve grafting and extraplexal nerve transfers is reviewed and compared with the recent literature on intraplexal distal nerve transfers in obstetrical brachial plexus injury. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-12-15

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

  14. Treatment of a brachial plexus injury using kinesiotape and exercise.

    Science.gov (United States)

    Walsh, Sharon Fleming

    2010-10-01

    This describes a child whose neonatal brachial plexus injury was treated with kinesiotape and exercise. The subject was a two-year-old female whose X-rays demonstrated severe inferior subluxation of the humeral head and winging of the scapula on the left. She was fitted with a shoulder brace with surgery scheduled in six months. The initial PT exam noted 80 degrees of shoulder abduction (trumpet sign), significant asymmetry, and nonuse. Mallet score was 15/25. Treatment consisted of d/c of the brace and E-stimulation, parent education on exercise and taping, and kinesiotape to facilitate rotator cuff and scapular stabilizers. Typical wear time was 2-3 days on, 1-2 days off. After 2 weeks, there was prominent deltoid definition. The shoulder was in 20 degrees of abduction, shoulders level with less scapular winging. Scapular stabilizers were then taped. At 4 weeks, her arm was held to her side displaying a stable symmetrical scapula. The arm displayed increased fine motor use and initiation of activities. At 10 weeks there was a forced d/c, and a decline toward baseline levels. After 2 weeks of reinstatement, function returned to prior level. At 20 weeks (12 total visits) she displayed full ROM, symmetrical shoulders, Mallet score of 20/25, rare trumpet sign, and was hanging by arms during play. X-rays displayed significant improvement in humeral head position, rib cage rotation, angle of scapula and clavicle, and size and mineralization of humerus. Reconstructive surgery was cancelled. Kinesiotape and parent education made a significant difference in this child's function.

  15. Impaired growth of denervated muscle contributes to contracture formation following neonatal brachial plexus injury.

    Science.gov (United States)

    Nikolaou, Sia; Peterson, Elizabeth; Kim, Annie; Wylie, Christopher; Cornwall, Roger

    2011-03-02

    The etiology of shoulder and elbow contractures following neonatal brachial plexus injury is incompletely understood. With use of a mouse model, the current study tests the novel hypothesis that reduced growth of denervated muscle contributes to contractures following neonatal brachial plexus injury. Unilateral brachial plexus injuries were created in neonatal mice by supraclavicular C5-C6 nerve root excision. Shoulder and elbow range of motion was measured four weeks after injury. Fibrosis, cross-sectional area, and functional length of the biceps, brachialis, and subscapularis muscles were measured over four weeks following injury. Muscle satellite cells were cultured from denervated and control biceps muscles to assess myogenic capability. In a comparison group, shoulder motion and subscapularis length were assessed following surgical excision of external rotator muscles. Shoulder internal rotation and elbow flexion contractures developed on the involved side within four weeks following brachial plexus injury. Excision of the biceps and brachialis muscles relieved the elbow flexion contractures. The biceps muscles were histologically fibrotic, whereas fatty infiltration predominated in the brachialis and rotator cuff muscles. The biceps and brachialis muscles displayed reduced cross-sectional and longitudinal growth compared with the contralateral muscles. The upper subscapularis muscle similarly displayed reduced longitudinal growth, with the subscapularis shortening correlating with internal rotation contracture. However, excision of the external rotators without brachial plexus injury caused no contractures or subscapularis shortening. Myogenically capable satellite cells were present in denervated biceps muscles despite impaired muscle growth in vivo. Injury of the upper trunk of the brachial plexus leads to impaired growth of the biceps and brachialis muscles, which are responsible for elbow flexion contractures, and impaired growth of the subscapularis

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

    Science.gov (United States)

    Liu, Ying; Xu, Xun-cheng; Zou, Yi; Li, Su-rong; Zhang, Bin; Wang, Yue

    2015-01-01

    Phrenic nerve transfer is a major dynamic treatment used to repair brachial plexus root avulsion. We analyzed 72 relevant articles on phrenic nerve transfer to repair injured brachial plexus that were indexed by Science Citation Index. The keywords searched were brachial plexus injury, phrenic nerve, repair, surgery, protection, nerve transfer, and nerve graft. In addition, we performed neurophysiological analysis of the preoperative condition and prognosis of 10 patients undergoing ipsilateral phrenic nerve transfer to the musculocutaneous nerve in our hospital from 2008 to 201 3 and observed the electromyograms of the biceps brachii and motor conduction function of the musculocutaneous nerve. Clinically, approximately 28% of patients had brachial plexus injury combined with phrenic nerve injury, and injured phrenic nerve cannot be used as a nerve graft. After phrenic nerve transfer to the musculocutaneous nerve, the regenerated potentials first appeared at 3 months. Recovery of motor unit action potential occurred 6 months later and became more apparent at 12 months. The percent of patients recovering ‘excellent’ and ‘good’ muscle strength in the biceps brachii was 80% after 18 months. At 12 months after surgery, motor nerve conduction potential appeared in the musculocutaneous nerve in seven cases. These data suggest that preoperative evaluation of phrenic nerve function may help identify the most appropriate nerve graft in patients with an injured brachial plexus. The functional recovery of a transplanted nerve can be dynamically observed after the surgery. PMID:25883637

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

    Directory of Open Access Journals (Sweden)

    Ying Liu

    2015-01-01

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

  18. A Case of Scapulothoracic Dissociation with Brachial Plexus Injury: Magnetic Resonance Imaging Findings

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    Lee, G.K.; Suh, K.J.; Choi, J.A.; Oh, O.Y. [Dept. of Radiology, Hallym Univ. College of Medicine, Hangang Sacred Heart Hospital, Seoul (Korea)

    2007-11-15

    Scapulothoracic dissociation is defined as violent lateral or rotational displacement of the shoulder girdle from its thoracic attachments with severe neurovascular injury. We describe the radiographic and associated magnetic resonance (MR) imaging findings of a case of scapulothoracic dissociation with brachial plexus injury in a 17-year-old man, and include a review of the relevant literature.

  19. Types and severity of operated supraclavicular brachial plexus injuries caused by traffic accidents.

    Science.gov (United States)

    Kaiser, Radek; Waldauf, Petr; Haninec, Pavel

    2012-07-01

    Brachial plexus injuries occur in up to 5% of polytrauma cases involving motorcycle accidents and in approximately 4% of severe winter sports injuries. One of the criteria for a successful operative therapy is the type of lesion. Upper plexus palsy has the best prognosis, whereas lower plexus palsy is surgically untreatable. The aim of this study was to evaluate a group of patients with brachial plexus injury caused by traffic accidents, categorize the injuries according to type of accident, and look for correlations between type of palsy (injury) and specific accidents. A total of 441 brachial plexus reconstruction patients from our department were evaluated retrospectively(1993 to 2011). Sex, age, neurological status, and the type and cause of injury were recorded for each case. Patients with BPI caused by a traffic accident were assessed in detail. Traffic accidents were the cause of brachial plexus injury in most cases (80.7%). The most common type of injury was avulsion of upper root(s) (45.7%) followed by rupture (28.2%), complete avulsion (16.9%) and avulsion of lower root(s) (9.2%). Of the patients, 73.9% had an upper,22.7% had a complete and only 3.4% had a lower brachial plexus palsy. The main cause was motorcycle accidents(63.2%) followed by car accidents (23.5%), bicycle accidents(10.7%) and pedestrian collisions (3.1%) (pcar accidents had a higher percentage of lower avulsion (22.7%) and a lower percentage of upper avulsion (29.3%), whereas cyclists had a higher percentage of upper avulsion (68.6%) based on the data from the entire group of patients (pcar accidents (9.3%,pcar and motorcycle accidents),significantly more upper and fewer lower palsies were present. In the bicycle accident group, upper palsy was the most common (89%). Study results indicate that the most common injury was an upper plexus palsy. It was characteristic of bicycle accidents, and significantly more common in car and motorcycle accidents. The results also indicate that it is

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

    Science.gov (United States)

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

    2012-01-01

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

  1. Brachial plexus injury in two red-tailed hawks (Buteo jamaicensis).

    Science.gov (United States)

    Shell, L; Richards, M; Saunders, G

    1993-01-01

    Two red-tailed hawks (Buteo jamaicensis), found near Deltaville, Virginia (USA), were evaluated because of inability to use a wing. Results of needle electromyographic studies of the affected wing muscles in both hawks were compatible with denervation. On euthanasia, one hawk had extensive axon and myelin loss with multifocal perivascular lymphocytic inflammation of its brachial plexus and radial nerve. Demyelination and axon loss in the dorsal white matter of the spinal cord on the affected side also were found at the origin of the brachial plexus. The other hawk's wing had not returned to functional status > 2 yr after injury.

  2. Neurological recovery in obstetric brachial plexus injuries: an historical cohort study

    NARCIS (Netherlands)

    Hoeksma, Agnes F.; ter Steeg, Anne Marie; Nelissen, Rob G. H. H.; van Ouwerkerk, Willem J. R.; Lankhorst, Gustaaf J.; de Jong, Bareld A.

    2004-01-01

    An historical cohort study was conducted to investigate the rate and extent of neurological recovery in obstetric brachial plexus injury (OBPI) and to identify possible prognostic factors in a cohort of children with OBPI from birth to 7 years. All children (n=56; 31 females, 25 males) with OBPI

  3. High prevalence of neuropathic pain in the hand of patients with traumatic brachial plexus injury: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Marcus V. B. Santana

    Full Text Available ABSTRACT Objective To describe the pain profile of patients with traumatic brachial plexus injury. Methods We enrolled 65 patients with traumatic brachial plexus injury. The Douleur Neuropathique 4 questionnaire was used to classify pain and the SF-36 was used to evaluate quality of life. Results The patients with traumatic brachial plexus injury were predominantly young male victims of motorcycle accidents. Pain was present in 75.4% of the individuals and 79% presented with neuropathic pain, mostly located in the hands (30.41%. The use of auxiliary devices (p = 0.05 and marital status (p = 0.03 were both independent predictors of pain. Pain also impacted negatively on the quality of life (p = 0.001. Conclusions Pain is frequent in patients with traumatic brachial plexus injury. Despite the peripheral nervous system injury, nociceptive pain is not unusual. Pain evaluation, including validated instruments, is essential to guide optimal clinical management of patients with the condition.

  4. The role of elective amputation in patients with traumatic brachial plexus injury.

    Science.gov (United States)

    Maldonado, Andrés A; Kircher, Michelle F; Spinner, Robert J; Bishop, Allen T; Shin, Alexander Y

    2016-03-01

    Despite undergoing complex brachial plexus, surgical reconstructions, and rehabilitation, some patients request an elective amputation. This study evaluates the role of elective amputation after brachial plexus injury. A retrospective chart review was performed for all the 2140 patients with brachial plexus injuries treated with elective amputation between 1999 and 2012 at a single institution. Analysis was conducted on the potential predisposing factors for amputation, amputation level, and postamputation complications. Patients were evaluated using pre- and postamputation Disabilities of the Shoulder, Arm, and hand scores in addition to visual analog pain scores. The following three conditions were observed in all nine patients who requested an elective amputation: (1) Pan-plexus injury; (2) non-recovery (mid-humeral amputation) or elbow flexion recovery only (forearm amputation) 1 year after all other surgical options were performed; and (3) at least one chronic complication (chronic infection, nonunion fractures, full-thickness burns, chronic neck pain with arm weight, etc.). Pain improvement was found in five patients. Subjective patient assessments and visual analog pain scores before and after amputation did not show a statistically significant improvement in Disabilities of the Shoulder, Arm, and Hand Scores. However, four patients reported that their shoulder pain felt "better" than it did before the amputation, and two patients indicated they were completely cured of chronic pain after surgery. Elective amputation after brachial plexus injury should be considered as an option in the above circumstances. When the informed and educated decision is made, patients can have satisfactory outcomes regarding amputation. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. Refinement of myotome values in the upper limb: Evidence from brachial plexus injuries.

    Science.gov (United States)

    Bell, S W; Brown, M J C; Hems, T J

    2017-02-01

    We reviewed patients with partial supraclavicular brachial plexus injuries in order to refine the myotome values of the upper limb. Forty-two patients with defined partial injuries to the supraclavicular brachial plexus were reviewed from a prospective database. The injuries patterns covered C5, C5-6, C5-7, C5-8, C7-T1 and C8-T1 roots. Upper plexus injuries were classified on the basis of surgical exploration and intraoperative stimulation and lower plexus injuries from MRI. Flexor Carpi Radialis (FCR) was paralyzed in C5-7 injuries, in addition to paralysis of deltoid, supraspinatus, infraspinatus and biceps, when compared to C5-6 injuries. Complete paralysis of Flexor Digitorum Profundus (FDP) and Flexor Digitorum Superficialis (FDS) to all digits was identified in C7-T1 injuries. In C5-8 injuries weakness was noted in FDP of ulnar digits and intrinsics innervated by the ulnar nerve, while in C8-T1 injuries paralysis was noted in the FDP to the radial digits. All patients with C8-T1 injuries had paralysis of FDS and the thenar muscles. In upper plexus injuries paralysis of FCR indicated involvement of C7 root in addition to C5 and C6 roots. The results provide new detail of innervation of muscles acting on the hand. Flexor muscles and intrinsic muscles of the thumb and radial fingers (median nerve) have an important contribution from T1, while for those acting on the ulnar digits (ulnar nerve) the main contribution is from C8 with some input from C7. T1 also gives consistent innervation to extensor pollicis longus. A revised myotome chart for the upper limb is proposed. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  6. Diagnostic accuracy of magnetic resonance imaging in post-traumatic brachial plexus injuries: A systematic review.

    Science.gov (United States)

    Fuzari, Helen K B; Dornelas de Andrade, Armèle; Vilar, Clarice F; Sayão, Larissa B; Diniz, Paula R B; Souza, Fernando H; de Oliveira, Daniella A

    2017-11-11

    Computed Tomographic Myelography (CTM) is a gold-standard imaging test for evaluating the brachial plexus and has been used for a long time. Another imaging test more recently used is Magnetic Resonance imaging (MRI), which is also part of the plexus evaluation. The purpose of this study was to determine the accuracy of MRI in diagnosing post-traumatic injuries of the brachial plexus. We conducted a Systematic Review with cross-sectional studies of diagnostic accuracy. Studies with populations presenting post-traumatic brachial plexus injury, over 16 years old, both genders, and examined by CT Myelography and MRI were evaluated. The trial resulted in three studies that covered the inclusion criteria. The sample consisted of 46 participants. The tool Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality of the studies, and the software RevMan was used to identify the homogeneity of the studies that entered the analysis. The study was registered in PROSPERO under the number CRD42016041720. Studies showed moderate to high risk of bias, with low or very low quality of evidence due to the limitations of studies and differences in comparing the assessment groups. The heterogeneity of the studies made it impossible to create meta-analyzes. MRI has been an excellent test for assessing traumatic brachial plexus injuries in clinical practice; however, the quantitative analysis of studies identified a lack in methodological rigor. Future studies should focus on methodological rigor, providing more accurate assessments of modalities and their benefits. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. [Complications in brachial plexus surgery].

    Science.gov (United States)

    Martínez, Fernando; Pinazzo, Samantha; Moragues, Rodrigo; Suarez, Elizabeth

    2015-01-01

    Although traumatic brachial plexus injuries are relatively rare in trauma patients, their effects on the functionality of the upper limb can be very disabling. The authors' objective was to assess the complications in a series of patients operated for brachial plexus injuries. This was a retrospective evaluation of patients operated on by the authors between August 2009 and March 2013. We performed 36 surgeries on 33 patients. The incidence of complications was 27.7%. Of these, only 1 (2.7%) was considered serious and associated with the procedure (iatrogenic injury of brachial artery). There was another serious complication (hypoxia in patients with airway injury) but it was not directly related to the surgical procedure. All other complications were considered minor (wound dehiscence, hematoma, infection). There was no mortality in our series. The complications in our series are similar to those reported in the literature. Serious complications (vascular, neural) are rare and represent less than 5% in all the different series. Given the rate of surgical complications and the poor functional perspective for a brachial plexus injury without surgery, we believe that surgery should be the treatment of choice. Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  8. Extended long-term (5 years) outcomes of triangle tilt surgery in obstetric brachial plexus injury.

    Science.gov (United States)

    Nath, Rahul K; Somasundaram, Chandra

    2013-01-01

    We evaluated the "extended" long-term (5 years) functional outcomes in obstetric brachial plexus injury (OBPI) patients, who underwent triangle tilt surgery between February 2005 and January 2008. Twenty two children (9 girls and 13 boys, mean age at surgery was 5.8 years; ranging 2.1-11.8 years old), who initially presented with medial rotation contracture and scapula deformity secondary to obstetric brachial plexus injury were included in this study. Functional movements were evaluated pre-operatively, and 5 years following triangle tilt surgery by modified Mallet scale. Here, we report long-term (5 years) follow-up of triangle tilt surgery for 22 OBPI patients. Upper extremity functional movements such as, external rotation (2.5±0.6 to 4.1±0.8, ptriangle tilt surgery improved all shoulder functions significantly, and maintained over the extended long-term (5 years) in these patients.

  9. Bionic reconstruction to restore hand function after brachial plexus injury: a case series of three patients.

    Science.gov (United States)

    Aszmann, Oskar C; Roche, Aidan D; Salminger, Stefan; Paternostro-Sluga, Tatjana; Herceg, Malvina; Sturma, Agnes; Hofer, Christian; Farina, Dario

    2015-05-30

    Brachial plexus injuries can permanently impair hand function, yet present surgical reconstruction provides only poor results. Here, we present for the first time bionic reconstruction; a combined technique of selective nerve and muscle transfers, elective amputation, and prosthetic rehabilitation to regain hand function. Between April 2011, and May 2014, three patients with global brachial plexus injury including lower root avulsions underwent bionic reconstruction. Treatment occurred in two stages; first, to identify and create useful electromyographic signals for prosthetic control, and second, to amputate the hand and replace it with a mechatronic prosthesis. Before amputation, the patients had a specifically tailored rehabilitation programme to enhance electromyographic signals and cognitive control of the prosthesis. Final prosthetic fitting was applied as early as 6 weeks after amputation. Bionic reconstruction successfully enabled prosthetic hand use in all three patients. After 3 months, mean Action Research Arm Test score increased from 5·3 (SD 4·73) to 30·7 (14·0). Mean Southampton Hand Assessment Procedure score improved from 9·3 (SD 1·5) to 65·3 (SD 19·4). Mean Disabilities of Arm, Shoulder and Hand score improved from 46·5 (SD 18·7) to 11·7 (SD 8·42). For patients with global brachial plexus injury with lower root avulsions, who have no alternative treatment, bionic reconstruction offers a means to restore hand function. Austrian Council for Research and Technology Development, Austrian Federal Ministry of Science, Research & Economy, and European Research Council Advanced Grant DEMOVE. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Use of the DEKA Arm for amputees with brachial plexus injury: A case series.

    Directory of Open Access Journals (Sweden)

    Linda Resnik

    Full Text Available Patients with upper limb amputation and brachial plexus injuries have high rates of prosthesis rejection. Study purpose is to describe experiences of subjects with transhumeral amputation and brachial plexus injury, who were fit with, and trained to use, a DEKA Arm.This was a mixed-methods study utilizing qualitative (e.g. interview, survey and quantitative data (e.g. self-report and performance measures. Subject 1, a current prosthesis user, had a shoulder arthrodesis. Subject 2, not a prosthesis user, had a subluxed shoulder. Both were trained in laboratory and participated in a trial of home use. Descriptive analyses of processes and outcomes were conducted.Subject 1 was fitted with the transhumeral configuration (HC DEKA Arm using a compression release stabilized socket. He had 12 hours of prosthetic training and participated in all home study activities. Subject 1 had improved dexterity and prosthetic satisfaction with the DEKA Arm and reported better quality of life (QOL at the end of participation. Subject 2 was fit with the shoulder configuration (SC DEKA Arm using a modified X-frame socket. He had 30 hours of training and participated in 3 weeks of home activities. He reported less functional disability at the end of training as compared to baseline, but encountered personal problems and exacerbation of PTSD symptoms and withdrew from home use portion at 3 weeks. Both subjects reported functional benefits from use, and expressed a desire to receive a DEKA Arm in the future.This paper reported on two different strategies for prosthetic fitting and their outcomes. The advantages and limitations of each approach were discussed.Use of both the HC and SC DEKA Arm for patients with TH amputation and brachial plexus injury was reported. Lessons learned may be instructive to clinicians considering prosthetic choices for future cases.

  11. Use of the DEKA Arm for amputees with brachial plexus injury: A case series.

    Science.gov (United States)

    Resnik, Linda; Fantini, Christopher; Latlief, Gail; Phillips, Samuel; Sasson, Nicole; Sepulveda, Eve

    2017-01-01

    Patients with upper limb amputation and brachial plexus injuries have high rates of prosthesis rejection. Study purpose is to describe experiences of subjects with transhumeral amputation and brachial plexus injury, who were fit with, and trained to use, a DEKA Arm. This was a mixed-methods study utilizing qualitative (e.g. interview, survey) and quantitative data (e.g. self-report and performance measures). Subject 1, a current prosthesis user, had a shoulder arthrodesis. Subject 2, not a prosthesis user, had a subluxed shoulder. Both were trained in laboratory and participated in a trial of home use. Descriptive analyses of processes and outcomes were conducted. Subject 1 was fitted with the transhumeral configuration (HC) DEKA Arm using a compression release stabilized socket. He had 12 hours of prosthetic training and participated in all home study activities. Subject 1 had improved dexterity and prosthetic satisfaction with the DEKA Arm and reported better quality of life (QOL) at the end of participation. Subject 2 was fit with the shoulder configuration (SC) DEKA Arm using a modified X-frame socket. He had 30 hours of training and participated in 3 weeks of home activities. He reported less functional disability at the end of training as compared to baseline, but encountered personal problems and exacerbation of PTSD symptoms and withdrew from home use portion at 3 weeks. Both subjects reported functional benefits from use, and expressed a desire to receive a DEKA Arm in the future. This paper reported on two different strategies for prosthetic fitting and their outcomes. The advantages and limitations of each approach were discussed. Use of both the HC and SC DEKA Arm for patients with TH amputation and brachial plexus injury was reported. Lessons learned may be instructive to clinicians considering prosthetic choices for future cases.

  12. Role of еlectromyography in assessing prognosis for children with obstetric brachial plexus injury in practice of a specialized center

    Directory of Open Access Journals (Sweden)

    M. L. Novikov

    2014-01-01

    Full Text Available The aim of current publication – to present our own experience in use of electromyographic examination in prognosis for children with obstetric brachial plexus injury to practical neurologists and neurophysiologists. Review of literature shows that common approaches to electrotrophysiological diagnosis of obstetric brachial plexus injury do not exist. The aim of this study– to evaluate retrospectively electrophysiological and sonographic parameters of obstetric brachial plexus injury in children, determining the most informative variables. Since 2007 to 2014 we examined 218 children, 74 of them were operated. Electrophysiological investigation in young children have difficulties in performance.We present our algorithm of diagnostic of obstetric brachial plexus injury: 1 testing main muscles, which perform basic movementsin upper limb (needle EMG of supra- and infraspinatus muscles and cutaneous EMG of biceps muscles; 2 localization of injury (paralysis or Duchenne – Erb palsy and electrophysiological criteria of spinal cord root avulsion. We found out that the most crucial role in assessing prognosis plays an examination of motor unit potentials (MUPs duration. Absence of MUPs within needle EMG from supraspinatus muscle and absence of interference curve from biceps muscle during first 6 months have poor prognosis. After 6 months careful, dynamic study of MUPs duration in infraspinatus muscle and co-contraction of agonist and antagonist muscles is needed. To decide whether reconstructive surgery in a patient with obstetric brachial plexus injury is necessary, surgeon must analyze clinical and instrumental data. The possibility of usage of the ultrasonogrophy in brachial plexus injury requires further investigation.

  13. Sensory restoration by lateral antebrachial cutaneous to ulnar nerve transfer in children with global brachial plexus injuries.

    Science.gov (United States)

    Ruchelsman, David E; Price, Andrew E; Valencia, Herbert; Ramos, Lorna E; Grossman, John A I

    2010-12-01

    Selective peripheral nerve transfers represent an emerging reconstructive strategy in the management of both pediatric and adult brachial plexus and peripheral nerve injuries. Transfer of the lateral antebrachial cutaneous nerve of the forearm into the distal ulnar nerve is a useful means to restore sensibility to the ulnar side of the hand when indicated. This technique is particularly valuable in the management of global brachial plexus birth injuries in children for which its application has not been previously reported. Four children ages 4 to 9 years who sustained brachial plexus birth injury with persistent absent sensibility on the unlar aspect of the hand underwent transfer of the lateral antebrachial cutaneous nerve to the distal ulnar nerve. In three patients, a direct transfer with a distal end-to-side repair through a deep longitudinal neurotomy was performed. In a single patient, an interposition nerve graft was required. Restoration of sensibility was evaluated by the "wrinkle test."

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

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

    1996-03-01

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

  15. Outcome following spinal accessory to suprascapular (spinoscapular) nerve transfer in infants with brachial plexus birth injuries.

    Science.gov (United States)

    Ruchelsman, David E; Ramos, Lorna E; Alfonso, Israel; Price, Andrew E; Grossman, Agatha; Grossman, John A I

    2010-06-01

    The purpose of this study is to evaluate the value of distal spinal accessory nerve (SAN) transfer to the suprascapular nerve (SSN) in children with brachial plexus birth injuries in order to better define the application and outcome of this transfer in these infants. Over a 3-year period, 34 infants with brachial plexus injuries underwent transfer of the SAN to the SSN as part of the primary surgical reconstruction. Twenty-five patients (direct repair, n = 20; interposition graft, n = 5) achieved a minimum follow-up of 24 months. Fourteen children underwent plexus reconstruction with SAN-to-SSN transfer at less than 9 months of age, and 11 underwent surgical reconstruction at the age of 9 months or older. Mean age at the time of nerve transfer was 11.6 months (range, 5-30 months). At latest follow-up, active shoulder external rotation was measured in the arm abducted position and confirmed by review of videos. The Gilbert and Miami shoulder classification scores were utilized to report shoulder-specific functional outcomes. The effects of patient age at the time of nerve transfer and the use of interpositional nerve graft were analyzed. Overall mean active external rotation measured 69.6°; mean Gilbert score was 4.1 and the mean Miami score was 7.1, corresponding to overall good shoulder functional outcomes. Similar clinical and shoulder-specific functional outcomes were obtained in patients undergoing early (9 months of age, n = 11) SAN-to-SSN transfer and primary plexus reconstruction. Nine patients (27%) were lost to follow-up and are not included in the analysis. Optimum results were achieved following direct transfer (n = 20). Results following the use of an interpositional graft (n = 5) were rated satisfactory. No patient required a secondary shoulder procedure during the study period. There were no postoperative complications. Distal SAN-to-SSN (spinoscapular) nerve transfer is a reliable option for shoulder reinnervation in

  16. Aspects of activities and participation of 7-8 year-old children with an obstetric brachial plexus injury

    NARCIS (Netherlands)

    Spaargaren, E.; Ahmed, J.; van Ouwerkerk, W.J.R.; de Groot, V.; Beckerman, H.

    2011-01-01

    Background: Children with an obstetric brachial plexus injury (OBPI) can experience problems in the performance of meaningful activities such as writing, bimanual activities, and participation in sports and leisure activities. Aims: To quantify the everyday functioning and participation of 7-8

  17. Etiological risk factors for brachial plexus palsy.

    Science.gov (United States)

    Hudić, Igor; Fatusić, Zlatan; Sinanović, Osman; Skokić, Fahrija

    2006-10-01

    To investigate risk factors for brachial plexus palsy in newborns. We analyzed 45 544 live-born children, born over a nine-year period from January 1, 1996 to December 31, 2004. The analysis was retrospective and based on the medical documentation of the Clinic for Gynecology and Obstetrics, Clinic for Neurology, and Clinic for Physical Medicine and Rehabilitation of the University Clinical Center Tuzla. We compared study and control groups of newborns. Rates among groups were compared using Chi-square, with significance at p labor pattern itself, it was found that the highest factors of risk for brachial plexus injury were birth weight of over 4000 g, a precipitous second stage of labor (labor. Brachial plexus palsy was more frequent when the mothers were overweight, with a body mass index >or=29 kg/m2. None of the parturient women, whose newborns were diagnosed with brachial plexus palsy, had external conjugate diameter <18 cm. Newborns delivered vaginally were not diagnosed with a higher frequency of brachial plexus palsy when compared to newborns who were delivered by cesarean section, but newborns who were vaginal breech-delivered were diagnosed to have a higher incidence of brachial plexus palsy. Newborns whose mothers were older than 35 years were diagnosed to have brachial plexus palsy more frequently, but a statistically significant difference between primiparas and multiparas was not found. A total of 39 newborns (45.2%) were diagnosed with a fracture of the clavicle, which was the most frequently combined damage with brachial plexus injury. Forty-two newborns (48.8%) had an Apgar score of brachial plexus damage was 3858.1+/-587.7 g, which for an average gestational age of 38.8+/-1.8 weeks, corresponds to eutrophic newborns. Both male and female newborns were

  18. MRI of the brachial plexus

    Energy Technology Data Exchange (ETDEWEB)

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

    2001-02-01

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

  19. Neonatal Magnetic Resonance Imaging Without Sedation Correlates With Injury Severity in Brachial Plexus Birth Palsy.

    Science.gov (United States)

    Bauer, Andrea S; Shen, Peter Y; Nidecker, Anna E; Lee, Paul S; James, Michelle A

    2017-05-01

    Which infants with brachial plexus birth palsy (BPBP) should undergo microsurgical plexus reconstruction remains controversial. The current gold standard for the decision for plexus reconstruction is serial clinical examinations, but this approach obviates the possibility of early surgical treatment. We hypothesize that a new technique using 3-dimensional volumetric proton density magnetic resonance imaging (MRI) without sedation can evaluate the severity of BPBP injury earlier than serial clinical examinations. Infants were prospectively enrolled prior to 12 weeks of age and imaged using 3 Tesla MRI without sedation. Clinical scores were collected at all visits. The imaging findings were graded based on the number of injured levels and the severity of each injury, and a radiological score was calculated. All infants were followed at least until the decision for surgery was made based on clinical examination. Nine infants completed the MRI scan and clinical follow-up. The average Toronto score at presentation was 4.4 out of 10 (range, 0-8.2); the average Active Movement Scale score was 50 out of 105 (range, 0-86). Four infants required surgery: 2 because of a flail limb and Horner syndrome and 2 owing to failure to recover antigravity elbow flexion by age 6 months. Radiological scores ranged from 0 to 18 out of a maximum score of 25. The average radiological score for those infants who required surgery was 12 (range, 6.5-18), whereas the average score for infants who did not require surgery was 3.5 (range, 0-8). Three-dimensional proton density MRI can evaluate spinal nerve roots in infants without the need for radiation, contrast agents, or sedation. These data suggest that MRI can help determine the severity of injury earlier than clinical examination in infants with BPBP, although further study of a larger sample of infants with varying severity of disease is necessary. Diagnostic II. Copyright © 2017 American Society for Surgery of the Hand. Published by

  20. Neonatal brachial plexus palsy : impact throughout the lifespan

    NARCIS (Netherlands)

    Holst, van der M.

    2017-01-01

    Neonatal brachial plexus palsy (NBPP) is a nerve injury to the brachial plexus which controls arm-movements. This thesis describes the impact of this injury on the lives of patients in terms of quality of life, participation, healthcare use and treatment outcomes. Findings in this thesis

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

    DEFF Research Database (Denmark)

    Stiasny, Jerzy; Birkeland, Peter

    2015-01-01

    INTRODUCTION: Brachial plexus injuries are usually a result of road traffic accidents and a cause of severe disability that typically affects young adult males. In 2010, a national centre was established for referral of these cases from Danish trauma centres. In this paper, we report on our...... surgical activity and reflect on the role for this new national centre. METHODS: Records from all our operated patients were reviewed retrospectively. For outcome analysis, we focused on patients who had sustained traction injuries with a surgical follow-up exceeding one year. We used either nerve grafting...... or transfers for nerve repairs based on the pattern of nerve injury seen intraoperatively. RESULTS: Overall, 24 patients were operated, and 12 patients were included in the outcome analysis. The six patients with upper brachial plexus palsies all regained shoulder function and useful elbow flexion. Of the six...

  2. Differences in Brain Adaptive Functional Reorganization in Right and Left Total Brachial Plexus Injury Patients.

    Science.gov (United States)

    Feng, Jun-Tao; Liu, Han-Qiu; Xu, Jian-Guang; Gu, Yu-Dong; Shen, Yun-Dong

    2015-09-01

    Total brachial plexus avulsion injury (BPAI) results in the total functional loss of the affected limb and induces extensive brain functional reorganization. However, because the dominant hand is responsible for more cognitive-related tasks, injuries on this side induce more adaptive changes in brain function. In this article, we explored the differences in brain functional reorganization after injuries in unilateral BPAI patients. We applied resting-state functional magnetic resonance imaging scanning to 10 left and 10 right BPAI patients and 20 healthy control subjects. The amplitude of low-frequency fluctuation (ALFF), which is a resting-state index, was calculated for all patients as an indication of the functional activity level of the brain. Two-sample t-tests were performed between left BPAI patients and controls, right BPAI patients and controls, and between left and right BPAI patients. Two-sample t-tests of the ALFF values revealed that right BPAIs induced larger scale brain reorganization than did left BPAIs. Both left and right BPAIs elicited a decreased ALFF value in the right precuneus (P right BPAI patients exhibited increased ALFF values in a greater number of brain regions than left BPAI patients, including the inferior temporal gyrus, lingual gyrus, calcarine sulcus, and fusiform gyrus. Our results revealed that right BPAIs induced greater extents of brain functional reorganization than left BPAIs, which reflected the relatively more extensive adaptive process that followed injuries of the dominant hand. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Psychosocial outcomes and coping after complete avulsion traumatic brachial plexus injury.

    Science.gov (United States)

    Franzblau, Lauren; Chung, Kevin C

    2015-01-01

    To understand psychosocial outcomes, coping and adjustment after complete avulsion traumatic brachial plexus injury (BPI). We conducted a grounded theory analysis of 12 semi-structured patient interviews exploring psychosocial outcomes, augmented by quantitative evaluation of self-reported mental health and social functioning, body image and coping strategies obtained via three questionnaires (SF-36, Brief COPE and modified SWAP). Subjects' main sources of psychological stress were chronic pain, unemployment, decreased self-efficacy and social-emotional consequences of poor body image. One third of participants reported depression, half experienced anger and frustration and two-thirds were dissatisfied with the appearance of their affected limbs. Acceptance, active coping, planning and emotional support were the most frequently used coping strategies. Patients encounter high levels of physical and psychological stress after complete avulsion BPI and must find ways to cope to adjust to their injuries. They face similar challenges to patients with spinal cord injuries, for whom many models describing coping and adjustment exist. Similar models could facilitate more complete adjustment and rehabilitation of BPI patients and help to reduce the prevalence of negative stress responses, including anger and depression. Future patients would benefit from a multidisciplinary treatment program, involving medical and mental health services.

  4. Detection of positional brachial plexus injury by radial arterial line during spinal exposure before neuromonitoring confirmation: a retrospective case study.

    Science.gov (United States)

    Chen, Zhengyong; Chen, Leo; Kwon, Paul; Montez, Michele; Voegeli, Thomas; Bueff, Hans

    2012-12-01

    To demonstrate the potential usefulness of radial arterial line monitoring in detection of brachial plexus injury in spinal surgery. Multiple neuromonitoring modalities including SEPs, MEPs and EMG were performed for a posterior thoracicolumbar surgery. Radial arterial line (A-line) was placed on the right wrist for arterial blood pressure monitoring. Reliable ulnar nerve SEPs, hand muscle MEPs and arterial blood pressure readings were obtained after patient was placed in a prone position. A-line malfunction was noted about 15 min after incision. Loss of ulnar nerve SEPs and hand muscle MEPs with a cold hand on the right was noticed when neuromonitoring resumed after spine exposure. SEPs, MEPs, A-line readings and hand temperature returned after modification of the right arm position. Radial arterial line monitoring may help detect positional brachial plexus injury in spinal surgery when continuous neuromonitoring is interrupted during spine exposure in prone position.

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

    Directory of Open Access Journals (Sweden)

    Björkman Anders

    2010-07-01

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

  6. Brain Reorganization in Patients with Brachial Plexus Injury: A Longitudinal Functional MRI Study

    Directory of Open Access Journals (Sweden)

    Takeharu Yoshikawa

    2012-01-01

    Full Text Available The aim of this study is to assess plastic changes of the sensorimotor cortex (SMC in patients with traumatic brachial plexus injury (BPI using functional magnetic resonance imaging (fMRI. Twenty patients with traumatic BPI underwent fMRI using blood oxygen level-dependent technique with echo-planar imaging before the operation. Sixteen patients underwent their second fMRI at approximately one year after injury. The subjects performed two tasks: a flexion-extension task of the affected elbow and a task of the unaffected elbow. After activation, maps were generated, the number of significantly activated voxels in SMC contralateral to the elbow movement in the affected elbow task study (Naf and that in the unaffected task study (Nunaf were counted. An asymmetry index (AI was calculated, where AI=(Naf−Nunaf/(Naf+Nunaf. Ten healthy volunteers were also included in this fMRI study. The AI of the first fMRI of the patients with BPI was significantly lower than that of the healthy subjects (P=0.035. The AI of the second fMRI significantly decreased compared with that of the first fMRI (P=0.045. Brain reorganization associates with peripheral nervous changes after BPI and after operation for functional reconstruction.

  7. Medical treatment decision making after total avulsion brachial plexus injury: a qualitative study.

    Science.gov (United States)

    Franzblau, Lauren E; Maynard, Mallory; Chung, Kevin C; Yang, Lynda J-S

    2015-06-01

    Complete avulsion traumatic brachial plexus injuries (BPIs) can be treated using nerve and musculoskeletal reconstruction procedures. However, these interventions are most viable within certain timeframes, and even then they cannot restore all lost function. Little is known about how patients make decisions regarding surgical treatment or what impediments they face during the decision-making process. Using qualitative methodology, the authors aimed to describe how and why patients elect to pursue or forego surgical reconstruction, identify the barriers precluding adequate information transfer, and determine whether these patients are satisfied with their treatment choices over time. Twelve patients with total avulsion BPIs were interviewed according to a semi-structured guide. The interview transcripts were qualitatively analyzed using the systematic inductive techniques of grounded theory to identify key themes related to the decision-making process and long-term satisfaction with decisions. Four decision factors emerged from our analysis: desire to restore function, perceived value of functional gains, weighing the risks and costs of surgery, and having concomitant injuries. Lack of insurance coverage (4 patients), delayed diagnosis (3 patients), and insufficient information regarding treatment (4 patients) prevented patients from making informed decisions and accessing care. Three individuals, all of whom had decided against reconstruction, had regrets about their treatment choices. Patients with panplexus avulsion injuries are missing opportunities for reconstruction and often not considering the long-term outcomes of surgery. As more Americans gain health insurance coverage, it is very likely that the number of patients able to pursue reconstruction will increase. The authors recommend implementing clinical pathways to help patients meet critical points in care within the ideal timeframe and using a patient- and family-centered care approach combined with

  8. Microanatomy of the brachial plexus roots and its clinical significance.

    Science.gov (United States)

    Zhong, Li-Yuan; Wang, Ai-Ping; Hong, Li; Chen, Sheng-Hua; Wang, Xian-Qin; Lv, Yun-Cheng; Peng, Tian-Hong

    2017-06-01

    To provide the anatomical basis of brachial plexus roots for the diagnosis and treatment of brachial plexus root avulsion injury. The morphological features of brachial plexus roots were observed and measured on 15 cervicothoracic spine of adult cadavers. The relationship of brachial plexus nerve roots and the surrounding tissues also were observed, as well as the blood supply of anterior and posterior roots of the brachial plexus. Origination of the nerve roots in the dorsal-ventral direction from the midline was fine-tuned at each level along the spinal cord. The minimum distance of the origin of the nerve root to midline was 2.2 mm at C 5, while the maximum was 3.1 mm at T 1. Inversely, the distance between the origin of the posterior root and the midline of the spinal cord gradually decreased, the maximum being 4.2 mm at C 5 and minimum 2.7 mm at T 1. Meanwhile, there was complicated fibrous connection among posterior roots of the brachial plexus. The C 5-6 nerve roots interlaced with tendons of the scalenus anterior and scalenus medius and fused with the transverse-radicular ligaments in the intervertebral foramina. However, these ligaments were not seen in C 7-8, and T 1. The blood supply of the anterior and posterior roots of the brachial plexus was from the segmental branches of the vertebral artery, deep cervical artery and ascending cervical artery, with a mean outer diameter of 0.61 mm. The systematic and comprehensive anatomic data of the brachial plexus roots provides the anatomical basis to diagnose and treat the brachial plexus root avulsion injury.

  9. Modified Pectoralis Major Tendon Transfer for Reanimation of Elbow Flexion as a Salvage Procedure in Complete Brachial Plexus Injury: A Case Report

    Directory of Open Access Journals (Sweden)

    S Taran

    2013-03-01

    Full Text Available Traumatic brachial plexus injuries rarely recover spontaneously and if the window period for neurotisation has elapsed, the only option for restoration of function lies in a salvage procedure. Many such salvage procedures have been described in the literature with variable functional results. We report the case of a 16-year-old boy who presented after unsuccessful treatment for a complete brachial plexus injury; we performed a pectoralis major tendon transfer to attain elbow flexion. Postoperatively, the elbow was splinted with flexion at 100°. After 4 weeks of immobilization the splint was removed and the patient could actively flex his elbow from 30° to 100°.

  10. Coracoid Abnormalities and Their Relationship with Glenohumeral Deformities in Children with Obstetric Brachial Plexus Injury

    Directory of Open Access Journals (Sweden)

    Wentz Melissa J

    2010-10-01

    Full Text Available Abstract Background Patients with incomplete recovery from obstetric brachial plexus injury (OBPI usually develop secondary muscle imbalances and bone deformities at the shoulder joint. Considerable efforts have been made to characterize and correct the glenohumeral deformities, and relatively less emphasis has been placed on the more subtle ones, such as those of the coracoid process. The purpose of this retrospective study is to determine the relationship between coracoid abnormalities and glenohumeral deformities in OBPI patients. We hypothesize that coracoscapular angles and distances, as well as coracohumeral distances, diminish with increasing glenohumeral deformity, whereas coracoid overlap will increase. Methods 39 patients (age range: 2-13 years, average: 4.7 years, with deformities secondary to OBPI were included in this study. Parameters for quantifying coracoid abnormalities (coracoscapular angle, coracoid overlap, coracohumeral distance, and coracoscapular distance and shoulder deformities (posterior subluxation and glenoid retroversion were measured on CT images from these patients before any surgical intervention. Paired Student t-tests and Pearson correlations were used to analyze different parameters. Results Significant differences between affected and contralateral shoulders were found for all coracoid and shoulder deformity parameters. Percent of humeral head anterior to scapular line (PHHA, glenoid version, coracoscapular angles, and coracoscapular and coracohumeral distances were significantly lower for affected shoulders compared to contralateral ones. Coracoid overlap was significantly higher for affected sides compared to contralateral sides. Significant and positive correlations were found between coracoscapular distances and glenohumeral parameters (PHHA and version, as well as between coracoscapular angles and glenohumeral parameters, for affected shoulders. Moderate and positive correlations existed between coracoid

  11. Brachial Plexus Anatomy: Normal and Variant

    Directory of Open Access Journals (Sweden)

    Steven L. Orebaugh

    2009-01-01

    Full Text Available Effective brachial plexus blockade requires a thorough understanding of the anatomy of the plexus, as well as an appreciation of anatomic variations that may occur. This review summarizes relevant anatomy of the plexus, along with variations and anomalies that may affect nerve blocks conducted at these levels. The Medline, Cochrane Library, and PubMed electronic databases were searched in order to compile reports related to the anatomy of the brachial plexus using the following free terms: "brachial plexus", "median nerve", "ulnar nerve", "radial nerve", "axillary nerve", and "musculocutanous nerve". Each of these was then paired with the MESH terms "anatomy", "nerve block", "anomaly", "variation", and "ultrasound". Resulting articles were hand searched for additional relevant literature. A total of 68 searches were conducted, with a total of 377 possible articles for inclusion. Of these, 57 were found to provide substantive information for this review. The normal anatomy of the brachial plexus is briefly reviewed, with an emphasis on those features revealed by use of imaging technologies. Anomalies of the anatomy that might affect the conduct of the various brachial plexus blocks are noted. Brachial plexus blockade has been effectively utilized as a component of anesthesia for upper extremity surgery for a century. Over that period, our understanding of anatomy and its variations has improved significantly. The ability to explore anatomy at the bedside, with real-time ultrasonography, has improved our appreciation of brachial plexus anatomy as well.

  12. Brachial Plexus Lesions

    African Journals Online (AJOL)

    Patrick

    patient showed paralysis of all muscles of the shoulder and muscles of the anterior compartment of the arm. This clinical ... patient had paralysis of muscles of the hand being innerved by median nerve or ulna nerve. He showed also ... This a temporary condition where the muscle regains complete function. Injury of the ...

  13. Mechanisms, Treatment, and Patient Outcome of Iatrogenic Injury to the Brachial Plexus-A Retrospective Single-Center Study.

    Science.gov (United States)

    Dengler, Nora Franziska; Antoniadis, Gregor; Grolik, Brigitta; Wirtz, Christian Rainer; König, Ralph; Pedro, Maria Teresa

    2017-11-01

    Injury to the brachial plexus is a devastating condition, with severe impairment of upper extremity function resulting in distinct disability. There are no systematic reports on epidemiology, causative mechanisms, treatment strategies. or outcomes of iatrogenic brachial plexus injury (iBPI). We screened all cases of iatrogenic nerve injuries recorded between 2007 and 2017 at a single specialized institution. Mechanism of iBPI, type of previous causative intervention, location and type of the lesion as well as the type of revision surgery and functional patient outcome were analyzed. We identified 14 cases of iBPI, which all presented with significant impairment of upper extremity motor function (at least 1 muscle Medical Research Council grade 0). Neuropathic pain was present in most patients (11/14). Orthopedic shoulder procedures such as rotator cuff fixation, arthroplasty, and repositioning of a clavicle fracture accounted for iBPI in 7 of 14 patients. Other reasons for iBPI were resection or biopsy of a peripheral nerve sheath tumor in 3 patients or lymph node situated at the cervicomediastinal area in 2 patients. Mechanisms also included transaxillary rib resection in one and sternotomy in another patient. The treatment of iBPI was conducted according to each individual's needs and included neurolysis in 4, nerve grafting in 9, and nerve transfers in 1 patient. We found improved symptoms after treatment in most patients (11/14). Most common causes for iBPI were shoulder surgery and resection or biopsy of peripheral nerve sheath tumor and lymph nodes. Early referral to specialized peripheral nerve centers may help to improve functional patient outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Ultrasonography for neonatal brachial plexus palsy.

    Science.gov (United States)

    Joseph, Jacob Rahul; DiPietro, Michael A; Somashekar, Deepak; Parmar, Hemant A; Yang, Lynda J S

    2014-11-01

    Ultrasonography has previously been reported for use in the evaluation of compressive or traumatic peripheral nerve pathology and for its utility in preoperative mapping. However, these studies were not performed in infants, and they were not focused on the brachial plexus. The authors report a case in which ultrasonography was used to improve operative management of neonatal brachial plexus palsy (NBPP). An infant boy was born at term, complicated by right-sided shoulder dystocia. Initial clinical evaluation revealed proximal arm weakness consistent with an upper trunk injury. Unlike MRI or CT myelography that focus on proximal nerve roots, ultrasonography of the brachial plexus in the supraclavicular fossa was able to demonstrate a small neuroma involving the upper trunk (C-5 and C-6) and no asymmetry in movement of the diaphragm or in the appearance of the rhomboid muscle when compared with the unaffected side. However, the supra- and infraspinatus muscles were significantly asymmetrical and atrophied on the affected side. Importantly, ultrasound examination of the shoulder revealed posterior glenohumeral laxity. Instead of pursuing the primary nerve reconstruction first, timely treatment of the shoulder subluxation prevented formation of joint dysplasia and formation of a false glenoid, which is a common sequela of this condition. Because the muscles innervated by proximal branches of the cervical nerve roots/trunks were radiographically normal, subsequent nerve transfers were performed and good functional results were achieved. The authors believe this to be the first report describing the utility of ultrasonography in the surgical treatment planning in a case of NBPP. Noninvasive imaging, in addition to thorough history and physical examination, reduces the intraoperative time required to determine the extent and severity of nerve injury by allowing improved preoperative planning of the surgical strategy. Inclusion of ultrasonography as a preoperative

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

    OpenAIRE

    Jimmy Thomas

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jimmy Thomas

    2014-01-01

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

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

    Science.gov (United States)

    Thomas, Jimmy

    2014-01-01

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

  18. Neonatal brachial plexus palsy: a permanent challenge

    Directory of Open Access Journals (Sweden)

    Carlos Otto Heise

    2015-09-01

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

  19. MR imaging of the brachial plexus

    NARCIS (Netherlands)

    Es, Hendrik Wouter van

    1997-01-01

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

  20. Burnout, depression and anxiety levels in mothers of infants with brachial plexus injury and the effects of recovery on mothers' mental health.

    Science.gov (United States)

    Karadavut, Kiymet Ikbal; Uneri, Sukran Ozden

    2011-07-01

    To evaluate depression, anxiety and burnout in mothers of infants with brachial plexus injury and assess the effects of the severity of injury on the mothers' mental health, as the literature provides no information on this topic. The study was based on eighteen mothers without psychiatric antecedents who had infants with perinatal brachial plexus paralysis (PBPP). The severity of the brachial plexus injury was classified according to the Narakas classification system. The recovery rate following conservative treatment was classified according to the Modified Mallet Classification System. The Maslach burnout inventory, Beck depression inventory, and Beck anxiety inventory were administered to the mothers. The mothers whose infants were in the third Narakas group were mildly depressed and the depression scores of the mothers in Narakas groups II and III were regularly increased. Mothers in the first and second groups reported a minimal level of anxiety scores. There was no statistically significant difference between the depression, anxiety, emotional exhaustion, depersonalization, and personal accomplishment scores of the mothers in relation to the severity of the injury in the child (p=0.218, p=0.078, p=0.149, p=0.138, and p=0.246). In addition, the depression and anxiety levels of the mothers whose infants recovered fully or partially showed a statistically significant decrease when compared to the mothers of infants with no recovery (p=0.003, p=0.015). There was, however, no statistically significant difference between the emotional exhaustion, depersonalization, and personal accomplishment scores of the mothers of infants with full recovery, partial recovery and no recovery (p=0.591, p=0591, p=0.062). Infants' disability may cause psychological distress in their mothers. When brachial plexus injury is predicted in infants, more mothers may become depressed. Crown Copyright © 2011. Published by Elsevier Ireland Ltd. All rights reserved.

  1. Lower trunk of brachial plexus injury in the neonate rat: effects of timing repair.

    Science.gov (United States)

    Lauretti, Liverana; Pallini, Roberto; Romani, Rossana; Di Rocco, Federico; Ciampini, Alessandro; Gangitano, Carlo; Del Fa, Aurora; Fernandez, Eduardo

    2009-06-01

    After lesion of a peripheral nerve in neonatal mammals, motoneurons undergo a cell death. We wanted to ascertain if early surgery could influence such post-axotomy motoneuronal death and improve the functional outcome. In this study, we investigated the functional and anatomical results after immediate and delayed repair of the lower trunk of brachial plexus (BP) sectioned at birth in rats. In neonate rats, the lower trunk of the left BP was cut. This nerve trunk was repaired either immediately [immediately-reconstructed group of rats (IR), or 30 days after, tardy reconstructed group of rats (TR)]; in the third group of animals, the nerve was not repaired (noreconstructed group of rats, NoR). In each group of animals, functional studies were performed at 90 days of age using the grooming test and the walking tracks analysis. Histologic studies of the C7-T1 spinal cord and lower trunk of BP were performed at 30 and 90 days of age; the numbers of motoneuron and axon were counted. Functional recovery was related to the difference in motoneuron number between the injured and the uninjured sides of the spinal cord of the operated animals. On the one side, only in the rats in which the inferior trunk was immediately repaired, the difference in motoneuron number between the two sides of the spinal cord was not statistically significant; these animals showed a good axonal regeneration and function recovery. On the other side, in the rats in which the inferior trunk was left unrepaired or tardy repaired, the decrease in motoneuron number in the injured side compared with the uninjured side of the spinal cord was statistically significant; these animals showed no axonal regeneration and no function recovery. The results cited above suggest that an important role in restoration of good neurological function after section of the lower trunk of BP in neonate rats is played by early nerve repair. Good neurological function was related more to a quite numerical balance of

  2. Obstetrical brachial plexus palsy (OBPP) outcome with conservative management

    NARCIS (Netherlands)

    Eng, GD; Binder, H; Getson, P; ODonnell, R

    Resurgence of neurosurgical intervention oi obstetrical brachial plexus palsy prompted our review of 186 patients evaluated between 1981 and 1993, correlating clinical examination, electrodiagnosis, and functional outcome with conservative management. Eighty-eight percent had upper brachial plexus

  3. Delivery factors for brachial plexus palsy by newborns

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    D. Balić

    2007-02-01

    Full Text Available Brachial plexus injuries represent a low percentage of delivery complications. Most newborns fully recover from the injury, very few retain a permanent neurological deficit whereas some remain unnoticed. An objective of this study was to establish delivery factors for brachial plexus palsy at the Clinic for Gynecology and Obstetrics and relation between the deficits with length of delivery, the length of delivery periods, induction of delivery and surgical interventions at delivery. The analysed group involved 90 newborn babies with an injury of brachial plexus made at the delivery in the period between 01.01.1996 and 31.12.2005. The controlled group included 90 newborns randomly selected. The comparison was made using an χ2 test. The incidence of injuries of plexus brachialis was 1.72 per 1,000 newborns. Analysing the length of delivery there was no difference found between the analysed and controlled group (p > 0.05. In the group of newborns with the injury of brachial plexus it was found that the second delivery period was significantly shorter (p < 0.01. In the analysed group 89 (98.8% newborn babies were delivered vaginally and one (1.2% was delivered by the cesarean section. 13 newborns (14.4% from the analysed group were delivered with application of vacuum extractor and in the controlled group it was the case with one (1.2% newborn baby (p < 0.01. The delivery of 98.8% newborns from the analysed group started spontaneously and two deliveries (1.2% were induced. Risk factors for injuries of plexus brachialis in newborns at the Clinic for Gynaecology and Obstetrics of the University Clinical Centre Tuzla include shortened second delivery period and completion of deliveries applying the vacuum extractor.

  4. Tolerance of the Brachial Plexus to High-Dose Reirradiation.

    Science.gov (United States)

    Chen, Allen M; Yoshizaki, Taeko; Velez, Maria A; Mikaeilian, Argin G; Hsu, Sophia; Cao, Minsong

    2017-05-01

    To study the tolerance of the brachial plexus to high doses of radiation exceeding historically accepted limits by analyzing human subjects treated with reirradiation for recurrent tumors of the head and neck. Data from 43 patients who were confirmed to have received overlapping dose to the brachial plexus after review of radiation treatment plans from the initial and reirradiation courses were used to model the tolerance of this normal tissue structure. A standardized instrument for symptoms of neuropathy believed to be related to brachial plexus injury was utilized to screen for toxicity. Cumulative dose was calculated by fusing the initial dose distributions onto the reirradiation plan, thereby creating a composite plan via deformable image registration. The median elapsed time from the initial course of radiation therapy to reirradiation was 24 months (range, 3-144 months). The dominant complaints among patients with symptoms were ipsilateral pain (54%), numbness/tingling (31%), and motor weakness and/or difficulty with manual dexterity (15%). The cumulative maximum dose (Dmax) received by the brachial plexus ranged from 60.5 Gy to 150.1 Gy (median, 95.0 Gy). The cumulative mean (Dmean) dose ranged from 20.2 Gy to 111.5 Gy (median, 63.8 Gy). The 1-year freedom from brachial plexus-related neuropathy was 67% and 86% for subjects with a cumulative Dmax greater than and less than 95.0 Gy, respectively (P=.05). The 1-year complication-free rate was 66% and 87%, for those reirradiated within and after 2 years from the initial course, respectively (P=.06). The development of brachial plexus-related symptoms was less than expected owing to repair kinetics and to the relatively short survival of the subject population. Time-dose factors were demonstrated to be predictive of complications. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Effects of Exercise Training With Proprioceptive Equipment on Proprioceptive and Functional Status of Children with Obstetrical Brachial Plexus Injury

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    Deran Oskay

    2017-03-01

    Full Text Available Objective: Decreased proprioception in Obstetric Brachial Plexus Injury (OBPI reduces the quality of functional movement. Hence, the aim of our study was to evaluate the effects of exercise training with additional proprioceptive equipments on the functional status and proprioceptive sense in children with OBPI. Methods: Forty children with OBPI were randomly divided into two groups. Passive, active and active-assisted range of motion and stretching exercises were included in home-based program (HP group while additional exercises with proprioceptive equipments were also added in the proprioceptive training (PT group. After 6 weeks, proprioceptive perception and functional level were compared to pre-treatment results. Results: Proprioceptive perception at the beginning and at the end of the movement increased in both groups (p<0,05. The Active Movement Scale (AMS scores increased significantly only in some movements in both groups (p<0,05. AMS scores of shoulder abduction and external rotation in PT group were better than HP group (p<0,05. Conclusion: Home exercise program and proprioceptive exercise training both improve proprioceptive sense and functional status in children with OBPI. The proprioceptive exercise training seems to be more beneficial in improving functional movements of shoulder.

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

    Science.gov (United States)

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

    2016-02-01

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

  7. Ultrasound-guided supraclavicular brachial plexus anaesthesia ...

    African Journals Online (AJOL)

    Ultrasound-guided supraclavicular brachial plexus anaesthesia improves arteriovenous fistula flow characteristics in end-stage renal disease patients. ... In all patients, a radiocephalic arteriovenous fistula was created by an experienced surgeon using a standard surgical technique. In both groups 20 ml of 0.375% ...

  8. Obstetric brachial plexus lesions: CT myelography

    NARCIS (Netherlands)

    Steens, S.C.A.; Pondaag, W.; Malessy, M.J.; Verbist, B.M.

    2011-01-01

    PURPOSE: To evaluate the value of computed tomographic (CT) myelography in the detection of root damage and differentiation of root avulsions from neurotmesis in a large cohort of patients with an obstetric brachial plexus lesion (OBPL). MATERIALS AND METHODS: Institutional review board approval was

  9. Comparison between Conventional and Ultrasound-Guided Supraclavicular Brachial Plexus Block in Upper Limb Surgeries

    OpenAIRE

    Honnannavar, Kiran Abhayakumar; Mudakanagoudar, Mahantesh Shivangouda

    2017-01-01

    Introduction: Brachial plexus blockade is a time-tested technique for upper limb surgeries. The classical approach using paresthesia technique is a blind technique and may be associated with a higher failure rate and injury to the nerves and surrounding structures. To avoid some of these problems, use of peripheral nerve stimulator and ultrasound techniques were started which allowed better localization of the nerve/plexus. Ultrasound for supraclavicular brachial plexus block has improved the...

  10. The natural history and management of brachial plexus birth palsy.

    Science.gov (United States)

    Buterbaugh, Kristin L; Shah, Apurva S

    2016-12-01

    Brachial plexus birth palsy (BPBP) is an upper extremity paralysis that occurs due to traction injury of the brachial plexus during childbirth. Approximately 20 % of children with brachial plexus birth palsy will have residual neurologic deficits. These permanent and significant impacts on upper limb function continue to spur interest in optimizing the management of a problem with a highly variable natural history. BPBP is generally diagnosed on clinical examination and does not typically require cross-sectional imaging. Physical examination is also the best modality to determine candidates for microsurgical reconstruction of the brachial plexus. The key finding on physical examination that determines need for microsurgery is recovery of antigravity elbow flexion by 3-6 months of age. When indicated, both microsurgery and secondary shoulder and elbow procedures are effective and can substantially improve functional outcomes. These procedures include nerve transfers and nerve grafting in infants and secondary procedures in children, such as botulinum toxin injection, shoulder tendon transfers, and humeral derotational osteotomy.

  11. Assessment of triangle tilt surgery in children with obstetric brachial plexus injury using the pediatric outcomes data collection instrument.

    Science.gov (United States)

    Nath, Rahul K; Avila, Meera B; Karicherla, Priyanka; Somasundaram, Chandra

    2011-01-01

    The benefits of triangle tilt surgery in children with OBPI have been previously validated through measurements of statistical improvements in Mallet scores and in glenohumeral congruity. The purpose of the current study was to evaluate the effectiveness of triangle tilt surgery through the application of the Pediatric Outcomes Data Collection Instrument, a well validated questionnaire designed to evaluate function and comfort in children with musculoskeletal disorders. OBPI patients between 2 and 10 years of age who came to our institute for routine office visits between May 2009 and October 2009 were considered to participate in the study. Among the patient group, the first 130 completed surveys who met the study criteria were included in the study. The Pediatric Outcomes Data Collection Instrument was completed by the parents of patients who have undergone triangle tilt surgery (Group 1: N=63) or those who were considered candidates for this procedure (Group 2: N=67). The results were compared between the two patient groups and analyzed using the unpaired student's t-test. Later, 23 patients from the group 2, underwent triangle tilt surgery (Group 3). We collected post-op data, compared and analyzed the outcome of the surgery in these patients to their own pre-op PODCI scores, using the paired student's t test. In patients who have undergone triangle tilt surgery, significantly higher PODCI scores were observed in the parameters of upper extremity function (ptriangle tilt surgery. Further, PODCI scores in group 3 patients were significantly higher after surgery in the parameters of upper extremity function (p triangle tilt surgery. The results of the Pediatric Outcomes Data Collection Instrument demonstrate the functional benefits of triangle tilt surgery in patients with obstetric brachial plexus injury.

  12. High resolution neurography of the brachial plexus by 3 Tesla magnetic resonance imaging.

    Science.gov (United States)

    Cejas, C; Rollán, C; Michelin, G; Nogués, M

    2016-01-01

    The study of the structures that make up the brachial plexus has benefited particularly from the high resolution images provided by 3T magnetic resonance scanners. The brachial plexus can have mononeuropathies or polyneuropathies. The mononeuropathies include traumatic injuries and trapping, such as occurs in thoracic outlet syndrome due to cervical ribs, prominent transverse apophyses, or tumors. The polyneuropathies include inflammatory processes, in particular chronic inflammatory demyelinating polyneuropathy, Parsonage-Turner syndrome, granulomatous diseases, and radiation neuropathy. Vascular processes affecting the brachial plexus include diabetic polyneuropathy and the vasculitides. This article reviews the anatomy of the brachial plexus and describes the technique for magnetic resonance neurography and the most common pathologic conditions that can affect the brachial plexus. Copyright © 2016 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  13. 3 T MR tomography of the brachial plexus: Structural and microstructural evaluation

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-09-15

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

  14. Tolerance of the Brachial Plexus to High-Dose Reirradiation

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Allen M., E-mail: achen5@kumc.edu; Yoshizaki, Taeko; Velez, Maria A.; Mikaeilian, Argin G.; Hsu, Sophia; Cao, Minsong

    2017-05-01

    Purpose: To study the tolerance of the brachial plexus to high doses of radiation exceeding historically accepted limits by analyzing human subjects treated with reirradiation for recurrent tumors of the head and neck. Methods and Materials: Data from 43 patients who were confirmed to have received overlapping dose to the brachial plexus after review of radiation treatment plans from the initial and reirradiation courses were used to model the tolerance of this normal tissue structure. A standardized instrument for symptoms of neuropathy believed to be related to brachial plexus injury was utilized to screen for toxicity. Cumulative dose was calculated by fusing the initial dose distributions onto the reirradiation plan, thereby creating a composite plan via deformable image registration. The median elapsed time from the initial course of radiation therapy to reirradiation was 24 months (range, 3-144 months). Results: The dominant complaints among patients with symptoms were ipsilateral pain (54%), numbness/tingling (31%), and motor weakness and/or difficulty with manual dexterity (15%). The cumulative maximum dose (Dmax) received by the brachial plexus ranged from 60.5 Gy to 150.1 Gy (median, 95.0 Gy). The cumulative mean (Dmean) dose ranged from 20.2 Gy to 111.5 Gy (median, 63.8 Gy). The 1-year freedom from brachial plexus–related neuropathy was 67% and 86% for subjects with a cumulative Dmax greater than and less than 95.0 Gy, respectively (P=.05). The 1-year complication-free rate was 66% and 87%, for those reirradiated within and after 2 years from the initial course, respectively (P=.06). Conclusion: The development of brachial plexus–related symptoms was less than expected owing to repair kinetics and to the relatively short survival of the subject population. Time-dose factors were demonstrated to be predictive of complications.

  15. Nerve transfer versus muscle transfer to restore elbow flexion after pan-brachial plexus injury: a cost-effectiveness analysis.

    Science.gov (United States)

    Wali, Arvin R; Santiago-Dieppa, David R; Brown, Justin M; Mandeville, Ross

    2017-07-01

    OBJECTIVE Pan-brachial plexus injury (PBPI), involving C5-T1, disproportionately affects young males, causing lifelong disability and decreased quality of life. The restoration of elbow flexion remains a surgical priority for these patients. Within the first 6 months of injury, transfer of spinal accessory nerve (SAN) fascicles via a sural nerve graft or intercostal nerve (ICN) fascicles to the musculocutaneous nerve can restore elbow flexion. Beyond 1 year, free-functioning muscle transplantation (FFMT) of the gracilis muscle can be used to restore elbow flexion. The authors present the first cost-effectiveness model to directly compare the different treatment strategies available to a patient with PBPI. This model assesses the quality of life impact, surgical costs, and possible income recovered through restoration of elbow flexion. METHODS A Markov model was constructed to simulate a 25-year-old man with PBPI without signs of recovery 4.5 months after injury. The management options available to the patient were SAN transfer, ICN transfer, delayed FFMT, or no treatment. Probabilities of surgical success rates, quality of life measurements, and disability were derived from the published literature. Cost-effectiveness was defined using incremental cost-effectiveness ratios (ICERs) defined by the ratio between costs of a treatment strategy and quality-adjusted life years (QALYs) gained. A strategy was considered cost-effective if it yielded an ICER less than a willingness-to-pay of $50,000/QALY gained. Probabilistic sensitivity analysis (PSA) was performed to address parameter uncertainty. RESULTS The base case model demonstrated a lifetime QALYs of 22.45 in the SAN group, 22.0 in the ICN group, 22.3 in the FFMT group, and 21.3 in the no-treatment group. The lifetime costs of income lost through disability and interventional/rehabilitation costs were $683,400 in the SAN group, $727,400 in the ICN group, $704,900 in the FFMT group, and $783,700 in the no

  16. Nerve reconstruction: A cohort study of 93 cases of global brachial plexus palsy

    Directory of Open Access Journals (Sweden)

    Anil Bhatia

    2011-01-01

    Conclusion: Acceptable function (restoration of biceps power ≥3 can be obtained in more than two thirds (73% of these global brachial plexus injuries by using the principles of early exploration and nerve transfer with rehabilitation.

  17. Intermediate Type of Obstetric Brachial Plexus Palsy.

    Science.gov (United States)

    El-Sayed, Amel A F

    2016-12-01

    Data of 829 infants with obstetric brachial plexus palsy were reviewed to identify any cases that could not be fitted into the any of the well-known types of palsy. These unusual cases were studied in detail with regard to clinical presentation and electrophysiological findings as well as management and spontaneous motor recovery. Erb's, extended Erb's, and total palsies were seen in 42.8%, 28.8%, and 28.0% of cases, respectively. Three cases (0.4%) did not fit into any of the classic types. One case had bilateral palsy, and the remaining 2 cases had unilateral palsy. All affected limbs presented with "abducted arms," "flexed forearms," and electrophysiological evidence of denervation of shoulder adductors and triceps. All cases had excellent spontaneous recovery within 6-12 months. It was concluded that these cases represent mild "intermediate" types of palsy in which the C7 root was the predominant site of injury. Good spontaneous recovery is expected. © The Author(s) 2016.

  18. Axillary brachial plexus blockade in moyamoya disease?

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    Saban Yalcin

    2011-01-01

    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.

  19. Brachial Plexus Neuropraxia: A Case Report

    Directory of Open Access Journals (Sweden)

    Bayram Kelle

    2012-08-01

    Full Text Available Neuropraxia develops as a result of localized nerve compression. The anatomical structure of the nerve is protected. Motor loss and paresthesias may occur, pain sensation is rarely affected. The distal portion of the extremities are affected more often. Clinical symptoms respond well to treatments. In this case was presented brachial plexus neuropraxia which is a very rare situation und the literature was reviewed. [Cukurova Med J 2012; 37(4.000: 247-250

  20. Brachial Plexus Neuropraxia: A Case Report

    OpenAIRE

    Bayram Kelle; Filiz Koc

    2012-01-01

    Neuropraxia develops as a result of localized nerve compression. The anatomical structure of the nerve is protected. Motor loss and paresthesias may occur, pain sensation is rarely affected. The distal portion of the extremities are affected more often. Clinical symptoms respond well to treatments. In this case was presented brachial plexus neuropraxia which is a very rare situation und the literature was reviewed. [Cukurova Med J 2012; 37(4.000): 247-250

  1. Results of Operative Treatment of Brachial Plexus Injury Resulting from Shoulder Dislocation: A Study with A Long-Term Follow-Up.

    Science.gov (United States)

    Gutkowska, Olga; Martynkiewicz, Jacek; Mizia, Sylwia; Bąk, Michał; Gosk, Jerzy

    2017-09-01

    Injury to the infraclavicular brachial plexus is an uncommon but serious complication of shoulder dislocation. This work aims to determine the effectiveness of operative treatment in patients with this type of injury. Thirty-three patients (26 men and 7 women; mean age, 45 years and 3 months) treated operatively for brachial plexus injury resulting from shoulder dislocation between the years 2000 and 2013 were included in this retrospective case series. Motor function of affected limbs was assessed pre- and postoperatively with the use of the British Medical Research Council (BMRC) scale. Sensory function in the areas innervated by ulnar and median nerves was evaluated with the BMRC scale modified by Omer and Dellon and in the remaining areas with the Highet classification. Follow-up lasted 2-10 years (mean, 5.1 years). Good postoperative recovery of nerve function was observed in 100% of musculocutaneous, 93.3% of radial, 66.7% of median, 64% of axillary, and 50% of ulnar nerve injuries. No recovery was observed in 5.6% of median, 6.7% of radial, 10% of ulnar, and 20% of axillary nerve injuries. Injury to a single nerve was associated with worse treatment outcome than multiple nerve injury. Obtaining improvement in peripheral nerve function after injury resulting from shoulder dislocation may require operative intervention. The type of surgical procedure depends on intraoperative findings: sural nerve grafting in cases of neural elements' disruption, internal neurolysis when intraneural fibrosis is observed, and external neurolysis in the remaining cases. The outcomes of surgical treatment are good, and the risk of intra- and postoperative complications is low. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Restoration of Elbow Flexion in Patients With Complete Traumatic and Obstetric Brachial Plexus Injury After Functional Free Gracilis Muscle Transfer: Our Experience and Management.

    Science.gov (United States)

    Nath, Rahul K; Boutros, Sean G; Somasundaram, Chandra

    2017-01-01

    Background: Functional free gracilis muscle transfer is an operative procedure for elbow reconstruction in patients with complete brachial plexus nerve and avulsion injuries and in delayed or prolonged nerve denervation, as well as in patients with inadequate upper extremity function after primary nerve reconstruction. Methods: We retrospectively reviewed our patient records and identified 24 patients with complete brachial plexus nerve injury (13 obstetric, 11 males and 2 females; 11 traumatic, 9 males and 2 females) whose affected arm and shoulder were totally paralyzed and their voluntary elbow flexion or the biceps function was poor preoperatively (mean M0-1/5 in MRC grade). These patients had undergone the functional free gracilis muscle transfer procedure at our clinic since 2005. Results: Ninety-two percent of all patients showed recovery and improvement. Successful free gracilis muscle transfer is defined as antigravity biceps muscle strength of M3-4/5 and higher, which was observed in 16 (8 obstetric and 8 traumatic) of our 24 patients (67%) in this study at least 1 year after functional free gracilis muscle transfer. This is statistically significant ( P antigravity and elbow flexion at least 1 year after free gracilis muscle transfer at our clinic.

  3. Upper Trunk Brachial Plexus Palsy Following Chiropractic Manipulation

    Directory of Open Access Journals (Sweden)

    John Cunningham

    2016-11-01

    Full Text Available Introduction:Upper trunk brachial plexus palsy can result from high energy trauma and has never been reported following spinal manipulation.Background:The case is presented of a patient who developed an acute brachial plexus upper trunk palsy following spinal manipulative therapy. Discussion:Discussion is made on the incidence of complications following manipulation and recommendations to prospectively capture all serious complications.Concluding Remarks:Risks exist with spinal manipulative therapy. Neurological injury can occur. Risk assessment and re-examination should occur at every visit. Large rigorous prospective studies are required to identify the true incidence of serious complications resulting from manipulative therapy and the benefit:risk ratio.

  4. Trapezius transfer to treat flail shoulder after brachial plexus palsy

    Directory of Open Access Journals (Sweden)

    Diaz Humberto

    2007-01-01

    Full Text Available Abstract Background After severe brachial palsy involving the shoulder, many different muscle transfers have been advocated to restore movement and stability of the shoulder. Paralysis of the deltoid and supraspinatus muscles can be treated by transfer of the trapezius. Methods We treated 10 patients, 8 males and 2 females, by transfer of the trapezius to the proximal humerus. In 6 patients the C5 and C6 roots had been injuried; in one C5, C6 and C7 roots; and 3 there were complete brachial plexus injuries. Eight of the 10 had had neurosurgical repairs before muscle transfer. Their average age was 28.3 years (range 17 to 41, the mean delay between injury and transfer was 3.1 years (range 14 months to 6.3 years and the average follow-up was 17.5 months (range 6 to 52, reporting the clinical and radiological results. Evaluation included physical and radiographic examinations. A modification of Mayer's transfer of the trapezius muscle was performed. The principal goal of this work was to evaluate the results of the trapezius transfer for flail shoulder after brachial plexus injury. Results All 10 patients had improved function with a decrease in instability of the shoulder. The average gain in shoulder abduction was 46.2°; the gain in shoulder flexion average 37.4°. All patients had stable shoulder (no subluxation of the humeral head on radiographs. Conclusion Trapezius transfer for a flail shoulder after brachial plexus palsy can provide satisfactory function and stability.

  5. SU-F-R-06: Traumatic Brachial Plexus Injury Imaging, Developing a Coherent Clinical Protocol From Literature Review Through Practice

    Energy Technology Data Exchange (ETDEWEB)

    Wu, D; France, E; Lambert, J; Hinkle, J [The University of Oklahoma Health Sciences Center, Oklahoma City, OK (United States)

    2016-06-15

    Purpose: Medical Physics teams can now play a critical role to help plan and provide studied approaches for traumatic brachial plexus MR imaging (tbpMRI). This is especially important for coordination with uncommon applications, since it is challenging to select the right modality, parameters, and train technologists on the essential components. For this work, we started with a review of the medical literature, performed crossover/volunteer studies to bring tbpMRI to practice with greater image QC and protocol management. Methods: To the best of our knowledge, we reviewed the known searchable domain for tbpMRI. We found 69 total articles since 2000. Articles were evaluated with our published protocol for literature management (LIMES3). Two physicists and two radiologists condensed the information from all articles into a knowledgebase. Results: The initial literature demonstrated great heterogeneity, which was a sign that this area needed greater consistency. Despite inconsistency and imprecision, we extracted the most relevant targets using our long-term experience with protocol development in MSK. We ran volunteers on six different magnets of various field strengths with multiple receiver coils, and rebuilt a coherent protocol for tbpMRI. Our radiologists rated LIMES3 work as superior. We have received referrals from the ER and have conducted four patient evaluations. Conclusion: Traumatic brachial plexus MRI has great possible benefits for patients. This work supports the complexity of tbpMRI scanning. As this is rarely performed, it requires a more diligent protocol workflow, coordination of caregivers, and education within multiple clinical departments. Choosing the correct imaging exam can be critical, as patients can have significant neuropathy and/or paralysis. The LIMES3 protocol is well liked at our institution, and forms the cornerstone of understanding for our work. Our literature management led to a better clinical protocol creation despite the diffuse

  6. Functional connectivity of motor cortical network in patients with brachial plexus avulsion injury after contralateral cervical nerve transfer: a resting-state fMRI study

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Aihong; Cheng, Xiaoguang; Liang, Wei; Bai, Rongjie [The 4th Medical College of Peking University, Department of Radiology, Beijing Jishuitan Hospital, Xicheng Qu, Beijing (China); Wang, Shufeng; Xue, Yunhao; Li, Wenjun [The 4th Medical College of Peking University, Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing (China)

    2017-03-15

    The purpose of this study is to assess the functional connectivity of the motor cortical network in patients with brachial plexus avulsion injury (BPAI) after contralateral C7 nerve transfer, using resting-state functional magnetic resonance imaging (RS-fMRI). Twelve patients with total brachial plexus root avulsion underwent RS-fMRI after contralateral C7 nerve transfer. Seventeen healthy volunteers were also included in this fMRI study as controls. The hand motor seed regions were defined as region of interests in the bilateral hemispheres. The seed-based functional connectivity was calculated in all the subjects. Differences in functional connectivity of the motor cortical network between patients and healthy controls were compared. The inter-hemispheric functional connectivity of the M1 areas was increased in patients with BPAI compared with the controls. The inter-hemispheric functional connectivity between the supplementary motor areas was reduced bilaterally. The resting-state inter-hemispheric functional connectivity of the bilateral M1 areas is altered in patients after contralateral C7 nerve transfer, suggesting a functional reorganization of cerebral cortex. (orig.)

  7. Functional outcome and quality of life after traumatic total brachial plexus injury treated by nerve transfer or single/double free muscle transfers: a comparative study.

    Science.gov (United States)

    Satbhai, N G; Doi, K; Hattori, Y; Sakamoto, S

    2016-02-01

    Between 2002 and 2011, 81 patients with a traumatic total brachial plexus injury underwent reconstruction by double free muscle transfer (DFMT, 47 cases), single muscle transfer (SMT, 16 cases) or nerve transfers (NT, 18 cases). They were evaluated for functional outcome and quality of life (QoL) using the Disability of Arm, Shoulder and Hand questionnaire, both pre- and post-operatively. The three groups were compared and followed-up for at least 24 months. The mean shoulder abduction and flexion were comparable in all groups, but external rotation was significantly better in the DFMT group as were range and quantitative power of elbow flexion. Patients who had undergone DFMT had reasonable total active finger movement and hook grip strength. All groups showed improvement in function at a level greater than a minimum clinically important difference. The DFMT group showed the greatest improvement. Patients in the DFMT group had a better functional outcome and QoL recovery than those in the NT and SMT groups. Double free muscle transfer procedure is capable of restoring maximum function in patients of total brachial plexus palsy. ©2016 The British Editorial Society of Bone & Joint Surgery.

  8. Variations in the formation of supraclavicular brachial plexus among ...

    African Journals Online (AJOL)

    Objective: To describe the pattern and prevalence of variations that occur in the supraclavicular part of the brachial plexus in a. Kenyan population. Study design: Descriptive cross-sectional study. Materials and methods: Ninety-four brachial plexuses from forty-seven formalin fixed cadavers were displayed by gross

  9. hoarseness and Horner's after supraclavicular brachial plexus block

    African Journals Online (AJOL)

    to compressive effects on the axillary fascial sheath. However, further studies are required to prove this. Keywords: combined incidence, Horner's syndrome, recurrent laryngeal nerve palsy, supraclavicular brachial plexus block. Introduction. Supraclavicular block is performed at the level of divisions of the brachial plexus.

  10. Contralateral Spinal Accessory Nerve Transfer: A New Technique in Panavulsive Brachial Plexus Palsy.

    Science.gov (United States)

    Zermeño-Rivera, Jaime; Gutiérrez-Amavizca, Bianca Ethel

    2015-06-01

    Brachial plexus avulsion results from excessive stretching and can occur secondary to motor vehicle accidents, mainly in motorcyclists. In a 28-year-old man with panavulsive brachial plexus palsy, we describe an alternative technique to repair brachial plexus avulsion and to stabilize and preserve shoulder function by transferring the contralateral spinal accessory nerve to the suprascapular nerve. We observed positive clinical and electromyographic results in sternocleidomastoid, trapezius, supraspinatus, infraspinatus, pectoralis, triceps, and biceps, with good outcome and prognosis for shoulder function at 12 months after surgery. This technique provides a unique opportunity for patients suffering from severe brachial plexus injuries and lacking enough donor nerves to obtain shoulder stability and mobility while avoiding bone fusion and preserving functionality of the contralateral shoulder with favorable postoperative outcomes.

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

    Science.gov (United States)

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

    2015-01-01

    The transplantation of embryonic stem cells can effectively improve the creeping strength of nerves near an injury site in animals. Amniotic epithelial cells have similar biological properties as embryonic stem cells; therefore, we hypothesized that transplantation of amniotic epithelial cells can repair peripheral nerve injury and recover the creeping strength of the brachial plexus nerve. In the present study, a brachial plexus injury model was established in rabbits using the C6 root avulsion method. A suspension of human amniotic epithelial cells was repeatedly injected over an area 4.0 mm lateral to the cephal and caudal ends of the C6 brachial plexus injury site (1 × 106 cells/mL, 3 μL/injection, 25 injections) immediately after the injury. The results showed that the decrease in stress and increase in strain at 7,200 seconds in the injured rabbit C6 brachial plexus nerve were mitigated by the cell transplantation, restoring the viscoelastic stress relaxation and creep properties of the brachial plexus nerve. The forepaw functions were also significantly improved at 26 weeks after injury. These data indicate that transplantation of human amniotic epithelial cells can effectively restore the mechanical properties of the brachial plexus nerve after injury in rabbits and that viscoelasticity may be an important index for the evaluation of brachial plexus injury in animals. PMID:25883625

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

    Directory of Open Access Journals (Sweden)

    Hua Jin

    2015-01-01

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

  13. Motor cortex neuroplasticity following brachial plexus transfer.

    Science.gov (United States)

    Dimou, Stefan; Biggs, Michael; Tonkin, Michael; Hickie, Ian B; Lagopoulos, Jim

    2013-01-01

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

  14. Motor cortex neuroplasticity following brachial plexus transfer

    Directory of Open Access Journals (Sweden)

    Stefan eDimou

    2013-08-01

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

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

    Science.gov (United States)

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

    2013-01-01

    To present the unique case of a collegiate wrestler with C7 neurologic symptoms due to T1-T2 disc herniation. 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. Cervical spine injury, stinger/burner, peripheral nerve injury, spinal cord injury, thoracic outlet syndrome, brachial plexus radiculopathy. 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. 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. 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.

  16. Radial Nerve Injury after Brachial Nerve Block - Case Series

    Directory of Open Access Journals (Sweden)

    Szederjesi Janos

    2016-03-01

    Full Text Available Adding epinephrine to local anesthetics is recommended to extend the duration of peripheral nerve blocks. We describe in this article two cases of radial nerve injury possible due to coadministration of epinephrine during brachial plexus block.

  17. Comparison of Two Techniques of Brachial Plexus Block for Upper ...

    African Journals Online (AJOL)

    The study compared trans-arterial approach and mid-humeral technique of axillary brachial plexus block in terms of the clinical benefit of each method; adequacy of block, onset of sensory and motor block, duration of block and complications. .In a prospective randomized study, axillary plexus block was carried out in 50 ...

  18. Estudo epidemiológico das lesões traumáticas de plexo braquial em adultos Epidemiological study of the traumatic brachial plexus injuries in adults

    Directory of Open Access Journals (Sweden)

    Leandro Pretto Flores

    2006-03-01

    Full Text Available OBJETIVO: Determinar informações epidemiológicas sobre as variáveis relacionadas ao trauma de plexo braquial em adultos. MÉTODO: Foram analisados 35 pacientes, de maneira prospectiva, atendidos consecutivamente no período de um ano. RESULTADOS: A maioria das lesões apresentou localização supraclavicular (62%, sendo 21 lesões por mecanismo de tração (60%, nove por projétil de arma de fogo (25%, três por compressão (8,5% e dois ferimentos cortantes (5,7%. Acidentes motociclísticos responderam por 54% das causas do trauma. A TC-mielografia identificou avulsão radicular em 16 casos (76%. Melhora neurológica parcial espontânea foi observada em 43% dos pacientes. Dor neuropática foi observada em 25 casos (71% sendo que em 16 (64% pôde ser controlada com medicações orais. CONCLUSÃO: Os traumas de plexo braquial são mais freqüentemente associados aos mecanismos de tração, sendo comum identificação de avulsão radicular. Em geral produzem dor no membro afetado e estão associados a lesões em outros órgãos. Na presente série, a incidência calculada para a população de abrangência foi 1,75/100000/ano.OBJECTIVE: This study aims to provide information about epidemiological factors related to traumatic brachial plexus injuries in adults. METHOD: Prospective analysis of 35 consecutive cases, observed in a period of one year. RESULTS: Most of the lesions were supraclavicular (62%. Twenty-one cases occurred due to traction (60%, 9 to gun shot wound (25%, 3 to compression (8.5% and two perforation/laceration (5.7%. Motorcycle accidents were the cause of trauma in 54% of patients. CT myelography demonstrated root avulsion in 16 cases (76%. Parcial spontaneous neurological recovery was observed in 43% of the patients. Neuropathic pain occurred in 25 (71% cases, and the use of some oral intake drugs (as amitriptiline or carbamazepine controlled it in 64% of times. CONCLUSION: Traction is the most frequent mechanism related to

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

    Science.gov (United States)

    2008-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Faruquee Sajedur

    2008-05-01

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

  1. The current role of diagnostic imaging in the preoperative workup for refractory neonatal brachial plexus palsy.

    Science.gov (United States)

    Somashekar, Deepak K; Wilson, Thomas J; DiPietro, Michael A; Joseph, Jacob R; Ibrahim, Mohannad; Yang, Lynda J-S; Parmar, Hemant A

    2016-08-01

    Despite recent improvements in perinatal care, the incidence of neonatal brachial plexus palsy (NBPP) remains relatively common. CT myelography is currently considered to be the optimal imaging modality for evaluating nerve root integrity. Recent improvements in MRI techniques have made it an attractive alternative to evaluate nerve root avulsions (preganglionic injuries). We demonstrate the utility of MRI for the evaluation of normal and avulsed spinal nerve roots. We also show the utility of ultrasound in providing useful preoperative evaluation of the postganglionic brachial plexus in patients with NBPP.

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

    Directory of Open Access Journals (Sweden)

    Leandro Pretto Flores

    2011-08-01

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

  3. [Ipsilateral brachial plexus C7 root transfer. Presentation of a case and a literature review].

    Science.gov (United States)

    Vergara-Amador, Enrique; Ramírez, Alejandro

    2014-01-01

    The C7 root in brachial plexus injuries has been used since 1986, since the first description by Gu at that time. This root can be used completely or partially in ipsilateral or contralateral lesions of the brachial plexus. A review of the literature and the case report of a 21-month-old girl with stab wounds to the neck and section of the C5 root of the right brachial plexus are presented. A transfer of the anterior fibres of the ipsilateral C7 root was performed. At 9 months there was complete recovery of abduction and external rotation of the shoulder. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  4. A cadaveric microanatomical study of the fascicular topography of the brachial plexus.

    Science.gov (United States)

    Sinha, Sumit; Prasad, G Lakshmi; Lalwani, Sanjeev

    2016-08-01

    OBJECT Mapping of the fascicular anatomy of the brachial plexus could provide the nerve surgeon with knowledge of fascicular orientation in spinal nerves of the brachial plexus. This knowledge might improve the surgical outcome of nerve grafting in brachial plexus injuries by anastomosing related fascicles and avoiding possible axonal misrouting. The objective of this study was to map the fascicular topography in the spinal nerves of the brachial plexus. METHODS The entire right-sided brachial plexus of 25 adult male cadavers was dissected, including all 5 spinal nerves (C5-T1), from approximately 5 mm distal to their exit from the intervertebral foramina, to proximal 1 cm of distal branches. All spinal nerves were tagged on the cranial aspect of their circumference using 10-0 nylon suture for orientation. The fascicular dissection of the C5-T1 spinal nerves was performed under microscopic magnification. The area occupied by different nerve fascicles was then expressed as a percentage of the total cross-sectional area of a spinal nerve. RESULTS The localization of fascicular groups was fairly consistent in all spinal nerves. Overall, 4% of the plexus supplies the suprascapular nerve, 31% supplies the medial cord (comprising the ulnar nerve and medial root of the median nerve [MN]), 27.2% supplies the lateral cord (comprising the musculocutaneous nerve and lateral root of the MN), and 37.8% supplies the posterior cord (comprising the axillary and radial nerves). CONCLUSIONS The fascicular dissection and definitive anatomical localization of fascicular groups is feasible in plexal spinal nerves. The knowledge of exact fascicular location might be translatable to the operating room and can be used to anastomose related fascicles in brachial plexus surgery, thereby avoiding the possibility of axonal misrouting and improving the results of plexal reconstruction.

  5. A quantitative assessment of the functional recovery of flexion of the elbow after nerve transfer in patients with a brachial plexus injury.

    Science.gov (United States)

    Quick, T J; Singh, A K; Fox, M; Sinisi, M; MacQuillan, A

    2016-11-01

    Improvements in the evaluation of outcome after nerve transfers are required. The assessment of force using the Medical Research Council (MRC) grades (0 to 5) is not suitable for this purpose. A ceiling effect is encountered within MRC grade 4/5 rendering this tool insensitive. Our aim was to show how the strength of flexion of the elbow could be assessed in patients who have undergone a re-innervation procedure using a continuous measurement scale. A total of 26 patients, 23 men and three women, with a mean age of 37.3 years (16 to 66), at the time of presentation, attended for review from a cohort of 52 patients who had undergone surgery to restore flexion of the elbow after a brachial plexus injury and were included in this retrospective study. The mean follow-up after nerve transfer was 56 months (28 to 101, standard deviation (sd) 20.79). The strength of flexion of the elbow was measured in a standard outpatient environment with a static dynamometer. In total, 21 patients (81%) gained MRC grade 4 strength of flexion of the elbow. The mean force of flexion was 7.2 kgf (3 to 15.5, sd 3.3). This study establishes that the dynamometer may be used for assessing the strength of flexion of the elbow in the outpatient department after nerve reconstructive surgery. Cite this article: Bone Joint J 2016;98-B:1517-20. ©2016 The British Editorial Society of Bone & Joint Surgery.

  6. Comparison of objective muscle strength in C5-C6 and C5-C7 brachial plexus injury patients after double nerve transfer.

    Science.gov (United States)

    Tsai, Yi-Jung; Su, Fong-Chin; Hsiao, Chih-Kun; Tu, Yuan-Kun

    2015-02-01

    The purpose of this study was to evaluate the quantitative muscle strength to distinguish the outcomes of different injury levels in upper arm type brachial plexus injury (BPI) patients with double nerve transfer. Nine patients with C5-C6 lesions (age = 32.2 ± 13.9 year old) and nine patients with C5-C7 lesions (age = 32.4 ± 7.9 year old) received neurotization of the spinal accessory nerve to the suprascapular nerve combined with the Oberlin procedure (fascicles of ulnar nerve transfer to the musculocutaneous nerve) were recruited. The average time interval between operation and evaluation were 27.3 ± 21.0 and 26.9 ± 20.6 months for C5-C6 and C5-C7, respectively. British Medical Research Council (BMRC) scores and the objective strength measured by a handheld dynamometer were evaluated in multiple muscles to compare outcomes between C5-C6 and C5-C7 injuries. There were no significant differences in BMRC scores between the groups. C5-C6 BPI patients had greater quantitative strength in shoulder flexor (P = 0.02), shoulder extensor (P C5-C7 BPI patients. Upper arm type BPI patients have a good motor recovery after double nerve transfer. The different outcomes between C5-C6 and C5-C7 BPI patients appeared in muscles responding to hand grip, wrist extension, and sagittal movements in shoulder and elbow joints. © 2014 Wiley Periodicals, Inc.

  7. Successful Outcome of Modified Quad Surgical Procedure in Preteen and Teen Patients with Brachial Plexus Birth Palsy

    OpenAIRE

    Nath, Rahul K; Somasundaram, Chandra

    2012-01-01

    Objective: To evaluate the outcome of modified Quad procedure in preteen and teen patients with brachial plexus birth palsy. Background: We have previously demonstrated a significant improvement in shoulder abduction, resulting from the modified Quad procedure in children (mean age 2.5 years; range, 0.5?9 years) with obstetric brachial plexus injury. Methods: We describe in this report the outcome of 16 patients (6 girls and 10 boys; 7 preteen and 9 teen) who have undergone the modified Quad ...

  8. [Myxoid/round cell liposarcoma of the brachial plexus].

    Science.gov (United States)

    Giner, Javier; Isla, Alberto; Hernández, Borja; Nistal, Manuel

    2014-01-01

    Myxoid/round cell liposarcoma is a soft tissue sarcoma that is extremely rare in the brachial plexus. We report a case of a myxoid/round cell liposarcoma originating in the brachial plexus that was surgically resected and evolved well, with no deficit or recurrence after 2 years of follow-up. To date, there has been no other case of this sarcoma in the literature. Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  9. Brachial plexus block in phantom limb pain: a case report.

    Science.gov (United States)

    Preissler, Sandra; Dietrich, Caroline; Meissner, Winfried; Huonker, Ralph; Hofmann, Gunther O; Miltner, Wolfgang H R; Weiss, Thomas

    2011-11-01

    The purpose of this case report is twofold: first, to present evidence of long-lasting relief in a patient suffering from phantom limb pain after pharmacologically blocking his plexus brachialis and, second, to replicate results from a previous study focusing on cortical reorganization and phantom limb pain. Before regional anesthesia, the patient suffered from a phantom hand that cramped and was immovable. We performed a diagnostic axillary blockade of the brachial plexus to differentiate peripheral from more central contributions to phantom limb pain. During blockade of the brachial plexus, the patient reported a reduction of phantom limb pain for the first time following years of suffering and a complete loss of cramping together with muscle relaxation of the phantom hand. Additionally, we found cortical reorganization in the primary somatosensory cortex (re-reorganization). Strikingly, the relaxed phantom limb together with the reduction of phantom limb pain remained preserved even 6 months after blockade of the brachial plexus. A single temporary blockade of the brachial plexus may relieve phantom limb pain and unpleasant phantom feelings (cramping) for an extended period. Wiley Periodicals, Inc.

  10. Evaluation of elbow flexion following free muscle transfer from the medial gastrocnemius or transfer from the latissimus dorsi, in cases of traumatic injury of the brachial plexus

    Directory of Open Access Journals (Sweden)

    Frederico Barra de Moraes

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVE: To compare the gain in elbow flexion in patients with traumatic injury of the brachial plexus following muscle transfer from latissimus dorsi with the gain following free muscle transfer from the medial belly of the gastrocnemius. METHODS: This was a retrospective study in which the medical files of a convenience sample of 13 patients operated between 2000 and 2010 were reviewed. Group 1 comprised seven patients who underwent transfers from the gastrocnemius and group 2 (controls comprised six patients who underwent transfers from the latissimus dorsi. The following functions were evaluated: (1 range of motion (ROM of elbow flexion, in degrees, using manual goniometry and (2 grade of elbow flexion strength, using a muscle strength scale. Satisfactory results were defined as: (1 elbow flexion ROM ≥ 80° and (2 elbow flexion strength ≥ M3. The Fisher exact and Kruskal-Wallis tests were used (p < 0.05. RESULTS: The patients' mean age was 32 years (range: 17-56 and 72% had been involved in motorcycle accidents. Elbow flexion strength ≥ M3 was observed in seven patients (100% in group 1 and in five patients (83.3% in group 2 (p = 0.462. None of the patients presented M5, and one patient (16.7% in group 2 had a poor result (M2. Elbow flexion ROM with a gain ≥ 80° (daily functions was found in six patients (86% in group 1 and in three patients (50% in group 2 ( p = 0.1. CONCLUSION: The patients in group 1 had greater gains in strength and ROM than did those in group 2, but without statistical significance. Thus, transfers from the gastrocnemius become a new surgical option, if other techniques cannot be used.

  11. Brachial plexus 3D reconstruction from MRI with dissection validation: a baseline study for clinical applications.

    Science.gov (United States)

    Van de Velde, Joris; Bogaert, Stephanie; Vandemaele, Pieter; Huysse, Wouter; Achten, Eric; Leijnse, Joris; De Neve, Wilfried; Van Hoof, Tom

    2016-03-01

    The present study aimed to establish a baseline for detailed 3D brachial plexus reconstruction from magnetic resonance imaging (MRI). Concretely, the goal was to determine the individual brachial plexus anatomy with maximum detail and accuracy achievable, as yet irrespective of whether the methods used could be economically and practically applied in the clinical setting. Six embalmed cadavers were randomly taken for MRI imaging of the brachial plexus. Detailed two-dimensional (2D) segmentation for all brachial plexus parts was done. The 2D brachial plexus segmentations were 3D reconstructed using Mimics(®) software. Then, these 3D reconstructions were anatomically validated by dissection of the cadavers. After finalising the cadaver experiments, brachial plexus MRIs were obtained in three healthy male volunteers and the same reconstruction procedure as in vitro was followed. A procedure was developed for brachial plexus 3D reconstruction based on MRI without the use of any contrast agent. Anatomical validation of six cadaver brachial plexus reconstructions showed high correspondence with the dissected brachial plexuses. Anatomical variations of the main branches were equally present in the 3D reconstructions generated. However, there were also some differences that related to the difference between the surface anatomy of the nerve and the internal nerve structure. In vivo, it was possible to reconstruct the complete brachial plexus in such a manner that normal-appearing BPs were derived in a reproducible way. This study showed that the described procedure results in accurate and reproducible brachial plexus 3D reconstructions.

  12. [Bilateral brachial plexus block. Case report and systematic review].

    Science.gov (United States)

    Mejia-Terrazas, Gabriel Enrique; Garduño-Juárez, María de Ángeles; Limón-Muñoz, Marisol; Torres-Maldonado, Areli Seir; Carrillo-Esper, Raúl

    2015-01-01

    The bilateral brachial plexus block is considered a contraindication, due to the possible development of complications, such as: toxicity from local anaesthetics or bilateral diaphragmatic paralysis. However, with the real time visualisation provided by the ultrasound scan, these complications have decreased and it is a safer procedure. Four cases are presented where the bilateral block was performed using guided ultrasound, as the patients were unable to receive general anaesthesia due to a history of adverse effects or the use of opioids in the post-operative or by the prediction of a difficult airway associated with obesity. A systematic review of the literature from January 1993 to June 2013, was also performed by using a search in the MEDLINE, EMBASE, ARTEMISA, LILACS, Google data bases, in Spanish and English language with the following words: bilateral brachial plexus block, bilateral interscalene block, bilateral infraclavicular block, bilateral supraclavicular block, bilateral lateral supraclavicular block, bilateral axillary block, ultrasound-guided bilateral brachial plexus block. Based on the evidence found, ultrasound-guided bilateral brachial plexus block in selected patients and expert hands, is no longer a contraindication. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  13. Brachial Plexus Blocks for Upper Extremity Surgeries in a Nigerian ...

    African Journals Online (AJOL)

    Background: Different techniques of brachial plexus blocks are in use to provide surgical anaesthesia from the shoulder to the fingertips. However, they are perceived as time-consuming and unreliable as the sole anaesthetic for surgical procedures. Until recently (July 2008), only general anaesthesia was employed in our ...

  14. Transarterial Brachial Plexus Anaesthesia for Upper Limb Surgery ...

    African Journals Online (AJOL)

    Objective: We present our experience with the transarterial brachial plexus anaesthesia as a technique of choice for upper limb procedure in developing countries where nerve stimulator may not be readily available. Methods: For all consenting patients, the axillary block was instituted using a 23G hypodermic needle and ...

  15. Ultrasound of the cervical roots and brachial plexus in neonates

    NARCIS (Netherlands)

    Pillen, S.; Semmekrot, B.; Meulstee, J.; Verrips, A.; Alfen, N. van

    2015-01-01

    INTRODUCTION: In this exploratory study we investigated whether ultrasound can visualize the neonatal cervical roots and brachial plexus. METHODS: In 12 healthy neonates <2 days old, the neck region was studied unilaterally with ultrasound using a small-footprint 15-7-MHz transducer. RESULTS: The

  16. Use Of Continuous Axillary Brachial Plexus Block Facilitates ...

    African Journals Online (AJOL)

    Objective: To report the successful use of continuous axillary brachial plexus block in the assessment of muscle functions during tendon repair. Methods: A prospective observational study carried out at Obafemi Awolowo University Teaching Hospital, Ile-Ife between November 2006 and December 2007. The study included ...

  17. General intravenous anesthesia for brachial plexus surgery in the rabbit.

    Science.gov (United States)

    Reichert, P; Rutowski, R; Kielbowicz, Z; Kuryszko, J; Kielbowicz, M

    2013-01-01

    The rabbit is a good experimental model for brachial plexus surgery. The risks of death during anesthesia were significantly greater in rabbits than cats or dogs. This article presents the protocol of injectable anesthesia for a short surgical procedure, safe for the rabbit patient and convenient for the surgeon.

  18. Anatomical variations of the brachial plexus terminal branches in ...

    African Journals Online (AJOL)

    Anatomical variations are clinically significant, but many are inadequately described or quantified. Variations in anatomy of the brachial plexus are important to surgeons and anesthesiologists performing surgical procedures in the neck, axilla and upper limb regions. It is also important for radiologists who interpret plain and ...

  19. Hamartoma fibroso infantil: lesão volumosa com envolvimento de plexo braquil Children's fibrous hamartoma: extensive injury involving brachial plexus

    Directory of Open Access Journals (Sweden)

    Lisieux Eyer de Jesus

    2006-01-01

    Full Text Available OBJETIVO: Apresentar um caso de hamartoma fibroso da infância em lactente ressecado tardiamente e se apresentando como lesão extensa, com envolvimento de elementos vasculares e neurais do plexo braquial. MÉTODOS: Estudo de caso clínico e revisão de literatura pertinente. RESULTADOS: Criança do sexo masculino, com massa tumoral axilar direita, irregular surgida aos 2 meses de idade e relacionada à administração da vacina BCG, sendo tratada com agentes anti-tuberculosos, sem resposta. Mediante biópsia a lesão foi diagnosticada como hamartoma fibroso infantil, e, após sofrer período de crescimento rápido, foi submetida à exérese cirúrgica completa. CONCLUSÃO: O hamartoma fibroso juvenil é um tumor benigno raro, tipicamente se apresentando no primeiro ano de vida em meninos, com localização mais comum no oco axilar. O diagnóstico diferencial se faz com tumores de partes moles em geral e, em casos de apresentação na axila direita, com adenopatias axilares causadas por reação à BCG. O tratamento é exerese completa da lesão e o prognóstico é favorável.OBJECTIVE: To present a case of fibrous hamartoma in a late-dried infant presenting as an extensive injury, involving vascular and neural elements of brachial plexus. METHODS: Clinical case study and pertinent literature review. RESULTS: Male child, with right axillary irregular tumoral mass, of which onset occurred at 2 months of age and related to BCG vaccine application, being treated with anti-tuberculosis agents, not responding to therapy. Upon biopsy, the injury was diagnosed as children’s fibrous hamartoma, and, after a fast growing period, was submitted to total surgical exeresis. CONCLUSION: The juvenile fibrous hamartoma is a rare benign tumor, typically occurring within the first year of life in boys, most commonly located at axillary gap. The differential diagnosis is performed with soft parts tumors in general, and, in right axillary location cases, with

  20. Co-infusion of autologous adipose tissue derived neuronal differentiated mesenchymal stem cells and bone marrow derived hematopoietic stem cells, a viable therapy for post-traumatic brachial plexus injury: A case report

    Directory of Open Access Journals (Sweden)

    Umang G Thakkar

    2014-08-01

    Full Text Available Stem cell therapy is emerging as a viable approach in regenerative medicine. A 31-year-old male with brachial plexus injury had complete sensory-motor loss since 16 years with right pseudo-meningocele at C5-D1 levels and extra-spinal extension up to C7-D1, with avulsion on magnetic resonance imaging and irreversible damage. We generated adipose tissue derived neuronal differentiated mesenchymal stem cells (N-AD-MSC and bone marrow derived hematopoietic stem cells (HSC-BM. Neuronal stem cells expressed β-3 tubulin and glial fibrillary acid protein which was confirmed on immunofluorescence. On day 14, 2.8 ml stem cell inoculum was infused under local anesthesia in right brachial plexus sheath by brachial block technique under ultrasonography guidance with a 1.5-inch-long 23 gauge needle. Nucleated cell count was 2 × 10 4 /μl, CD34+ was 0.06%, and CD45-/90+ and CD45-/73+ were 41.63% and 20.36%, respectively. No untoward effects were noted. He has sustained recovery with re-innervation over a follow-up of 4 years documented on electromyography-nerve conduction velocity study.

  1. Posterior subscapular dissection: An improved approach to the brachial plexus for human anatomy students.

    Science.gov (United States)

    Hager, Shaun; Backus, Timothy Charles; Futterman, Bennett; Solounias, Nikos; Mihlbachler, Matthew C

    2014-05-01

    Students of human anatomy are required to understand the brachial plexus, from the proximal roots extending from spinal nerves C5 through T1, to the distal-most branches that innervate the shoulder and upper limb. However, in human cadaver dissection labs, students are often instructed to dissect the brachial plexus using an antero-axillary approach that incompletely exposes the brachial plexus. This approach readily exposes the distal segments of the brachial plexus but exposure of proximal and posterior segments require extensive dissection of neck and shoulder structures. Therefore, the proximal and posterior segments of the brachial plexus, including the roots, trunks, divisions, posterior cord and proximally branching peripheral nerves often remain unobserved during study of the cadaveric shoulder and brachial plexus. Here we introduce a subscapular approach that exposes the entire brachial plexus, with minimal amount of dissection or destruction of surrounding structures. Lateral retraction of the scapula reveals the entire length of the brachial plexus in the subscapular space, exposing the brachial plexus roots and other proximal segments. Combining the subscapular approach with the traditional antero-axillary approach allows students to observe the cadaveric brachial plexus in its entirety. Exposure of the brachial dissection in the subscapular space requires little time and is easily incorporated into a preexisting anatomy lab curriculum without scheduling additional time for dissection. Copyright © 2014 Elsevier GmbH. All rights reserved.

  2. A novel technique for teaching the brachial plexus.

    Science.gov (United States)

    Lefroy, Henrietta; Burdon-Bailey, Victoria; Bhangu, Aneel; Abrahams, Peter

    2011-09-01

    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. 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. 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. 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. © Blackwell Publishing Ltd 2011.

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

    Directory of Open Access Journals (Sweden)

    Duz Bulent

    2009-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Gessica Ariane de Melo Cruz

    2013-09-01

    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.

  5. A giant plexiform schwannoma of the brachial plexus: case report

    OpenAIRE

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

    2011-01-01

    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 enla...

  6. Comparison between Conventional and Ultrasound-Guided Supraclavicular Brachial Plexus Block in Upper Limb Surgeries.

    Science.gov (United States)

    Honnannavar, Kiran Abhayakumar; Mudakanagoudar, Mahantesh Shivangouda

    2017-01-01

    Brachial plexus blockade is a time-tested technique for upper limb surgeries. The classical approach using paresthesia technique is a blind technique and may be associated with a higher failure rate and injury to the nerves and surrounding structures. To avoid some of these problems, use of peripheral nerve stimulator and ultrasound techniques were started which allowed better localization of the nerve/plexus. Ultrasound for supraclavicular brachial plexus block has improved the success rate of the block with excellent localization as well as improved safety margin. Hence, this study was planned for comparing the efficacy of conventional supraclavicular brachial plexus block with ultrasound-guided technique. After obtaining the Institutional ethical committee approval and patient consent total of 60 patients were enrolled in this prospective randomized study and were randomly divided into two groups: US (Group US) and C (Group C). Both groups received 0.5% bupivacaine. The amount of local anesthetic injected calculated according to the body weight and was not crossing the toxic dosage (injection bupivacaine 2 mg/kg). The parameters compared between the two groups were lock execution time, time of onset of sensory and motor block, quality of sensory and motor block success rates were noted. The failed blocks were supplemented with general anesthesia. Demographic data were comparable in both groups. The mean time taken for the procedure to administer a block by eliciting paresthesia is less compared to ultrasound, and it was statistically significant. The mean time of onset of motor block, sensory blockade, the duration of sensory and motor blockade was not statistically significant. The success rate of the block is more in ultrasound group than conventional group which was not clinically significant. The incidence of complications was seen more in conventional method. Ultrasound guidance is the safe and effective method for the supraclavicular brachial plexus block

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

    Directory of Open Access Journals (Sweden)

    Cihangir Tetik

    2014-01-01

    Full Text Available Brachial plexus surgery using the da Vinci surgical robot is a new procedure. Although the supraclavicular approach is a well known described and used procedure for robotic surgery, axillary approach was unknown for brachial plexus surgery. A cadaveric study was planned to evaluate the robotic axillary approach for brachial plexus surgery. Our results showed that robotic surgery is a very useful method and should be used routinely for brachial plexus surgery and particularly for thoracic outlet syndrome. However, we emphasize that new instruments should be designed and further studies are needed to evaluate in vivo results.

  8. 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)

    Marcelo Rosa de Rezende

    2012-12-01

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

  9. Obstetric brachial plexus palsy: reviewing the literature comparing the results of primary versus secondary surgery.

    Science.gov (United States)

    Socolovsky, Mariano; Costales, Javier Robla; Paez, Miguel Domínguez; Nizzo, Gustavo; Valbuena, Sebastian; Varone, Ernesto

    2016-03-01

    Obstetric brachial plexus injuries (OBPP) are a relatively common stretch injury of the brachial plexus that occurs during delivery. Roughly 30 % of patients will not recover completely and will need a surgical repair. Two main treatment strategies have been used: primary surgery, consisting in exploring and reconstructing the affected portions of the brachial plexus within the first few months of the patient's life, and secondary procedures that include tendon or muscle transfers, osteotomies, and other orthopedic techniques. Secondary procedures can be done as the only surgical treatment of OBPP or after primary surgery, in order to minimize any residual deficits. Two things are crucial to achieving a good outcome: (1) the appropriate selection of patients, to separate those who will spontaneously recover from those who will recover only partially or not at all; and (2) a good surgical technique. The objective of the present review is to assess the published literature concerning certain controversial issues in OBPP, especially in terms of the true current state of primary and secondary procedures, their results, and the respective roles each plays in modern-day treatment of this complex pathology. Considerable published evidence compiled over decades of surgical experience favors primary nerve surgery as the initial therapeutic step in patients who do not recover spontaneously, followed by secondary surgeries for further functional improvement. As described in this review, the results of such treatment can greatly ameliorate function in affected limbs. For best results, multi-disciplinary teams should treat these patients.

  10. Correlation between ultrasound imaging, cross-sectional anatomy, and histology of the brachial plexus: a review.

    NARCIS (Netherlands)

    Geffen, G.J. van; Moayeri, N.; Bruhn, J.; Scheffer, G.J.; Chan, V.W.; Groen, G.J.

    2009-01-01

    The anatomy of the brachial plexus is complex. To facilitate the understanding of the ultrasound appearance of the brachial plexus, we present a review of important anatomic considerations. A detailed correlation of reconstructed, cross-sectional gross anatomy and histology with ultrasound

  11. Correlation between ultrasound imaging, cross-sectional anatomy, and histology of the brachial plexus: a review.

    Science.gov (United States)

    van Geffen, Geert J; Moayeri, Nizar; Bruhn, Jörgen; Scheffer, Gert J; Chan, Vincent W; Groen, Gerbrand J

    2009-01-01

    The anatomy of the brachial plexus is complex. To facilitate the understanding of the ultrasound appearance of the brachial plexus, we present a review of important anatomic considerations. A detailed correlation of reconstructed, cross-sectional gross anatomy and histology with ultrasound sonoanatomy is provided.

  12. Correlation Between Ultrasound Imaging, Cross-Sectional Anatomy, and Histology of the Brachial Plexus A Review

    NARCIS (Netherlands)

    van Geffen, Geert J.; Moayeri, Nizar; Bruhn, Joergen; Scheffer, Gert J.; Chan, Vincent W.; Groen, Gerbrand J.

    2009-01-01

    The anatomy of the brachial plexus is complex. To facilitate the understanding of the ultrasound appearance of the brachial plexus, we present a review of important anatomic considerations. A detailed correlation of reconstructed, cross-sectional gross anatomy and histology with ultrasound

  13. Brachial plexus magnetic resonance imaging differentiates between inflammatory neuropathies and does not predict disease course

    NARCIS (Netherlands)

    Jongbloed, BA; Bos, Jeroen W; Rutgers, Dirk; van der Pol, WL; van den Berg, Leonard H

    OBJECTIVE: The main objective of this study was to evaluate the correlation between the distribution of brachial plexus magnetic resonance imaging (MRI) abnormalities and clinical weakness, and to evaluate the value of brachial plexus MRI in predicting disease course and response to treatment in

  14. Explaining daily functioning in young adults with obstetric brachial plexus lesion

    NARCIS (Netherlands)

    de Heer, J.A.; Beckerman, H.; de Groot, V.

    2015-01-01

    Purpose: To study the influence of obstetric brachial plexus lesion (OBPL) on arm-hand function and daily functioning in adults, and to investigate the relationship of arm-hand function and pain to daily functioning. Method: Adults with unilateral OBPL who consulted the brachial plexus team at the

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

    LENUS (Irish Health Repository)

    Frizelle, H P

    2012-02-03

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

  16. Brachial plexus variations in its formation and main branches

    Directory of Open Access Journals (Sweden)

    Valéria Paula Sassoli Fazan

    2003-01-01

    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

  17. A literature review of intercostal-to-musculocutaneous-nerve transfers in brachial plexus injury patients: Does body mass index influence results in Eastern versus Western countries?

    Science.gov (United States)

    Socolovsky, Mariano; Paez, Miguel Domínguez

    2013-01-01

    Background: A wide range of results have appeared in the literature for intercostal nerve transfers in brachial plexus patients. Oriental countries generally have a lower body mass index (BMI) than their occidental counterparts. We analyzed published series of intercostal nerve transfers for elbow reinnervation to determine if a difference in outcomes exists between Eastern and Western series that could be inversely related to BMI. Methods: A PubMed search was conducted. Inclusion criteria were: (1) time from trauma to surgery <12 months, (2) minimum follow-up one year, (3) intercostal to musculocutaneous nerve transfer the only surgical procedure performed to reestablish elbow flexion, and (4) males comprising more than 75% of cases. Two groups were created: Series from western countries, including America, Europe, and Africa; and series from Asia. Pearson correlation analysis was performed to assess for the degree of correlation between percent responders and mean national BMI. Results: A total of 26 series were included, 14 from western countries and 12 from Eastern countries, encompassing a total of 274 and 432 surgical cases, respectively. The two groups were almost identical in mean age, but quite different in mean national BMI (26.3 vs. 22.5) and in the percentage of patients who achieved at least a Medical Research Council (MRC) level 3 (59.5% vs. 79.3%). Time from trauma to surgery was slightly shorter in Eastern (3.4 months) versus Western countries (5.0 months). Conclusions: The percentage of responders to intercostal to musculocutaneous nerve transfer was inversely correlated with the mean national BMI among male residents of the country where the series was performed. PMID:24381795

  18. Clinical findings in C5-C6 and C5-C7 root palsies with brachial plexus traction lesions.

    Science.gov (United States)

    Bertelli, J A; Ghizoni, M F

    2013-03-01

    Stretch injuries of the C5-C7 roots of the brachial plexus traditionally have been associated with palsies of shoulder abduction/external rotation, elbow flexion/extension, and wrist, thumb, and finger extension. Based on current myotome maps we hypothesized that, as far as motion is concerned, palsies involving C5-C6 and C5-C7 root injuries should be similar. In 38 patients with upper-type palsies of the brachial plexus, we examined for correlations between clinical findings and root injury level, as documented by CT tomomyeloscan. Contrary to commonly held beliefs, C5-C7 root injuries were not associated with loss of extension of the elbow, wrist, thumb, or fingers, but residual hand strength was much lower with C5-C7 vs C5-C6 lesions.

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

    Directory of Open Access Journals (Sweden)

    Hafezi Rahmatollah

    2008-03-01

    Full Text Available 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 brachial plexus and recording the evoked response in hand muscles. Design This descriptive study was done on 112 upper limbs of healthy volunteers. Forty-six limbs belonging to men and sixty-six belonging to women were studied by magnetic stimulation of both motor cortex and brachial plexus and recording the evoked response in thenar and hypothenar muscles. Stimulation of the motor cortex gives rise to absolute latency of each nerve whereas stimulation of the brachial plexus results in peripheral conduction time. The difference between these two values was considered the central motor conduction time (CMCT. Results In summary the result are as follows; Cortex-thenar latency = 21.4 ms (SD = 1.7, CMCT-thenar = 9.6 ms (SD = 1.9, Cortex-hypothenar latency = 21.3 ms (SD = 1.8, CMCT-hypothenar = 9.4 ms (SD = 1.8. Conclusion These findings showed that there is no meaningful difference between two genders. CMCT calculated by this method is a little longer than that obtained by electrical stimulation that is due to the more distally placed second stimulation. We recommend magnetic stimulation as the method of choice to calculate CMCT and its use for lower brachial plexus conduction time. This method could serve as a diagnostic tool for diagnosis of lower plexus entrapment and injuries especially in early stages.

  20. Lipomas of the Brachial Plexus: A Case Series and Review of the Literature.

    Science.gov (United States)

    Graf, Alexander; Yang, Kai; King, David; Dzwierzynski, William; Sanger, James; Hettinger, Patrick

    2017-10-01

    Lipomas are common benign tumors. When they develop in proximity to peripheral nerves, they can cause neurologic symptoms secondary to mass effect. Previous reports have shown symptom resolution after removal of lipomas compressing various upper extremity peripheral nerves. However, brachial plexus lipomas are relatively rare. Our multidisciplinary experience with brachial plexus lipoma resection is reviewed in the largest case series to date. A retrospective chart review of all patients undergoing resection of brachial plexus lipomatous tumors between 2006 and 2016 was performed. Patient demographic data, diagnostic imaging, clinical presentation, operative details, surgical pathology, and clinical outcomes were reviewed. Twelve brachial plexus lipomatous tumors were resected in 11 patients: 10 lipomas, 1 hibernoma, and 1 atypical lipomatous tumor. The most common tumor location was supraclavicular (50%), followed by axillary (42%), and proximal medial arm (8%). The most common brachial plexus segment involved was the upper trunk (50%), followed by posterior cord (25%), lateral pectoral nerve (8%), lower trunk (8%), and proximal median nerve (8%). Most patients presented with an enlarging painless mass (58%). Of the patients who presented with neurologic symptoms, symptoms resolved in the majority (80%). Brachial plexus lipomas are rare causes of compression neuropathy in the upper extremity. Careful resection and knowledge of brachial plexus anatomy, which may be distorted by the tumor, are critical to achieving a successful surgical outcome with predictable symptom resolution. Finally, surveillance magnetic resonance imaging may be warranted for atypical lesions.

  1. Dose–Volume Modeling of Brachial Plexus-Associated Neuropathy After Radiation Therapy for Head-and-Neck Cancer: Findings From a Prospective Screening Protocol

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Allen M., E-mail: amchen@mednet.ucla.edu [Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California (United States); Wang, Pin-Chieh [Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California (United States); Daly, Megan E.; Cui, Jing; Hall, William H. [Department of Radiation Oncology, University of California, Davis, Comprehensive Cancer Center, Sacramento, California (United States); Vijayakumar, Srinivasan [Department of Radiation Oncology, University of Mississippi School of Medicine, Jackson, Mississippi (United States); Phillips, Theodore L. [Department of Radiation Oncology, University of California, Davis, Comprehensive Cancer Center, Sacramento, California (United States); Farwell, D. Gregory [Department of Otolaryngology–Head and Neck Surgery, University of California, Davis, Comprehensive Cancer Center, Sacramento, California (United States); Purdy, James A. [Department of Radiation Oncology, University of California, Davis, Comprehensive Cancer Center, Sacramento, California (United States)

    2014-03-15

    Purpose: Data from a prospective screening protocol administered for patients previously irradiated for head-and-neck cancer was analyzed to identify dosimetric predictors of brachial plexus-associated neuropathy. Methods and Materials: Three hundred fifty-two patients who had previously completed radiation therapy for squamous cell carcinoma of the head and neck were prospectively screened from August 2007 to April 2013 using a standardized self-administered instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from radiation therapy was 40 months (range, 6-111 months). A total of 177 patients (50%) underwent neck dissection. Two hundred twenty-one patients (63%) received concurrent chemotherapy. Results: Fifty-one patients (14%) reported brachial plexus-related neuropathic symptoms with the most common being ipsilateral pain (50%), numbness/tingling (40%), and motor weakness and/or muscle atrophy (25%). The 3- and 5-year estimates of freedom from brachial plexus-associated neuropathy were 86% and 81%, respectively. Clinical/pathological N3 disease (P<.001) and maximum radiation dose to the ipsilateral brachial plexus (P=.01) were significantly associated with neuropathic symptoms. Cox regression analysis revealed significant dose–volume effects for brachial plexus-associated neuropathy. The volume of the ipsilateral brachial plexus receiving >70 Gy (V70) predicted for symptoms, with the incidence increasing with V70 >10% (P<.001). A correlation was also observed for the volume receiving >74 Gy (V74) among patients treated without neck dissection, with a cutoff of 4% predictive of symptoms (P=.038). Conclusions: Dose–volume guidelines were developed for radiation planning that may limit brachial plexus-related neuropathies.

  2. Correlation between motor function recovery and daily living activity outcomes after brachial plexus surgery

    Directory of Open Access Journals (Sweden)

    Sonia Regina Ferreira

    Full Text Available ABSTRACT Objective To establish the correlation between clinical evaluation of motor function recovery and daily living activities in 30 patients with upper traumatic brachial plexus injury submitted to surgery. Methods The score of the Disabilities of the Arm, Shoulder and Hand (DASH questionnaire and the Louisiana State University Health Sciences Center (LSUHSC scale were determined in 30 patients. Epidemiologic factors were also examined and correlations were determined. Results There was a significant correlation between the clinical evaluation and the daily living activities after a 12-month period (r = 0.479 and p = 0.007. A direct correlation was observed between the functional recovery of the upper limb and the time between injury and surgery (r = 0.554 and p = 0.001. The LSUHSC scores (p = 0.049 and scores from the DASH questionnaire (p = 0.013 were better among patients who returned to work. Conclusions Clinical evaluation and daily living activities in adult patients who underwent nerve transfer after brachial plexus injury showed significant and measurable improvements.

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

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

    1990-01-01

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

  4. Morphometric Atlas Selection for Automatic Brachial Plexus Segmentation

    Energy Technology Data Exchange (ETDEWEB)

    Van de Velde, Joris, E-mail: joris.vandevelde@ugent.be [Department of Anatomy, Ghent University, Ghent (Belgium); Department of Radiotherapy, Ghent University, Ghent (Belgium); Wouters, Johan [Department of Anatomy, Ghent University, Ghent (Belgium); Vercauteren, Tom; De Gersem, Werner; Duprez, Fréderic; De Neve, Wilfried [Department of Radiotherapy, Ghent University, Ghent (Belgium); Van Hoof, Tom [Department of Anatomy, Ghent University, Ghent (Belgium)

    2015-07-01

    Purpose: The purpose of this study was to determine the effects of atlas selection based on different morphometric parameters, on the accuracy of automatic brachial plexus (BP) segmentation for radiation therapy planning. The segmentation accuracy was measured by comparing all of the generated automatic segmentations with anatomically validated gold standard atlases developed using cadavers. Methods and Materials: Twelve cadaver computed tomography (CT) atlases (3 males, 9 females; mean age: 73 years) were included in the study. One atlas was selected to serve as a patient, and the other 11 atlases were registered separately onto this “patient” using deformable image registration. This procedure was repeated for every atlas as a patient. Next, the Dice and Jaccard similarity indices and inclusion index were calculated for every registered BP with the original gold standard BP. In parallel, differences in several morphometric parameters that may influence the BP segmentation accuracy were measured for the different atlases. Specific brachial plexus-related CT-visible bony points were used to define the morphometric parameters. Subsequently, correlations between the similarity indices and morphometric parameters were calculated. Results: A clear negative correlation between difference in protraction-retraction distance and the similarity indices was observed (mean Pearson correlation coefficient = −0.546). All of the other investigated Pearson correlation coefficients were weak. Conclusions: Differences in the shoulder protraction-retraction position between the atlas and the patient during planning CT influence the BP autosegmentation accuracy. A greater difference in the protraction-retraction distance between the atlas and the patient reduces the accuracy of the BP automatic segmentation result.

  5. Brachial Plexus-Associated Neuropathy After High-Dose Radiation Therapy for Head-and-Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Allen M., E-mail: allen.chen@ucdmc.ucdavis.edu [Department of Radiation Oncology, University of California, Davis School of Medicine, Sacramento, California (United States); Hall, William H. [Department of Radiation Oncology, University of California, Davis School of Medicine, Sacramento, California (United States); Li, Judy; Beckett, Laurel [Department of Biostatistics, University of California, Davis School of Medicine, Sacramento, California (United States); Farwell, D. Gregory [Department of Otolaryngology-Head and Neck Surgery, University of California, Davis School of Medicine, Sacramento, California (United States); Lau, Derick H. [Department of Medical Oncology, University of California, Davis School of Medicine, Sacramento, California (United States); Purdy, James A. [Department of Radiation Oncology, University of California, Davis School of Medicine, Sacramento, California (United States)

    2012-09-01

    Purpose: To identify clinical and treatment-related predictors of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer. Methods and Materials: Three hundred thirty patients who had previously completed radiation therapy for head-and-neck cancer were prospectively screened using a standardized instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from completion of radiation therapy was 56 months (range, 6-135 months). One-hundred fifty-five patients (47%) were treated by definitive radiation therapy, and 175 (53%) were treated postoperatively. Radiation doses ranged from 50 to 74 Gy (median, 66 Gy). Intensity-modulated radiation therapy was used in 62% of cases, and 133 patients (40%) received concurrent chemotherapy. Results: Forty patients (12%) reported neuropathic symptoms, with the most common being ipsilateral pain (50%), numbness/tingling (40%), motor weakness, and/or muscle atrophy (25%). When patients with <5 years of follow-up were excluded, the rate of positive symptoms increased to 22%. On univariate analysis, the following factors were significantly associated with brachial plexus symptoms: prior neck dissection (p = 0.01), concurrent chemotherapy (p = 0.01), and radiation maximum dose (p < 0.001). Cox regression analysis confirmed that both neck dissection (p < 0.001) and radiation maximum dose (p < 0.001) were independently predictive of symptoms. Conclusion: The incidence of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer may be underreported. In view of the dose-response relationship identified, limiting radiation dose to the brachial plexus should be considered when possible.

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

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    Minko Minkov

    2012-11-01

    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.

  7. La prise en charge de la paralysie obstétricale du plexus brachial du ...

    African Journals Online (AJOL)

    Averagely, evaluations of the results were uncertain due to a high drop out rate. And finally the authors suggest that prevention should be refrained in our African context. Keywords: Physiotherapy – Obstetrical paralysis- Brachial plexus – Infancy ...

  8. Distal transfers as a primary treatment in obstetric brachial plexus palsy: a series of 20 cases.

    Science.gov (United States)

    Ghanghurde, B A; Mehta, R; Ladkat, K M; Raut, B B; Thatte, M R

    2016-10-01

    The purpose of this study was to examine the results of spinal accessory nerve to suprascapular nerve (with or without axillary nerve neurotization) and an Oberlin transfer as primary treatment in children with Narakas type I obstetric brachial plexus injuries, when parents refused to consent to conventional nerve trunk-/root-level reconstruction. A total of 20 children with poor shoulder abduction and no biceps antigravity function but with good hand function were treated with spinal accessory nerve to suprascapular nerve and an Oberlin transfer at a mean age of 5.8 months (SD 3.27; range 3-12.) All the patients were evaluated at a mean of 2.8 years (SD 0.8; range 1.5 to 3.8) post-operatively. Three patients were lost to follow-up. Of the remainder, 11 had grade 4+ power of elbow flexion and six patients had grade 4 power at 1 year follow-up; all had 4+ power of elbow flexion at final follow-up. At final follow-up the Mallet score was a mean of 15; (SD 4.22, range 9 to 20). Primary distal nerve transfers can give good outcomes in patients with obstetric brachial plexus injuries and may be an alternative to surgery on the nerve trunks IV. © The Author(s) 2016.

  9. Avaliação do ganho funcional do cotovelo com a cirurgia de Steindler na lesão do plexo braquial Evaluation of functional gain of the elbow following Steindler surgery for brachial plexus injury

    Directory of Open Access Journals (Sweden)

    Marcelo Rosa de Rezende

    2011-01-01

    Full Text Available OBJETIVO: Avaliar ganho de força e amplitude de movimento do cotovelo após cirurgia de Steindler Modificada em pacientes com lesão do tronco superior do plexo braquial. MÉTODO: Foram acompanhados de 1998 a 2007 onze pacientes com lesão traumática fechada do tronco superior do plexo braquial. Todos apresentavam evolução de pelo menos 1 ano da lesão e grau de força de flexão do cotovelo que variou de M1 a M3. Os pacientes foram submetidos à cirurgia de Steindler modificada e seguidos por período mínimo de 6 meses. Realizadas avaliações pré e pós-operatórias do ganho de força muscular, amplitude de movimento do cotovelo e pontuação conforme escala DASH. RESULTADOS: Dos onze pacientes analisados, nove (82% atingiram nível de força igual ou maior a M3 (MRC. Dois (18% chegaram ao nível de força M2(MRC. Observamos que os pacientes apresentaram ganho médio de amplitude de movimento do cotovelo pós-operatória de 43,45 graus. A média de flexão do cotovelo pós-operatória foi de 88 graus. Houve melhora da função do cotovelo demonstrada na Escala DASH em 81% dos pacientes do estudo. CONCLUSÃO: A cirurgia de Steindler Modificada mostrou-se eficaz no tratamento dos pacientes com lesão de tronco superior de plexo braquial, com ganho estatisticamente significativo de amplitude de movimento. Em todos os casos algum grau de ganho de força e amplitude de flexão do cotovelo, sendo tanto maior quanto maior a força muscular inicial. Nível de Evidência: Nível II, ensaio clínico prospective.OBJECTIVE: To evaluate the gain in strength and range of motion after modified Steindler surgery of the elbow in patients with lesions of the upper trunk of the brachial plexus. METHOD: From 1998 to 2007, eleven patients with traumatic closed upper trunk lesion of the brachial plexus were studied. All the patients had development of at least 1 year of injury and degree of strength of elbow flexion ranging from M1 to M3. The patients

  10. Variations in branching of the posterior cord of brachial plexus in a Kenyan population

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    Matakwa Ludia C

    2011-06-01

    Full Text Available Abstract Background Variations in the branching of posterior cord are important during surgical approaches to the axilla and upper arm, administration of anesthetic blocks, interpreting effects of nervous compressions and in repair of plexus injuries. The patterns of branching show population differences. Data from the African population is scarce. Objective To describe the branching pattern of the posterior cord in a Kenyan population. Materials and methods Seventy-five brachial plexuses from 68 formalin fixed cadavers were explored by gross dissection. Origin and order of branching of the posterior cord was recorded. Representative photographs were then taken using a digital camera (Sony Cybershot R, W200, 7.2 Megapixels. Results Only 8 out of 75 (10.7% posterior cords showed the classical branching pattern. Forty three (57.3% lower subscapular, 8(10.3% thoracodorsal and 8(10.3% upper subscapular nerves came from the axillary nerve instead of directly from posterior cord. A new finding was that in 4(5.3% and in 3(4% the medial cutaneous nerves of the arm and forearm respectively originated from the posterior cord in contrast to their usual origin from the medial cord. Conclusions Majority of posterior cords in studied population display a wide range of variations. Anesthesiologists administering local anesthetic blocks, clinicians interpreting effects of nerve injuries of the upper limb and surgeons operating in the axilla should be aware of these patterns to avoid inadvertent injury. A wider study of the branching pattern of infraclavicular brachial plexus is recommended.

  11. Utility of ultrasound in noninvasive preoperative workup of neonatal brachial plexus palsy.

    Science.gov (United States)

    Somashekar, Deepak K; Di Pietro, Michael A; Joseph, Jacob R; Yang, Lynda J-S; Parmar, Hemant A

    2016-05-01

    Ultrasound has been utilized in the evaluation of compressive and traumatic peripheral nerve pathology. To determine whether US can provide comprehensive evaluation of the post-ganglionic brachial plexus in the setting of neonatal brachial plexus palsy and whether this information can be used to guide preoperative nerve reconstruction strategies. In this retrospective cohort study, preoperative brachial plexus ultrasonography was performed in 52 children with neonatal brachial plexus palsy who were being considered for surgery. The 33 children who had surgery compose the patient cohort. The presence and location of post-ganglionic neuromas were evaluated by US and compared to the surgical findings. US evaluation of shoulder muscle atrophy was conducted as an indirect way to assess the integrity of nerves. Finally, we correlated glenohumeral joint laxity to surgical and clinical management. Ultrasound correctly identified 21 of 25 cases of upper trunk and middle trunk neuroma involvement (84% sensitivity for each). It was 68% sensitive and 40% specific in detection of lower trunk involvement. US identified shoulder muscle atrophy in 11 of 21 children evaluated; 8 of these 11 went on to nerve transfer procedures based upon the imaging findings. US identified 3 cases of shoulder joint laxity of the 13 children evaluated. All 3 cases were referred for orthopedic evaluation, with 1 child undergoing shoulder surgery and another requiring casting. Ultrasound can provide useful preoperative evaluation of the post-ganglionic brachial plexus in children with neonatal brachial plexus palsy.

  12. Platysma motor branch transfer in brachial plexus repair: report of the first case

    Directory of Open Access Journals (Sweden)

    Bertelli Jayme

    2007-05-01

    Full Text Available Abstract Background Nerve transfers are commonly employed in the treatment of brachial plexus injuries. We report the use of a new donor for transfer, the platysma motor branch. Methods A patient with complete avulsion of the brachial plexus and phrenic nerve paralysis had the suprascapular nerve neurotized by the accessory nerve, half of the hypoglossal nerve transferred to the musculocutaneous nerve, and the platysma motor branch connected to the medial pectoral nerve. Results The diameter of both the platysma motor branch and the medial pectoral nerve was around 2 mm. Eight years after surgery, the patient recovered 45° of abduction. Elbow flexion and shoulder adduction were rated as M4, according to the BMC. There was no deficit after the use of the above-mentioned nerves for transfer. Volitional control was acquired for independent function of elbow flexion and shoulder adduction. Conclusion The use of the platysma motor branch seems promising. This nerve is expendable; its section led to no deficits, and the relearning of motor control was not complicated. Further anatomical and clinical studies would help to clarify and confirm the usefulness of the platysma motor branch as a donor for nerve transfer.

  13. Pan-brachial plexus neuropraxia following lightning: A rare case report.

    Science.gov (United States)

    Patnaik, Ashis; Mahapatra, Ashok Kumar; Jha, Menka

    2015-01-01

    Neurological complications following lightning are rare and occur in form of temporary neurological deficits of central origin. Involvement of peripheral nervous system is extremely rare and only a few cases have been described in the literature. Isolated unilateral pan-brachial plexus neuropraxia has never been reported in the literature. Steroids have long been used for treatment of neuropraxia. However, their use in lightning neural injury is unique and requires special mention. We report a rare case of lightning-induced unilateral complete flaccid paralysis along with sensory loss in a young patient. Lightning typically causes central nervous involvement in various types of motor and sensory deficit. Surprisingly, the nerve conduction study showed the involvement of peripheral nervous system involvement. Steroids were administered and there was significant improvement in neurological functions within a short span of days. Patients' functions in the affected limb were normal in one month. Our case was interesting since it is the first such case in the literature where lightning has caused such a rare instance of unilateral pan-brachial plexus lesion. Such cases when seen, raises the possibility of more common central nervous system pathology rather than peripheral involvement. However, such lesions can be purely benign forms of peripheral nerve neuropraxia, which can be managed by steroid treatment without leaving any long-term neurological deficits.

  14. Superficial siderosis of the central nervous system due to brachial plexus injury: a case report; Siderose superficial do sistema nervoso central por lesao do plexo braquial: relato de caso

    Energy Technology Data Exchange (ETDEWEB)

    Setogutti, Enio Tadashi; Cassuriaga, Jefferson; Valduga, Simone Gianella [Fundacao Universitaria de Cardiologia, Porto Alegre, RS (Brazil). Instituto de Cardiologia. Setor de Ressonancia Magnetica]. E-mails: pesquisa@cardiologia.org.br; editoracao-pc@cardiologia.org.br; Lorenzzoni, Pablo Longhi; Severgnini, Giancarlo Muraro [Fundacao Universitaria de Cardiologia, Porto Alegre, RS (Brazil). Instituto de Cardiologia; Feldman, Carlos Jader [Fundacao Universitaria de Cardiologia, Porto Alegre, RS (Brazil). Instituto de Cardiologia. Setor de Radiologia

    2005-10-15

    Superficial siderosis can be caused by hemosiderin deposition o the leptomeninges and subpial layers of the neuro-axis due to recurrent subarachnoid haemorrhage. Probable intrathecal bleeding sites must be investigated. In ut t 50% of the patients the bleeding source may be identified and the progression of the disease can be interrupted. In this study, the authors present a case of superficial siderosis of the central nervous system developed two decades after a traumatic lesion of the brachial plexus.(author)

  15. MRI of the Brachial Plexus: Modified Imaging Technique Leading to a Better Characterization of Its Anatomy and Pathology

    Science.gov (United States)

    Torres, Carlos; Mailley, Kathleen; del Carpio O’Donovan, Raquel

    2013-01-01

    Summary Magnetic resonance imaging (MRI) is the imaging modality of choice for the evaluation of the brachial plexus due to its superior soft tissue resolution and multiplanar capabilities. The evaluation of the brachial plexus however represents a diagnostic challenge for the clinician and the radiologist. The imaging assessment of the brachial plexus, in particular, has been traditionally challenging due to the complexity of its anatomy, its distribution in space and due to technical factors. Herein, we describe a modified technique used in our institution for the evaluation of the brachial plexus which led to a substantial decrease in scanning time and to better visualization of all the segments of the brachial plexus from the roots to the branches, in only one or two images, facilitating therefore the understanding of the anatomy and the interpretation of the study. To our knowledge, we are the first group to describe this technique of imaging the brachial plexus. We illustrate the benefit of this modified technique with an example of a patient with a lesion in the proximal branches of the left brachial plexus that was clinically suspected but missed on conventional brachial plexus imaging for six consecutive years. In addition, we review the common and infrequent benign and malignant pathology that can affect the brachial plexus. PMID:24355190

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

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    Yong Jun Choi

    2013-01-01

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

  17. Perineural spread of melanoma to the brachial plexus: identifying the anatomic pathway(s).

    Science.gov (United States)

    Marek, Tomas; Laughlin, Ruple S; Howe, B Matthew; Spinner, Robert J

    2018-01-08

    Perineural spread of melanoma is a well-known mechanism of metastasis in cases involving cranial nerves. Brachial plexus involvement is rare and the pathway is unknown. A retrospective review of the Mayo Clinic database was performed to identify patients with a history of melanoma and brachial plexus compromise between 1994 and 2017. Inclusion criteria were a history of melanoma, a clinical diagnosis of brachial plexopathy, radiological features consistent with perineural spread and biopsy of melanoma within nerve. We identified 42 cases, 24 men and 18 women with a median age of 61 years (37 - 84 years) with a history of melanoma and a brachial plexopathy. After review of their clinical information, 2 cases fulfilled inclusion criteria. Both patients presented with progressive brachial plexopathy and imaging studies revealed features consistent with perineural spread. In 40 excluded cases, brachial plexopathy was caused by: metastasis to axillary lymph nodes (n = 11); trauma (n = 8); post-surgical sequelae (n = 7); tumors other than melanoma (n = 5); inflammation (n = 5); radiation (n = 2); a combination of radiation and post-surgical changes (n = 1); and radiculopathy (n = 1). The 2 identified cases both showed similar clinical and radiological features. We believe that there is a pattern of perineural spread to the brachial plexus through the cervical plexus. Literature review shows several recently published cases demonstrating an analogous mechanism of melanoma spread involving upper cervical nerves which supports our proposed pathway. Copyright © 2018. Published by Elsevier Inc.

  18. Successful Outcome of Triangle Tilt as Revision Surgery in a Pediatric Obstetric Brachial Plexus Patient with Multiple Previous Operations

    Science.gov (United States)

    Nath, Rahul K.

    2014-01-01

    Introduction. Obstetric brachial plexus injury (OBPI) occurs during the process of labor and childbirth. OBPI has been reported to be associated with shoulder dystocia, macrosomia, and breech delivery. Its occurrence in uncomplicated delivery is possible as well. Case Presentation. The patient in the present report is a 6.5-year-old girl, who suffered a severe brachial plexus injury at birth and had many reconstructive surgical procedures at an outside brachial plexus center before presenting to us. Discussion. The traditional surgical treatments by other surgical groups were unsuccessful and therefore the patient came to our clinic for further treatment. She had triangle tilt surgery with us, as a salvage procedure. Conclusion. The OBPI patient in this study clearly showed noticeable clinical and functional improvements after triangle tilt surgical management. The posture of the arm at rest was greatly improved to a more normal position, and hand to mouth movement was improved as well. Triangle tilt surgery should be conducted as a first choice treatment for medial rotation contracture of the shoulder in OBPI patients. PMID:25506033

  19. Evaluation of suprascapular nerve neurotization after nerve graft or transfer in the treatment of brachial plexus traction lesions.

    Science.gov (United States)

    Malessy, Martijn J A; de Ruiter, Godard C W; de Boer, Kees S; Thomeer, Ralph T W M

    2004-09-01

    The aim of this retrospective study was to evaluate the restoration of shoulder function by means of suprascapular nerve neurotization in adult patients with proximal C-5 and C-6 lesions due to a severe brachial plexus traction injury. The primary goal of brachial plexus reconstructive surgery was to restore biceps muscle function and, secondarily, to reanimate shoulder function. Suprascapular nerve neurotization was performed by grafting the C-5 nerve in 24 patients and by accessory or hypoglossal nerve transfer in 29 patients. Additional neurotization involving the axillary nerve was performed in 18 patients. Postoperative needle electromyography studies of the supraspinatus, infraspinatus, and deltoid muscles showed signs of reinnervation in most patients; however, active glenohumeral shoulder function recovery was poor. In nine (17%) of 53 patients supraspinatus muscle strength was Medical Research Council (MRC) Grade 3 or 4 and in four patients (8%) infraspinatus muscle power was MRC Grade 3 or 4. In 18 patients in whom deltoid muscle reinnervation was attempted, MRC Grade 3 or 4 function was demonstrated in two (11%). In the overall group, eight patients (15%) exhibited glenohumeral abduction with a mean of 44 +/- 17 degrees (standard deviation [SD]; median 45 degrees) and four patients (8%) exhibited glenohumeral exorotation with a mean of 48 +/- 24 degrees (SD; median 53 degrees). In only three patients (6%) were both functions regained. The reanimation of shoulder function in patients with proximal C-5 and C-6 brachial plexus traction injuries following suprascapular nerve neurotization is disappointingly low.

  20. Successful Outcome of Triangle Tilt as Revision Surgery in a Pediatric Obstetric Brachial Plexus Patient with Multiple Previous Operations

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    Rahul K. Nath

    2014-01-01

    Full Text Available Introduction. Obstetric brachial plexus injury (OBPI occurs during the process of labor and childbirth. OBPI has been reported to be associated with shoulder dystocia, macrosomia, and breech delivery. Its occurrence in uncomplicated delivery is possible as well. Case Presentation. The patient in the present report is a 6.5-year-old girl, who suffered a severe brachial plexus injury at birth and had many reconstructive surgical procedures at an outside brachial plexus center before presenting to us. Discussion. The traditional surgical treatments by other surgical groups were unsuccessful and therefore the patient came to our clinic for further treatment. She had triangle tilt surgery with us, as a salvage procedure. Conclusion. The OBPI patient in this study clearly showed noticeable clinical and functional improvements after triangle tilt surgical management. The posture of the arm at rest was greatly improved to a more normal position, and hand to mouth movement was improved as well. Triangle tilt surgery should be conducted as a first choice treatment for medial rotation contracture of the shoulder in OBPI patients.

  1. Anatomic Basis for Brachial Plexus Block at the Costoclavicular Space: A Cadaver Anatomic Study.

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    Sala-Blanch, Xavier; Reina, Miguel Angel; Pangthipampai, Pawinee; Karmakar, Manoj Kumar

    2016-01-01

    The costoclavicular space (CCS), which is located deep and posterior to the midpoint of the clavicle, may be a better site for infraclavicular brachial plexus block than the traditional lateral paracoracoid site. However, currently, there is paucity of data on the anatomy of the brachial plexus at the CCS. We undertook this cadaver anatomic study to define the anatomy of the cords of the brachial plexus at the CCS and thereby establish the anatomic basis for ultrasound-guided infraclavicular brachial plexus block at this proximal site. The anatomy and topography of the cords of the brachial plexus at the CCS was evaluated in 8 unembalmed (cryopreserved), thawed, fresh adult human cadavers using anatomic dissection, and transverse anatomic and histological sections, of the CCS. The cords of the brachial plexus were located lateral and parallel to the axillary artery at the CCS. The topography of the cords, relative to the axillary artery and to one another, in the transverse (axial) plane was also consistent at the CCS. The lateral cord was the most superficial of the 3 cords and it was always anterior to both the medial and posterior cords. The medial cord was directly posterior to the lateral cord but medial to the posterior cord. The posterior cord was the lateral most of the 3 cords at the CCS and it was immediately lateral to the medial cord but posterolateral to the lateral cord. The cords of the brachial plexus are clustered together lateral to the axillary artery, and share a consistent relation relative to one another and to the axillary artery, at the CCS.

  2. A giant plexiform schwannoma of the brachial plexus: case report

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    Kohyama Sho

    2011-11-01

    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.

  3. Does Brachial Plexus Blockade Result in Improved Pain Scores After Distal Radius Fracture Fixation? A Randomized Trial.

    Science.gov (United States)

    Galos, David K; Taormina, David P; Crespo, Alexander; Ding, David Y; Sapienza, Anthony; Jain, Sudheer; Tejwani, Nirmal C

    2016-05-01

    Distal radius fractures are very common injuries and surgical treatment for them can be painful. Achieving early pain control may help improve patient satisfaction and improve functional outcomes. Little is known about which anesthesia technique (general anesthesia versus brachial plexus blockade) is most beneficial for pain control after distal radius fixation which could significantly affect patients' postoperative course and experience. We asked: (1) Did patients receiving general anesthesia or brachial plexus blockade have worse pain scores at 2, 12, and 24 hours after surgery? (2) Was there a difference in operative suite time between patients who had general anesthesia or brachial plexus blockade, and was there a difference in recovery room time? (3) Did patients receiving general anesthesia or brachial plexus blockade have higher narcotic use after surgery? (4) Do patients receiving general anesthesia or brachial plexus blockade have higher functional assessment scores after distal radius fracture repair at 6 weeks and 12 weeks after surgery? A randomized controlled study was performed between February, 2013 and April, 2014 at a multicenter metropolitan tertiary-care referral center. Patients who presented with acute closed distal radius fractures (Orthopaedic Trauma Association 23A-C) were potentially eligible for inclusion. During the study period, 40 patients with closed, displaced, and unstable distal radius fractures were identified as meeting inclusion criteria and offered enrollment and randomization. Three patients (7.5%), all with concomitant injuries, declined to participate at the time of randomization as did one additional patient (2.5%) who chose not to participate, leaving a final sample of 36 participants. There were no dropouts after randomization, and analyses were performed according to an intention-to-treat model. Patients were randomly assigned to one of two groups, general anesthesia or brachial plexus blockade, and among the 36 patients

  4. Acute brachial plexus neuropathy with involvement of cranial nerves IX, X, XI and XII.

    Science.gov (United States)

    Zuberbuhler, Paz; León Cejas, Luciana V; Binaghi, Daniela; Reisin, Ricardo C

    2013-11-15

    Acute brachial plexus neuropathy is characterized by acute onset of shoulder girdle and arm pain, followed by weakness of the shoulder and arm muscles. It affects primarily nerves of the upper trunk of the brachial plexus and the long thoracic nerve. Cranial nerve involvement is an infrequent association and implies a diagnostic challenge. We report a unique case of acute brachial plexus neuropathy with involvement of the cranial nerves IX, X, XI and XII. Fifty six year-old woman who developed acute dysphonia, dysphagia and left shoulder pain, followed, six days later, by left arm weakness. Needle examination showed only fibrillation potentials and positive sharp waves in the left deltoid muscle. MRI of the brachial plexus shows enlargement of the trunks, cords and terminal branches, with mild gadolinium enhancement. This case illustrates the unique presentation of neuralgic amyotrophy with involvement of nerves outside the brachial plexus, and the importance of MRI for diagnosis, in the absence of electrophysiologic involvement. © 2013 Elsevier B.V. All rights reserved.

  5. Hourglass-Like Constriction of the Brachial Plexus in the Posterior Cord: A Case Report.

    Science.gov (United States)

    Nakagawa, Yasunobu; Hirata, Hitoshi

    2018-01-01

    Hourglass-like constrictions are fascicular conditions confirmed definitively by interfascicular neurolysis. Certain peripheral nerves have vulnerable areas such as around the elbow in the posterior interosseous nerve. We report the first hourglass-like constriction in the brachial plexus supplying the radial innervated forearm musculature. Preoperative magnetic resonance imaging (MRI) findings of the brachial plexus were consistent with neuralgic amyotrophy (NA). A 9-yr-old boy experienced worsening left arm pain and difficulty in elevating the shoulder. Sequentially, severe palsy emerged when extending the wrist, thumb, and fingers. Based on the clinical picture, we diagnosed him with NA. The oblique coronal T2-weighted short-tau inversion recovery images showed mildly diffuse enlargement and hyperintensity of the brachial plexus. He showed few signs of improvement and interfascicular neurolysis was performed 11 mo after the onset. One of the fascicles in the posterior cord had developed an hourglass-like constriction. Electrical stimulation confirmed that the fascicle supplied forearm muscles. His wrist and finger extension had almost recovered at the 12-mo postoperative visit. Hourglass-like constrictions can occur in the brachial plexus. Although surgical approaches for the constrictions are still controversial, several reports demonstrated their effectiveness. Meanwhile, concerning NA treatment, evidence on the surgical intervention is lacking. Brachial plexus MRI might help in discerning the lesion and planning treatment options including surgical interventions. Hourglass-like constrictions are a possible etiology for certain NA patients with residual symptoms or paresis.

  6. Comparison of Outside Versus Inside Brachial Plexus Sheath Injection for Ultrasound-Guided Interscalene Nerve Blocks.

    Science.gov (United States)

    Maga, Joni; Missair, Andres; Visan, Alex; Kaplan, Lee; Gutierrez, Juan F; Jain, Annika R; Gebhard, Ralf E

    2016-02-01

    Ultrasound-guided interscalene brachial plexus blocks are commonly used to provide anesthesia for the shoulder and proximal upper extremity. Some reviews identify a sheath that envelops the brachial plexus as a potential tissue plane target, and current editorials in the literature highlight the need to establish precise and reproducible injection targets under ultrasound guidance. We hypothesize that an injection of a local anesthetic inside the brachial plexus sheath during ultrasound-guided interscalene nerve blocks will result in enhanced procedure success and provide a consistent tissue plane target for this approach with a reproducible and characteristic local anesthetic spread pattern. Sixty patients scheduled for shoulder surgery with a preoperative interscalene block for postoperative pain management were enrolled in this prospective randomized observer-blinded study. Each patient was randomly assigned to receive a single-shot interscalene block either inside or outside the brachial plexus sheath. The rate of complete motor and sensory blocks of the axillary nerve territory 10 minutes after local anesthetic injection for the inside group was 70% versus 37% for the outside group (P complete sensory blockade. The incidence rates of transient paresthesia during needle passage were 6.7% for the outside group and 96.7% for the inside group (P randomized trial did not find any advantages to performing an interscalene block inside the brachial plexus sheath. There was a higher incidence of transient paresthesia when injections were performed inside compared to outside the sheath. © 2016 by the American Institute of Ultrasound in Medicine.

  7. A case study and literature review of surgical treatment for brachial plexus pain caused by Pancoast syndrome

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    Xian Hang

    2016-10-01

    Full Text Available This study reports the diagnosis and treatment of brachial plexus-associated intractable pain caused by Pancoast syndrome, along with the associated literature review, based on a patient we attended to in April 2011. A full examination was performed after his admission, and neurolysis was conducted on the right brachial plexus of lower trunk. Follow-ups and treatment evaluations were carried out 1, 2, 3, and 6 months after the initial neurolysis procedure, which was followed by a radiation therapy two months later. The patient’s pain symptoms were relieved and he partially regained sense awareness and movement of his right hand. We found that early clinical manifestations of Pancoast syndrome are atypical and are sometimes difficult to detect. It is very similar to brachial plexus injury-related pain, and the patient must be referred to an orthopaedics or hand surgery specialist for treatment. Therefore, improving medical practitioners’ general understanding of this disease is essential in order to avoid potential misdiagnoses.

  8. Rehabilitation of patients following traction lesions of the brachial plexus.

    Science.gov (United States)

    Wynn Parry, C B

    1984-01-01

    The management of patients with brachial plexus lesions requires a multidisciplinary approach. We insist on admission to our rehabilitation ward for a full assessment by the physiotherapist, occupational therapist, rehabilitation officer, and social worker when necessary. We confirm the diagnosis by clinical, electrophysiologic, and radiologic techniques and set out a plan of action, either involving definitive surgery or a conservative program involving functional splintage, relief of pain when possible, and return to work. We insist on regular follow-ups to check that the pain is still being relieved. At subsequent reviews it may become clear that spontaneous recovery is not going to occur, and a program of reconstructive surgery can be instituted. In general terms, three years or more should have elapsed before accepting that elbow flexion is not going to return. In patients with C5-C6 lesions, where elbow flexion is permanently paralyzed, the simple elbow lock splint may be perfectly satisfactory, but in some patients it may be wise to advise reconstructive procedure. In our experience the most satisfactory means of restoring elbow flexion is the Steindler flexor plasty, advancing the origins of the extensors and flexors of the forearm up the humerus. If present, latissimus dorsi can be transferred to replace the biceps. The pectoralis major transfer is useful but almost always requires an external rotation osteotomy, as there is too much adduction when the patient flexes the elbow. Finally, triceps can be transferred to biceps, but this is an operation that we do not like, as elbow extension is so useful.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. [Treatment of residual obstetrical brachial plexus palsy with tendon transfer].

    Science.gov (United States)

    Demirhan, Mehmet; Erdem, Mehmet; Uysal, Mustafa

    2002-01-01

    We evaluated the results of the correction of adduction and internal rotation deformities of the shoulder associated with residual obstetrical brachial plexus palsy (OBPP) by the transfer of latissimus dorsi and teres major muscles to the rotator cuff. In order to correct adduction and internal rotation deformities associated with residual OBPP, 10 patients (7 males, 3 females; mean age 8.1 years; range 4 to 19 years) underwent transfer of the latissimus dorsi and teres major muscles to the rotator cuff and lengthening of the pectoralis major tendon with Z-plasty. The right and left extremities were affected in seven and three patients, respectively. Involvement of the C5-C6 nerve roots was detected in four, and C5-C6-C7 nerve roots in six patients. In two patients with a positive Putti sign, axillary roentgenograms showed posterior subluxation of the humeral head, and magnetic resonance and computed tomography scans revealed type III glenohumeral deformity. Functional evaluations were made using a 5-point scoring system proposed by Mallet. The mean follow-up was 23.6 months (range 5 to 42 months). Postoperatively, the mean abduction and external rotation were 134.5 degrees (range 95 degrees to 170 degrees ) and 70 degrees (range 45 degrees to 90 degrees ), respectively. The mean global abduction score was 4, external rotation score was 4.2, and the scores assigned to the ability to move hand to the neck and mouth were 3.5. Of two patients with type III glenohumeral deformity, whose ages were four and 19 years, abduction and external rotation were 150 degrees and 45 degrees in the former, 135 degrees and 70 degrees in the latter, respectively. The transfer of the latissimus dorsi and teres major tendons is a necessary procedure to restore external rotation and abduction functions of paralysed shoulders. Compared to other techniques employed, it offers obvious advantages in terms of ease and cost, as well.

  10. Constraint-Induced Movement Therapy for Children with Obstetric Brachial Plexus Palsy: Two Single-Case Series

    Science.gov (United States)

    Buesch, Francisca Eugster

    2010-01-01

    The objective of this pilot study was to investigate the feasibility of constraint-induced movement therapy (CIMT) in children with obstetric brachial plexus palsy and receive preliminary information about functional improvements. Two patients (age 12 years) with obstetric brachial plexus palsy were included for a 126-h home-based CIMT…

  11. Radiologic manifestation of the malignant peripheral nerve sheet tumor involving the brachial plexus

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    Shima Aran, MD

    2017-09-01

    Full Text Available A 63-year-old African American female with history of bilateral breast cancer status after lumpectomy and radiation therapy presented with right hand, wrist, and arm pain. She was found to have a right axillary mass and a large lesion in the right brachial plexus. A biopsy of the brachial plexus mass came back as a malignant peripheral nerve sheath tumor. This case report illustrates the critical value of multiple imaging modalities in definitive diagnosis of this rare pathologic entity.

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

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    Lucélia Gonçalves Vieira

    2013-03-01

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

  13. Long-term clinical outcomes of spinal accessory nerve transfer to the suprascapular nerve in patients with brachial plexus palsy.

    Science.gov (United States)

    Emamhadi, Mohammadreza; Alijani, Babak; Andalib, Sasan

    2016-09-01

    For the reconstruction of brachial plexus lesions, restoration of elbow flexion and shoulder function is fundamental and is achieved by dual nerve transfers. Shoulder stabilization and movement are crucial in freedom of motion of the upper extremity. In patients with C5-C6 brachial plexus injury, spinal accessory nerve transfer to the suprascapular nerve and a fascicle of ulnar nerve to musculocutaneous nerve (dual nerve transfer) are carried out for restoration of shoulder abduction and elbow flexion, respectively. In the present study, we evaluated the long-term clinical outcomes of spinal accessory nerve transfer to the suprascapular nerve for restoration of shoulder abduction in patients with brachial plexus palsy undergoing a dual nerve transfer. In the present retrospective review, 22 consecutive subjects with upper brachial plexus palsy were assessed. All of the subjects underwent spinal accessory nerve transfer to the suprascapular nerve and a dual nerve transfer from the ulnar nerve to the biceps branch and from the median nerve to the brachialis branch of the musculocutaneous nerve simultaneously. All of the subjects were followed up for 18 to 24 months (average, 21.7 months) for assessing the recovery of the shoulder abduction and motor function. Spinal accessory nerve transfer to the suprascapular nerve showed a motor function recovery of M3 and M4 in 13.6 and 63.6% of the subjects, respectively. However, 22.7 % of the subjects remained with a motor function of M2. The mean of shoulder abduction reached 55.55 ± 9.95° (range, 40-72°). Altogether, good functional results regained in 17 out of 22 the subjects (77.2 %). Linear regression analysis showed that advanced age was a predictor of low motor functional grade. The evidence from the present study suggests that transferring spinal accessory nerve to the suprascapular nerve for restoring shoulder abduction is an effective and reliable treatment with high success rate in patients with brachial

  14. Evaluation of clonidine as an adjuvant to brachial plexus block and its comparison with tramadol

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    Prakash Kelika

    2017-01-01

    Conclusion: Clonidine in a dose of 1.5 μg/kg body weight provided the fastest onset of sensory as well as motor block and the longest duration of postoperative analgesia and thus is a good additive to local anesthetic solutions for brachial plexus blocks.

  15. Does the Addition of Tramadol and Ketamine to Ropivacaine Prolong the Axillary Brachial Plexus Block?

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    Ahmet Can Senel

    2014-01-01

    Full Text Available Background and Objectives. A prospective, randomized, controlled, double-blind clinical trial to assess the effect of tramadol and ketamine, 50 mg, added to ropivacaine in brachial plexus anesthesia. Methods. Thirty-six ASA physical statuses I and II patients, between 18 and 60 years of age, scheduled for forearm and hand surgery under axillary brachial plexus block, were allocated to 3 groups. Group R received 0.375% ropivacaine in 40 mL, group RT received 0.375% ropivacaine in 40 mL with 50 mg tramadol, and group RK received 0.375% ropivacaine in 40 mL with 50 mg ketamine for axillary brachial plexus block. The onset times and the duration of sensory and motor blocks, duration of analgesia, hemodynamic parameters, and adverse events (nausea, vomiting, and feeling uncomfortable were recorded. Results. The onset time of sensorial block was the fastest in ropivacaine + tramadol group. Duration of sensorial and motor block was the shortest in the ropivacaine + tramadol group. Duration of analgesia was significantly longer in ropivacaine + tramadol group. Conclusion. We conclude that when added to brachial plexus analgesia at a dose of 50 mg, tramadol extends the onset and duration time of the block and improves the quality of postoperative analgesia without any side effects.

  16. A comparison of the lateral and posterior approach for brachial plexus block.

    NARCIS (Netherlands)

    Rettig, H.C.; Gielen, M.J.M.; Jack, N.T.; Boersma, E.; Klein, J.

    2006-01-01

    BACKGROUND: Brachial plexus block by the posterior approach described by Pippa is not widely used in contrast to the lateral approach of Winnie. We compared the clinical efficacy of both approaches in a randomized prospective study. METHODS: Eighty patients, American Society of Anesthesiologists

  17. Bilateral brachial plexus blocks in a patient of hypertrophic obstructive cardiomyopathy with hypertensive crisis.

    Science.gov (United States)

    Pai, Rohini V Bhat; Hegde, Harihar V; Santhosh, McB; Roopa, S; Deshpande, Shrinivas S; Rao, P Raghavendra

    2013-01-01

    Hypertrophic obstructive cardiomyopathy (HOCM) is a challenge to anesthesiologists due to the complex pathophysiology involved and various perioperative complications associated with it. We present a 50-year-old man, a known case of HOCM, who successfully underwent emergency haemostasis, and debridement of the traumatically amputated right upper limb and the contused lacerated wound on the left forearm under bilateral brachial plexus blocks. His co-morbidities included hypertension (in hypertensive crisis) and diabetes mellitus. He was full stomach and also had an anticipated difficult airway. The management included invasive pressure monitoring and labetalol infusion for emergent control of blood pressure. The regional anaesthesia technique required careful consideration to the dosage of local anaesthetics and staggered performance of brachial plexus blocks on each of the upper limbs to avoid local anaesthetic toxicity. Even though bilateral brachial plexus blocks are rarely indicated, it seemed to be the most appropriate anaesthetic technique in our patient. With careful consideration of the local anaesthetic toxicity and meticulous technique, bilateral brachial plexus blocks can be successfully performed in those patients where general anaesthesia is deemed to be associated with higher risk.

  18. A clinical assessment tool for ultrasound-guided axillary brachial plexus block.

    LENUS (Irish Health Repository)

    Sultan, S F

    2012-05-01

    Competency in anesthesia traditionally has been determined subjectively in practice. Optimal training in procedural skills requires valid and reliable forms of assessment. The objective was to examine a procedure-specific clinical assessment tool for ultrasound-guided axillary brachial plexus block for inter-rater reliability and construct validity in a clinical setting.

  19. Bilateral brachial plexus blocks in a patient of hypertrophic obstructive cardiomyopathy with hypertensive crisis

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    Rohini V Bhat Pai

    2013-01-01

    Full Text Available Hypertrophic obstructive cardiomyopathy (HOCM is a challenge to anesthesiologists due to the complex pathophysiology involved and various perioperative complications associated with it. We present a 50-year-old man, a known case of HOCM, who successfully underwent emergency haemostasis, and debridement of the traumatically amputated right upper limb and the contused lacerated wound on the left forearm under bilateral brachial plexus blocks. His co-morbidities included hypertension (in hypertensive crisis and diabetes mellitus. He was full stomach and also had an anticipated difficult airway. The management included invasive pressure monitoring and labetalol infusion for emergent control of blood pressure. The regional anaesthesia technique required careful consideration to the dosage of local anaesthetics and staggered performance of brachial plexus blocks on each of the upper limbs to avoid local anaesthetic toxicity. Even though bilateral brachial plexus blocks are rarely indicated, it seemed to be the most appropriate anaesthetic technique in our patient. With careful consideration of the local anaesthetic toxicity and meticulous technique, bilateral brachial plexus blocks can be successfully performed in those patients where general anaesthesia is deemed to be associated with higher risk.

  20. Robot-Assisted Surgery of the Shoulder Girdle and Brachial Plexus

    Science.gov (United States)

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

    2014-01-01

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

  1. Ipsilateral Brachial Plexus Block and Hemidiaphragmatic Paresis as Adverse Effect of a High Thoracic Paravertebral Block

    NARCIS (Netherlands)

    Renes, Steven H.; van Geffen, Geert J.; Snoeren, Miranda M.; Gielen, Matthieu J.; Groen, Gerbrand J.

    Background: Thoracic paravertebral block is regularly used for unilateral chest and abdominal surgery and is associated with a low complication rate. Case Reports: We describe 2 patients with an ipsilateral brachial plexus block with Horner syndrome after a high continuous thoracic paravertebral

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

    Science.gov (United States)

    da Cunha, Anderson F; Strain, George M; Rademacher, Nathalie; Schnellbacher, Rodney; Tully, Thomas N

    2013-01-01

    To compare palpation-guided with ultrasound-guided brachial plexus blockade in Hispaniolan Amazon parrots. Prospective randomized experimental trial. Eighteen adult Hispaniolan Amazon parrots (Amazona ventralis) weighing 252-295 g. 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. 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. 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

  3. A Population-Based Analysis of Time to Surgery and Travel Distances for Brachial Plexus Surgery.

    Science.gov (United States)

    Dy, Christopher J; Baty, Jack; Saeed, Mohammed J; Olsen, Margaret A; Osei, Daniel A

    2016-09-01

    Despite the importance of timely evaluation for patients with brachial plexus injuries (BPIs), in clinical practice we have noted delays in referral. Because the published BPI experience is largely from individual centers, we used a population-based approach to evaluate the delivery of care for patients with BPI. We used statewide administrative databases from Florida (2007-2013), New York (2008-2012), and North Carolina (2009-2010) to create a cohort of patients who underwent surgery for BPI (exploration, repair, neurolysis, grafting, or nerve transfer). Emergency department and inpatient records were used to determine the time interval between the injury and surgical treatment. Distances between treating hospitals and between the patient's home ZIP code and the surgical hospital were recorded. A multivariable logistic regression model was used to determine predictors for time from injury to surgery exceeding 365 days. Within the 222 patients in our cohort, median time from injury to surgery was 7.6 months and exceeded 365 days in 29% (64 of 222 patients) of cases. Treatment at a smaller hospital for the initial injury was significantly associated with surgery beyond 365 days after injury. Patient insurance type, travel distance for surgery, distance between the 2 treating hospitals, and changing hospitals between injury and surgery did not significantly influence time to surgery. Nearly one third of patients in Florida, New York, and North Carolina underwent BPI surgery more than 1 year after the injury. Patients initially treated at smaller hospitals are at risk for undergoing delayed BPI surgery. These findings can inform administrative and policy efforts to expedite timely referral of patients with BPI to experienced centers. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-01-15

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

  5. [Short-term efficacy of multiple nerves branch transfer for treating superior trunk brachial plexus in jury].

    Science.gov (United States)

    Lu, Jiuzhou; Xu, Jianguang; Xu, Wendong; Xu, Lei; Gu, Shihui; Shen, Yundong; Zhao, Xin; Gu, Yudong

    2008-09-01

    To recover the loss of the shoulder and elbow function after superior trunks injury of brachial plexus through multiple nerves branch transfer simultaneously near the nerve entering points of recipient nerves. Four male patients (aged 21-39 years) with superior trunks injury of brachial plexus were treated from February to September 2007. All cases were injured in the traffic accident, left side in 1 case and right side in 3 cases, resulting in the loss of shoulder abduction, shoulder extorsion, shoulder lift and elbow flexion, and the increase of muscle strength of shoulder shrug, elbow extension and finger flexion to above or equal to 4th grade. Patients were hospitalized 3-11 months after injury. Electromyography showed that the functions of accessory nerve, ulnar nerve and the branch to long head of triceps brachii were good, but the function of median nerve was injured partially. The following multiple donor nerves transfer were performed under general anaesthesia, namely from posterior approach accessory nerve to suprascapular nerve, from triceps to axillary nerve, from the partial branch of ulnar nerve to the biceps and/or brachial is muscular branch of musculocutaneous nerve. All incisions healed by first intention. One case suffered postoperative numbness on the ulnar side of hand and was symptomatically relieved after expectant treatment, while 3 cases had no manifestation of the motor and sensory functional injury related to donor nerve. All patients were followed up for 7-12 months. All patients regained the shoulder abduction and the elbow flexion 3-4 months after operation and electromyography showed that there was the regenerative potential in 3 recipient muscles. The shoulder abduction, elbow flexion and the muscle strength of the patients was 30-65 degrees, 90-120 degrees and 3-4 grade, respectively, 6-7 months after operation. Twelve months after operation, the first patient's shoulder abduction, external rotation, superinduction and elbow flexion

  6. Anatomical Variations of Brachial Plexus in Adult Cadavers; A Descriptive Study

    Science.gov (United States)

    Emamhadi, Mohammadreza; Chabok, Shahrokh Yousefzadeh; Samini, Fariborz; Alijani, Babak; Behzadnia, Hamid; Firozabadi, Fariborz Ayati; Reihanian, Zoheir

    2016-01-01

    Background: Variations of the brachial plexus are common and a better awareness of the variations is of crucial importance to achieve successful results in its surgical procedures. The aim of the present study was to evaluate the anatomical variations of the brachial plexus in adult cadavers. Methods: Bilateral upper limbs of 32 fresh cadavers (21 males and 11 females) consecutively referred to Guilan legal medicine organization from November 2011 to September 2014, were dissected and the trunks, cords and terminal nerves were evaluated. Results: Six plexuses were prefixed in origin. The long thoracic nerve pierced the middle scalene muscle in 6 cases in the supra clavicular zone. The suprascapular nerve in 7 plexuses was formed from posterior division of the superior trunk. Five cadavers showed anastomosis between medial brachial cutaneous nerve and T1 root in the infra clavicular zone. Terminal branches variations were the highest wherein the ulnar nerve received a communicating branch from the lateral cord in 3 cases. The median nerve was formed by 2 lateral roots from lateral cord and 1 medial root from the medial cord in 6 cadavers. Some fibers from C7 root came to the musculocutaneous nerve in 8 cadavers. Conclusion: The correlation analysis between the variations and the demographic features was impossible due to the small sample size. The findings of the present study suggest a meta-analysis to assess the whole reported variations to obtain a proper approach for neurosurgeons. PMID:27517072

  7. Anatomical Variations of Brachial Plexus in Adult Cadavers; A Descriptive Study

    Directory of Open Access Journals (Sweden)

    Mohammadreza Emamhadi

    2016-07-01

    Full Text Available Background: Variations of the brachial plexus are common and a better awareness of the variations is of crucial importance to achieve successful results in its surgical procedures. The aim of the present study was to evaluate the anatomical variations of the brachial plexus in adult cadavers.   Methods: Bilateral upper limbs of 32 fresh cadavers (21 males and 11 females consecutively referred to Guilan legal medicine organization from November 2011 to September 2014, were dissected and the trunks, cords and terminal nerves were evaluated. Results: Six plexuses were prefixed in origin. The long thoracic nerve pierced the middle scalene muscle in 6 cases in the supra clavicular zone. The suprascapular nerve in 7 plexuses was formed from posterior division of the superior trunk. Five cadavers showed anastomosis between medial brachial cutaneous nerve and T1 root in the infra clavicular zone. Terminal branches variations were the highest wherein the ulnar nerve received a communicating branch from the lateral cord in 3 cases. The median nerve was formed by 2 lateral roots from lateral cord and 1 medial root from the medial cord in 6 cadavers. Some fibers from C7 root came to the musculocutaneous nerve in 8 cadavers. Conclusion: The correlation analysis between the variations and the demographic features was impossible due to the small sample size. The findings of the present study suggest a meta-analysis to assess the whole reported variations to obtain a proper approach for neurosurgeons.

  8. Brachial plexopathy

    Directory of Open Access Journals (Sweden)

    Satish V Khadilkar

    2013-01-01

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

  9. Participation restrictions among adolescents and adults with neonatal brachial plexus palsy: the patient perspective.

    Science.gov (United States)

    van der Holst, Menno; Groot, Jeroen; Steenbeek, Duco; Pondaag, Willem; Nelissen, Rob Ghh; Vliet Vlieland, Thea Pm

    2017-09-24

    To examine the impact of neonatal brachial plexus palsy (NBPP) on societal participation of adolescents and adults. This cross-sectional study was conducted among patients with NBPP, aged ≥16 years, who had visited our NBPP clinic. Patients completed questions on the influence of NBPP on their choices regarding education/work and their work-performance, the Impact on Participation/Autonomy questionnaire and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P). In addition, health-related quality of life (HRQoL) was assessed. Seventy-five patients participated (median age 20, inter quartile range 17-27). Twenty were full-time students, 28 students with a job, 21 employed, two unemployed, and four work-disabled. Sixty-six patients had had a job at some stage. Patients' overall HRQoL was comparable to the general population. 27/75 patients reported that NBPP had affected their choices regarding education and 26/75 those regarding work. 33/66 reported impact on their work performance. On the Impact on Participation/Autonomy questionnaire, 80% (49/61) reported restrictions in the work-and-education domain, 74% in social-relations and 67% in autonomy-outdoors. 37/61 reported participation restrictions on the USER-P. Although their overall HRQoL was not impaired, a substantial proportion of adolescent/adult patients reported that NBPP had an impact on choices regarding education and profession, as well as on work-performance. Restrictions in participation, especially in work and education were also reported. Guiding patients in making choices on education and work at an early stage and providing tailored physical as well as psychosocial care may prevent or address restrictions, which may improve participation. Implications for Rehabilitation Adolescent and adult patients with neonatal brachial plexus palsy perceive restrictions in societal participation, especially regarding the work-and-education domain. All patients with neonatal brachial plexus

  10. An estimation of the minimum effective anesthetic volume of 2% lidocaine in ultrasound-guided axillary brachial plexus block.

    LENUS (Irish Health Repository)

    O'Donnell, Brian D

    2009-07-01

    Ultrasound guidance facilitates precise needle and injectate placement, increasing axillary block success rates, reducing onset times, and permitting local anesthetic dose reduction. The minimum effective volume of local anesthetic in ultrasound-guided axillary brachial plexus block is unknown. The authors performed a study to estimate the minimum effective anesthetic volume of 2% lidocaine with 1:200,000 epinephrine (2% LidoEpi) in ultrasound-guided axillary brachial plexus block.

  11. brachial plexus blocks for upper extremity surgeries in a nigerian ...

    African Journals Online (AJOL)

    2011-04-04

    Apr 4, 2011 ... and oxygen therapy. To localise the target nerve/ plexus, paraesthesia was elicited by mechanical stimulation before injecting the local anaesthetic solution in four out of ten patients in 2008. In 2009,. PNS technique was employed in 36 BPB with muscle twitch at 0.2-0.4mA as end-point, while the remaining.

  12. Schwannoma of the left brachial plexus mimicking a ...

    African Journals Online (AJOL)

    schwannomas ofthe vagus and phrenic nervcs appeafing as medi— astinal masses”. Bmchial plexus schwannomatas have been reported to mani— fest as causing nerve compression symptoms8 which our patient cxperienced or an abnormal mediastinal shadow on plain chest— xray due to intrathoracïc extension'.

  13. Pulsed radiofrequency of brachial plexus under ultrasound guidance for refractory stump pain: a case report

    Directory of Open Access Journals (Sweden)

    Zheng B

    2017-11-01

    Full Text Available Bixin Zheng, Li Song, Hui Liu Department of Pain Management, West China Hospital of Sichuan University, Chengdu, China Abstract: The post-amputation (pain syndrome, including stump pain, phantom limb sensation, and phantom limb pain is common but difficult to treat. Refractory stump pain in the syndrome is an extremely challenging and troublesome clinical condition. Patients respond poorly to drugs, nerve blocks, and other effective treatments like spinal cord stimulation and surgery. Pulsed radiofrequency (PRF technique has been shown to be effective in reducing neuropathic pain. This report describes a patient with persistent and refractory upper limb stump pain being successfully relieved with PRF of brachial plexus under ultrasound guidance after a 6-month follow-up period, suggesting that PRF may be considered as an alternative treatment for refractory stump-neuroma pain. Keywords: ultrasound guidance, pulsed radiofrequency, brachial plexus, refractory stump pain 

  14. Dorsal Scapular Artery Variations and Relationship to the Brachial Plexus, and a Related Thoracic Outlet Syndrome Case.

    Science.gov (United States)

    Verenna, Anne-Marie A; Alexandru, Daniela; Karimi, Afshin; Brown, Justin M; Bove, Geoffrey M; Daly, Frank J; Pastore, Anthony M; Pearson, Helen E; Barbe, Mary F

    2016-01-01

    Rationale Knowledge of the relationship of the dorsal scapular artery (DSA) with the brachial plexus is limited. Objective We report a case of a variant DSA path, and revisit DSA origins and under-investigated relationship with the plexus in cadavers. Methods The DSA was examined in a male patient and 106 cadavers. Results In the case, we observed an unusual DSA compressing the lower plexus trunk, that resulted in intermittent radiating pain and paresthesia. In the cadavers, the DSA originated most commonly from the subclavian artery (71%), with 35% from the thyrocervical trunk. Nine sides of eight cadavers (seven females) had two DSA branches per side, with one branch from each origin. The most typical DSA path was a subclavian artery origin before passing between upper and middle brachial plexus trunks (40% of DSAs), versus between middle and lower trunks (23%), or inferior (4%) or superior to the plexus (1%). Following a thyrocervical trunk origin, the DSA passed most frequently superior to the plexus (23%), versus between middle and lower trunks (6%) or upper and middle trunks (4%). Bilateral symmetry in origin and path through the brachial plexus was observed in 13 of 35 females (37%) and 6 of 17 males (35%), with the most common bilateral finding of a subclavian artery origin and a path between upper and middle trunks (17%). Conclusion Variability in the relationship between DSA and trunks of the brachial plexus has surgical and clinical implications, such as diagnosis of thoracic outlet syndrome.

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

    LENUS (Irish Health Repository)

    O'Sullivan, Owen

    2012-07-13

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

  16. Prolonged blockade of the brachial plexus for the early rehabilitation of children with posttraumatic elbow contractures

    Directory of Open Access Journals (Sweden)

    D. V. Zabolotsky

    2015-01-01

    Full Text Available Objective. Improvement of surgical treatment outcomes in children with post-traumatic elbow contractures. Materials and methods. The study is based on the diagnostic findings of 48 children with post-traumatic elbow contractures who were treated at the Turner Scientific and Research Institute for Children’s Orthopedics. All children underwent complex rehabilitation after reconstructive intra-articular surgery to work out passive motions in the elbow using ARTROMOT-E2 device. The patients of the study group started rehabilitation in the first days after reconstructive intra-articular surgery in the background of prolonged blockade of the brachial plexus. In the control group, the rehabilitation was carried out traditionally on the 6th day after surgery without regional anesthesia. The patients of the study group were supplied with Contiplex SU perinural catheters for prolonged blockade of the brachial plexus using ultrasound (Edge SonoSite and neurostimulation (Stimuplex® HNS12 before surgery. For perioperative blockade of the brachial plexus we used intermittent injection of 0.5% ropivacaine (2 mg / kg. The severity of pain at the stages of rehabilitation was assessed using 10-point grading scale (FPS-R. The range of active and passive motions in the joints was evaluated by measuring the range of motions with a fleximeter. Results. Intermittent injection of ropivacaine before rehabilitation allowed to correct post-traumatic elbow contractures in children in the first days after surgery associated with the minimum subjective pain level and stable hemodynamic parameteres, accompanied with a significant increase of the elbow motion range in comparison with the group of the patients who were not performed regional anesthesia . Conclusion. Prolonged blockade of the brachial plexus in rehabilitation treatment of children with post-traumatic contractures provides appropriate analgesic and myoneural block components from the 1st day after intra

  17. Targeted fascicular biopsy of the brachial plexus: rationale and operative technique.

    Science.gov (United States)

    Laumonerie, Pierre; Capek, Stepan; Amrami, Kimberly K; Dyck, P James B; Spinner, Robert J

    2017-03-01

    OBJECTIVE Nerve biopsy is useful in the management of neuromuscular disorders and is commonly performed in distal, noncritical cutaneous nerves. In general, these procedures are diagnostic in only 20%-50%. In selected cases in which preoperative evaluation points toward a more localized process, targeted biopsy would likely improve diagnostic yield. The authors report their experience with targeted fascicular biopsy of the brachial plexus and provide a description of the operative technique. METHODS All cases of targeted biopsy of the brachial plexus biopsy performed between 2003 and 2015 were reviewed. Targeted nerve biopsy was performed using a supraclavicular, infraclavicular, or proximal medial arm approach. Demographic data and clinical presentation as well as the details of the procedure, adverse events (temporary or permanent), and final pathological findings were recorded. RESULTS Brachial plexus biopsy was performed in 74 patients (47 women and 27 men). The patients' mean age was 57.7 years. All patients had abnormal findings on physical examination, electrodiagnostic studies, and MRI. The overall diagnostic yield of biopsy was 74.3% (n = 55). The most common diagnoses included inflammatory demyelination (19), breast carcinoma (17), neurolymphomatosis (8), and perineurioma (7). There was a 19% complication rate; most of the complications were minor or transient, but 4 patients (5.4%) had increased numbness and 3 (4.0%) had additional weakness following biopsy. CONCLUSIONS Targeted fascicular biopsy of the brachial plexus is an effective diagnostic procedure, and in highly selected cases should be considered as the initial procedure over nontargeted, distal cutaneous nerve biopsy. Using MRI to guide the location of a fascicular biopsy, the authors found this technique to produce a higher diagnostic yield than historical norms as well as providing justification for definitive treatment.

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

    OpenAIRE

    Cevdet Düger; Ahmet Cemil İsbir; İclal Özdemir Kol,; Kenan Kaygusuz; Sinan Gürsoy,; Caner Mimaroğlu

    2013-01-01

    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 ...

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

    OpenAIRE

    Düger, Cevdet; İsbir, Ahmet; Özdemir Kol, İclal; Kaygusuz,Kenan; Gürsoy, Sinan; Mimaroğlu, Caner

    2012-01-01

    Abstract 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,...

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

    OpenAIRE

    Düger, Cevdet; İsbir, Ahmet Cemil; Özdemir Kol, İclal; Kaygusuz,Kenan; Gürsoy, Sinan; Mimaroğlu, Caner

    2013-01-01

    Abstract 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,...

  1. Progressive arm weakness and tonic hand spasm from multifocal motor neuropathy in the brachial plexus.

    Science.gov (United States)

    Veltkamp, R; Krause, M; Schranz, C; Meinck, H-M

    2003-08-01

    A 50-year-old waitress presented with a 10-year history of progressive weakness in her right arm without atrophy and with tonic hand spasms suggesting a central motor disorder. Electromyography, however, disclosed chronic neurogenic changes including fasciculations and atypical cramps. Isolated motor conduction block in the right brachial plexus suggested a variant of multifocal motor neuropathy. Strength recovered and cramps disappeared after intravenous immunoglobulins. Motor neuropathies may thus manifest with features of central motor disorders.

  2. Bilateral brachial plexus blocks in a patient of hypertrophic obstructive cardiomyopathy with hypertensive crisis

    OpenAIRE

    Bhat Pai, Rohini V; Hegde, Harihar V.; MCB, Santhosh; S Roopa; Shrinivas S Deshpande; P Raghavendra Rao

    2013-01-01

    Hypertrophic obstructive cardiomyopathy (HOCM) is a challenge to anesthesiologists due to the complex pathophysiology involved and various perioperative complications associated with it. We present a 50-year-old man, a known case of HOCM, who successfully underwent emergency haemostasis, and debridement of the traumatically amputated right upper limb and the contused lacerated wound on the left forearm under bilateral brachial plexus blocks. His co-morbidities included hypertension (in hypert...

  3. DEVELOPMENT AND DISTRIBUTION OF THE BRACHIAL PLEXUS IN BLUE-FRONTED PARROT (Amazona aestiva, Linnaeus, 1758

    Directory of Open Access Journals (Sweden)

    Rayssa Marley Nóbrega da Silva

    2015-07-01

    Full Text Available Local anesthetic procedures are commonly used in domestic and wild birds, because of its low cost and fast induction, as long as applied with great precision, which requires specific anatomical knowledge of the site of incision. This study aimed to establish the origin and distribution of the brachial plexus of the Blue-fronted Parrot (Amazona aestiva by anatomic dissection of the skin and musculature of 22 specimens (17 males and 5 females from the Wild Animals Screening Center of the Federal District after death by natural causes. The dissection work promoted the isolation of the forming roots of the brachial plexus, as well as its ramifications. The brachial plexus was formed by four trunks, including the ventral spinal cord rami segments from C9 to C10, C10 to C11, C11 to T1 and T1 to T2, which joined into a short common trunk, branched into dorsal and ventral cords. The thin nerves subcoracoideus and subscapularis and the branch to the scapulohumeralis muscle originated from the common trunk. The dorsal cord originated the anconeal, axillaris and radialis nerves, while the ventral cord gave origin for the pectoralis cranialis, pectoralis caudalis, coracobrachialis and medianoulnaris. These branches innervated the muscles of the extensor and flexor compartments of the forelimb, pectoral muscles and overlying skin.

  4. Biceps Brachii Long Head Overactivity Associated with Elbow Flexion Contracture in Brachial Plexus Birth Palsy

    Science.gov (United States)

    Sheffler, Lindsey C.; Lattanza, Lisa; Sison-Williamson, Mitell; James, Michelle A.

    2012-01-01

    Background: The etiology of elbow flexion contracture in children with brachial plexus birth palsy remains unclear. We hypothesized that the long head of the biceps brachii muscle assists with shoulder stabilization in children with brachial plexus birth palsy and that overactivity of the long head during elbow and shoulder activity is associated with an elbow flexion contracture. Methods: Twenty-one patients with brachial plexus birth palsy-associated elbow flexion contracture underwent testing with surface electromyography. Twelve patients underwent repeat testing with fine-wire electromyography. Surface electrodes were placed on the muscle belly, and fine-wire electrodes were inserted bilaterally into the long and short heads of the biceps brachii. Patients were asked to perform four upper extremity tasks: elbow flexion-extension, hand to head, high reach, and overhead ball throw. The mean duration of muscle activity in the affected limb was compared with that in the contralateral, unaffected limb, which was used as a control. Three-dimensional motion analysis, surface dynamometry, and validated function measures were used to evaluate upper extremity kinematics, elbow flexor-extensor muscle imbalance, and function. Results: The mean activity duration of the long head of the biceps brachii muscle was significantly higher in the affected limb as compared with the contralateral, unaffected limb during hand-to-head tasks (p = 0.02) and high-reach tasks (p = 0.03). No significant differences in mean activity duration were observed for the short head of the biceps brachii muscle between the affected and unaffected limbs. Isometric strength of elbow flexion was not significantly higher than that of elbow extension in the affected limb (p = 0.11). Conclusions: Overactivity of the long head of the biceps brachii muscle is associated with and may contribute to the development of elbow flexion contracture in children with brachial plexus birth palsy. Elbow flexion

  5. Explaining daily functioning in young adults with obstetric brachial plexus lesion.

    Science.gov (United States)

    de Heer, Conny; Beckerman, Heleen; Groot, Vincent de

    2015-01-01

    To study the influence of obstetric brachial plexus lesion (OBPL) on arm-hand function and daily functioning in adults, and to investigate the relationship of arm-hand function and pain to daily functioning. Adults with unilateral OBPL who consulted the brachial plexus team at the VU University Medical Center in the past were invited to participate. Daily functioning was measured with the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and the SF36, pain with VAS Pain Scales and arm-hand function with the Nine Hole Peg Test (9-HP-test) and the Action Research Arm Test (ARAT). Scores of the affected arm were compared to those of the non-affected arm or norm values for healthy controls. Twenty-seven persons (mean age 22, SD 4.2 years), of whom 10 men, participated. The ARAT and 9-HP-test scores for the affected arm were significantly worse than those for the non-affected arm. Moderate to severe pain in the affected arm, the non-affected arm or the back was reported by 50% of the participants. The DASH general, sports/music and SF36 physical functioning scores were significantly worse than norm values. The ARAT/9-HP-test and daily functioning showed little association. Low to moderate associations were found between pain and daily functioning. Many young adults with OBPL experience limitations in daily functioning. Pain, rather than arm-hand function, seems to explain these limitations. Implications for Rehabilitation Obstetric brachial plexus lesion (OBPL) is caused by traction to the brachial plexus during labour, resulting in denervation of the muscles of the arm and shoulder girdle. Adults with OBPL are hardly seen in rehabilitation medicine. This study shows that many young adults with OBPL experience limitations in daily functioning. Pain, rather than arm-hand function, seems to explain these limitations. Fifty percent of the participants complained about moderate or severe pain, which was located in the affected arm, the back and the non

  6. The Prevalence, Rate of Progression, and Treatment of Elbow Flexion Contracture in Children with Brachial Plexus Birth Palsy

    Science.gov (United States)

    Sheffler, Lindsey C.; Lattanza, Lisa; Hagar, Yolanda; Bagley, Anita; James, Michelle A.

    2012-01-01

    Background: Elbow flexion contracture is a well-known complication of brachial plexus birth palsy that adversely affects upper-extremity function. The prevalence, risk factors, and rate of progression of elbow flexion contracture associated with brachial plexus birth palsy have not been established, and the effectiveness of nonoperative treatment involving nighttime splinting or serial casting has not been well studied. Methods: The medical records of 319 patients with brachial plexus birth palsy who had been seen at our institution between 1992 and 2009 were retrospectively reviewed to identify patients with an elbow flexion contracture (≥10°). The chi-square test for trend and the Kaplan-Meier estimator were used to evaluate risk factors for contracture, including age, sex, and the extent of brachial plexus involvement. Longitudinal models were used to estimate the rate of contracture progression and the effectiveness of nonoperative treatment. Results: An elbow flexion contracture was present in 48% (152) of the patients with brachial plexus birth palsy. The median age of onset was 5.1 years (range, 0.25 to 14.8 years). The contracture was ≥30° in 36% (fifty-four) of these 152 patients and was accompanied by a documented radial head dislocation in 6% (nine). The prevalence of contracture increased with increasing age (p contracture increased by 4.4% per year before treatment (p contracture decreased by 31% when casting was performed (p contracture did not improve when splinting was performed but the rate of increase thereafter decreased to contracture in children with brachial plexus birth palsy may be greater than clinicians perceive. The prevalence increased with patient age but was not significantly affected by sex or by the extent of brachial plexus involvement. Serial casting may initially improve severe contractures, whereas nighttime splinting may prevent further progression of milder contractures. Level of Evidence: Therapeutic Level IV. See

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

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    Amiri HR

    2009-05-01

    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

  8. [About of 82 obstetrical astro-articular injuries of the new-born (excepting brachial plexus palsies). Limits of initial therapeutic aggression and follow-up of evolution, particulary concerning traumatic separation of upper femoral epiphysis (author's transl)].

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    Lubrano di Diego, J G; Chappuis, J P; Montsegur, P; Kohler, R; Dodat, H; Bertrix, L; Eulry, M L; Daudet, M

    1978-01-01

    Obstetrical fracture has not a bad character, because of quick healing and, above all, because of extraordinary modelling by growth. The authors record 33 fractures of long bones which confirm this good prognosis. 20 birth fractures of the clavicule associated with brachial plexus palsies are recorded on account of their pathogenic, diagnostic and therapeutic intricacies. Prognosis of obstetrical traumatic separation of the epiphysis (epiphysiolysis) would be more preoccupying. This feeling is not given off the series of 28 observations recorded which conern 13 upper humeral, 6 lower humeral epiphysis, 1 of 6 upper femoral and 1 lower femoral epiphysis, of upper and lower of tibia. Diagnosis is not so easy, helped, if necessary, by arthrography. The clinical aspect of "pseudo-dislocation" associated with periostal callus, early appearing (about on the 10th day) rectifies diagnosis. Early treatment, as little aggressive as possible, (essentially orthopedic management by tractions along the axis of limb, giving up an anatomy as close as possible to normality) avoids sequellae, not existing at shoulder nor elbow and, if they exist, extremely decreased at hip, and the surgical management of which is always delayed. Initially good result of one birth dislocation of cervical spine, precedently recorded is considerably impaired.

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

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    Luane Lopes Pinheiro

    2013-09-01

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

  10. [Evaluation of brachial plexus fascicles involvement on infraclavicular block: unfixed cadaver study].

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    Gusmão, Luiz Carlos Buarque de; Lima, Jacqueline Silva Brito; Ramalho, Jeane da Rosa Oiticica; Leite, Amanda Lira Dos Santos; Silva, Alberson Maylson Ramos da

    2015-01-01

    This study shows how occurs the diffusion of the anesthetic into the sheath through the axiliary infraclavicular space and hence prove the efficacy of the anesthetic block of the brachial plexus, and may thereby allow a consolidation of this pathway, with fewer complications, previously attached to the anesthesia. 33 armpits of adult cadavers were analyzed and unfixed. We injected a solution of neoprene with latex dye in the infraclavicular space, based on the technique advocated by Gusmão et al., and put the corpses in refrigerators for three weeks. Subsequently, the specimens were thawed and dissected, exposing the axillary sheath along its entire length. Was demonstrated involvement of all fasciculus of the plexus in 51.46%. In partial involvement was 30.30%, and 18.24% of cases the acrylic was located outside the auxiliary sheath involving no issue. The results allow us to establish the infraclavicular as an effective and easy way to access plexus brachial, because the solution involved the fascicles in 81.76% partially or totally, when was injected inside the axillary sheath. We believe that only the use of this pathway access in practice it may demonstrate the efficiency. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  11. Evaluation of brachial plexus fascicles involvement on infraclavicular block: unfixed cadaver study.

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    de Gusmão, Luiz Carlos Buarque; Lima, Jacqueline Silva Brito; Ramalho, Jeane da Rosa Oiticica; Leite, Amanda Lira dos Santos; da Silva, Alberson Maylson Ramos

    2015-01-01

    This study shows how the diffusion of the anesthetic into the sheath occurs through the axillary infraclavicular space and hence proves the efficacy of the anesthetic block of the brachial plexus, and may thereby allow a consolidation of this pathway, with fewer complications, previously attached to the anesthesia. 33 armpits of adult cadavers were analyzed and unfixed. We injected a solution of neoprene with latex dye in the infraclavicular space, based on the technique advocated by Gusmão et al., and put the corpses in refrigerators for three weeks. Subsequently, the specimens were thawed and dissected, exposing the axillary sheath along its entire length. Was demonstrated involvement of all fasciculus of the plexus in 51.46%. In partial involvement was 30.30%, 18.24% of cases the acrylic was located outside the auxiliary sheath involving no issue. The results allow us to establish the infraclavicular as an effective and easy way to access plexus brachial, because the solution involved the fascicles in 81.76% partially or totally, when it was injected inside the axillary sheath. We believe that only the use of this pathway access in practice it may demonstrate the efficiency. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  12. Evaluation of brachial plexus fascicles involvement on infraclavicular block: unfixed cadaver study

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    Luiz Carlos Buarque de Gusmão

    2015-06-01

    Full Text Available BACKGROUND AND OBJECTIVES: This study shows how the diffusion of the anesthetic into the sheath occurs through the axillary infraclavicular space and hence proves the efficacy of the anesthetic block of the brachial plexus, and may thereby allow a consolidation of this pathway, with fewer complications, previously attached to the anesthesia. MATERIALS AND METHODS: 33 armpits of adult cadavers were analyzed and unfixed. We injected a solution of neoprene with latex dye in the infraclavicular space, based on the technique advocated by Gusmão et al., and put the corpses in refrigerators for three weeks. Subsequently, the specimens were thawed and dissected, exposing the axillary sheath along its entire length. RESULTS AND DISCUSSION: Was demonstrated involvement of all fasciculus of the plexus in 51.46%. In partial involvement was 30.30%, 18.24% of cases the acrylic was located outside the auxiliary sheath involving no issue. CONCLUSIONS: The results allow us to establish the infraclavicular as an effective and easy way to access plexus brachial, because the solution involved the fascicles in 81.76% partially or totally, when it was injected inside the axillary sheath. We believe that only the use of this pathway access in practice it may demonstrate the efficiency.

  13. Variations of the origin of collateral branches emerging from the posterior aspect of the brachial plexus

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    Ramirez Luis

    2007-06-01

    Full Text Available Abstract Background The frequency of variation found in the arrangement and distribution of the branches in the brachial plexus, make this anatomical region extremely complicated. The medical concerns involved with these variations include anesthetic blocks, surgical approaches, interpreting tumor or traumatic nervous compressions having unexplained clinical symptoms (sensory loss, pain, wakefulness and paresis, and the possibility of these structures becoming compromised. The clinical importance of these variations is discussed in the light of their differential origins. Methods The anatomy of brachial plexus structures from 46 male and 11 female cadaverous specimens were studied. The 40–80 year-old specimens were obtained from the Universidad Industrial de Santander's Medical Faculty's Anatomy Department (dissection laboratory. Parametric measures were used for calculating results. Results Almost half (47.1% of the evaluated plexuses had collateral variations. Subscapular nerves were the most varied structure, including the presence of a novel accessory nerve. Long thoracic nerve variations were present, as were the absence of C5 or C7 involvement, and late C7 union with C5–C6. Conclusion Further studies are needed to confirm the existence of these variations in a larger sample of cadaver specimens.

  14. Low-Volume Brachial Plexus Block Providing Surgical Anesthesia for Distal Arm Surgery Comparing Supraclavicular, Infraclavicular, and Axillary Approach. A Randomized Observer Blind Trial

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    Vazin, Mojgan; Jensen, Kenneth; Hjort, Mathias

    2016-01-01

    Background. Distal arm surgery is widely performed under regional anesthesia with brachial plexus block. The preponderance of evidence for the efficacy relies upon injection of local anesthetic in excess of 30 mL. We aimed to compare three different ultrasound-guided brachial plexus block techniq...

  15. Peripheral nerve stimulation (PNS) in the trapezius muscle region alleviate chronic neuropathic pain after lower brachial plexus root avulsion lesion: A case report

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    Sørensen, Jens Christian Hedemann; Meier, Kaare; Perinpam, Larshan

    Peripheral nerve stimulation (PNS) in the trapezius muscle region alleviate chronic neuropathic pain after lower brachial plexus root avulsion lesion: A case report......Peripheral nerve stimulation (PNS) in the trapezius muscle region alleviate chronic neuropathic pain after lower brachial plexus root avulsion lesion: A case report...

  16. Hoarseness of voice after supraclavicular ultrasound-guided subclavian perivascular brachial plexus block

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    Monika Gupta

    2017-01-01

    Full Text Available Supraclavicular brachial plexus nerve block is ideal for surgical procedures at or distal to the elbow. Ultrasound (USG continues to grow in popularity as a method of nerve localization, and for the supraclavicular block, it has the advantage of allowing real-time visualization of the plexus, pleura, and vessels along with the needle and local anesthetic spread, but it may conversely create a false sense of security. The incidence of the recurrent laryngeal nerve (RLN block occurring with supraclavicular approach is 1.3% of patients.[10] Incidence of RLN block with USG-guided supraclavicular block is not known. In this case report, we discuss a rare complication of RLN block which occurred while performing a supraclavicular perivascular block performed under USG guidance.

  17. Glenohumeral abduction contracture in children with unresolved neonatal brachial plexus palsy.

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    Eismann, Emily A; Little, Kevin J; Laor, Tal; Cornwall, Roger

    2015-01-21

    Following neonatal brachial plexus palsy, the Putti sign-obligatory tilt of the scapula with brachiothoracic adduction-suggests the presence of glenohumeral abduction contracture. In the present study, we utilized magnetic resonance imaging (MRI) to quantify this glenohumeral abduction contracture and evaluate its relationship to shoulder joint deformity, muscle atrophy, and function. We retrospectively reviewed MRIs of the thorax and shoulders obtained before and after shoulder rebalancing surgery (internal rotation contracture release and external rotation tendon transfer) for twenty-eight children with unresolved neonatal brachial plexus palsy. Two raters measured the coronal positions of the scapula, thoracic spine, and humeral shaft bilaterally on coronal images, correcting trigonometrically for scapular protraction on axial images. Supraspinatus, deltoid, and latissimus dorsi muscle atrophy was assessed, blinded to other measures. Correlations between glenohumeral abduction contracture and glenoid version, humeral head subluxation, passive external rotation, and Mallet shoulder function before and after surgery were performed. MRI measurements were highly reliable between raters. Glenohumeral abduction contractures were present in twenty-five of twenty-eight patients, averaging 33° (range, 10° to 65°). Among those patients, abductor atrophy was present in twenty-three of twenty-five, with adductor atrophy in twelve of twenty-five. Preoperatively, greater abduction contracture severity correlated with greater Mallet global abduction and hand-to-neck function. Abduction contracture severity did not correlate preoperatively with axial measurements of glenohumeral dysplasia, but greater glenoid retroversion was associated with worse abduction contractures postoperatively. Surgery improved passive external rotation, active abduction, and hand-to-neck function, but did not change the abduction contracture. A majority of patients with persistent shoulder weakness

  18. Sonographic Guidance for Supraclavicular Brachial Plexus Blocks: Single vs. Double Injection Cluster Approach.

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    Choi, Jung Ju; Kwak, Hyun Jeong; Jung, Wol Seon; Chung, Seung Hyun; Lee, Mi Geum

    2017-09-01

    The cluster approach for supraclavicular brachial plexus block (SC-BPB) can be easily performed but may result in asymmetric local anesthetic (LA) spread. The authors hypothesized that the use of a cluster approach in each of the 2 planes would achieve better 3-dimensional LA distribution than the traditional single cluster approach. The purpose of the present study was to compare a double injection (DI) in 2 planes (one injection in each plane) with the traditional single injection (SI) cluster approach for ultrasound-guided SC-BPB. A randomized, controlled trial. Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center. In the SI group (n = 18), 30 mL of LA was injected into the main neural cluster after penetrating the brachial plexus sheath laterally. In the DI group (n = 18), the needle penetrated the sheath in a downward direction at the first skin puncture, and 15 mL of LA was injected, and at the second skin puncture (behind the initial puncture site), the needle penetrated the sheath in an upward direction, and 15 mL was again injected. Ultrasound-guided SC-BPB was evaluated from immediately after the block every 5 minutes to 30 minutes by sensory and motor testing. The main outcome variables were procedural time; onset time (time for complete sensory and motor block of the median, radial, ulnar, and musculocutaneous nerves); and rate of blockage of all 4 nerves. Procedure times (medians [interquartile range]) were similar in the DI and SI groups (5.5 [4.75 - 8] vs. 5 [4 - 7] minutes, respectively; P = 0.137). Block onset time in the DI group was not significantly different from that in the SI group (10 [5 - 17.5] vs. 20 [6.25 - 30] minutes, P = 0.142). However, the rate of blockage of all 4 nerves was significantly higher in the DI group (94% vs. 67%, P = 0.035). Although the results of this study indicate LA distribution in the DI group was more evenly spread within brachial plexus sheaths than in the SI group, this was not

  19. Microsurgical technique in obstetric brachial plexus repair: a personal experience in 200 cases over 10 years

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    Ocampo-Pavez Claudia

    2007-01-01

    Full Text Available Abstract We present our personal operative technique in exposing and repairing obstetric brachial plexus (obp lesions. This technical description of the operative procedure and the strategic choice for the neurotisations are analysed with special regards on the follow-up of these patients (always performed by the surgeon, the histological quality of the proximal root stumps used for cable grafting, and the general reconstruction principles established in international workshops. We would like to encourage debate on these detailed considerations wherever they could affect the functional outcome.

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

    Science.gov (United States)

    Bertelli, Jayme Augusto; Ghizoni, Marcos Flávio

    2016-06-01

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

  1. A Case of Suspected Breast Cancer Metastasis to Brachial Plexus Detected by Magnetic Resonance Neurography

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    Atsushi Mizuma

    2016-07-01

    Full Text Available Metastasis of breast cancer is often detected through a long-term course and difficult to diagnose. We report a case of brachial plexopathy suspected to be the initial lesion of breast cancer metastasis, which was only detected by magnetic resonance (MR neurography. A 61-year-old woman was admitted to our hospital within 2 years after operation for breast cancer because of progressive dysesthesia and motor weakness initially in the upper limb on the affected side and subsequently on the contralateral side. Enhanced computed tomography, axillary lymph node echo, gallium scintigraphy, and short tau inversion recovery MR images showed no abnormalities. MR neurography revealed a swollen region in the left brachial plexus. We suspected neuralgic amyotrophy and initiated treatment with intravenous immunoglobulin therapy and steroid therapy. However, there was no improvement, and the progression of motor weakness in the bilateral lower limbs appeared over 4 years. Concomitant elevation of carbohydrate antigen 15-3 level (58.9 U/ml led us to suspect breast cancer metastasis, which was associated with the worsening of neurological findings, although gallium scintigraphy and bone scintigraphy showed no inflammatory and metastatic lesions. Swelling of the cauda equina in enhanced lumbar MR imaging and abnormal accumulation at the brachial plexus and cervical spinal cord in positron-emission tomography were newly detected contrary to the normal findings on the gallium scintigraphy, which suggested cerebrospinal fluid seeding. We suspected breast cancer metastasis about the initial brachial plexopathy based on the clinical course. MR neurography may be a helpful tool to detect metastatic lesion, especially in nerve roots.

  2. Results of intercostal nerve transfer to the musculocutaneous nerve in brachial plexus birth palsy.

    Science.gov (United States)

    Luo, Peng-Bo; Chen, Liang; Zhou, Cheng-Huan; Hu, Shao-Nan; Gu, Yu-Dong

    2011-12-01

    Intercostal nerve (ICN) transfer has been one of the main extraplexal nerve transfers in treating brachial plexus root avulsion. This retrospective study evaluated results of ICN transfer for reconstruction of the musculocutaneous nerve (MCN) in brachial plexus birth palsy (BPBP). Eighteen boys and 6 girls with BPBP, who had avulsion of at least 2 spinal nerves of the plexus, underwent ICN transfer for reconstruction of MCN, from March 2003 to October 2005. The brachial plexus lesion was diagnosed by clinical assessment, surgical exploration, and intraoperative neurophysiological investigations. The age at surgery ranged from 3 to 11 months of life, with a mean of 5 months. Two intercostals were used for one, 3 intercostals for 9, and 4 intercostals for 14 patients. The intercostals were transferred to MCN in 12 and to the anterior division of the upper trunk in the other 12 cases. Twenty-four children were followed up for 24 to 79 months, with an average of 53 months. No complications were found in the respiratory system. Of 14 transfers with 4 intercostals, biceps gained M4 strength in 8, M3 in 4, and M2 in 2. Of 9 transfers with 3 intercostals, biceps obtained M4 strength in 8 and M3 in 1. One transfer with 2 intercostals got M4 strength of biceps. Twelve patients whose intercostals were transferred to MCN, gained M4 strength of biceps in 11 and M3 in 1, whereas the other 12 patients with intercostals transferred to anterior division of the upper trunk, obtained M4 strength of biceps in 6, M3 in 4, and M2 in 2. The rate of M3 strength or more was 92% and that of M4 was 71%. ICN transfer is a safe and reliable procedure for reconstruction of the MCN in BPBP. There seems to be no difference of effects between transfers with 3 and those with 4 intercostals. The transferred nerves should be coapted to MCN, rather than a more proximal portion of the plexus. Level III: retrospective comparative study.

  3. Comprehensive approach to newborns and infants with brachial plexus impairment – proposal of Slovenian guidelines

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    Katja Groleger Sršen

    2015-06-01

    Full Text Available The impairment of brachial plexus (IBP in the neonate and infant remains an important problem. Risk factors for IBP are well known, but the mechanisms of impairment are not yet fully understood. It is important to identify early signs of IBP and to evaluate the hand function. In the guidelines we propose to use the Toronto scale for evaluation of hand function. The newborn with IBP should be referred to physiotherapy, and then regularly followed-up once a month. If the arm and hand function, especially flexion of the elbow, is not improving at the age of two months, the infant should be referred to the tertiary level rehabilitation centre and to department for plastic surgery at the University Medical Centre in Ljubljana. When necessary, the reconstructive procedure should be done by the age of three to six months. After reconstruction of brachial plexus, the child needs a comprehensive therapy program, which involves passive stretching, sensory stimulation, exercises to promote the development of active voluntary movements, bimanual activities, and symmetrical posture and movement patterns.

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

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    Alexandre Takeda

    2015-06-01

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

  5. [Faster onset time of supraclavicular brachial plexus block using local anesthetic diluted with dextrose].

    Science.gov (United States)

    Lim, Hong Jin; Hasan, Mohd Shahnaz; Chinna, Karuthan

    2016-01-01

    A high sodium concentration is known to antagonize local anesthetics when infiltrated around neural tissue. Thus, we hypothesized that the onset time for sensory and motor blockade, in supraclavicular brachial plexus block using ropivacaine diluted with dextrose would be shorter than with saline. Patients scheduled for upper limb surgery were randomized to receive ultrasound guided supraclavicular brachial plexus block with 0.5% ropivacaine. Evaluation of sensory and motor blockade was performed every 5min for 60min. Patients were followed-up on postoperative day 1, and between days 7 and 10 for the presence of any complications. Twenty-five patients in each group were analyzed. Mean time for onset of analgesia for the dextrose group was 37.6±12.9min while the mean time for the saline group was 45.2±13.9min with a p-value of 0.05. The effect size was 0.567, which was moderate to large. No major complications were observed. We conclude that there was a decrease in onset time of analgesia when dextrose was used as a diluent instead of saline for ultrasound guided supraclavicular block. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  6. Faster onset time of supraclavicular brachial plexus block using local anesthetic diluted with dextrose.

    Science.gov (United States)

    Lim, Hong Jin; Hasan, Mohd Shahnaz; Chinna, Karuthan

    2016-01-01

    A high sodium concentration is known to antagonize local anesthetics when infiltrated around neural tissue. Thus, we hypothesized that the onset time for sensory and motor blockade, in supraclavicular brachial plexus block using ropivacaine diluted with dextrose would be shorter than with saline. Patients scheduled for upper limb surgery were randomized to receive ultrasound guided supraclavicular brachial plexus block with 0.5% ropivacaine. Evaluation of sensory and motor blockade was performed every 5min for 60min. Patients were followed-up on postoperative day 1, and between days 7 and 10 for the presence of any complications. Twenty-five patients in each group were analyzed. Mean time for onset of analgesia for the dextrose group was 37.6±12.9min while the mean time for the saline group was 45.2±13.9min with a p-value of 0.05. The effect size was 0.567, which was moderate to large. No major complications were observed. We conclude that there was a decrease in onset time of analgesia when dextrose was used as a diluent instead of saline for ultrasound guided supraclavicular block. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  7. Faster onset time of supraclavicular brachial plexus block using local anesthetic diluted with dextrose

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    Hong Jin Lim

    Full Text Available Abstract Background and objectives: A high sodium concentration is known to antagonize local anesthetics when infiltrated around neural tissue. Thus, we hypothesized that the onset time for sensory and motor blockade, in supraclavicular brachial plexus block using ropivacaine diluted with dextrose would be shorter than with saline. Methods: Patients scheduled for upper limb surgery were randomized to receive ultrasound guided supraclavicular brachial plexus block with 0.5% ropivacaine. Evaluation of sensory and motor blockade was performed every 5 min for 60 min. Patients were followed-up on postoperative day 1, and between days 7 and 10 for the presence of any complications. Twenty-five patients in each group were analyzed. Results: Mean time for onset of analgesia for the dextrose group was 37.6 ± 12.9 min while the mean time for the saline group was 45.2 ± 13.9 min with a p-value of 0.05. The effect size was 0.567, which was moderate to large. No major complications were observed. Conclusion: We conclude that there was a decrease in onset time of analgesia when dextrose was used as a diluent instead of saline for ultrasound guided supraclavicular block.

  8. Extending the Indications for Primary Nerve Surgery in Obstetrical Brachial Plexus Palsy

    Directory of Open Access Journals (Sweden)

    Stuart A. Bade

    2014-01-01

    Full Text Available Purpose. This study identifies a small subset of patients with obstetrical brachial plexus palsy who, while they do not meet common surgical indications, may still benefit from primary nerve surgery. Methods. Between April 2004 and April 2009, 17 patients were offered primary nerve surgery despite not meeting the standard surgical indications of the authors. The authors performed a retrospective analysis of these 17 patients using prospectively collected data. Results. This group of 17 patients were identified as having poor shoulder function at about 9 months of age despite passing the Cookie Test. Fourteen patients underwent surgical intervention and three families declined surgery. All patients in the operative group regained some active external rotation after surgery. Five patients in this group have required further interventions. Two of the three patients for whom surgery was declined have had no subsequent spontaneous improvement in active external rotation. Discussion. The commonly used indications for primary nerve surgery in obstetrical brachial plexus palsy may not adequately identify all patients who may benefit from surgical intervention. Patients who pass the Cookie Test but have poor spontaneous recovery of active shoulder movements, particularly external rotation, may still benefit from primary nerve surgery.

  9. Posterior parasagittal in-plane ultrasound-guided infraclavicular brachial plexus block-a case series.

    Science.gov (United States)

    Beh, Zhi Yuen; Hasan, M Shahnaz; Lai, Hou Yee; Kassim, Normadiah M; Md Zin, Siti Rosmani; Chin, Kin Fah

    2015-07-21

    The brachial plexus at the infraclavicular level runs deeper compared to its course proximally, giving rise to impaired needle visualisation due to the steep angle of needle insertion with the current ultrasound-guided approach. A new posterior parasagittal in-plane ultrasound-guided infraclavicular approach was introduced to improve needle visibility. However no further follow up study was done. We performed a case series and a cadaveric dissection to assess its feasibility in a single centre, University of Malaya Medical Centre, Kuala Lumpur, Malaysia from November 2012 to October 2013. After obtaining approval from the Medical Ethics Committee, University Malaya Medical Centre, 18 patients undergoing upper limb surgery were prospectively recruited. A cadaveric dissection was also performed. The endpoints of this study were the success rate, performance time, total anaesthesia-related time, quality of anaesthesia and any incidence of complications. All patients had 100 % success rate. The imaging time, needling time and performance time were comparable with previously published study. There were no adverse events encountered in this study. The cadaveric dissection revealed a complete spread of methylene blue dye over the brachial plexus. This study demonstrated that the posterior parasagittal in-plane approach is a feasible and reliable technique with high success rate. Future studies shall compare this technique with the conventional lateral parasagittal in-plane approach. ClinicalTrials.gov NCT02312453 . Registered on 8 December 2014.

  10. Pneumothorax post brachial plexus block guided by ultrasound: a case report.

    Science.gov (United States)

    Mandim, Beatriz L S; Alves, Rodrigo R; Almeida, Rodrigo; Pontes, João Paulo J; Arantes, Lorena J; Morais, Fabíola P

    2012-01-01

    Brachial plexus block is used for upper limbs anesthesia. The use of ultrasound-guided (USG) technique for blockade has become popular in recent years, facilitating its execution by providing real-time images of the plexus and surrounding structures while minimizing complications. The purpose of this report is to describe a case of pneumothorax following ultrasound-guided interscalene block. Male patient, 49 years old, weight 62kg and height 1.72m, slender, smoker, asymptomatic, ASA II E. The patient underwent surgical repair of right ulna open fracture through USG-guided interscalene brachial plexus block with axillary supplementation. After sedation and antisepsis, the linear probe of the USG apparatus was placed perpendicular to the interscalene groove (12 Hz), and stimucath A50 introduced in plane. After visualization of nerve trunks, 20mL of ropivacaine 0.5% was administered with axillary block supplementation (same volume and concentration of anesthetic). At the end of surgery, the patient complained of respiratory-dependent chest pain associated with dyspnea and decreased pulse oximetry (91% in room air), but hemodynamic stable (BP=130/70 and HR=84 bpm). Although pulmonary auscultation was normal, chest X-ray showed the presence of right pneumothorax. Water seal chest drainage was performed, after which the patient reported improvement of symptoms and was discharged from hospital in good general condition after 8 days. Despite the dynamic visualization of cervical structures with USG, interscalene block may result in pneumothorax. An unusual higher pleural dome due to the hyperinflated lung (smoking) probably facilitated the accidental pleural puncture. Copyright © 2012 Elsevier Editora Ltda. All rights reserved.

  11. Contributions of muscle imbalance and impaired growth to postural and osseous shoulder deformity following brachial plexus birth palsy: a computational simulation analysis.

    Science.gov (United States)

    Cheng, Wei; Cornwall, Roger; Crouch, Dustin L; Li, Zhongyu; Saul, Katherine R

    2015-06-01

    Two potential mechanisms leading to postural and osseous shoulder deformity after brachial plexus birth palsy are muscle imbalance between functioning internal rotators and paralyzed external rotators and impaired longitudinal growth of paralyzed muscles. Our goal was to evaluate the combined and isolated effects of these 2 mechanisms on transverse plane shoulder forces using a computational model of C5-6 brachial plexus injury. We modeled a C5-6 injury using a computational musculoskeletal upper limb model. Muscles expected to be denervated by C5-6 injury were classified as affected, with the remaining shoulder muscles classified as unaffected. To model muscle imbalance, affected muscles were given no resting tone whereas unaffected muscles were given resting tone at 30% of maximal activation. To model impaired growth, affected muscles were reduced in length by 30% compared with normal whereas unaffected muscles remained normal in length. Four scenarios were simulated: normal, muscle imbalance only, impaired growth only, and both muscle imbalance and impaired growth. Passive shoulder rotation range of motion and glenohumeral joint reaction forces were evaluated to assess postural and osseous deformity. All impaired scenarios exhibited restricted range of motion and increased and posteriorly directed compressive glenohumeral joint forces. Individually, impaired muscle growth caused worse restriction in range of motion and higher and more posteriorly directed glenohumeral forces than did muscle imbalance. Combined muscle imbalance and impaired growth caused the most restricted joint range of motion and the highest joint reaction force of all scenarios. Both muscle imbalance and impaired longitudinal growth contributed to range of motion and force changes consistent with clinically observed deformity, although the most substantial effects resulted from impaired muscle growth. Simulations suggest that treatment strategies emphasizing treatment of impaired longitudinal

  12. Transfer of Pectoralis Major to Subscapularis in the Management of Brachial Plexus Birth Palsy Sequels.

    Science.gov (United States)

    Lahiji, Faryvar A; Tahririan, Mohammad A; Karami, Mohsen; Madadi, Firooz; Emami, Mohammad; Maleki, Arash

    Limitations in abduction and external rotation are the sequel of brachial palsy. The purpose of this study was to evaluate functional outcomes of modified L'Episcopo procedure in children with brachial palsy who do not have gross shoulder joint subluxation. From 2002 to 2012, a continuous series of 22 patients with brachial plexus birth palsy underwent a modified L'Episcopo procedure. Through an axillary approach, subscapularis release with latissimus dorsi rerouting and transfer of pectoralis major to subscapularis footprint was performed. The mean age of patients at surgery was 49 months. The mean follow-up time was 51 months (range, 24 to 90 mo). Preoperatively, the mean active abduction and external rotation were 77.5 and 2.5 degrees, respectively. The mean active abduction and external rotation were 135.6 and 32 degrees, respectively, at the final follow-up (P<0.001). This modified L'Episcopo technique is an effective and reproducible procedure that improves shoulder function significantly. Level III.

  13. Development of a set of activities to evaluate the arm and hand function in children with obstetric brachial plexus lesion

    NARCIS (Netherlands)

    Boeschoten, K. H.; Folmer, K. B.; van der Lee, J. H.; Nollet, F.

    2007-01-01

    OBJECTIVE: To develop an observational instrument that can be used to evaluate the quality of arm and hand skills in daily functional activities in children with obstetric brachial plexus lesion (OBPL). A set of functional activities was constructed and standardized, and the intra-observer

  14. Phantom Remodeling Effect of Dorsal Root Entry Zone Lesioning in Phantom Limb Pain Caused by Brachial Plexus Avulsion.

    Science.gov (United States)

    Son, Byung-Chul; Ha, Sang-Woo

    2015-01-01

    Dorsal root entry zone (DREZ) lesioning has been reported to be effective for phantom limb pain caused by brachial plexus avulsion pain. Most reports on DREZ lesioning for brachial plexus avulsion pain have focused on the results of pain relief without a detailed description of phantom sensations following DREZ lesioning. Two patients (1 with amputation and the other nonamputated) with chronic intractable phantom limb pain caused by brachial plexus avulsion underwent DREZ lesioning on the avulsed segments of the cervical spinal cords. Changes of the phantom limb were observed. Immediately following DREZ lesioning, the phantom limb pain disappeared in the amputee, the phantom arm was shortened and the phantom hand disappeared. The other patient with the nonamputated arm reported an immediate 50% reduction in the size of the phantom hand, and pain relief was up to 70% of the preoperative phantom limb pain. There was no further change in the phantom arm and hand during the follow-up of 1.5-2 years. The phantom arms and hands showed a prompt shortening and reduction in size, rather than a disappearance, following successful DREZ lesioning in patients with chronic phantom limb pain caused by brachial plexus avulsion. © 2015 S. Karger AG, Basel.

  15. A comparative study of brachial plexus sonography and magnetic resonance imaging in chronic inflammatory demyelinating neuropathy and multifocal motor neuropathy.

    Science.gov (United States)

    Goedee, H S; Jongbloed, B A; van Asseldonk, J-T H; Hendrikse, J; Vrancken, A F J E; Franssen, H; Nikolakopoulos, S; Visser, L H; van der Pol, W L; van den Berg, L H

    2017-10-01

    To compare the performance of neuroimaging techniques, i.e. high-resolution ultrasound (HRUS) and magnetic resonance imaging (MRI), when applied to the brachial plexus, as part of the diagnostic work-up of chronic inflammatory demyelinating neuropathy (CIDP) and multifocal motor neuropathy (MMN). Fifty-one incident, treatment-naive patients with CIDP (n = 23) or MMN (n = 28) underwent imaging of the brachial plexus using (i) a standardized MRI protocol to assess enlargement or T2 hyperintensity and (ii) bilateral HRUS to determine the extent of nerve (root) enlargement. We found enlargement of the brachial plexus in 19/51 (37%) and T2 hyperintensity in 29/51 (57%) patients with MRI and enlargement in 37/51 (73%) patients with HRUS. Abnormal results were only found in 6/51 (12%) patients with MRI and 12/51 (24%) patients with HRUS. A combination of the two imaging techniques identified 42/51 (83%) patients. We found no association between age, disease duration or Medical Research Council sum-score and sonographic nerve size, MRI enlargement or presence of T2 hyperintensity. Brachial plexus sonography could complement MRI in the diagnostic work-up of patients with suspected CIDP and MMN. Our results indicate that combined imaging studies may add value to the current diagnostic consensus criteria for chronic inflammatory neuropathies. © 2017 EAN.

  16. Accessory nerve to suprascapular nerve transfer to restore shoulder exorotation in otherwise spontaneously recovered obstetric brachial plexus lesions

    NARCIS (Netherlands)

    van Ouwerkerk, Willem J. R.; Uitdehaag, Bernard M. J.; Strijers, Rob L. M.; Nollet, Frans; Holl, Kurt; Fellner, Franz A.; Vandertop, W. Peter

    2006-01-01

    A systematic follow-up of infants with an obstetric brachial plexus lesion of C5 and C6 or the superior trunk showing satisfactory spontaneous recovery of shoulder and arm function except for voluntary shoulder exorotation, who underwent an accessory to suprascapular nerve transfer to improve active

  17. A comparative study of brachial plexus sonography and magnetic resonance imaging in chronic inflammatory demyelinating neuropathy and multifocal motor neuropathy

    NARCIS (Netherlands)

    Goedee, H S; Jongbloed, B A; van Asseldonk, J.T.H.; Hendrikse, J|info:eu-repo/dai/nl/266590268; Vrancken, A F J E|info:eu-repo/dai/nl/30354693X; Franssen, H|info:eu-repo/dai/nl/072250313; Nikolakopoulos, S; Visser, L H; van der Pol, W L|info:eu-repo/dai/nl/203721721; van den Berg, L H|info:eu-repo/dai/nl/288255216

    2017-01-01

    BACKGROUND AND PURPOSE: To compare the performance of neuroimaging techniques, i.e. high-resolution ultrasound (HRUS) and magnetic resonance imaging (MRI), when applied to the brachial plexus, as part of the diagnostic work-up of chronic inflammatory demyelinating neuropathy (CIDP) and multifocal

  18. Ultrasound-guided training in the performance of brachial plexus block by the posterior approach: an observational study.

    NARCIS (Netherlands)

    Geffen, G.J. van; Rettig, H.C.; Koornwinder, T.; Renes, S.; Gielen, M.J.M.

    2007-01-01

    The application of ultrasonography in guiding and controlling the path of the stimulating needle to the brachial plexus via the posterior approach (Pippa technique) was studied. In 21 ASA physical status 1 and 2 patients, scheduled for surgery of the shoulder or upper arm, needle insertion was

  19. Comparison between isotropic linear-elastic law and isotropic hyperelastic law in the finite element modeling of the brachial plexus.

    Science.gov (United States)

    Perruisseau-Carrier, A; Bahlouli, N; Bierry, G; Vernet, P; Facca, S; Liverneaux, P

    2017-12-01

    Augmented reality could help the identification of nerve structures in brachial plexus surgery. The goal of this study was to determine which law of mechanical behavior was more adapted by comparing the results of Hooke's isotropic linear elastic law to those of Ogden's isotropic hyperelastic law, applied to a biomechanical model of the brachial plexus. A model of finite elements was created using the ABAQUS® from a 3D model of the brachial plexus acquired by segmentation and meshing of MRI images at 0°, 45° and 135° of shoulder abduction of a healthy subject. The offset between the reconstructed model and the deformed model was evaluated quantitatively by the Hausdorff distance and qualitatively by the identification of 3 anatomical landmarks. In every case the Hausdorff distance was shorter with Ogden's law compared to Hooke's law. On a qualitative aspect, the model deformed by Ogden's law followed the concavity of the reconstructed model whereas the model deformed by Hooke's law remained convex. In conclusion, the results of this study demonstrate that the behavior of Ogden's isotropic hyperelastic mechanical model was more adapted to the modeling of the deformations of the brachial plexus. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  20. [Self-mutilation of the hand in a girl with total, persistent obstetric brachial plexus palsy--case report].

    Science.gov (United States)

    Sibiński, Marcin; Dorman, Tomsz; Synder, Marek

    2008-01-01

    A case of hand self-mutilation in six years old girl with totals persistent obstetric brachial plexus palsy was presented. Self-mutilation involved biting the tips of the digits what lead to removal of nail of IV finger and partial V finger distal phalanx amputation. Furthermore, possible etiology, mechanism, evaluation of this behavior and literature was discussed in the text.

  1. The SPA arrangement of the branches of the upper trunk of the brachial plexus: a correction of a longstanding misconception and a new diagram of the brachial plexus.

    Science.gov (United States)

    Hanna, Amgad

    2016-08-01

    OBJECT Brachial plexus (BP) diagrams in most textbooks and papers represent the branches and divisions of the upper trunk (UT) in the following sequence from cranial to caudal: suprascapular nerve, anterior division, and then posterior division. This concept contradicts what is seen in the operating room and is noticed by most peripheral nerve surgeons. This cadaveric study was conducted to look specifically at the exact pattern of branching of the upper trunk of the BP. METHODS Ten cadavers (20 BPs) were dissected. Both supra- and infraclavicular exposures were performed. The clavicle was retracted or resected to identify the divisions of the BP. A posterior approach was used in 2 cases. RESULTS In all dissections the origin of the posterior division was in a more cranial and dorsal plane in relation to the anterior division. In most dissections the supra scapular nerve branched off distally from the UT, giving it the appearance of a trifurcation, taking off just cranial and dorsal to the posterior division. The branching pattern of the UT consistently had the following sequential arrangement from cranial and posterior to caudal and anterior: suprascapular nerve (S), posterior division (P), and anterior division (A), hence the acronym SPA. CONCLUSIONS Supraclavicular exposure of the BP exposes only the trunks and divisions. Recognizing the "SPA" arrangement of the branches helps in identifying the correct targets for neurotization, especially given that these 3 branches are the most common targets for BP repair. Understanding the anatomy means better surgical planning and better patient outcomes.

  2. [Effects of different doses of dexmedetomidine combined with ropivacaine for brachial plexus nerve block in children undergoing polydactyly surgery].

    Science.gov (United States)

    Yang, Shi-Hui; Sun, Wei-Guo; Li, Yong-le; Chen, Xiang-Nan; Qi, Dong-Mei; Sun, Yi-Juan

    2017-06-20

    To observe the anesthetic effect and safety of different doses of dexmedetomidine combined with ropivacaine for brachial plexus nerve block in children undergoing polydactyly surgery. Eighty children undergoing polydactyly surgery were randomized into 4 groups to receive brachial plexus nerve block with dexmedetomidine at 0.25, 0.50 or 0.75 µg/kg combined with 0.25% ropivacaine (0.20 mL/kg) (D1, D2, and D3 groups, respectively) or with 0.25% ropivacaine (0.20 mL/kg) only (control group). The onset time, duration of brachial plexus nerve block, awakening time, success rate, and incidence of complications were compared among the groups. Results In D2 and D3 groups, the onset time and awakening time were shorter and anesthesia lasted longer than those in the control group. The onset time and awakening time were shorter and anesthesia maintenance time was longer in D3 group than in D1 group. The success rates of brachial plexus nerve block were significantly higher in D1-3 groups than in the control group (Pblock occurred in 1 child and respiratory depression in another; 2 or 3 patients had Horner syndrome, and 1 patient in D3 group experienced an episode of lowered heart beat to below 70 min(-1). All the complications were managed properly and the patients all recovered uneventfully. Brachial plexus nerve block with 0.5 µg/kg dexmedetomidine combined with 0.25% ropivacaine (0.20 mL/kg) is safe for effective anesthesia in children undergoing surgery for polydactyly.

  3. Forearm Pronation Osteotomy for Supination Contracture Secondary to Obstetrical Brachial Plexus Palsy: A Retrospective Cohort Study.

    Science.gov (United States)

    Gladstein, Aharon Z; Sachleben, Brant; Ho, Emily S; Anthony, Alison; Clarke, Howard M; Hopyan, Sevan

    2017-09-01

    Obstetrical brachial plexus palsy can lead to fixed forearm supination contracture. Fixed supination may lead to functional deficits as the affected hand cannot be positioned optimally for activities on a desk such as writing and typing, or for using tools including utensils, which require a neutral or pronated forearm. Forearm pronation osteotomy has been used to address this problem, although the functional benefit over nonoperative management has not been clearly defined. Potentially deleterious consequences on hand function that requires supination or fine motor skills are also uncertain. Patients with fixed forearm supination contracture were selected from our institutional brachial plexus database. Those who underwent both bone forearm rotational osteotomy were analyzed for age at time of surgery, preoperative forearm resting position, active and passive supination and pronation, and preoperative function assessed by the brachial plexus outcome measure (BPOM) and active movement scale (AMS). Preoperative results were compared with values obtained at follow-up at least 12 months postoperatively. A matched cohort of children with fixed forearm supination contracture that were treated nonoperatively and followed for at least 12 months, was also selected. For this group, forearm resting position, movement, AMS, and BPOM scores were analyzed at a baseline clinic visit and the most recent follow-up. Changes in forearm resting position, AMS, and BPOM activity scale scores were then compared between groups. Records were obtained for 14 cases and 10 controls. Study groups were similar with respect to resting forearm position, hand function, and time from initial to final evaluation. Groups differed with respect to age and active supination. We observed a statistically significant change in resting position among operative patients compared with their preoperative status and compared with controls. Hand-specific AMS score did not change significantly in the operative

  4. [Palsy of the upper limb: Obstetrical brachial plexus palsy, arthrogryposis, cerebral palsy].

    Science.gov (United States)

    Salazard, B; Philandrianos, C; Tekpa, B

    2016-10-01

    "Palsy of the upper limb" in children includes various diseases which leads to hypomobility of the member: cerebral palsy, arthrogryposis and obstetrical brachial plexus palsy. These pathologies which differ on brain damage or not, have the same consequences due to the early achievement: negligence, stiffness and deformities. Regular entire clinical examination of the member, an assessment of needs in daily life, knowledge of the social and family environment, are key points for management. In these pathologies, the rehabilitation is an emergency, which began at birth and intensively. Splints and physiotherapy are part of the treatment. Surgery may have a functional goal, hygienic or aesthetic in different situations. The main goals of surgery are to treat: joints stiffness, bones deformities, muscles contractures and spasticity, paresis, ligamentous laxity. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  5. [Brachial plexus compression from supraclavicular encapsulated fat necrosis. A case report].

    Science.gov (United States)

    Domínguez-Páez, Miguel; de Miguel-Pueyo, Luis; Marín-Salido, Esteban José; Carrasco-Brenes, Antonio; Martín-Gallego, Alvaro; Arráez-Sánchez, Miguel Ángel

    2014-01-01

    We report the case of a 44-year-old male, lacking clinical history of previous illness, who had surgery at our hospital to treat a mass in the supraclavicular space. The patient presented with a 1-month progressive distal paresis of the left arm. The histo-pathological examination of the mass revealed an encapsulated fat necrosis. Fat necrosis is characterised by cystic architecture, encapsulation with fat necrosis within, and inflammatory infiltration of its walls. Neural structure compression secondary to this tumour mass is very rare. Fat necrosis is more frequent in the lower limbs, in areas exposed to trauma. This article is the first report of brachial plexus compression due to supraclavicular fat necrosis. Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  6. High prevalence of cranial asymmetry exists in infants with neonatal brachial plexus palsy.

    Science.gov (United States)

    Tang, Megan; Gorbutt, Kimberly A; Peethambaran, Ammanath; Yang, Lynda; Nelson, Virginia S; Chang, Kate Wan-Chu

    2016-11-30

    This study aimed to: 1) evaluate the prevalence of cranial asymmetry (positional plagiocephaly) in infants with neonatal brachial plexus palsy (NBPP); 2) examine the association of patient demographics, arm function, and NBPP-related factors to positional plagiocephaly; and 3) determine percentage of spontaneous recovery from positional plagiocephaly and its association with arm function. Infants plagio group), including infants with resolved positional plagiocephaly (plagio-resolved subgroup); and 2) those who never had positional plagiocephaly (non-plagio group). Standard statistics were applied. Eighteen of 28 infants (64%) had positional plagiocephaly. Delivery type might be predictive for plagiocephaly. Infants in the non-plagio group exhibited more active range of motion than infants in the plagio group. All other factors had no significant correlations. A high prevalence of positional plagiocephaly exists among the NBPP population examined. Parents and physicians should encourage infants to use their upper extremities to change position and reduce chance of cranial asymmetry.

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

    Directory of Open Access Journals (Sweden)

    Vikas Trehan

    2010-01-01

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

  8. Effect of Verapamil as an Adjuvant to Levobupivacaine in Supraclavicular Brachial Plexus Block.

    Science.gov (United States)

    Routray, Sidharth Sraban; Mishra, Debasis; Routray, Daityari; Nanda, Kasturi

    2017-01-01

    Many adjuvants have been used with local anesthetics to reduce the time of onset and prolong the duration of analgesia in brachial plexus blocks. However, few studies are there using verapamil as an adjuvant with levobupivacaine. This study aims to study the effects of verapamil as adjuvant to levobupivacaine in supraclavicular block for upper extremity surgery. In this double-blinded clinical trial, 60 American Society of Anesthesiologist Class I and II patients posted to undergo upper extremity surgery were divided into 2 different groups randomly. In Group A, the patients received 30 ml levobupivacaine 0.5% plus 2 ml normal saline and Group B patients received 30 ml levobupivacaine 0.5% plus 5 mg verapamil diluted to 2 ml normal saline for supraclavicular block. Time of request for rescue analgesia, onset and duration of sensory motor blocks and changes in hemodynamic parameters were studied and analyzed. P < 0.001 was considered statistically significant. Time for a request for rescue analgesia was 425.80 ± 90.46 min in Group B and 366.13 ± 70.42 min in Group A which was clinically significant. The mean of sensory and motor block onset time in Group B was less than in Group A, the difference between the two groups being statistically significant (P < 0.001). In Group A, mean duration of sensory block was 316.13 ± 91.08 min and in Group B was 375.83 ± 114.48 min, which was statistically significant (P < 0.001). The addition of verapamil as an adjuvant to levobupivacaine in brachial plexus blockade delayed the requirement of rescue analgesia with decreased onset time and prolonged duration of sensory and motor block characteristics.

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

    Science.gov (United States)

    Takeda, Alexandre; Ferraro, Leonardo Henrique Cunha; Rezende, André Hosoi; Sadatsune, Eduardo Jun; Falcão, Luiz Fernando dos Reis; Tardelli, Maria Angela

    2015-01-01

    The use of ultrasound in regional anesthesia allows reducing the dose of local anesthetic used for peripheral nerve block. The present study was performed to determine the minimum effective concentration (MEC90) of bupivacaine for axillary brachial plexus block. Patients undergoing hand surgery were recruited. To estimate the MEC90, a sequential up-down biased coin method of allocation was used. The bupivacaine dose was 5 mL for each nerve (radial, ulnar, median, and musculocutaneous). The initial concentration was 0.35%. This concentration was changed by 0.05% depending on the previous block; a blockade failure resulted in increased concentration for the next patient; in case of success, the next patient could receive or reduction (0.1 probability) or the same concentration (0.9 probability). Surgical anesthesia was defined as driving force ≤ 2 according to the modified Bromage scale, lack of thermal sensitivity and response to pinprick. Postoperative analgesia was assessed in the recovery room with numeric pain scale and the amount of drugs used within 4h after the blockade. MEC90 was 0.241% [R(2): 0.978, confidence interval: 0.20-0.34%]. No patient, with successful block, reported pain after 4h. This study demonstrated that ultrasound guided axillary brachial plexus block can be performed with the use of low concentration of local anesthetics, increasing the safety of the procedure. Further studies should be conducted to assess blockade duration at low concentrations. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  10. [Pharmacokinetic and clinical effects of two bupivacaine concentrations on axillary brachial plexus block].

    Science.gov (United States)

    Ferraro, Leonardo H C; Takeda, Alexandre; Barreto, Cleber N; Faria, Bernadete; Assunção, Nilson A

    2017-10-16

    The risk of systemic bupivacaine toxicity is a persistent problem, which makes its pharmacokinetic study fundamental for regional anesthesia safety. There is little evidence of its influence on plasma peak at different concentrations. The present study compares two bupivacaine concentrations to establish how the concentration affects this drug plasma peak in axillary brachial plexus block. Postoperative latency and analgesia were also compared. 30 patients were randomized. In the 0.25% Group, 0.25% bupivacaine (10mL) was injected per nerve. In the 0.5% Group, 0.5% bupivacaine (5mL) was injected per nerve. Peripheral blood samples were collected during the first 2hours after the blockade. For sample analyses, high performance liquid chromatography mass spectrometry was used. Plasma peak occurred 45minutes after the blockade, with no difference between groups at the assessed time-points. Plasma peak was 933.97 ± 328.03 ng.mL-1 (mean ± SD) in 0.25% Group and 1022.79 ± 253.81 ng.mL-1 in 0.5% Group (p = 0.414). Latency was lower in 0.5% Group than in 0.25% Group (10.67 ± 3.71 × 17.33min ± 5.30, respectively, p = 0.004). No patient had pain within the first 4hours after the blockade. For axillary brachial plexus block, there was no difference in bupivacaine plasma peak despite the use of different concentrations with the same local anesthetic mass. The concentration inversely influenced latency. Copyright © 2017. Publicado por Elsevier Editora Ltda.

  11. C8 cross transfer for the treatment of caudal brachial plexus avulsion in three dogs.

    Science.gov (United States)

    Moissonnier, Pierre; Carozzo, Claude; Thibaut, Jean-Laurent; Escriou, Catherine; Hidalgo, Antoine; Blot, Stéphane

    2017-01-01

    To evaluate the cervical nerve 8 cross-transfer technique (C8CT) as a part of surgical treatment of caudal brachial plexus avulsion (BPA) in the dog. Case series. Client-owned dogs suspected to have caudal BPA based on neurological examination and electrophysiological testing (n = 3). The distal stump of the surgically transected contralateral C8 ventral branch (donor) was bridged to the proximal stump of the avulsed C8 ventral branch (recipient) and secured with 9-0 polypropylene suture under an operating microscope. A carpal panarthrodesis was performed on the injured limb after C8CT. Surgical exploration confirmed avulsion of nerve roots C7, C8, and T1 in all cases. There was no evidence of an iatrogenic effect on the donor forelimb. Gradual improvement in function of the affected forelimb occurred in all dogs, with eventual recovery of voluntary elbow extension. Reinnervation was evident in EMG recordings 6 months postoperatively in all three dogs. Stimulation of the donor C8 ventral branch led to motor evoked potentials in the avulsed side triceps brachialis and radial carpus extensor muscles. Variable functional outcome was observed in the 3 dogs during clinical evaluation 3-4 years after surgery. Digital abrasion wounds, distal interphalangeal infectious arthritis, and self-mutilation necessitated distal phalanx amputation of digits 3 and 4 in 2 dogs. C8CT provided partial reconnection of the donor C8 ventral branch to the avulsed brachial plexus in the 3 dogs of this series. Reinnervation resulted in active elbow extension and promoted functional recovery in the affected limb. © 2017 The American College of Veterinary Surgeons.

  12. Ultrasonographic Diagnosis of Thoracic Outlet Syndrome Secondary to Brachial Plexus Piercing Variation

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    Vanessa Leonhard

    2017-07-01

    Full Text Available Structural variations of the thoracic outlet create a unique risk for neurogenic thoracic outlet syndrome (nTOS that is difficult to diagnose clinically. Common anatomical variations in brachial plexus (BP branching were recently discovered in which portions of the proximal plexus pierce the anterior scalene. This results in possible impingement of BP nerves within the muscle belly and, therefore, predisposition for nTOS. We hypothesized that some cases of disputed nTOS result from these BP branching variants. We tested the association between BP piercing and nTOS symptoms, and evaluated the capability of ultrasonographic identification of patients with clinically relevant variations. Eighty-two cadaveric necks were first dissected to assess BP variation frequency. In 62.1%, C5, superior trunk, or superior + middle trunks pierced the anterior scalene. Subsequently, 22 student subjects underwent screening with detailed questionnaires, provocative tests, and BP ultrasonography. Twenty-one percent demonstrated atypical BP branching anatomy on ultrasound; of these, 50% reported symptoms consistent with nTOS, significantly higher than subjects with classic BP anatomy (14%. This group, categorized as a typical TOS, would be missed by provocative testing alone. The addition of ultrasonography to nTOS diagnosis, especially for patients with BP branching variation, would allow clinicians to visualize and identify atypical patient anatomy.

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

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    Prashant A Biradar

    2013-01-01

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

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

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

    2016-05-01

    Accepted indications for exploration in obstetrical brachial plexus palsy (OBPP) vary by center. Most agree that full elbow flexion against gravity at nine months of age implies high chance of spontaneous recovery and thus excludes a baby from surgical intervention. However, there are certain movements of the shoulder and forearm that may not be used frequently by the infant, but are extremely important functionally as they grow. These movements are difficult to assess in a baby and may lead to some clinicians to recommend conservative treatment, when this cohort of infants may in fact benefit substantially from surgery. A retrospective review was conducted on all infants managed surgically at the Brachial Plexus Center of a major children's hospital from 2009 to 2014. Further analysis identified five patients who had near-normal AMS scores for elbow flexion but who had weakness of shoulder abduction, flexion, external rotation, and/or forearm supination. In contrast to standard conservative management, this cohort underwent exploration, C5-6 neuroma excision, and sural nerve grafting. Data analysis was performed on this group to look for overall improvement in function. During an average follow-up period of 29 months, all patients made substantial gains in motor function of the shoulder and forearm, without loss of elbow flexion or extension, or worsening of overall outcome. In select infants with brachial plexus injuries but near-normal AMS scores for elbow flexion, surgical intervention may be indicated to achieve the best functional outcome. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  15. Diagnostic accuracy of MRI in adults with suspect brachial plexus lesions: A multicentre retrospective study with surgical findings and clinical follow-up as reference standard

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    Tagliafico, Alberto, E-mail: alberto.tagliafico@unige.it [Institute of Anatomy, Department of Experimental Medicine, University of Genoa, Largo Rosanna Benzi 8, 16132 Genoa (Italy); Succio, Giulia; Serafini, Giovanni [Department of Radiology, Santa Corona Hospital, Pietra Ligure, Italy via XXV Aprile, 38- Pietra Ligure, 17027 Savona (Italy); Martinoli, Carlo [Radiology Department, DISC, Università di Genova, Largo Rosanna Benzi 8, 16138 Genova (Italy)

    2012-10-15

    Objective: To evaluate brachial plexus MRI accuracy with surgical findings and clinical follow-up as reference standard in a large multicentre study. Materials and methods: The research was approved by the Institutional Review Boards, and all patients provided their written informed consent. A multicentre retrospective trial that included three centres was performed between March 2006 and April 2011. A total of 157 patients (men/women: 81/76; age range, 18–84 years) were evaluated: surgical findings and clinical follow-up of at least 12 months were used as the reference standard. MR imaging was performed with different equipment at 1.5 T and 3.0 T. The patient group was divided in five subgroups: mass lesion, traumatic injury, entrapment syndromes, post-treatment evaluation, and other. Sensitivity, specificity with 95% confidence intervals (CIs), positive predictive value (PPV), pre-test-probability (the prevalence), negative predictive value (NPV), pre- and post-test odds (OR), likelihood ratio for positive results (LH+), likelihood ratio for negative results (LH−), accuracy and post-test probability (post-P) were reported on a per-patient basis. Results: The overall sensitivity and specificity with 95% CIs were: 0.810/0.914; (0.697–0.904). Overall PPV, pre-test probability, NPV, LH+, LH−, and accuracy: 0.823, 0.331, 0.905, 9.432, 0.210, 0.878. Conclusions: The overall diagnostic accuracy of brachial plexus MRI calculated on a per-patient base is relatively high. The specificity of brachial plexus MRI in patients suspected of having a space-occupying mass is very high. The sensitivity is also high, but there are false-positive interpretations as well.

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

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

    2015-04-15

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

  17. Lack of physician-patient communication as a key factor associated with malpractice litigation in neonatal brachial plexus palsy.

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    Domino, Joseph; McGovern, Connie; Chang, Kate W C; Carlozzi, Noelle E; Yang, Lynda J S

    2014-02-01

    Perinatal disorders are prone to malpractice litigation. Neonatal brachial plexus palsy (NBPP) results from stretching the nerves in the perinatal period and may lead to paresis or paralysis and sensory loss in the affected arm. Little is known about the key factors associated with malpractice litigation by families of patients with NBPP and whether these factors reflect the practice environment or are inherent to the condition. In this study, the authors documented the percentage of families of NBPP patients at a specialty center that had filed a malpractice suit and described the key factors associated with that pursuit of legal action. The families/caregivers of 51 patients with NBPP who had presented to the University of Michigan Interdisciplinary Brachial Plexus Program participated in this study. A qualitative research design was applied using both a questionnaire to examine psychosocial factors and a dynamic tool to measure health outcomes from the patient perspective via parent proxy (Patient-Reported Outcomes Measurement Information System [PROMIS] assessment instruments). Statistical analysis included the Fisher exact test, chi-square test, and Student t-test. The study protocol was approved by the University of Michigan institutional review board. Forty-seven percent of the families pursued malpractice litigation. In comparing patient families that had pursued legal action with those that had not, significant differences were revealed in the perception that the sustained birth injury was unnecessary (p = 0.002), the information received in the perinatal period was inadequate (p = 0.003), family concerns were ignored in the perinatal period (p = 0.005), and family concerns were not adequately addressed (p communication in the perinatal period, are associated with malpractice litigation in NBPP. The perceived level of global disability may affect the pursuit of malpractice litigation, whereas the isolated extent of nerve root involvement and/or upper

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

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    Dushyant Sharma

    2013-01-01

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

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

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    Rao Vani

    2007-10-01

    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.

  20. Assessment of Self-Determination in Adolescents with Neonatal Brachial Plexus Palsy.

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    Bergman, Donna; Rasmussen, Lynnette; Chang, Kate Wan-Chu; Yang, Lynda J-S; Nelson, Virginia S

    2017-06-23

    The term self-determination refers to decision-making, goal setting, and perseverance to achieve those goals. Numerous studies have established the importance of self-determination to enhance learning and improve postschool outcomes. However, most studies evaluate students with learning disabilities, cognitive impairment, or behavioral disabilities. There is an absence of research on self-determination for adolescents with physical disabilities. To assess self-determination of adolescents with neonatal brachial plexus palsy (NBPP) compared with their typically developing peers via self-reported measures of function. Case-control study. Brachial plexus clinic. Twenty adolescents with NBPP (aged 10-17 years) and their parents and 20 age/gender-matched typically developing adolescents and their parents were recruited. Non-English-speaking participants and those with other physical impairments were excluded from study. Participants completed demographic and American Institutes for Research (AIR) self-determination surveys. One of two designated occupational therapists evaluated participant physical function. A demographic survey and AIR self-determination assessment were administered, and active range of motion measurements in shoulder forward flexion, elbow flexion, elbow extension, forearm pronation, and supination were obtained. Grip/pinch strength, MRC muscle strength, 9-Hole Peg Test, and Mallet scale scores also were evaluated. Despite physical differences, adolescents with NBPP presented similar self-determination levels as their typically developing peers. Adolescents with NBPP rated their opportunities to engage in self-determined behaviors at school significantly lower than at home. Both adolescents with NBPP and those in the control group rated their opportunities to engage in self-determined behaviors at school significantly lower than at home. Adolescents with NBPP presented similar self-determination scores as their age/gender-matched typically developing

  1. Quantitative magnetic resonance (MR) neurography for evaluation of peripheral nerves and plexus injuries

    Science.gov (United States)

    Barousse, Rafael; Socolovsky, Mariano; Luna, Antonio

    2017-01-01

    Traumatic conditions of peripheral nerves and plexus have been classically evaluated by morphological imaging techniques and electrophysiological tests. New magnetic resonance imaging (MRI) studies based on 3D fat-suppressed techniques are providing high accuracy for peripheral nerve injury evaluation from a qualitative point of view. However, these techniques do not provide quantitative information. Diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI) are functional MRI techniques that are able to evaluate and quantify the movement of water molecules within different biological structures. These techniques have been successfully applied in other anatomical areas, especially in the assessment of central nervous system, and now are being imported, with promising results for peripheral nerve and plexus evaluation. DWI and DTI allow performing a qualitative and quantitative peripheral nerve analysis, providing valuable pathophysiological information about functional integrity of these structures. In the field of trauma and peripheral nerve or plexus injury, several derived parameters from DWI and DTI studies such as apparent diffusion coefficient (ADC) or fractional anisotropy (FA) among others, can be used as potential biomarkers of neural damage providing information about fiber organization, axonal flow or myelin integrity. A proper knowledge of physical basis of these techniques and their limitations is important for an optimal interpretation of the imaging findings and derived data. In this paper, a comprehensive review of the potential applications of DWI and DTI neurographic studies is performed with a focus on traumatic conditions, including main nerve entrapment syndromes in both peripheral nerves and brachial or lumbar plexus. PMID:28932698

  2. A study of the formation and branching pattern of brachial plexus and its variations in adult human cadavers of north Karnataka

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    Sheetal V Pattanshetti

    2012-01-01

    Full Text Available Introduction and Objectives: The brachial plexus is highly variable, in its formation and branching pattern thus, knowledge of its anatomical patterns, may be insufficient for the surgeon operating on or around these nerves or for the regional anesthesiologist working in this area. Therefore, the present study was an attempt to study further about variations of brachial plexus encountered during routine dissection classes. Materials and Methods: The present descriptive study was carried out by dissection of 60 upper limbs of 30 cadavers, in the age group of 18 to 85 years, obtained during a study period of 2 years from the Department of Anatomy. The plexus was studied in its entire course commencing from the formation in cervical region, course through root of the neck and axilla, up to the main terminal branches of the upper extremity. During the dissection, variations of brachial plexus pertaining to its formation from the roots, trunks, divisions and cords and the branching pattern were observed and data was collected. Results: Out of the 60 cadaveric upper limbs studied for the anatomical variations of the brachial plexus, 2 limbs (3.33% were pre-fixed plexuses. Fusion of adjacent trunks was detected in 2 limbs (3.33%. Variations in branches of lateral cord were detected in 8 limbs (13.33%. Among Posterior cord variations 2-thoracodorsal nerves were detected in 2 limbs (3.33%. All the other branches from brachial plexus had been found to have no anatomical variations. Conclusion: In the present study, an attempt has been made to know the possible variations of the brachial plexus. Though the variations mentioned may not alter the normal functioning of the limb of the individual, but knowledge of the variations is of prime importance to be kept in mind, during anaesthetic and surgical procedures.

  3. Imaging assessment of glenohumeral dysplasia secondary to brachial plexus birth palsy

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    Chagas-Neto, Francisco Abaete [Universidade de Fortaleza (UNIFOR), Fortaleza, CE (Brazil). Divisao de Radiologia; Dalto, Vitor Faeda, E-mail: fdalto@gmail.com [Universidade de Sao Paulo (FMRP/USP), Ribeirao, Preto, SP (Brazil). Faculdade de Medicina. Divisao de Radiologia; Crema, Michel Daoud [Department of Radiology, Quantitative Imaging Center, University School of Medicine, Boston, MA (United States); Waters, Peter M. [Orthopedic Center, Boston Children' s Hospital, Harvard Medical School, Boston, MA (United States); Gregio-Junior, Everaldo [Uniao Medica Radiologica Catanduva (UMERC), Catanduva, SP (Brazil); Mazzer, Nilton; Nogueira-Barbosa, Marcello Henrique [Universidade de Sao Paulo (FM/USP), Ribeirao, Preto, SP (Brazil). Faculdade de Medicina

    2016-05-15

    Objective: to assess imaging parameters related to the morphology of the glenohumeral joint in children with unilateral brachial plexus birth palsy (BPBP), in comparison with those obtained for healthy shoulders. Materials and methods: we conducted a retrospective search for cases of unilateral BPBP diagnosed at our facility. Only patients with a clinical diagnosis of unilateral BPBP were included, and the final study sample consisted of 10 consecutive patients who were assessed with cross-sectional imaging. The glenoid version, the translation of the humeral head, and the degrees of glenohumeral dysplasia were assessed. Results: the mean diameter of the affected humeral heads was 1.93 cm, compared with 2.33 cm for those of the normal limbs. In two cases, there was no significant posterior displacement of the humeral head, five cases showed posterior subluxation of the humeral head, and the remaining three cases showed total luxation of the humeral head. The mean glenoid version angle of the affected limbs (90-α) was -9.6°, versus +1.6° for the normal, contralateral limbs. Conclusion: the main deformities found in this study were BPBP-associated retroversion of the glenoid cavity, developmental delay of the humeral head, and posterior translation of the humeral head. (author)

  4. Tendon transfer for treatment of internal rotation contracture of the shoulder in brachial plexus birth palsy.

    Science.gov (United States)

    Abdel-Ghani, H; Hamdy, K A; Basha, N; Tarraf, Y N

    2012-10-01

    We retrospectively analyzed 63 patients with internal rotation contracture of the shoulder secondary to brachial plexus birth palsy treated with subscapularis sliding combined with either latissimus dorsi transfer (group A: n = 18) or latissimus dorsi and teres major transfer (group B: n = 45) to the rotator cuff. The mean age at time of surgery was 43 months (SD 21 months; range 8 months to 9 years). We used a modification of the Gilbert shoulder grading system for assessment. All patients showed statistically significant improvement of active shoulder abduction and external rotation without significant differences between the two groups. Significant external rotation contracture of the shoulder (inability to touch the abdomen with the wrist extended) occurred in 42 of 63 patients, and there was a greater incidence of external rotation contracture in group B. We conclude that surgery should be restricted to latissimus dorsi transfer without teres major transfer to avoid external rotation contractures. Our modification of the Gilbert grading system appears to be valid and applicable.

  5. Serial casting for elbow flexion contractures in neonatal brachial plexus palsy.

    Science.gov (United States)

    Duijnisveld, B J; Steenbeek, D; Nelissen, R G H H

    2016-09-02

    The objective of this study was to evaluate the effectiveness of serial casting of elbow flexion contractures in neonatal brachial plexus palsy. A prospective consecutive cohort study was performed with a median follow-up of 5 years. Forty-one patients with elbow flexion contractures ≥ 30° were treated with serial casting until the contracture was ≤ 10°, for a maximum of 8 weeks. Range of motion, number of recurrences and patient satisfaction were recorded and analyzed using Wilcoxon signed-rank and Cox regression tests. Passive extension increased from a median of -40° (IQR -50 to -30) to -15° (IQR -10 to -20, p casting had to be prematurely replaced by night splinting due to complaints. Serial casting improved elbow flexion contractures, although recurrences were frequent. The severity of elbow flexion contracture is a predictor of recurrence. We recommend more research on muscle degeneration and determinants involved in elbow flexion contractures to improve treatment strategies and prevent side-effects.

  6. Imaging assessment of glenohumeral dysplasia secondary to brachial plexus birth palsy

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    Francisco Abaete Chagas-Neto

    2016-06-01

    Full Text Available Abstract Objective: To assess imaging parameters related to the morphology of the glenohumeral joint in children with unilateral brachial plexus birth palsy (BPBP, in comparison with those obtained for healthy shoulders. Materials and Methods: We conducted a retrospective search for cases of unilateral BPBP diagnosed at our facility. Only patients with a clinical diagnosis of unilateral BPBP were included, and the final study sample consisted of 10 consecutive patients who were assessed with cross-sectional imaging. The glenoid version, the translation of the humeral head, and the degrees of glenohumeral dysplasia were assessed. Results: The mean diameter of the affected humeral heads was 1.93 cm, compared with 2.33 cm for those of the normal limbs. In two cases, there was no significant posterior displacement of the humeral head, five cases showed posterior subluxation of the humeral head, and the remaining three cases showed total luxation of the humeral head. The mean glenoid version angle of the affected limbs (90-α was -9.6º, versus +1.6º for the normal, contralateral limbs. Conclusion: The main deformities found in this study were BPBP-associated retroversion of the glenoid cavity, developmental delay of the humeral head, and posterior translation of the humeral head.

  7. Imaging assessment of glenohumeral dysplasia secondary to brachial plexus birth palsy*

    Science.gov (United States)

    Chagas-Neto, Francisco Abaete; Dalto, Vitor Faeda; Crema, Michel Daoud; Waters, Peter M.; Gregio-Junior, Everaldo; Mazzer, Nilton; Nogueira-Barbosa, Marcello Henrique

    2016-01-01

    Objective To assess imaging parameters related to the morphology of the glenohumeral joint in children with unilateral brachial plexus birth palsy (BPBP), in comparison with those obtained for healthy shoulders. Materials and Methods We conducted a retrospective search for cases of unilateral BPBP diagnosed at our facility. Only patients with a clinical diagnosis of unilateral BPBP were included, and the final study sample consisted of 10 consecutive patients who were assessed with cross-sectional imaging. The glenoid version, the translation of the humeral head, and the degrees of glenohumeral dysplasia were assessed. Results The mean diameter of the affected humeral heads was 1.93 cm, compared with 2.33 cm for those of the normal limbs. In two cases, there was no significant posterior displacement of the humeral head, five cases showed posterior subluxation of the humeral head, and the remaining three cases showed total luxation of the humeral head. The mean glenoid version angle of the affected limbs (90-α) was -9.6º, versus +1.6º for the normal, contralateral limbs. Conclusion The main deformities found in this study were BPBP-associated retroversion of the glenoid cavity, developmental delay of the humeral head, and posterior translation of the humeral head. PMID:27403013

  8. The role of muscle imbalance in the pathogenesis of shoulder contracture after neonatal brachial plexus palsy: a study in a rat model.

    Science.gov (United States)

    Soldado, Francisco; Fontecha, Cesar G; Marotta, Mario; Benito, David; Casaccia, Marcelo; Mascarenhas, Vasco V; Zlotolow, Dan; Kozin, Scott H

    2014-07-01

    An internal rotation contracture of the shoulder is common after neonatal brachial plexus injuries due to subscapularis shortening and atrophy. It has been explained by 2 theories: muscle denervation and muscle imbalance between the internal and external rotators of the shoulder. The goal of this study was to test the hypothesis that muscle imbalance alone could cause subscapularis changes and shoulder contracture. We performed selective neurectomy of the suprascapular nerve in 15 newborn rats to denervate only the supraspinatus and the infraspinatus muscles, leaving the subscapularis muscle intact. After 4 weeks, passive shoulder external rotation was measured and a 7.2-T magnetic resonance imaging scan of the shoulders was used to determine changes in the infraspinatus and subscapularis muscles. The subscapularis muscle was weighed to determine the degree of mass loss. An additional group of 10 newborn rats was evaluated to determine the sectional muscle fiber size and muscle area of fibrosis by use of images from type I collagen immunostaining. There was a significant decrease in passive shoulder external rotation, with a mean loss of 66°; in the thickness of the denervated infraspinatus, with a mean loss of 40%; and in the thickness and weight of the non-denervated subscapularis, with mean losses of 28% and 25%, respectively. No differences were found in subscapularis muscle fiber size and area of fibrosis between shoulders after suprascapular nerve injury. Our study supports the theory that shoulder muscle imbalance is a cause of shoulder contracture in patients with neonatal brachial plexus palsy. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  9. Continuous interscalene brachial plexus block versus parenteral analgesia for postoperative pain relief after major shoulder surgery.

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    Ullah, Hameed; Samad, Khalid; Khan, Fauzia A

    2014-02-04

    Postoperative pain may lead to adverse effects on the body, which might result in an increase in morbidity. Its management therefore poses a unique challenge for the clinician. Major shoulder surgery is associated with severe postoperative pain, and different modalities are available to manage such pain, including opioid and non-opioid analgesics, local anaesthetics infiltrated into and around the shoulder joint and regional anaesthesia. All of these techniques, alone or in combination, have been used to treat the postoperative pain of major shoulder surgery but with varying success. The objective of this review was to compare the analgesic efficacy of continuous interscalene brachial plexus block (ISBPB) with parenteral opioid analgesia for pain relief after major shoulder surgery. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 12), MEDLINE (1950 to December 2012), EMBASE (1980 to December 2012), Web of Science (1954 to December 2012), CINAHL (1982 to December 2012) and bibliographies of published studies. We included randomized controlled trials assessing the effectiveness of continuous ISBPB compared with different forms of parenteral opioid analgesia in relieving pain in adult participants undergoing elective major shoulder surgery. Two review authors independently assessed trial quality and extracted outcome data. We included two randomized controlled trials (147 participants). A total of 17 participants were excluded from one trial because of complications related to continuous ISBPB (16) or parenteral opioid analgesia (one). Thus we have information on 130 participants (66 in the continuous ISBPB group and 64 in the parenteral opioid group). The studies were clinically heterogeneous. No meta-analysis was undertaken. However, results of the two included studies showed better pain relief with continuous ISBPB following major shoulder surgery and a lower incidence of complications when interscalene block is performed under

  10. Incidence of hemidiaphragmatic paresis after peripheral nerve stimulator versus ultrasound guided interscalene brachial plexus block

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    Poonam Sachin Ghodki

    2016-01-01

    Full Text Available Background and Aims: We compared interscalene brachial plexus block (ISBPB using peripheral nerve stimulation (PNS and ultrasound (US techniques. The primary outcomes were the incidence of hemidiaphragmatic paresis (HDP and the duration of the block. Secondary outcomes were the block success rate, time to conduct the block, onset of sensory block, and dermatomal spread, postoperative pain by Numeric Rating Scale (NRS, duration of postoperative analgesia and incidence of complications. Material and Methods: We conducted a prospective, randomized, and observer-blinded study in 60 patients undergoing shoulder arthroscopy under block plus general anesthesia. ISBPB was performed with 10 ml of 0.5% bupivacaine using either PNS (Group PNS, n = 30 or US (Group US, n = 30. Hemidiaphragmatic function, the primary outcome, was assessed by ultrasonographic evaluation of diaphragmatic movement and pulmonary function tests using a bedside spirometer (forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate. General anesthesia was administered to all the patients for surgery. P < 0.05 test was considered to be statistically significant. Results: Twelve patients in Group PNS had HDP and none in Group US (P < 0.0001. PFTs were also significantly reduced in Group PNS (P < 0.0001. The time to conduct the block and sensory onset time both were less in Group US (P < 0.05. The groups did not differ in block success rate, duration of analgesia, and NRS. Other complications like incidence of Horner′s syndrome and vascular puncture were comparable in both the groups. Conclusions: PNS guided ISBPB with 10 ml of 0.5% bupivacaine is associated with a higher incidence of HDP as compared to US guided ISBPB. There is no significant difference in quality or duration of analgesia in the two groups.

  11. Severe obstetric brachial plexus palsies can be identified at one month of age.

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    Martijn J A Malessy

    Full Text Available OBJECTIVE: To establish whether severe obstetric brachial plexus palsy (OBPP can be identified reliably at or before three months of age. METHODS: Severe OBPP was defined as neurotmesis or avulsion of spinal nerves C5 and C6 irrespective of additional C7-T1 lesions, assessed during surgery and confirmed by histopathological examination. We first prospectively studied a derivation group of 48 infants with OBPP with a minimal follow-up of two years. Ten dichotomous items concerning active clinical joint movement and needle electromyography of the deltoid, biceps and triceps muscles were gathered at one week, one month and three months of age. Predictors for a severe lesion were identified using a two-step forward logistic regression analysis. The results were validated in two independent cohorts of OBPP infants of 60 and 13 infants. RESULTS: Prediction of severe OBPP at one month of age was better than at one week and at three months. The presence of elbow extension, elbow flexion and of motor unit potentials in the biceps muscle correctly predicted whether lesions were mild or severe in 93.6% of infants in the derivation group (sensitivity 1.0, specificity 0.88, in 88.3% in the first validation group (sensitivity 0.97, specificity 0.76 and in 84.6% in the second group (sensitivity of 1.0, specificity 0.66. INTERPRETATION: Infants with OBPP with severe lesions can be identified at one month of age by testing elbow extension, elbow flexion and recording motor unit potentials (MUPs in the biceps muscle. The decision rule implies that children without active elbow extension at one month should be referred to a specialized center, while children with active elbow extension as well as active flexion should not. When there is active elbow extension, but no active elbow flexion an EMG is needed; absence of MUPs in the biceps muscle is an indication for referral.

  12. [Randomized prospective study of three different techniques for ultrasound-guided axillary brachial plexus block].

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    Ferraro, Leonardo Henirque Cunha; Takeda, Alexandre; Sousa, Paulo César Castello Branco de; Mehlmann, Fernanda Moreira Gomes; Junior, Jorge Kiyoshi Mitsunaga; Falcão, Luiz Fernando Dos Reis

    2017-06-23

    Randomized prospective study comparing two perivascular techniques with the perineural technique for ultrasound-guided axillary brachial plexus block (US-ABPB). The primary objective was to verify if these perivascular techniques are noninferior to the perineural technique. 240 patients were randomized to receive the techniques: below the artery (BA), around the artery (AA) or perineural (PN). The anesthetic volume used was 40mL of 0.375% bupivacaine. All patients received a musculocutaneous nerve blockade with 10mL. In BA technique, 30mL were injected below the axillary artery. In AA technique, 7.5mL were injected at 4 points around the artery. In PN technique, the median, ulnar, and radial nerves were anesthetized with 10mL per nerve. Confidence interval analysis showed that the perivascular techniques studied were not inferior to the perineural technique. The time to perform the blockade was shorter for the BA technique (300.4±78.4sec, 396.5±117.1sec, 487.6±172.6sec, respectively). The PN technique showed a lower latency time (PN - 655.3±348.9sec; BA -1044±389.5sec; AA-932.9±314.5sec), and less total time for the procedure (PN-1132±395.8sec; BA -1346.2±413.4sec; AA 1329.5±344.4sec). TA technique had a higher incidence of vascular puncture (BA - 22.5%; AA - 16.3%; PN - 5%). The perivascular techniques are viable alternatives to perineural technique for US-ABPB. There is a higher incidence of vascular puncture associated with the BA technique. Copyright © 2017. Publicado por Elsevier Editora Ltda.

  13. [Minimum effective concentration of bupivacaine for axillary brachial plexus block guided by ultrasound].

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    Takeda, Alexandre; Ferraro, Leonardo Henrique Cunha; Rezende, André Hosoi; Sadatsune, Eduardo Jun; Falcão, Luiz Fernando Dos Reis; Tardelli, Maria Angela

    2015-01-01

    The use of ultrasound in regional anesthesia allows reducing the dose of local anesthetic used for peripheral nerve block. The present study was performed to determine the minimum effective concentration (MEC90) of bupivacaine for axillary brachial plexus block (ABPB). Patients undergoing hand surgery were recruited. To estimate the MEC90, a sequential up-down biased coin method of allocation was used. The bupivacaine dose was 5mL for each nerve (radial, ulnar, median, and musculocutaneous). The initial concentration was 0.35%. This concentration was changed by 0.05% depending on the previous block: a blockade failure resulted in increased concentration for the next patient; in case of success, the next patient could receive or reduction (0.1 probability) or the same concentration (0.9 probability). Surgical anesthesia was defined as driving force ≤ 2 according to the modified Bromage scale, lack of thermal sensitivity and response to pinprick. Postoperative analgesia was assessed in the recovery room with numeric pain scale and the amount of drugs used within 4hours after the blockade. MEC90 was 0.241% [R2: 0.978, confidence interval: 0.20%-0.34%]. No successful block patient reported pain after 4hours. This study demonstrated that ultrasound guided ABPB can be performed with the use of low concentration of local anesthetics, increasing the safety of the procedure. Further studies should be conducted to assess blockade duration at low concentrations. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  14. Efficacy of 3 therapeutic taping configurations for children with brachial plexus birth palsy.

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    Russo, Stephanie A; Zlotolow, Dan A; Chafetz, Ross S; Rodriguez, Luisa M; Kelly, Devin; Linamen, Holly; Richards, James G; Lubahn, John D; Kozin, Scott H

    2017-04-25

    Cross-sectional clinical measurement study. Scapular winging is a frequent complaint among children with brachial plexus birth palsy (BPBP). Therapeutic taping for scapular stabilization has been reported to decrease scapular winging. This study aimed to determine which therapeutic taping construct was most effective for children with BPBP. Twenty-eight children with BPBP participated in motion capture assessment with 4 taping conditions: (1) no tape, (2) facilitation of rhomboid major and rhomboid minor, (3) facilitation of middle and lower trapezius, and (4) facilitation of rhomboid major, rhomboid minor, and middle and lower trapezius (combination of both 2 and 3, referred to as combined taping). The participants held their arms in 4 positions: (1) neutral with arms by their sides, (2) hand to mouth, (3) hand to belly, and (4) maximum crossbody adduction (CBA). The scapulothoracic, glenohumeral and humerothoracic (HT) joint angles and joint angular displacements were compared using multivariate analyses of variance with Bonferroni corrections. Scapular winging was significantly decreased in both the trapezius and combined taping conditions in all positions compared with no tape. Rhomboids taping had no effect. Combined taping reduced HT CBA in the CBA position. Rhomboid taping cannot be recommended for treatment of children with BPBP. Both trapezius and combined taping approaches reduced scapular winging, but HT CBA was limited with combined taping. Therefore, therapeutic taping of middle and lower trapezius was the most effective configuration for scapular stabilization in children with BPBP. Resting posture improved, but performance of the positions was not significantly improved. Level II. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  15. Schwanoma de plexo braquial: relato de dois casos Schwannoma of brachial plexus: report of two cases

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    Manoel Baldoíno Leal Filho

    2004-03-01

    Full Text Available Schwanomas, neurinomas ou neurilemomas são tumores benignos de nervos periféricos. Podem ocorrer em associação com a neurofibromatose tipo 2. Relatamos dois casos de tumor cervical originado em plexo braquial sem associação com neurofibromatose. Uma mulher, de 31 anos apresentando uma tumefação em região supraclavicular direita, dor irradiada para o membro ipsilateral e sinal de Tinel à percussão da região. Outra mulher, 52 anos, com cervicobraquialgia persistente à direita há um ano. Ambas foram submetidas a microcirurgia, com ressecção total da lesão. O estudo histopatológico foi compatível com schwanoma. As duas pacientes tiveram boa evolução neurológica, com desaparecimento dos sinais e sintomas.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.

  16. An Anatomically Validated Brachial Plexus Contouring Method for Intensity Modulated Radiation Therapy Planning

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    Van de Velde, Joris, E-mail: joris.vandevelde@ugent.be [Department of Anatomy, Ghent University, Ghent (Belgium); Department of Radiotherapy, Ghent University, Ghent (Belgium); Audenaert, Emmanuel [Department of Physical Medicine and Orthopedic Surgery, Ghent University, Ghent (Belgium); Speleers, Bruno; Vercauteren, Tom; Mulliez, Thomas [Department of Radiotherapy, Ghent University, Ghent (Belgium); Vandemaele, Pieter; Achten, Eric [Department of Radiology, Ghent University, Ghent (Belgium); Kerckaert, Ingrid; D' Herde, Katharina [Department of Anatomy, Ghent University, Ghent (Belgium); De Neve, Wilfried [Department of Radiotherapy, Ghent University, Ghent (Belgium); Van Hoof, Tom [Department of Anatomy, Ghent University, Ghent (Belgium)

    2013-11-15

    Purpose: To develop contouring guidelines for the brachial plexus (BP) using anatomically validated cadaver datasets. Magnetic resonance imaging (MRI) and computed tomography (CT) were used to obtain detailed visualizations of the BP region, with the goal of achieving maximal inclusion of the actual BP in a small contoured volume while also accommodating for anatomic variations. Methods and Materials: CT and MRI were obtained for 8 cadavers positioned for intensity modulated radiation therapy. 3-dimensional reconstructions of soft tissue (from MRI) and bone (from CT) were combined to create 8 separate enhanced CT project files. Dissection of the corresponding cadavers anatomically validated the reconstructions created. Seven enhanced CT project files were then automatically fitted, separately in different regions, to obtain a single dataset of superimposed BP regions that incorporated anatomic variations. From this dataset, improved BP contouring guidelines were developed. These guidelines were then applied to the 7 original CT project files and also to 1 additional file, left out from the superimposing procedure. The percentage of BP inclusion was compared with the published guidelines. Results: The anatomic validation procedure showed a high level of conformity for the BP regions examined between the 3-dimensional reconstructions generated and the dissected counterparts. Accurate and detailed BP contouring guidelines were developed, which provided corresponding guidance for each level in a clinical dataset. An average margin of 4.7 mm around the anatomically validated BP contour is sufficient to accommodate for anatomic variations. Using the new guidelines, 100% inclusion of the BP was achieved, compared with a mean inclusion of 37.75% when published guidelines were applied. Conclusion: Improved guidelines for BP delineation were developed using combined MRI and CT imaging with validation by anatomic dissection.

  17. Interscalene brachial plexus block for outpatient shoulder arthroplasty: Postoperative analgesia, patient satisfaction and complications

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    Shah Anand

    2007-01-01

    Full Text Available Background: Shoulder arthroplasty procedures are seldom performed on an ambulatory basis. Our objective was to examine postoperative analgesia, nausea and vomiting, patient satisfaction and complications of ambulatory shoulder arthroplasty performed using interscalene brachial plexus block (ISB. Materials and Methods: We prospectively examined 82 consecutive patients undergoing total and hemi-shoulder arthroplasty under ISB. Eighty-nine per cent (n=73 of patients received a continuous ISB; 11% (n=9 received a single-injection ISB. The blocks were performed using a nerve stimulator technique. Thirty to 40 mL of 0.5% ropivacaine with 1:400,000 epinephrine was injected perineurally after appropriate muscle twitches were elicited at a current of less than 0.5% mA. Data were collected in the preoperative holding area, intraoperatively and postoperatively including the postanesthesia care unit (PACU, at 24h and at seven days. Results: Mean postoperative pain scores at rest were 0.8 ± 2.3 in PACU (with movement, 0.9 ± 2.5, 2.5 ± 3.1 at 24h and 2.8 ± 2.1 at seven days. Mean postoperative nausea and vomiting (PONV scores were 0.2 ± 1.2 in the PACU and 0.4 ± 1.4 at 24h. Satisfaction scores were 4.8 ± 0.6 and 4.8 ± 0.7, respectively, at 24h and seven days. Minimal complications were noted postoperatively at 30 days. Conclusions: Regional anesthesia offers sufficient analgesia during the hospital stay for shoulder arthroplasty procedures while adhering to high patient comfort and satisfaction, with low complications.

  18. Supraclavicular brachial plexus block: Comparison of varying doses of dexmedetomidine combined with levobupivacaine: A double-blind randomised trial

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    Srinivasa Rao Nallam

    2017-01-01

    Full Text Available Background and Aims: The ideal dose of dexmedetomidine for brachial plexus block is a matter of debate. This study was carried out to evaluate 50 μg or 100 μg of dexmedetomidine added to 0.5% levobupivacaine, with regard to the duration of analgesia. Our study also sought to assess the onset and duration of sensorimotor blockade, haemodynamic effects, sedation and adverse effects. Methods: One hundred adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block were randomly allocated into two groups. Group LD50 received 29 ml of 0.5% levobupivacaine plus 50 μg of dexmedetomidine diluted in 1 ml of normal saline. Group LD100 received 29 ml of 0.5% levobupivacaine plus 100 μg of dexmedetomidine diluted in 1 ml of normal saline. Duration of analgesia was the primary outcome. Onset and duration of sensorimotor blockade, haemodynamic variables, sedation score, and adverse effects were secondary outcomes. The data were analysed with Students' t-test and Chi-square test. Results: The onset of sensory block and motor block was 14.82 ± 3.8 min and 19.75 ± 6.3 min, respectively, in group LD50, while it was 11.15 ± 1.7 min and 14.3 ± 4.2 min, respectively, in group LD100. The duration of analgesia was significantly prolonged in group LD100 (1033.6 ± 141.6 vs. 776.4 ± 138.6 min; P = 0.001. The incidence of bradycardia and sedation was observed in significantly more patients in group LD100. Significantly fewer patients in group LD100 required rescue analgesia. Conclusion: The 100 μg dose of dexmedetomidine in brachial plexus block hastens the onset and prolongs the duration of sensorimotor blockade and analgesia, but with higher incidence of bradycardia and sedation.

  19. Neuro-Myelomatosis of the Brachial Plexus - An Unusual Site of Disease Visualized by FDG-PET/CT: A Case Report.

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    Fukunaga, Hisanori; Mutoh, Tatsushi; Tatewaki, Yasuko; Shimomura, Hideo; Totsune, Tomoko; Terao, Chiaki; Miyazawa, Hidemitsu; Taki, Yasuyuki

    2017-05-01

    BACKGROUND Peripheral or cranial nerve root dysfunction secondary to invasion of the CNS in multiple myeloma is a rare clinical event that is frequently mistaken for other diagnoses. We describe the clinical utility of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT scanning for diagnosing neuro-myelomatosis. CASE REPORT A 63-year-old woman whose chief complaints were right shoulder and upper extremity pain underwent MRI and 18F-FDG PET/CT scan. MRI revealed a non-specific brachial plexus tumor. 18F-FDG PET/CT demonstrated intense FDG uptake in multiple intramedullary lesions and in the adjacent right brachial plexus, indicating extramedullary neural involvement associated with multiple myeloma, which was confirmed later by a bone marrow biopsy. CONCLUSIONS This is the first reported case of neuro-myelomatosis of the brachial plexus. It highlights the utility of the 18F-FDG PET/CT scan as a valuable diagnostic modality.

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

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    Gregorio Rodríguez Boto

    2011-10-01

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

  1. Comparison Between Ultrasound-Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Patients Undergoing Arthroscopic Shoulder Surgery: A Prospective, Randomized, Parallel Study.

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    Ryu, Taeha; Kil, Byung Tae; Kim, Jong Hae

    2015-10-01

    Although supraclavicular brachial plexus block (SCBPB) was repopularized by the introduction of ultrasound, its usefulness in shoulder surgery has not been widely reported. The objective of this study was to compare motor and sensory blockades, the incidence of side effects, and intraoperative opioid analgesic requirements between SCBPB and interscalene brachial plexus block (ISBPB) in patients undergoing arthroscopic shoulder surgery. Patients were randomly assigned to 1 of 2 groups (ISBPB group: n = 47; SCBPB group: n = 46). The side effects of the brachial plexus block (Horner's syndrome, hoarseness, and subjective dyspnea), the sensory block score (graded from 0 [no cold sensation] to 100 [intact sensation] using an alcohol swab) for each of the 5 dermatomes (C5-C8 and T1), and the motor block score (graded from 0 [complete paralysis] to 6 [normal muscle force]) for muscle forces corresponding to the radial, ulnar, median, and musculocutaneous nerves were evaluated 20 min after the brachial plexus block. Fentanyl was administered in 50 μg increments when the patients complained of pain that was not relieved by the brachial plexus block. There were no conversions to general anesthesia due to a failed brachial plexus block. The sensory block scores for the C5 to C8 dermatomes were significantly lower in the ISBPB group. However, the percentage of patients who received fentanyl was comparable between the 2 groups (27.7% [ISBPB group] and 30.4% [SCBPB group], P = 0.77). SCBPB produced significantly lower motor block scores for the radial, ulnar, and median nerves than did ISBPB. A significantly higher incidence of Horner's syndrome was observed in the ISBPB group (59.6% [ISBPB group] and 19.6% [SCBPB group], P blocks. However, SCBPB produces a better motor blockade and a lower incidence of Horner's syndrome than ISBPB.

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

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    Bhanu SP

    2010-02-01

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

  3. Role of ultrasound-guided continuous brachial plexus block in the management of neonatal ischemia in upper limb

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    Vrushali C Ponde

    2012-01-01

    Full Text Available Neonatal upper limb ischemia due to accidental arterial damage remains a major concern, which can lead to devastating complications if untreated. The primary objective of this case report is to emphasize the role of continuous infraclavicular brachial plexus block, the issues related with block performance in an ischemic hand, and the importance of ultrasound guidance in this particular case scenario. A 1.1 kg infant suffered from distal forearm ischemia due to accidental arterial damage, which was treated with brachial plexus block. An ultrasound-guided single shot block with 0.5 mL/kg of 0.25% bupivacaine was followed by ultrasound-guided catheter placement in the target area. A continuous infusion of 0.03% of bupivacaine at the rate of 0.5 mL/kg/hr (approx. 0.15 mg/kg/h of bupivacaine was administered for 36 h. This treatment resulted in reversal of ischemia. Permanent ischemic damage was eventually confined to the tips of 4 fingers. We conclude that ultrasound-guided continuous infraclavicular block has a therapeutic role to play in the treatment of hand ischemia due to arterial damage and subsequent arterial spasm in neonates with added benefits.

  4. Dexamethasone as a ropivacaine adjuvant for ultrasound-guided interscalene brachial plexus block: A randomized, double-blinded clinical trial.

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    Sakae, Thiago Mamôru; Marchioro, Patricia; Schuelter-Trevisol, Fabiana; Trevisol, Daisson José

    2017-05-01

    The purpose of this study was to evaluate the effect of intravenous or perineural dexamethasone added to ropivacaine on the duration of ultrasound-guided interscalene brachial plexus blocks (BPB). Randomized clinical trial. Sixty ASA physical status I-II patients with elective shoulder arthroscopic surgeries under interscalene brachial plexus blocks were randomly allocated to receive 20ml of 0.75% ropivacaine with 1ml of isotonic saline (C group, n=20), 20ml of 0.75% ropivacaine with 1ml (4mg) of perineural dexamethasone (Dpn group, n=20), or 20ml of 0.75% ropivacaine with 1ml of isotonic saline and intravenous 4mg dexamethasone (IV) (Div group, n=20). A nerve stimulation technique with ultrasound was used in all patients. The onset time and duration of sensory blocks were assessed. Secondary outcomes were pain scores (VAS) and postoperative vomiting and nausea (PONV). The duration of the motor and sensory block was extended in group Dpn compared with group Div and group C (Pdexamethasone was more effective than intravenous in extending the duration of ropivacaine in ultrasound-guided interscalene BPB. Moreover, Dpn has significant effects on onset time, PONV, and VAS. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Analysis of normal and dysplastic glenohumeral morphology at magnetic resonance imaging in children with neonatal brachial plexus palsy

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    Bunt, Fabian van de [VU University Medical Center, Amsterdam (Netherlands); Pearl, Michael L.; Lee, Eric K.; Peng, Lauren; Didomenico, Paul [Kaiser Permanente, Los Angeles, CA (United States)

    2017-09-15

    Glenoid version and percentage of the humeral head anterior to the scapular line are commonly used 2-D measures to assess deformity of the glenohumeral joint of children with neonatal brachial plexus palsy. To assess whether glenoid version and percentage of the humeral head anterior to the scapular line would be altered by standardizing the measurements to the orientation of the scapula. Twenty-one bilateral magnetic resonance imaging (MRI) scans were evaluated by four reviewers. Measurements were performed on the axial image slices and again after applying 3-D reformatting. Three-dimensional reformatting led to intrapatient corrections up to 25 for version and -30% for percentage of the humeral head anterior to the scapular line. The mean difference on the involved side between clinical and anatomical version across all subjects from all reviewers was 2.2 ± 3.9 (range: -4.5 to 11.5 ). The mean difference in the percentage of the humeral head anterior to the scapular line after reformatting was -1.8% (range: -15.9% to 5.2%). Measurements can differ greatly for the same child depending on technical factors of image acquisition and presentation in the clinical setting. With this study, we present a clinically accessible protocol to correct for scapular orientation from MRI data of children with neonatal brachial plexus palsy. (orig.)

  6. Reliability and accuracy assessment of radiation therapy oncology group-endorsed guidelines for brachial plexus contouring

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    Velde, Joris van de [Ghent University, Department of Anatomy, Ghent (Belgium); Ghent University, Department of Radiotherapy, Ghent (Belgium); Vercauteren, Tom; Gersem, Werner de; Vandecasteele, Katrien; Vuye, Philippe; Vanpachtenbeke, Frank; Neve, Wilfried de [Ghent University, Department of Radiotherapy, Ghent (Belgium); Wouters, Johan; Herde, Katharina d' ; Kerckaert, Ingrid; Hoof, Tom van [Ghent University, Department of Anatomy, Ghent (Belgium)

    2014-07-15

    The goal of this work was to validate the Radiation Therapy Oncology Group (RTOG)-endorsed guidelines for brachial plexus (BP) contouring by determining the intra- and interobserver agreement. Accuracy of the delineation process was determined using anatomically validated imaging datasets as a gold standard. Five observers delineated the right BP on three cadaver computed tomography (CT) datasets. To assess intraobserver variation, every observer repeated each delineation three times with a time interval of 2 weeks. The BP contours were divided into four regions for detailed analysis. Inter- and intraobserver variation was verified using the Computerized Environment for Radiation Research (CERR) software. Accuracy was measured using anatomically validated fused CT-magnetic resonance imaging (MRI) datasets by measuring the BP inclusion of the delineations. The overall kappa (κ) values were rather low (mean interobserver overall κ: 0.29, mean intraobserver overall κ: 0.45), indicating poor inter- and intraobserver reliability. In general, the κ coefficient decreased gradually from the medial to lateral BP regions. The total agreement volume (TAV) was much smaller than the union volume (UV) for all delineations, resulting in a low Jaccard index (JI; interobserver agreement 0-0.124; intraobserver agreement 0.004-0.636). The overall accuracy was poor, with an average total BP inclusion of 38 %. Inclusions were insufficient for the most lateral regions (region 3: 21.5 %; region 4: 12.6 %). The inter- and intraobserver reliability of the RTOG-endorsed BP contouring guidelines was poor. BP inclusion worsened from the medial to lateral regions. Accuracy assessment of the contours showed an average BP inclusion of 38 %. For the first time, this was assessed using the original anatomically validated BP volume. The RTOG-endorsed BP guidelines have insufficient accuracy and reliability, especially for the lateral head-and-neck regions. (orig.) [German] Ziel der Studie war

  7. Low-Volume Brachial Plexus Block Providing Surgical Anesthesia for Distal Arm Surgery Comparing Supraclavicular, Infraclavicular, and Axillary Approach: A Randomized Observer Blind Trial

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    Mojgan Vazin

    2016-01-01

    Full Text Available Background. Distal arm surgery is widely performed under regional anesthesia with brachial plexus block. The preponderance of evidence for the efficacy relies upon injection of local anesthetic in excess of 30 mL. We aimed to compare three different ultrasound-guided brachial plexus block techniques restricting the total volume to 20 mL. Methods. 120 patients were prospectively randomized to ultrasound-guided brachial plexus block with 20 mL ropivacaine 0.75% at either the supraclavicular, infraclavicular, or axillary level. Multiinjection technique was performed with all three approaches. Primary outcome measure was performance time. Results. Performance time and procedural pain were similar between groups. Needle passes and injection numbers were significantly reduced in the infraclavicular group (P<0.01. Nerve visibility was significantly reduced in the axillary group (P=0.01. Success-rate was significantly increased in the supraclavicular versus the axillary group (P<0.025. Total anesthesia-related time was significantly reduced in the supraclavicular compared to the infraclavicular group (P<0.01. Block duration was significantly increased in the infraclavicular group (P<0.05. No early adverse effects occurred. Conclusion. Supraclavicular and infraclavicular blocks exhibited favorable characteristics compared to the axillary block. Supraclavicular brachial plexus block with the multiinjection intracluster technique exhibited significantly reduced total anesthesia-related time and higher success rate without any early adverse events.

  8. Treatment of internal rotation contracture of the shoulder in obstetric brachial plexus lesions by subscapular tendon lengthening and open reduction: early results and complications

    NARCIS (Netherlands)

    van der Sluijs, Johannes A.; van Ouwerkerk, Willem J. R.; de Gast, Arthur; Nollet, Frans; Winters, Hay; Wuisman, Paul I. J. M.

    2004-01-01

    In this prospective study of 19 consecutive children, the operative treatment of internal rotation contracture of the shoulder in obstetric brachial plexus lesions by subscapular tendon lengthening and open reduction of the humeral head is evaluated. The average age of the children was 3.7 years and

  9. Anatomia do plexo braquial de macaco-barrigudo (Lagothrix lagothricha Anatomy of the brachial plexus of the Woolly-Monkey (Lagothrix lagothricha.

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    Gessica Ariane M Cruz

    2010-10-01

    Full Text Available O macaco-barrigudo (Lagothrix lagothricha é um antropóide pertencente à Família Atelidae que possui os maiores primatas neotropicais. Um cadáver fêmea de macaco-barrigudo foi fixado com solução de formaldeído a 10%, posteriormente dissecado com o auxílio de lupa estereoscópica e fotodocumentado. O plexo braquial originou-se dos nervos espinhais C5 a C8 e T1, formando os troncos cranial, médio e caudal, dos quais derivaram os nervos periféricos que se assemelharam na origem e no território de inervação com os plexos de outros primatas, com exceção do nervo musculocutâneo que atravessou o músculo coracobraquial. Pesquisas sobre o plexo braquial de primatas fornecem dados que disponibilizam o acesso a informações valiosas sobre a morfologia destes animais e auxiliam no estabelecimento de parâmetros anatômicos entre as espécies, contribuindo também no tratamento de injúrias e procedimentos anestésicos.The woolly-monkey (Lagothrix lagothricha is an antropoid belonging to the Atelidae Family which includes the largest neotropical primates. A female cadaver woolly-monkey was fixed in a 10% formaldehyde solution and dissected using a stereoscopic magnifying glass and photodocumented. The brachial plexus originated from the spinal nerves C5 to C8 and T1, forming the cranial, medium, and caudal stems, from which derived the peripheral nerves; those nerves had similar origin and innervation area when compared to plexuses from other primates, with the exception of the musculocutaneous nerve that crossed the coracobraquial muscle. Data from studies with brachial plexus from primates allow the access to valuable information regarding the morphology of those animals, and could also assist in the establishment of anatomical parameters among species, which could then contribute to anesthetic procedures and injury treatments.

  10. Ultrasound-guided interscalene brachial plexus anaesthesia: differences in success between patients of normal and excessive weight.

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    Schwemmer, U; Papenfuss, T; Greim, C; Brederlau, J; Roewer, N

    2006-06-01

    Interscalene plexus blocks are an important part of the peri-operative treatment in shoulder surgery. The nerve stimulation technique uses external landmarks for the definition of the injection site. Patient obesity is, therefore, one causative factor for a reduced success rate of the blockade. This study investigated whether there are differences in visibility of the target nerves and in the success rate of the block between patients of normal weight (nw) and obese patients (ow), when portable sonography is used for guidance of the interscalene nerve blockade (ISB). We investigated 70 patients routinely scheduled for shoulder surgery (ASA status I-III). The patients were allocated to group nw (body mass index BMI 25). The interscalene part of the brachial plexus was examined using high-frequency portable ultrasound. The blockade was performed under continuous sonographic monitoring. The quality of the ISB was tested post-operatively, and the time required for the procedure was documented. Identification of nerve structures in the obese patients did require slightly more time than in patients of normal weight, statistically (ow: 5 +/- 1 min versus nw: 4 +/- 2 min, p = 0.02). While in 33 patients (94 %) of group nw the plexus blockade was complete, in group ow 27 (77 %) of the blocks were sufficient. The difference in success, however, was not significant (p = 0.08). Visualisation of nerves was difficult in 3 patients in ow-group. Portable ultrasound provides efficient depiction of the interscalene plexus structures in obese patients and, when used for guidance of regional blockade, renders similar results as in patients of normal weight.

  11. Neonatal brachial plexus palsy with neurotmesis of C5 and avulsion of C6: supraclavicular reconstruction strategies and outcome.

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    Malessy, M J A; Pondaag, W

    2014-10-15

    Nerve reconstruction strategies for restoration of elbow flexion and shoulder function in patients with neonatal brachial plexus palsy with neurotmesis of C5 and avulsion of C6 are not well defined and the outcomes are unclear. From 1990 to 2008, nerve surgery was performed in 421 patients with neonatal brachial plexus palsy. This study focused on thirty-four infants who had a neurotmetic lesion of C5 and avulsion or intraforaminal neurotmesis of C6, irrespective of C7. The C8 and T1 functions were intact. Intraplexal transfer of C6 to C5 with direct coaptation was preferred for restoration of elbow flexion. The suprascapular nerve was reconnected either by extra-intraplexal transfer of the accessory nerve or by grafting from C5 to restore shoulder function. Additional grafts were attached from C5 to the C5 contribution of the posterior division of the superior trunk when technically possible. Transfer of either the C6 anterior root filaments or the entire C6 nerve to C5 was performed in seventeen patients (group A) with direct coaptation in fifteen of them. Grafting from C5 to the anterior division of the superior trunk was performed in the remaining seventeen infants (group B). An accessory-to-suprascapular nerve transfer was applied in twenty-nine infants. The suprascapular nerve was reconnected in five patients by grafting from C5. It was possible to attach one, two, or three additional grafts from C5 to the posterior division of the superior trunk in twenty-one patients. All infants had biceps muscle recovery to a Medical Research Council (MRC) grade of ≥4, twenty-two (65%) of the thirty-four patients obtained Mallet grade-IV abduction, and eleven (32%) of the thirty-four obtained Mallet grade-IV external rotation. In patients with neonatal brachial plexus palsy who have neurotmesis of C5 and avulsion of C6, elbow flexion can be successfully restored with supraclavicular intraplexal reconstruction with use of C5 as the proximal outlet. However, shoulder

  12. Secondary shoulder reconstruction in patients with brachial plexus injuries.

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    Terzis, Julia K; Barmpitsioti, Antonia

    2011-07-01

    Restoration of shoulder stability in post-traumatic plexopathy patients is very important because more distal functions depend on a stable and functioning shoulder. The purpose of this study is to present our experience with secondary surgeries in patients with devastating paralysis. Functional outcomes were analyzed in relation to age, severity score and type of reconstruction. The medical records of 55 post-traumatic plexopathy patients who underwent secondary shoulder reconstruction, by a single surgeon, between 1978 and 2006, were reviewed. 55 patients had 73 procedures, 44 for shoulder abduction and 29 for external rotation. 38 patients underwent secondary surgery to augment shoulder abduction. Trapezius advancement was performed in 14 patients, double free muscle transfer in 18, free latissimus dorsi in 4 and triceps muscle transfer in 2 patients. 26 patients had secondary procedures for enhancement of shoulder external rotation. Dynamic rerouting of latissimus dorsi and teres major was carried out in 18 patients and rotational humerus osteotomy in 11 patients. All patients had improvement of shoulder stability and function. Shoulder abduction reached 40.80 ± 15.93 and external rotation at 24.28 ± 17.90°. Trapezius advancement yielded 41.81 ± 9.02° of abduction. Latissimus dorsi yielded stronger shoulder abduction than adductor longus. Rerouting of latissimus dorsi and teres major attained 22.33 ± 20.31° of dynamic external rotation while humerus osteotomy produced 26.87 ± 10.32 of external rotation. Secondary procedures such as pedicle and free muscles transfers, tendon transfers, and rotational humerus osteotomy augment shoulder stability and function in patients with irreparable paralysis. Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  13. 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.

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    Yuan, Jia-Min; Yang, Xiao-Hu; Fu, Shu-Kun; Yuan, Chao-Qun; Chen, Kai; Li, Jia-Yi; Li, Quan

    2012-05-01

    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. 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). 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 block performance (RR 0.13, 95%CI 0.06 - 0.27, P complete hemi-diaphragmatic paresis (RR 0.09, 95%CI 0.03 - 0.52, P = 0.0001). 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.

  14. Pharmacokinetics of Lidocaine Hydrochloride Administered with or without Adrenaline for the Paravertebral Brachial Plexus Block in Dogs.

    Science.gov (United States)

    Choquette, Amélie; Troncy, Eric; Guillot, Martin; Varin, France; Del Castillo, Jérôme R E

    2017-01-01

    Adrenaline is known to prolong the duration of local anesthesia but its effects on the pharmacokinetic processes of local anesthetic drugs are not fully understood. Our objective was to develop a compartmental model for quantification of adrenaline's impact on the pharmacokinetics of perineurally-injected lidocaine in the dog. Dogs were subjected to paravertebral brachial plexus block using lidocaine alone or adrenalinated lidocaine. Data was collected through a prospective, randomised, blinded crossover protocol performed over three periods. Blood samples were collected during 180 minutes following block execution. Compartmental pharmacokinetic models were developed and their goodness-of-fit were compared. The lowering effects of adrenaline on the absorption of lidocaine were statistically determined with one-sided tests. A one-compartment disposition model with two successive zero-order absorption processes best fitted our experimental data. Adrenaline decreased the peak plasma lidocaine concentration by approximately 60% (P Adrenaline decreased the absorption rate of lidocaine and prolonged the duration of its absorption.

  15. Health-Related Quality of Life Components in Children With Neonatal Brachial Plexus Palsy: A Qualitative Study.

    Science.gov (United States)

    Chang, Kate W-C; Austin, Amy; Yeaman, Jan; Phillips, Lauren; Kratz, Anna; Yang, Lynda J-S; Carlozzi, Noelle E

    2017-04-01

    Currently, no published, validated patient-reported outcome (PRO) measures of health-related quality of life (HRQOL) exist for use with neonatal brachial plexus palsy (NBPP). NBPP is a debilitating condition that occurs during the perinatal period, resulting in paralysis/paresis and loss of sensation in the affected arm. Commonly used NBPP measures are not comprehensive and do not fully account for clinically meaningful changes in function or progression of the disorder. To evaluate important components of HRQOL for children with NBPP and identify where new PRO measures are needed. Eleven focus groups comprising children with NBPP (4), family members (6), and professional providers (1) to assess HRQOL. Brachial plexus clinic. Children with NBPP, their parents, and professional providers. Children 7-17 years old with NBPP; parents/caregivers at least 18 years of age; professionals with ≥2 years' experience providing NBPP clinical care; ability to read and speak English fluently. Focus group sessions were recorded, transcribed verbatim, and deidentified. Qualitative frequency analysis identified different aspects of HRQOL relevant to NBPP. This analysis expands on the grounded-theory approach to qualitative analysis, including development of a domain framework, open and axial coding, selective coding, and descriptive analysis. The resulting HRQOL domain framework (and frequency analysis) was then compared to the domain framework for existing PRO measures (PROMIS and Neuro-QoL) to identify components of HRQOL where new PRO measures are needed for NBPP. Not applicable. Although many physical, social, and emotional health domains were captured by existing PRO measures, some significant NBPP-specific topics emerged from qualitative analysis-functionality, sensory, physical appearance, arm/hand compensation and preference, explaining functionality/appearance to others, and self-esteem and body image concerns. Development of sensitive and specific measures capturing arm

  16. Effect of ketamine as an adjuvant in ultrasound-guided supraclavicular brachial plexus block: A double-blind randomized clinical trial study

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    Mohammadreza Lashgarinia

    2014-01-01

    Full Text Available Background: Supraclavicular brachial plexus block is one of the most effective anesthetic procedures in operations for the upper extremity. Ketamine has been reported to enhance the analgesic effects of local anesthetics. We have conducted this study to assess whether coadministration of ketamine can prolong the local analgesic effect of lidocaine in the supraclavicular brachial plexus block for patients undergoing elective upper extremity surgery. Materials and Methods: Sixty adult patients undergoing elective surgery of the elbow, forearm, wrist or hand were randomly allocated in two groups of 30 patients each. Group 1 (ketamine group received 5 mg/kg lidocaine 1.5% plus 2 mg/kg ketamine, Group 2 (control group received 5 mg/kg lidocaine 1.5% and saline. The outcome measures included severity of pain by using visual analog scale (VAS, 0 = no pain 10 cm = the most severe pain, time of first request for analgesia, and total dose of postoperative opioid administration. The data was analyzed using the χ2 test, student′s t-test, Kaplan-Meier survival analysis, and Multivariate analysis tests. Results: Patients in the control group had a higher VAS than patients who received ketamine, at all time points during the first 24 hours after surgery (all P < 0.05. The time of first request for analgesia in the ketamine group was significantly more than in the control group (8.93 ± 1.0 vs. 7.30 ± 1.9, respectively, P < 0.001. Conclusion: The addition of ketamine to lidocaine in the ultrasound-guided brachial plexus block could decrease the postoperative pain and need for analgesic. Therefore, it could be considered as an option in the brachial plexus block to enhance the analgesic action of lidocaine.

  17. Is there a dose response of dexamethasone as adjuvant for supraclavicular brachial plexus nerve block? A prospective randomized double-blinded clinical study.

    Science.gov (United States)

    Liu, Jiabin; Richman, Kenneth A; Grodofsky, Samuel R; Bhatt, Siya; Huffman, George Russell; Kelly, John D; Glaser, David L; Elkassabany, Nabil

    2015-05-01

    The study objective is to examine the analgesic effect of 3 doses of dexamethasone in combination with low concentration local anesthetics to determine the lowest effective dose of dexamethasone for use as an adjuvant in supraclavicular brachial plexus nerve block. The design is a prospective randomized double-blinded clinical study. The setting is an academic medical center. The patients are 89 adult patients scheduled for shoulder arthroscopy. All patients were randomly assigned into 1 of 4 treatment groups: (i) bupivacaine, 0.25% 30 mL; (ii) bupivacaine, 0.25% 30 mL with 1-mg preservative-free dexamethasone; (iii) bupivacaine, 0.25% 30 mL with 2-mg preservative-free dexamethasone; and (iv) bupivacaine, 0.25% 30 mL with 4-mg preservative-free dexamethasone. All patients received ultrasound-guided supraclavicular brachial plexus nerve blocks and general anesthesia. The measurements are the duration of analgesia and motor block. The median analgesia duration of supraclavicular brachial plexus nerve block with 0.25% bupivacaine was 12.1 hours; and 1-, 2-, or 4-mg dexamethasone significantly prolonged the analgesia duration to 22.3, 23.3, and 21.2 hours, respectively (P = .0105). Dexamethasone also significantly extended the duration of motor nerve block in a similar trend (P = .0247). Low-dose dexamethasone (1-2 mg) prolongs analgesia duration and motor blockade to the similar extent as 4-mg dexamethasone when added to 0.25% bupivacaine for supraclavicular brachial plexus nerve block. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Guillain-Barré syndrome after brachial plexus trauma: case report Síndrome de Guillain-Barré após traumatismo de plexo braquial: relato de caso

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    Marcos R.G. de Freitas

    2006-12-01

    Full Text Available The Guilllain-Barré syndrome (GBS is an acute predominantly demyelinating polyneuropathy. In many cases GBS is preceding by infection, immunization, surgery or trauma. Although there are a few reports of GBS after head trauma, there is no report of this syndrome after brachial plexus injury. We report on a 51 years-old man who presented GBS fifteen days after a brachial plexus trauma. The polineuropathy resolved completely in a few weeks. We believe that GBS was triggered by the trauma that evoked an immune mediated disorder producing inflammation and demyelination of the peripheral nerves.A síndrome de Guillain-Barré (SGB é uma polineuropatia predominantemente desmielinizante, que ocorre na maioria das vezes após uma infecção, vacinação, cirurgia ou traumatismo. Embora tenham sido descritos alguns casos após traumatismo crânio encefálico, ainda não foi referido caso de SGB após traumatismo do plexo braquial. Relatamos o caso de um homem de 51 anos que 15 dias após ter apresentado paralisia traumática do plexo braquial, desenvolveu SGB. Recuperou-se inteiramente em algumas semanas. Achamos que em nosso caso a SGB foi desencadeada pelo traumatismo, que provocou distúrbios imunológicos com conseqüente acometimento dos nervos periféricos.

  19. Reconstruction of shoulder abduction and external rotation with latissimus dorsi and teres major transfer in obstetric brachial plexus palsy.

    Science.gov (United States)

    Oztürk, Kahraman; Bülbül, Murat; Demir, Bilal Birkan; Büyükkurt, Cem Dinçay; Ayanoğlu, Semih; Esenyel, Cem Zeki

    2010-01-01

    We evaluated the results of latissimus dorsi and teres major tendon transfer to the rotator cuff together with musculotendinous lengthening of the subscapularis and/or pectoralis major muscles in patients with internal rotation contracture and decreased external rotation and abduction secondary to obstetrical brachial plexus palsy. Thirty patients (18 boys, 12 girls; mean age 9 years; range 4 to 15 years) with internal rotation contracture and loss of external rotation and abduction of the shoulder secondary to obstetrical brachial plexus palsy underwent transfer of the latissimus dorsi/teres major tendons to the rotator cuff. In addition, musculotendinous lengthening of the subscapularis and pectoralis major (n=15), pectoralis major (n=9), and subscapularis (n=6) were performed. Nine patients had upper plexus involvement (C5-6), 14 had C5-7 involvement, and seven had complete plexus involvement (C5-T1). According to the Waters and Peljovich classification, all the patients had a congruent glenohumeral joint, which was classified as type 1 in one patient, type 2 in 15 patients, and type 3 in 14 patients. Pre- and postoperative range of motion values of the patients were measured and their motor functions were evaluated with the Mallet scoring system. The mean follow-up period was 47.8 months (range 9 to 84 months). Preoperatively, the mean active abduction was 75.8°, and the mean active external rotation was 25.2°. Postoperatively, the mean abduction and external rotation increased to 138.3° (by 62.5°, 82.5%) and 76.4 degrees (by 51.2°, 203.2%), respectively. Improvements in the degrees of abduction and external rotation were significant (p=0.000). According to the Mallet scoring system, the mean preoperative global abduction and global external rotation scores were 2.97 and 2.43, respectively; the mean Mallet scores for the ability to move the hand to the mouth, neck, and back were 2.50, 2.17, and 2.67, respectively. Postoperatively, the mean global abduction

  20. Comparison of visual and objective quantification of elbow and shoulder movement in children with obstetric brachial plexus palsy

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    Galea Mary

    2006-12-01

    Full Text Available Abstract Background The Active Movement Scale is a frequently used outcome measure for children with obstetric brachial plexus palsy (OBPP. Clinicians observe upper limb movements while the child is playing and quantify them on an 8 point scale. This scale has acceptable reliability however it is not known whether it accurately depicts the movements observed. In this study, therapist-rated Active Movement Scale grades were compared with objectively-quantified range of elbow flexion and extension and shoulder abduction and flexion in children with OBPP. These movements were chosen as they primarily assess the C5, C6 and C7 nerve roots, the most frequently involved in OBPP. Objective quantification of elbow and shoulder movements was undertaken by two-dimensional motion analysis, using the v-scope. Methods Young children diagnosed with OBPP were recruited from the Royal Children's Hospital (Melbourne, Australia Brachial Plexus registry. They participated in one measurement session where an experienced paediatric physiotherapist facilitated maximal elbow flexion and extension, shoulder abduction and extension through play, and quantified them on the Active Movement Scale. Two-dimensional motion analysis captured the same movements in degrees, which were then converted into Active Movement Score grades using normative reference data. The agreement between the objectively-quantified and therapist-rated grades was determined using percentage agreement and Kappa statistics. Results Thirty children with OBPP participated in the study. All were able to perform elbow and shoulder movements against gravity. Active Movement Score grades ranged from 5 to 7. Two-dimensional motion analysis revealed that full range of movement at the elbow and shoulder was rarely achieved. There was moderate percentage agreement between the objectively-quantified and therapist-rated methods of movement assessment however the therapist frequently over-estimated the range of

  1. Surgical correction of ulnar deviation deformity of the wrist in patients with birth brachial plexus palsy sequelae.

    Science.gov (United States)

    Bhardwaj, Praveen; Parekh, Harshil; Venkatramani, Hari; Raja Sabapathy, S

    2015-01-01

    Ulnar deviation deformity of the wrist in patients with birth brachial plexus palsy is an important cosmetic concern among the patients and their relatives; especially in the patients who have recovered the basic limb functions. Though there is ample literature available regarding the management of the shoulder deformity there is paucity of literature regarding management of wrist ulnar deviation deformity. We report our experience with correction of this deformity in five cases with isolated ulnar deviation deformity without forearm rotational deformity or weakness of the wrist muscles. All the patients underwent extensor carpi ulnaris (ECU) to extensor carpi radialis longus (ECRL) tendon transfer. At a minimum of 18 months follow-up all the patients and their families were satisfied with the cosmetic appearance of the limb. Correction of the deformity improves the appearance of the limb, improves self-confidence of the child, and allows them to integrate well into the society. Interestingly, the patients expressed improvement in their grip strength and overall hand function after this surgery. The notable functions which improved were easy reach of the hand-to-mouth for feeding and easy handling of the things requiring bimanual activities. Although the main aim of this operation was to correct the appearance of the hand it was found to be also functionally useful by the patients and hence we are encouraged to report it for wider use. The results were maintained during the follow-up period of as long as 47 months.

  2. Pharmacokinetics of Lidocaine Hydrochloride Administered with or without Adrenaline for the Paravertebral Brachial Plexus Block in Dogs.

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    Amélie Choquette

    Full Text Available Adrenaline is known to prolong the duration of local anesthesia but its effects on the pharmacokinetic processes of local anesthetic drugs are not fully understood. Our objective was to develop a compartmental model for quantification of adrenaline's impact on the pharmacokinetics of perineurally-injected lidocaine in the dog. Dogs were subjected to paravertebral brachial plexus block using lidocaine alone or adrenalinated lidocaine. Data was collected through a prospective, randomised, blinded crossover protocol performed over three periods. Blood samples were collected during 180 minutes following block execution. Compartmental pharmacokinetic models were developed and their goodness-of-fit were compared. The lowering effects of adrenaline on the absorption of lidocaine were statistically determined with one-sided tests. A one-compartment disposition model with two successive zero-order absorption processes best fitted our experimental data. Adrenaline decreased the peak plasma lidocaine concentration by approximately 60% (P < 0.001, decreased this local anesthetic's fast and slow zero-order absorption rates respectively by 50% and 90% (P = 0.046, and P < 0.001, which respective durations were prolonged by 90% and 1300% (P < 0.020 and P < 0.001. Lidocaine demonstrated a previously unreported atypical absorption profile following its paravertebral injection in dogs. Adrenaline decreased the absorption rate of lidocaine and prolonged the duration of its absorption.

  3. Low-dose ropivacaine for supraclavicular brachial plexus block combined with general anesthesia for successful postoperative analgesia: A case series

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    Toshio Iwata

    2013-01-01

    Full Text Available Background: Ropivacaine, a long-acting local anesthetic agent, has been used for postoperative analgesia in brachial plexus block (BPB at high doses. However, use of lower doses would reduce the occurrence of adverse effects. Methods: We applied BPB with low-dose ropivacaine (10 mL of 0.375% ropivacaine after induction of general anesthesia for surgery of the upper extremities in 62 patients at our hospital. Ropivacaine was administered via a fluoroscopy-guided supraclavicular method. Analgesic effects during surgery, visual analog scale pain scores, skin sensation, muscle strength, and postoperative patient satisfaction indices were evaluated. Results: Fifty-six patients (90.3% did not require supplemental analgesics during surgery. The remaining six patients were administered fentanyl due to the insufficient analgesic effects of the nerve block. Some adverse effects, including numbness and delayed motor and sensory recovery of the upper extremities, were observed. The mean postoperative patient-evaluated visual satisfaction scale was 94.1. Conclusions: Our results suggest that low-dose ropivacaine is clinically acceptable for BPB under general anesthesia.

  4. Efficacy of Ultrasound-Guided Axillary Brachial Plexus Block for Analgesia During Percutaneous Transluminal Angioplasty for Dialysis Access

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    Chiba, Emiko, E-mail: chibaemi23@comet.ocn.ne.jp; Hamamoto, Kohei, E-mail: hkouhei917@gmail.com [Jichi Medical University, Department of Radiology, Saitama Medical Center (Japan); Nagashima, Michio, E-mail: nagamic00@gmail.com [Asahikawa Medical University, Department of Emergency Medicine (Japan); Matsuura, Katsuhiko, E-mail: kmatsur@gmail.com; Okochi, Tomohisa, E-mail: t-shachi@dj8.so-net.ne.jp; Tanno, Keisuke, E-mail: tankichi1974@gmail.com; Tanaka, Osamu, E-mail: otanaka@omiya.jichi.ac.jp [Jichi Medical University, Department of Radiology, Saitama Medical Center (Japan)

    2016-10-15

    PurposeTo evaluate the efficacy and safety of ultrasound (US)-guided axillary brachial plexus block (ABPB) for analgesia during percutaneous transluminal angioplasty (PTA) for dialysis access.Subjects and MethodsTwenty-one patients who underwent PTA for stenotic dialysis access shunts and who had previous experience of PTA without sedation, analgesia, and anesthesia were included. The access type in all patients was native arteriovenous fistulae in the forearm. Two radiologists performed US-guided ABPB for the radial and musculocutaneous nerves before PTA. The patients’ pain scores were evaluated using a visual analog scale (VAS) after PTA, and these were compared with previous sessions without US-guided ABPB. The patient’s motor/sensory paralysis after PTA was also examined.ResultsThe mean time required to achieve US-guided ABPB was 8 min. The success rate of this procedure was 100 %, and there were no significant complications. All 21 patients reported lower VAS with US-guided ABPB as compared to without the block (p < 0.01). All patients expressed the desire for an ABPB for future PTA sessions, if required. Transient motor paralysis occurred in 8 patients, but resolved in all after 60 min.ConclusionUS-guided ABPB is feasible and effective for analgesia in patients undergoing PTA for stenotic dialysis access sites.Level of EvidenceLevel 4 (case series).

  5. Transfer of latissmus dorsi and teres major tendons without subscapularis release for the treatment of obstetrical brachial plexus palsy sequela.

    Science.gov (United States)

    Ozben, Hakan; Atalar, Ata Can; Bilsel, Kerem; Demirhan, Mehmet

    2011-12-01

    Patients with obstetrical brachial plexus palsy (OBPP) sequela exhibit adduction and internal rotation contractures. The muscular imbalance may result in secondary bony changes. Tendon transfers and muscular releases may improve shoulder function in these patients. The aim of this study is to evaluate the functional and radiological results of pectoralis major tendon Z-plasty with transfer of latissimus dorsi and teres major tendons to rotator cuff tendons without release of subscapularis muscle in patients with mild sequela of OBPP. Twenty-six consecutive patients, who were treated with tendon transfer and met the eligibility criteria, were included in the study. No additional humeral osteotomy or subscapularis tenotomy was performed. Functional evaluation is made according to range of motion and Mallet scoring system. Preoperative radiologic evaluation was made according to the grading system of Waters. A significant increase in shoulder function was found in all patients. Postoperative radiographs revealed glenohumeral congruity was maintained in all patients. Improvement in shoulder abduction and external rotation was higher in patients who were operated before the age of 7. Pectoralis major tendon lengthening with transfer of latissimus dorsi and teres major tendons to rotator cuff is an effective and reproducible technique and can improve shoulder functions in patients with OBPP. Subscapularis release is not always required to overcome internal rotation contracture. Secondary glenohumeral changes might also be prevented with this approach. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  6. Mobile technology: Creation and use of an iBook to teach the anatomy of the brachial plexus.

    Science.gov (United States)

    Stewart, Stuart; Choudhury, Bipasha

    2015-01-01

    In an era of digitally connected students, there is a demand for academic material to be delivered through electronic mobile devices and not just through traditional methods such as lectures and tutorials. A digital interactive book-iBook (for use on the Apple iPad)-was created to teach undergraduate anatomical science students (n = 26) four key areas of the brachial plexus: definitions, gross anatomy, relative anatomy, and functions of terminal branches. Students were asked to complete preresource and postresource questionnaires, which were used to calculate the mean improvement score and ultimately the efficacy of the resource. Free text comments were gathered to evaluate student opinions on this mode of learning. The mean score on the preresource and postresource questionnaires was 4.07 of 8 and 5.69 of 8, respectively. The overall mean improvement score was 1.62, determined statistically significant by a dependent t-test (P = 0.0004). Findings demonstrate that digital books on the iPad provide a uniquely interactive way of delivering information and engaging students. Furthermore, digital books can be used alongside traditional methods of teaching anatomy to enhance and promote deep learning in students. © 2014 American Association of Anatomists.

  7. [Effects of patient-controlled infraclavicular brachial plexus block for postoperative pain and surgical efficacy in patients with terrible tyriad of the elbow].

    Science.gov (United States)

    Xiu-Zhen, Wang; Ge, Ye-Ying; Ye, Guang-Yao; Zhang, Jing-Wei; Ma, Wei-Hu

    2017-11-25

    To study the effects of ultrasound guided inter-scalene brachial plexus block and patient-controlled infraclavicular brachial plexus block for postoperative pain and surgical efficacy in patients with terrible tyriad of the elbow. From March 2015 to August 2016, 60 patients with terrible tyriad of the elbows were treated in Ningbo No.6 Hospital with ASA I to II internal fixation. There were 32 males and 28 females, ranging in age from 16 to 70 years old, with a mean age of (55.6±18.2) years old. All the patients were divided into two groups(30 cases in each group): controlled intermuscular groove brachial plexus block (group C), infraclavicular brachial plexus block(group I). All catheters were placed using ultra-sound visualization and injected 0.33% ropivacaine 30 ml preoperatively. After regaining consciousness, all patients connected the electronic pump. The solution contained 0.2% ropiva-caine and the pump was setup to deliver a 5 ml bolus dose, with a 15 min lock out interval and background infusion at 5 ml/h. Both analgesia lasted until 5 d after operation. The patients underwent rehabilitation exercise everyday for 5 consecutive days starting from 24 h after operation.VAS score was recorded at 24 h, 48 h, 72 h and 4 d, 5 d after operation during rest and rehabilitation exercise time. The elbow articular range of motion and Mayo elbow performance score (MEPS) were recorded at 6 d after operation. Catheter-related adversereactions (such as oozing from the insertion site, obstruction, prolapse) were recorded. The success rate of blockade was 100% during insertion in both groups. Compared with group C, the VAS score at 3 d during rest time and 3, 4, 5 d after operation during rehabili-tation exercise were decreased(2.5±0.5 vs. 3.8±1.1, 3.0±0.4 vs. 5.0±0.9, 2.5±0.4 vs. 4.5±1.2, 2.1±0.3 vs. 4.1±1.0, P plexus block can be effectively used for postoperative pain after fixation for terrible tyriad of the elbows, and it can increase surgical outcome.

  8. Buprenorphine for postoperative analgesia: Axillary brachial plexus block versus intramuscular administration in a placebo-controlled trial

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    Deepali Thakur

    2015-01-01

    Full Text Available Background and Aims: Peripheral administration of opioids has been suggested for prolongation of regional analgesia. This prospective, randomized, double-blind placebo-controlled study was undertaken to compare the effect of regional (axillary brachial plexus block [ABPB] versus intramuscular (IM buprenorphine (2 μg/kg in adults. Material and Methods: Seventy-five adults undergoing upper limb surgery received ABPB with local anaesthetic (15 ml 0.5% bupivacaine, 15 ml 2% lignocaine with adrenaline 1:200,000, 9 ml normal saline [NS]. In addition, regional group RB (n = 25 received buprenorphine 2 μg/kg in ABPB and 1 ml NS IM. Systemic Group SB (n = 25 received 1 ml NS in ABPB and buprenorphine 2 μg/kg IM. Group C (n = 25 received 1 ml NS in ABPB and IM. Onset, duration of sensory and motor block, hemodynamic parameters, sedation score, pain scores using visual analog scale, duration of postoperative analgesia, rescue analgesic (RA requirement, adverse events, and patient satisfaction were noted. Results: Demographics, onset and duration of sensory, motor block were similar. RB group had longest duration of analgesia (20.61 ± 1.33 h compared to SB (10.91 ± 0.90 h and control group (5.86 ± 0.57 h (P < 0.05 RB vs. SB/C and SB vs. C. RA requirement was highest in the control group and least in RB group (P = 0.000 RB vs. SB/C and SB vs. C. SB group had a maximum number of side effects (P = 0.041, SB vs. RB/C. Patient satisfaction was highest with group RB (P < 0.05 RB vs. SB/C, and P = 0.06 SB vs. C. Conclusion: Buprenorphine 2 μg/kg in axillary plexus block provides significantly prolonged analgesia with less RA requirement and greater patient satisfaction compared to IM administration. This is highly suggestive of action on peripheral opioid receptors.

  9. Effect of brachial plexus block-driven vascular access planning on primary distal arteriovenous fistula recruitment and outcomes.

    Science.gov (United States)

    Renaud, Claude J; Leong, Chuo Ren; Bin, Hsien Wern; Wong, Julian Chi Leung

    2015-11-01

    Hemodialysis vascular accesses (VAs) are traditionally planned based on the nondominant upper extremity preoperative physical and sonographic vascular findings. Clinical guidelines advocate the use of the most suitably distended vein in the most distal location. Brachial plexus block (BPB), through its sympathectomy-like effect, promotes vasodilation and can thus further optimize vein recruitment and operative strategy. However, studies on its role in driving primary distal autogenous arteriovenous fistula (AVF) placement are limited. We therefore evaluated a traditional approach of clinic-based VA planning against an on-table sonography-guided strategy under BPB. This was a prospective observational study involving 110 consecutive end-stage renal disease multiethnic Asian patients referred for primary VA creation under BPB after preoperative venous mapping. Cases were grouped according to whether there was a preset operative plan for radial cephalic (RC) or brachial cephalic (BC) AVF creation based on artery and vein >2 mm and >2.5 mm size criteria respectively (group A) or vein size or length were suboptimal (2-2.5 mm and  .05). Satisfactory post-BPB forearm vasodilation resulted in 44% of 36 plans for BC being changed to RC AVFs. RC AVF 6-week hemodynamic maturation and 3-month functional maturation in group A vs B were 48% vs 60% and 69% vs 57%, respectively (P > .05). One-year primary and secondary patency rates were 57% vs 50% and 73% vs 87%, respectively (log rank >.05). Outcomes of RC AVFs in group B were not inferior to those of BC AVFs. On-table BPB-driven VA planning and plan modification strategy contribute to considerable AVF recruitment but do not lead to significantly better distal AVF prevalence or outcomes over the traditional approach. An adequately powered randomized controlled study is, however, warranted to better assess the long-term clinical and cost benefits of such a strategy. Copyright © 2015 Society for Vascular Surgery. Published by

  10. Accessory nerve to suprascapular nerve transfer to restore shoulder exorotation in otherwise spontaneously recovered obstetric brachial plexus lesions.

    Science.gov (United States)

    van Ouwerkerk, Willem J R; Uitdehaag, Bernard M J; Strijers, Rob L M; Frans, Nollet; Holl, Kurt; Fellner, Franz A; Vandertop, W Peter

    2006-10-01

    A systematic follow-up of infants with an obstetric brachial plexus lesion of C5 and C6 or the superior trunk showing satisfactory spontaneous recovery of shoulder and arm function except for voluntary shoulder exorotation, who underwent an accessory to suprascapular nerve transfer to improve active shoulder exorotation, to evaluate for functional recovery, and to understand why other superior trunk functions spontaneously recover in contrast with exorotation. In 54 children, an accessory to suprascapular nerve transfer was performed as a separate procedure at a mean age of 21.7 months. Follow-up examinations were conducted before and at 4, 8, 12, 24, and 36 months after operation and included scoring of shoulder exorotation and abduction. Intraoperative reactivity of spinatus muscles and additional needle electromyographic responses were registered after electrostimulation of suprascapular nerves. Histological examination of suprascapular nerves was performed. Trophy of spinatus muscles was followed by magnetic resonance imaging scanning. The influence of perinatal variables and results of ancillary investigations on outcome were evaluated. Exorotation improved from 70 degrees to functional levels exceeding 0 degrees, except in two patients. Abduction improved in 27 patients, with results of 90 degrees or more in 49 patients. Electromyography at 4 months did not show signs of denervation in 39 out of 40 patients. Intraoperative electrostimulation of suprascapular nerves elicited spinatus muscle reaction in 44 out of 48 patients. Histology of suprascapular nerves was normal. Preoperative magnetic resonance imaging scans showed only minor wasting of spinatus muscles in contrast with major wasting after successful operations. An accessory to suprascapular nerve transfer is effective to restore active exorotation when performed as the primary or a separate secondary procedure in children older than 10 months of age. Contradictory spontaneous recovery of other superior

  11. Combining interscalene brachial plexus block with intravenous-inhalation combined anesthesia for upper extremity fractures surgery: a randomized controlled trial.

    Science.gov (United States)

    Yuan, Lan; Tang, Wei; Fu, Guo-qiang; Wang, Jian; Guo, Jun; Chen, Wen-ting

    2014-12-01

    A parallel-group randomized controlled trial (RCT) was conducted to evaluate the effect of combining the interscalene brachial plexus block (IBPB) with Intravenous-inhalation combined anesthesia to isolated Intravenous-inhalation anesthesia in the upper extremity fractures surgery of elderly patients. One hundred elderly patients who underwent upper extremity surgery were randomly assigned to received isolated Intravenous-inhalation combined anesthesia (group CI, n = 50) and IBPB associated with Intravenous-inhalation combined anesthesia (group NB, n = 50). Associated side effects, recovery time after operation, as well as the dose of intraoperative vasoactive agents and auxiliary drugs were noted. The two groups were not significantly different in gender (P = 0.539), ages (P = 0.683) and weight (P = 0.212). Five patients (10%) in the group NB and 17 patients (34%) in the group CI suffered from preoperative hypotension (P = 0.004). Besides, lower incidence of other adverse effects such as mental stress, incision pain and hypertension were also found in the group NB; however, the differences were not statistically significant (P > 0.05). The consumption of general anesthetics in the group NB was significantly less than that of the group CI (propofol, P = 0.004; lsoflurane, P < 0.001), and the recovery time of the group NB was significantly shorter than that of the group CI (P = 0.020). Combining IBPB with Intravenous-inhalation combined anesthesia in elderly patients hold a greater potential for upper extremity fractures surgery due to its improved clinical effectiveness and fewer side effects. Copyright © 2014. Published by Elsevier Ltd.

  12. Volumetric tumor burden and its effect on brachial plexus dosimetry in head and neck intensity-modulated radiotherapy

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    Romesser, Paul B.; Qureshi, Muhammad M.; Kovalchuk, Nataliya; Truong, Minh Tam, E-mail: mitruong@bu.edu

    2014-07-01

    To determine the effect of gross tumor volume of the primary (GTV-P) and nodal (GTV-N) disease on planned radiation dose to the brachial plexus (BP) in head and neck intensity-modulated radiotherapy (IMRT). Overall, 75 patients underwent definitive IMRT to a median total dose of 69.96 Gy in 33 fractions. The right BP and left BP were prospectively contoured as separate organs at risk. The GTV was related to BP dose using the unpaired t-test. Receiver operating characteristics curves were constructed to determine optimized volumetric thresholds of GTV-P and GTV-N corresponding to a maximum BP dose cutoff of > 66 Gy. Multivariate analyses were performed to account for factors associated with a higher maximal BP dose. A higher maximum BP dose (> 66 vs ≤ 66 Gy) correlated with a greater mean GTV-P (79.5 vs 30.8 cc; p = 0.001) and ipsilateral GTV-N (60.6 vs 19.8 cc; p = 0.014). When dichotomized by the optimized nodal volume, patients with an ipsilateral GTV-N ≥ 4.9 vs < 4.9 cc had a significant difference in maximum BP dose (64.2 vs 59.4 Gy; p = 0.001). Multivariate analysis confirmed that an ipsilateral GTV-N ≥ 4.9 cc was an independent predictor for the BP to receive a maximal dose of > 66 Gy when adjusted individually for BP volume, GTV-P, the use of a low anterior neck field technique, total planned radiation dose, and tumor category. Although both the primary and the nodal tumor volumes affected the BP maximal dose, the ipsilateral nodal tumor volume (GTV-N ≥ 4.9 cc) was an independent predictor for high maximal BP dose constraints in head and neck IMRT.

  13. The components of shoulder and elbow movements as goals of primary reconstructive operation in obstetric brachial plexus lesions.

    Science.gov (United States)

    Luszawski, Jerzy; Marcol, Wiesław; Mandera, Marek

    Most of the cases of obstetric brachial plexus lesions (OBPL) show satisfactory improvement with conservative management, but in about 25% some surgical treatment is indicated. The present paper analyzes the effects of primary reconstructive surgeries in aspect of achieving delineated intraoperatively goals. Children operated before the age of 18 months with follow-up period longer than 1 year were selected. Therapeutic goals established during the operation were identified by analysis of initial clinical status and operative protocols. The elementary movement components in shoulder and elbow joints were classified by assessing range of motion, score in Active Movement Scale and modified British Medical Research Council scale of muscle strength. The effect was considered satisfactory when some antigravity movement was possible, and good when strength exceeded M3 or antigravity movement exceeded half of range of passive movement. In 13 of 19 patients most of established goals were achieved at good level, in 2 at satisfactory level. Remaining 4 patients showed improvement only in some aspects of extremity function. In 2 patients improvement in some movements was accompanied by worsening of other movements. The analysis of results separated into individual components of movements showed that goals were achieved in most of the cases, simultaneously clearly indicating which damaged structures failed to provide satisfactory function despite being addressed intraoperatively. The good results were obtained mainly by regeneration through grafts implanted after resection of neuroma in continuity, which proves that this technique is safe in spite of unavoidable temporary regression of function postoperatively. Copyright © 2017 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  14. Comparison of interscalene brachial plexus block and intra-articular local anesthetic administration on postoperative pain management in arthroscopic shoulder surgery

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    Recep Aksu

    2015-06-01

    Full Text Available BACKGROUND AND OBJECTIVES: In this study, the aim was to compare postoperative analgesia effects of the administration of ultrasound-guided interscalene brachial plexus block and intra-articular bupivacaine carried out with bupivacaine. METHODS: In the first group of patients 20 mL 0.25% bupivacaine and ultrasound-guided interscalene brachial plexus block (ISPB were applied, while 20 mL 0.25% bupivacaine was given via intra-articular (IA administration to the second group patients after surgery. Patients in the third group were considered the control group and no block was performed. Patient-controlled analgesia (PCA with morphine was used in all three groups for postoperative analgesia. RESULTS: In the ISPB group, morphine consumption in the periods between 0-4, 6-12 and 12-24 postoperative hours and total consumption within 24 h was lower than in the other two groups. Morphine consumption in the IA group was lower than in the control group in the period from 0 to 6 h and the same was true for total morphine consumption in 24 h. Postoperative VASr scores in the ISPB group were lower than both of the other groups in the first 2 h and lower than the control group in the 4th and 6th hours (p < 0.05. In the IA group, VASr and VASm scores in the 2nd, 4th and 6th hours were lower than in the control group (p < 0.05. CONCLUSION: Interscalene brachial plexus block was found to be more effective than intra-articular local anesthetic injection for postoperative analgesia.

  15. [Comparison of interscalene brachial plexus block and intra-articular local anesthetic administration on postoperative pain management in arthroscopic shoulder surgery].

    Science.gov (United States)

    Aksu, Recep; Biçer, Cihangir; Ülgey, Ayşe; Bayram, Adnan; Güneş, Işın; Güney, Ahmet; Yıldırım, Mustafa Denizhan; Gökahmetoğlu, Günhan; Yıldız, Karamehmet

    2015-01-01

    In this study, the aim was to compare postoperative analgesia effects of the administration of ultrasound-guided interscalene brachial plexus block and intra-articular bupivacaine carried out with bupivacaine. In the first group of patients 20mL 0.25% bupivacaine and ultrasound-guided interscalene brachial plexus block (ISPB) were applied, while 20mL 0.25% bupivacaine was given via intra-articular (IA) administration to the second group patients after surgery. Patients in the third group were considered the control group and no block was performed. Patient-controlled analgesia (PCA) with morphine was used in all three groups for postoperative analgesia. In the ISPB group, morphine consumption in the periods between 0-4, 6-12 and 12-24 postoperative hours and total consumption within 24h was lower than in the other two groups. Morphine consumption in the IA group was lower than in the control group in the period from 0 to 6h and the same was true for total morphine consumption in 24h. Postoperative VASr scores in the ISPB group were lower than both of the other groups in the first 2h and lower than the control group in the 4(th) and 6(th) hours (p<0.05). In the IA group, VASr and VASm scores in the 2(nd), 4(th) and 6(th) hours were lower than in the control group (p<0.05). Interscalene brachial plexus block was found to be more effective than intra-articular local anesthetic injection for postoperative analgesia. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  16. Comparison of interscalene brachial plexus block and intra-articular local anesthetic administration on postoperative pain management in arthroscopic shoulder surgery.

    Science.gov (United States)

    Aksu, Recep; Biçer, Cihangir; Ülgey, Ayşe; Bayram, Adnan; Güneş, Işın; Güney, Ahmet; Yıldırım, Mustafa Denizhan; Gökahmetoğlu, Günhan; Yıldız, Karamehmet

    2015-01-01

    In this study, the aim was to compare postoperative analgesia effects of the administration of ultrasound-guided interscalene brachial plexus block and intra-articular bupivacaine carried out with bupivacaine. In the first group of patients 20 mL 0.25% bupivacaine and ultrasound-guided interscalene brachial plexus block (ISPB) were applied, while 20 mL 0.25% bupivacaine was given via intra-articular (IA) administration to the second group patients after surgery. Patients in the third group were considered the control group and no block was performed. Patient-controlled analgesia (PCA) with morphine was used in all three groups for postoperative analgesia. In the ISPB group, morphine consumption in the periods between 0-4, 6-12 and 12-24 postoperative hours and total consumption within 24h was lower than in the other two groups. Morphine consumption in the IA group was lower than in the control group in the period from 0 to 6h and the same was true for total morphine consumption in 24h. Postoperative VASr scores in the ISPB group were lower than both of the other groups in the first 2h and lower than the control group in the 4th and 6th hours (p<0.05). In the IA group, VASr and VASm scores in the 2nd, 4th and 6th hours were lower than in the control group (p<0.05). Interscalene brachial plexus block was found to be more effective than intra-articular local anesthetic injection for postoperative analgesia. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  17. Brief reports: a clinical evaluation of block characteristics using one milliliter 2% lidocaine in ultrasound-guided axillary brachial plexus block.

    LENUS (Irish Health Repository)

    O'Donnell, Brian

    2010-09-01

    We report onset and duration of ultrasound-guided axillary brachial plexus block using 1 mL of 2% lidocaine with 1:200,000 epinephrine per nerve (total local anesthetic volume 4 mL). Block performance time, block onset time, duration of surgery, and block duration were measured. Seventeen consecutive patients were recruited. The mean (SD) block performance and onset times were 271 (67.9) seconds and 9.7 (3.7) minutes, respectively. Block duration was 160.8 (30.7) minutes. All operations were performed using regional anesthesia alone. The duration of anesthesia obtained is sufficient for most ambulatory hand surgery.

  18. Ropivacaine 7.5 mg/ml versus bupivacaine 5 mg/ml for interscalene brachial plexus block--a comparative study.

    Science.gov (United States)

    Hofmann-Kiefer, K; Herbrich, C; Seebauer, A; Schwender, D; Peter, K

    2002-06-01

    We investigated ropivacaine 75 mg/ml in comparison with bupivacaine 5 mg/ml in patients receiving interscalene brachial plexus block (ISB) and general anaesthesia. In this randomized, double-blind, prospective clinical trial, each patient received an ISB block according to the technique originally described by Winnie and a catheter technique as per Meier. The rapidity of onset and the quality of sensory and motor block were determined. After general anaesthesia had been induced further parameters evaluated were consumption of local anaesthetic, opioid and neuromuscular blocking drug. After arrival in the recovery room, the patients were assessed for intensity of pain using a visual analog scale (VAS). One hundred and twenty patients were included in the study. The onset and development of sensory block was similar in both groups. Development and quality of motor block was also nearly identical for both local anaesthetics. Consumption of neuromuscular blocking drug and opioid did not differ between ropivacaine and bupivacaine. In the recovery room the mean pain score was less than 25 in both groups. There were no significant differences in terms of onset and quality of sensory or motor block during the intraoperative and early postoperative period. In addition we did not identify any side-effects related to the administration of the local anaesthetics. Ropivacaine 7.5 mg/ml and bupivacaine 5mg/ml proved to be nearly indistinguishable when administered for interscalene brachial plexus block.

  19. Anatomical characterization of the brachial plexus in dog cadavers and comparison of three blind techniques for blockade.

    Science.gov (United States)

    Skelding, Alicia; Valverde, Alexander; Sinclair, Melissa; Thomason, Jeffrey; Moens, Noel

    2017-12-12

    To describe the ventral spinal nerve rami contribution to the formation of the brachial plexus (BP), and to compare ease of performing and nerve staining between three blind techniques for BP blockade in dogs. Prospective, randomized, blind study. A total of 18 dog cadavers weighing 28.2 ± 9.7 kg (mean ± standard deviation). Dogs were randomly assigned to two of three BP treatments: traditional approach (TA), perpendicular approach (PA), and axillary approach (AA). Dye (0.2 mL kg -1 ) was injected in the left BP using a spinal needle; another BP treatment was used in the right BP. Landmarks (L) included: L1, midpoint between point of the shoulder and sixth cervical (C 6 ) transverse process; L2, scapulohumeral joint; and L3, first rib. For TA, the needle was introduced craniocaudally through L1, medial to the limb and cranial to L3. For PA, the needle was directed perpendicular and caudal to L2, aligned with L1, until cranial to L3. For AA, the needle was directed ventrodorsally, parallel and cranial to L3 until at L1. All BPs were scored for dyeing quality [0 (poor) to 5 (excellent)]. The left BP was dissected for nerve origins. Durbin test was used to compare scores (p < 0.05). In all dogs, the musculocutaneous nerve originated from C 7 and C 8 ; the radial nerve from C 8 , the first thoracic vertebra (T 1 ) (16/18 dogs) and C 7 (2/18); and the median and ulnar nerves from C 8 , T 1 (17/18) and C 7 (1/18). Respective raw scores and adjusted scores for the incomplete block design were not significantly different (p = 0.72; ranks TA 16.5, PA 19.0, AA 18.5). The musculocutaneous, median, ulnar and radial nerves originate from C 7 , C 8 and T 1 . Regardless of the technique, knowledge of anatomy and precise landmarks are relevant for correct dye dispersion. Copyright © 2017 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.

  20. Axillary brachial plexus block duration with mepivacaine in patients with chronic renal failure. Case-control study.

    Science.gov (United States)

    Mojica, V; Nieuwveld, D; Herrera, A E; Mestres, G; López, A M; Sala-Blanch, X

    2017-04-01

    Regional anaesthesia is commonly preferred for arteriovenous fistula (AVF) creation. Previous studies suggest a shorter block duration in patients with chronic renal failure, maybe because of the changes in regional blood flow. The aim of our study was to evaluate the duration of the axillary block with 1.5% mepivacaine in patients with chronic renal failure scheduled for AVF compared with healthy controls. Patients scheduled for AVF creation for the first time (GIRC) were included. They were compared with patients without renal failure (GC), with similar anthropometric characteristics. Ultrasound-guided axillary blocks with 20mL of 1.5% mepivacaine were performed on all patients. We evaluated onset time, humeral artery diameter and blood flow before and after the block, as well as the block duration. Twenty-three patients (GIRC: 12 and GC: 11) were included. No differences between groups were observed in block duration (GIRC: 227±43min vs GC: 229±27min; P=.781), or in onset time (GIRC: 13±5min vs GC: 12.2±3min; P=.477). The humeral blood flow before and after block was significantly lower in the GIRC (pre-block: GIRC: 52±21ml/min GC: 100±62ml/min; P=.034 and p ost block: GIRC: 130±57ml/min and GC: 274±182ml/min; P=.010). There was no significant correlation between the duration of the block and the preblock humeral blood flow (Spearman Rho: 0.106; P=.657) or the postblock humeral blood flow (Spearman Rho: 0.267; P=.254). The duration of the axillary block with 1.5% mepivacaine in patients with chronic renal failure was similar to that of the control patients. The duration of axillary brachial plexus block seems not to be related to changes in regional blood flow. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Effect of tramadol as an adjuvant to local anesthetics for brachial plexus block: A systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Hye Won Shin

    Full Text Available Tramadol, a 4-phenyl-piperidine analog of codeine, has a unique action in that it has a central opioidergic, noradrenergic, serotonergic analgesic, and peripheral local anesthetic (LA effect. Many studies have reported contradictory findings regarding the peripheral analgesic effect of tramadol as an adjuvant to LA in brachial plexus block (BPB. This meta-analysis aimed to evaluate the effects of tramadol as an adjunct to LA in BPB during shoulder or upper extremity surgery.We searched the PubMed, EMBASE, Cochrane, KoreaMed databases, and Google Scholar for eligible randomized controlled trials (RCTs that compared BPB with LA alone and BPB with LA and tramadol. Primary outcomes were the effects of tramadol as an adjuvant on duration of sensory block, motor block, and analgesia. Secondary outcomes were the effects of tramadol as an adjuvant on time to onset of sensory block and motor block and on adverse effects. We performed the meta-analysis using Review Manager 5.3 software.We identified 16 RCTs with 751 patients. BPB with tramadol prolonged the duration of sensory block (mean difference [MD], -61.5 min; 95% CI, -95.5 to -27.6; P = 0.0004, motor block (MD, -65.6 min; 95% CI, -101.5 to -29.7; P = 0.0003, and analgesia (MD, -125.5 min; 95% CI, -175.8 to -75.3; P < 0.0001 compared with BPB without tramadol. Tramadol also shortened the time to onset of sensory block (MD, 2.1 min; 95% CI, 1.1 to 3.1; P < 0.0001 and motor block (MD, 1.2 min; 95% CI, 0.2 to 2.1; P = 0.010. In subgroup analysis, the duration of sensory block, motor block, and analgesia was prolonged for BPB with tramadol 100 mg (P < 0.05 but not for BPB with tramadol 50 mg. The quality of evidence was high for duration of analgesia according to the GRADE system. Adverse effects were comparable between the studies.In upper extremity surgery performed under BPB, use of tramadol 100 mg as an adjuvant to LA appears to prolong the duration of sensory block, motor block, and analgesia, and

  2. A prospective, randomized, double-blind comparison of ultrasound-guided axillary brachial plexus blocks using 2 versus 4 injections.

    Science.gov (United States)

    Imasogie, Ngozi; Ganapathy, Sugantha; Singh, Sudha; Armstrong, Kevin; Armstrong, Paidrig

    2010-04-01

    In this prospective, randomized, double-blind study, we compared the effectiveness and time efficiency of perioperative axillary blocks performed via 2 different techniques, 1 involving 2 and the other 4 separate skin punctures. One hundred twenty patients undergoing upper limb surgery were randomized to receive either (1) an axillary brachial plexus block involving 2 injections, with 30 mL local anesthetic injected posterior to the axillary artery (with redirection, as needed, to achieve circumferential spread), plus 10 mL local anesthetic to the musculocutaneous nerve, guided by ultrasound (group 1, n = 56); or (2) 4 separate 10-mL injections to the median, ulnar, radial, and musculocutaneous nerves, using a combined ultrasound and neurostimulation technique (group 2, n = 58). All patients received 40 mL of 0.5% ropivacaine with 1:400,000 epinephrine. The primary outcome was the success rate of the block, defined as anesthesia adequate for surgery. Secondary outcomes were the time to administer the block, time to the onset of motor-sensory block, time to surgical readiness, and incidence of adverse events. The 2-injection technique was slightly faster to administer (8 vs 11 minutes, P = 0.003). The mean nerve block score was slightly higher for the 4-injection group at the 10-, 15-, 20-, and 30-minute time points, but the cumulative percentages of blocks having taken effect were not significantly different over these time points, at 0.0%, 5.4%, 12.5%, and 37.5% among those who had received a 2-injection block versus 6.9%, 10.4%, 19.0%, and 48.3%, respectively, with the 4-injection block (P = 0.20). There was no difference in the percentage of patients with complete block by 30 minutes (32.1% vs 37.5%, P = 0.55) or in final block success rates (89.3% vs 87.9%, P = 0.99). An ultrasound-guided 2-injection axillary block may be as effective as, and more time efficient than, a 4-injection technique.

  3. Injury to the Lumbar Plexus and its Branches After Lateral Fusion Procedures: A Cadaver Study.

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    Grunert, Peter; Drazin, Doniel; Iwanaga, Joe; Schmidt, Cameron; Alonso, Fernando; Moisi, Marc; Chapman, Jens R; Oskouian, Rod J; Tubbs, Richard Shane

    2017-09-01

    Neurologic deficits from lumbar plexus nerve injuries commonly occur in patients undergoing lateral approaches. However, it is not yet clear what types of injury occur, where anatomically they are located, or what mechanism causes them. We aimed to study 1) the topographic anatomy of lumbar plexus nerves and their injuries in human cadavers after lateral transpsoas approaches to the lumbar spine, 2) the structural morphology of those injuries, and 3) the topographic anatomy of the lumbar plexus throughout the mediolateral approach corridor. Fifteen adult fresh frozen cadaveric torsos (26 sides) underwent lateral approaches (L1-L5) by experienced lateral spine surgeons. The cadavers were subsequently opened and the entire plexus dissected and examined for nerve injuries. The topographic anatomy of the lumbar plexus and its branches, their injuries, and the morphology of these injuries were documented. Fifteen injuries were found with complete or partial nerve transections (Sunderland IV and V). Injuries were found throughout the mediolateral approach corridor. At L1/2, the iliohypogastric, ilioinguinal, and subcostal nerves were injured within the psoas major muscle, the retroperitoneal space, or the outer abdominal muscles and subcutaneous tissues. Genitofemoral nerve injuries were found in the retroperitoneal space. Nerve root injuries occurred within the retroperitoneal space and psoas muscle. Femoral nerve injuries were found only within the psoas major muscle. No obturator nerve injuries occurred. Lateral approaches can lead to structural nerve damage. Knowledge of the complex plexus anatomy, specifically its mediolateral course, is critical to avoid approach-related injuries. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Supraclavicular brachial plexus block using ropivacaine alone or combined with dexmedetomidine for upper limb surgery: A prospective, randomized, double-blinded, comparative study.

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    Das, B; Lakshmegowda, M; Sharma, M; Mitra, S; Chauhan, R

    2016-03-01

    Dexmedetomidine is a new α-2 receptor agonist with analgesic and sedative properties. We used dexmedetomidine along with ropivacaine for supraclavicular brachial plexus block. Eighty ASA grade I-II patients, 18-60 years old, scheduled for elective upper limb orthopaedic surgery under supraclavicular brachial plexus block, were included in this prospective study. The patients were randomly assigned to group R (ropivacaine alone) and group RD (ropivacaine and dexmedetomidine) (40 patients in each group). Group R received ropivacaine 0.50% (30 cc)+placebo and group RD received ropivacaine 0.50% (30 cc)+dexmedetomidine 1 μg/kg. Primary outcome measure was duration of analgesia. Secondary measures were onset and duration of sensory blockade, pain scores, onset and duration of motor blockade, and evidence of any adverse drug reactions. There was no significant difference hemodynamic parameter during intra-operative period. Group RD showed a statistically significant shorter time to onset of sensory blockade (10.75±2.71 vs. 16.75±2.96 min, P=.003), longer sensory block duration (379.40±55.09 vs. 211.60±47.88 min, P=.002), shorter onset time to motor blockade (14.35±2.58 vs. 20.25±4.13 min, P=.003), longer motor block duration (312.0±49.91 vs. 184.7±36.76 min, P=.002), longer duration of postoperative analgesia (413.73±89.92 vs. 197.35±28.67 min, P=.002). Three patients in the group RD developed somnolence. (P=.04). Dexmedetomidine along with ropivacaine decreases the onset of motor and sensory block and increases the duration of sensory and motor block in supraclavicular brachial plexus block. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Diaphragm function after interscalene brachial plexus block: a double-blind, randomized comparison of 0.25% and 0.125% bupivacaine.

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    Thackeray, Elizabeth M; Swenson, Jeffrey D; Gertsch, Matthew C; Phillips, Kathleen M; Steele, John W; Burks, Robert T; Tashjian, Robert Z; Greis, Patrick E

    2013-03-01

    Interscalene brachial plexus block (ISBPB) provides excellent analgesia after rotator cuff surgery but is associated with diaphragm dysfunction. In this study, ISBPB with 20 mL of 0.125% or 0.25% bupivacaine were compared to assess the effect on diaphragm function, oxygen saturation, pain control, opioid requirements, and patient satisfaction. In this prospective, randomized, double-blind study, 30 adults undergoing outpatient arthroscopic rotator cuff repair were enrolled to receive ultrasound-guided interscalene brachial plexus catheter placement with 20 mL of 0.125% (n = 15) or 0.25% bupivacaine (n = 15). Diaphragm function and oxygen saturation were assessed before ISBPB placement and on discharge from the postanesthesia care unit. Postoperative pain scores, opioid requirements, and patient satisfaction were compared. Diaphragm function and oxygen saturation were superior in the low concentration group. Absent or paradoxic motion of the diaphragm was present in 78% of the 0.25% group compared with 21% of patients in the 0.125% group (P = .008). Oxygen saturation decreased 4.3% in the 0.25% group compared with a decrease of 2.6% in the 0.125% group (P = .04). Pain scores averaged 1 of 10 in the 0.25% group and 0 of 10 in the 0.125% group (P = .02). Opioid requirements and patient satisfaction were not different between the two groups. In this randomized, double-blind comparison of ISBPB performed with 20 mL of 0.125% or 0.25% bupivacaine, diaphragm function and oxygen saturation were superior in patients treated with more dilute bupivacaine. Furthermore, there were no clinically significant differences in pain scores, and no statistically significant differences in opioid requirements and patient satisfaction. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  6. Neonatal Brachial Plexus Palsy in Children Aged 0 to 2.5 Years; Parent-Perceived Family Impact, Quality of Life, and Upper Extremity Functioning.

    Science.gov (United States)

    van der Holst, Menno; Steenbeek, Duco; Pondaag, Willem; Nelissen, Rob G H H; Vliet Vlieland, Thea P M

    2016-09-01

    To investigate whether parents perceive impact of neonatal brachial plexus palsy on family and quality of life and upper extremity functioning in children less than 2.5 years. This cross-sectional study used the PedsQL Family Impact Module (36 items/one total/four scales/scores 0 to 100), TNO-AZL (Dutch Organisation of Applied Natural Science and Academic Hospital Leiden) Preschool Children Quality of Life (43 items/12 scales/scores 0 to 100) and 21 upper extremity functioning questions. Associations between neonatal brachial plexus palsy/patient characteristics and family impact, perceived quality of life, and upper extremity functioning were investigated using regression analysis. Parents of 59 children (median age, 18 months) participated, 49 with C5-C6/C5-C7 lesions. Median Family Impact Module and TNO-AZL Preschool Children Quality of Life scores were 81.3 to 100.0/100.0 and 78.6 to 100.0/100.0. TNO-AZL Preschool Children Quality of Life scores did not differ significantly to healthy references except for stomach, skin, communication, and motor functioning problems. Parents reported around three upper extremity functioning problems. Greater lesion extent, lower age, still being in follow-up, and right-sided lesions were associated with greater family impact (P quality of life. Greater lesion extent and nerve surgery history were associated with more upper extremity functioning problems (P quality of life as relatively normal and not significantly different to healthy peers. However, parents noticed upper extremity functioning problems which increased parental worrying. Health care specialists should take these findings into account to better inform or counsel parents in an early stage during treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. A prospective, randomized and controlled study of interscalene brachial plexus block for arthroscopic shoulder surgery: A comparison of C5 and conventional approach, a CONSORT-compliant article.

    Science.gov (United States)

    Shin, Hyun-Jung; Na, Hyo-Seok; Oh, Ah-Young; Hwang, Jung-Won; Kim, Byung-Gun; Park, Hee-Pyoung; Jeon, Young-Tae; Min, Seong-Won; Ryu, Jung-Hee

    2016-09-01

    The shoulder area is mainly innervated with the C5 and C6 nerve roots, and interscalene brachial plexus block (ISB) is widely used for postoperative analgesia after shoulder surgery. However, it is associated with adverse effects, such as numbness and weakness in the blocked arm due to an unwanted block of the lower brachial plexus (C7-T1). We hypothesized that the C5 approach during ISB would provide postoperative analgesia while minimizing adverse events after arthroscopic shoulder surgery. A total of 92 patients scheduled for arthroscopic shoulder surgery were enrolled and randomly assigned to 1 of the 3 groups: The control (no ISB, n = 31), conventional ISB (ISB with the conventional approach, n = 31), or C5 ISB (ISB with the C5 approach, n = 30) group. ISB was performed before the induction of anesthesia, and a subacromial catheter was placed in all patients at the end of the surgery. Postoperative pain scores, numbness, and weakness were recorded at 2, 8, and 24 hours after surgery. Oxygen saturation and overall patient satisfaction scores were also assessed at 1 and 48 hour after surgery, respectively. The pain scores were lower in the conventional ISB group and the C5 ISB group than in the control group at postoperative 2 and 8 hours (P C5 ISB group than in the conventional ISB group (P C5 ISB group than in the control group (P = 0.01). Overall patient satisfaction scores were higher in the C5 ISB group than in the control or conventional ISB group (P C5 approach for ISB provides analgesia as effectively as the conventional approach following arthroscopic shoulder surgery, with the advantages of minimal numbness and weakness.

  8. Rectal foreign body insertion as a rare cause of persistent lumbosacral plexus injury.

    Science.gov (United States)

    Meister, F A; Amygdalos, I; Neumann, U P; Lurje, G

    2017-07-01

    Rectal foreign body insertion is a common condition in emergency surgery, which often requires surgical intervention. Here we report a clinical case of rectal foreign body insertion as a rare cause of persistent lumbosacral plexus injury. A 72-year-old man presented to the emergency department complaining of acute bilateral paraplegia with loss of sensation in both legs, as well as total urinary retention. The patient underwent abdominal computed tomography, which showed a rectal foreign body measuring 13 × 11.5 × 10 cm in the lower abdomen and pelvis. Extraluminal assistance through a median laparotomy was required after unsuccessful attempts at transanal recovery alone. After removal of the foreign body, the rectal wall and anorectal sphincter were massively dilated, with severe bruising of the rectal mucosa on proctoscopy. A protective loop-ileostomy was performed. The sacral plexus is located posteriorly in the pelvis. Physiologically, the nerves are well protected by surrounding anatomical structures. Post-traumatic lumbosacral plexus injuries with paraplegia, urinary retention and anorectal sphincter insufficiency occur quite frequently after heavy traffic accidents. Lumbosacral plexus injury as a result of rectal foreign body insertion is rare. Severe neurological deficits through rectal foreign body insertion are rare but known medical conditions. To the best of our knowledge, this is the first reported case of severe and persistent post-traumatic lumbosacral plexus injury through a rectal foreign body.

  9. Comparison of dexamethasone and clonidine as an adjuvant to 1.5% lignocaine with adrenaline in infraclavicular brachial plexus block for upper limb surgeries

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    Dipal Mahendra Shah

    2015-01-01

    Full Text Available Background and Aims: The role of clonidine as an adjuvant to regional blocks to hasten the onset of the local anesthetics or prolong their duration of action is proven. The efficacy of dexamethasone compared to clonidine as an adjuvant is not known. We aimed to compare the efficacy of dexamethasone versus clonidine as an adjuvant to 1.5% lignocaine with adrenaline in infraclavicular brachial plexus block for upper limb surgeries. Material and Methods: Fifty three American Society of Anaesthesiologists-I and II patients aged 18-60 years scheduled for upper limb surgery were randomized to three groups to receive 1.5% lignocaine with 1:200,000 adrenaline and the study drugs. Group S (n = 13 received normal saline, group D (n = 20 received dexamethasone and group C (n = 20 received clonidine. The time to onset and peak effect, duration of the block (sensory and motor and postoperative analgesia requirement were recorded. Chi-square and ANOVA test were used for categorical and continuous variables respectively and Bonferroni or post-hoc test for multiple comparisons. P < 0.05 was considered significant. Results: The three groups were comparable in terms of time to onset and peak action of motor and sensory block, postoperative analgesic requirements and pain scores. 90% of the blocks were successful in group C compared to only 60% in group D (P = 0.028. The duration of sensory and motor block in group S, D and C were 217.73 ± 61.41 min, 335.83 ± 97.18 min and 304.72 ± 139.79 min and 205.91 ± 70.1 min, 289.58 ± 78.37 min and 232.5 ± 74.2 min respectively. There was significant prolongation of sensory and motor block in group D as compared to group S (P < 0.5. Time to first analgesic requirement was significantly more in groups C and D as compared with group S (P < 0.5. Clinically significant complications were absent. Conclusions: We conclude that clonidine is more efficacious than dexamethasone as an adjuvant to 1.5% lignocaine in brachial

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

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    Elenara B. Araújo

    2012-12-01

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

  11. Radiation Dose to the Brachial Plexus in Head-and-Neck Intensity-Modulated Radiation Therapy and Its Relationship to Tumor and Nodal Stage

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    Truong, Minh Tam, E-mail: mitruong@bu.edu [Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Romesser, Paul B.; Qureshi, Muhammad M.; Kovalchuk, Nataliya; Orlina, Lawrence; Willins, John [Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States)

    2012-09-01

    Purpose: The purpose of this retrospective study was to determine tumor factors contributing to brachial plexus (BP) dose in head-and-neck cancer (HNC) patients treated with intensity-modulated radiotherapy (IMRT) when the BP is routinely contoured as an organ at risk (OAR) for IMRT optimization. Methods and Materials: From 2004 to 2011, a total of 114 HNC patients underwent IMRT to a total dose of 69.96 Gy in 33 fractions, with the right and left BP prospectively contoured as separate OARs in 111 patients and the ipsilateral BP contoured in 3 patients (total, 225 BP). Staging category T4 and N2/3 disease were present in 34 (29.8%) and 74 (64.9%) patients, respectively. During IMRT optimization, the intent was to keep the maximum BP dose to {<=}60 Gy, but prioritizing tumor coverage over achieving the BP constraints. BP dose parameters were compared with tumor and nodal stage. Results: With a median follow-up of 16.2 months, 43 (37.7%) patients had {>=}24 months of follow-up with no brachial plexopathy reported. Mean BP volume was 8.2 {+-} 4.5 cm{sup 3}. Mean BP maximum dose was 58.1 {+-} 12.2 Gy, and BP mean dose was 42.2 {+-} 11.3 Gy. The BP maximum dose was {<=}60, {<=}66, and {<=}70 Gy in 122 (54.2%), 185 (82.2%), and 203 (90.2%) BP, respectively. For oropharynx, hypopharynx, and larynx sites, the mean BP maximum dose was 58.4 Gy and 63.4 Gy in T0-3 and T4 disease, respectively (p = 0.002). Mean BP maximum dose with N0/1 and N2/3 disease was 52.8 Gy and 60.9 Gy, respectively (p < 0.0001). Conclusions: In head-and-neck IMRT, dose constraints for the BP are difficult to achieve to {<=}60 to 66 Gy with T4 disease of the larynx, hypopharynx, and oropharynx or N2/3 disease. The risk of brachial plexopathy is likely very small in HNC patients undergoing IMRT, although longer follow-up is required.

  12. Ultrasound evaluation of diaphragm function and its application in critical patients, mechanical ventilation and brachial plexus block.

    Science.gov (United States)

    de la Quintana Gordon, F de B; Nacarino Alcorta, B; Fajardo Pérez, M

    2017-11-01

    Before diaphragm ultrasonography, assessment of diaphragm function was very difficult due to the complex nature of its exploration. The use of this new technique has shed light on diagnostic problems and treatment with an improvement in final outcomes for critically ill patients, in whom the incidence of diaphragm weakness or dysfunction has been underestimated. Better knowledge of diaphragm function enables us earlier diagnosis by quantification of diaphragm contractile activity or evaluation of functional status after delivery of plexus block anaesthesia, facilitating therapeutic decisions. It is also being used as a guide in the process of weaning from mechanical ventilation or as the safest approach for braquial plexus block. In this review we present how to perform a systematic exploration of diaphragm function and its clinical implications. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. [Association of physiotherapy under continuous brachial plexus analgesia and shoulder arthrographic-distension for treatment of resistant shoulder-hand syndrome].

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    Nouri, M; Barré, P; Vesvard, D; Hanifi, M; Estèbe, J P

    2014-05-01

    Evaluation of treatment of shoulder-hand syndromes resistant to conventional therapeutic. This approach consists of an intensive treatment based on arthrographic distension with rapid mobilization of the shoulder under general anaesthesia and on active rehabilitation under regional analgesia using infraclavicular brachial plexus catheter. It was a retrospective study of twenty-five consecutive patients with severe shoulder-hand syndrome treated between 2007 and 2012. Besides their persistent pain, these patients presented a functional disability of their shoulder, wrist and hand. Treatment was initiated at least three months after diagnosis. All were assessed at the admission and six months later. After treatment, pain was reduced by at least three points at the NS in 64% of the patients. Twelve patients described a complete recovery of their shoulder function; eleven patients described a normal hand function recovery and six patients a partial recovery allowing regular life. Nineteen patients evaluated their functional improvement of more than 50%. Only two patients with more than one year of chronic pain reported no improvement after treatment. After failure of the physiotherapy and analgesic treatment, there are no clear consensual procedures and guidelines remains discussed. The current study combined different approaches with a significant improvement of this complex regional pain syndrome called shoulder-hand syndromes. Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  14. Effect of intravenous ondansetron on reducing the incidence of hypotension and bradycardia events during shoulder arthroscopy in sitting position under interscalene brachial plexus block: A prospective randomized trial

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    Srinivasa Rao Nallam

    2015-01-01

    Full Text Available Background and Aims: Sudden, profound hypotension and bradycardia events (HBEs have been reported in more than 20% of patients undergoing shoulder arthroscopy in the sitting position. The present study was designed to know whether intravenous (IV ondansetron (selective 5-hydroxy tryptamine 3-antagonist can help in reducing the HBEs associated with shoulder arthroscopy performed in sitting position under interscalene brachial plexus block (ISBPB. Methods: A total of 100 patients (age 20-50 years undergoing shoulder arthroscopy performed in the sitting position under ISBPB were assigned randomly to one of the two groups: Group C received 10 ml of normal saline and Group T received 4 mg of ondansetron diluted in 10 ml of normal saline` IV. All patients received ISBPB using levobupivacaine 0.5%. Assessment of motor and sensory blockade, pulse rate, systolic blood pressure, respiration, and side effects were noted every 5 min for first 30 min and every 10 min till the end of surgery. HBEs were recorded in both groups. Results: IV injection of ondansetron significantly reduces the incidence of HBEs from 11 (22.44% in Group C to 3 (6.1% in Group T. The duration of analgesia was significantly longer in Group C (8.1 ± 3.3 in comparison with Group T (6.3 ± 4.2 h. Conclusion: We conclude that 4 ml of IV ondansetron can significantly reduce the HBEs during shoulder arthroscopy done in the sitting position under ISBPB.

  15. The choroid plexus as a site of damage in hemorrhagic and ischemic stroke and its role in responding to injury.

    Science.gov (United States)

    Xiang, Jianming; Routhe, Lisa J; Wilkinson, D Andrew; Hua, Ya; Moos, Torben; Xi, Guohua; Keep, Richard F

    2017-03-28

    While the impact of hemorrhagic and ischemic strokes on the blood-brain barrier has been extensively studied, the impact of these types of stroke on the choroid plexus, site of the blood-CSF barrier, has received much less attention. The purpose of this review is to examine evidence of choroid plexus injury in clinical and preclinical studies of intraventricular hemorrhage, subarachnoid hemorrhage, intracerebral hemorrhage and ischemic stroke. It then discusses evidence that the choroid plexuses are important in the response to brain injury, with potential roles in limiting damage. The overall aim of the review is to highlight deficiencies in our knowledge on the impact of hemorrhagic and ischemic strokes on the choroid plexus, particularly with reference to intraventricular hemorrhage, and to suggest that a greater understanding of the response of the choroid plexus to stroke may open new avenues for brain protection.

  16. Brachial artery injury following opened elbow dislocation associated ...

    African Journals Online (AJOL)

    Elbow dislocations are the most frequently encountered after shoulder dislocations. In their vast majority, these injuries carry a good prognosis. Although, concomitant arterial injury is rare and make them more serious. In this paper, we report a case of a 17 year old woman with opened elbow dislocation with arterial injury ...

  17. Direct cord implantation in brachial plexus avulsions: revised technique using a single stage combined anterior (first posterior (second approach and end-to-side side-to-side grafting neurorrhaphy

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    Abdel-Meguid Amr MS

    2009-06-01

    Full Text Available Abstract Background The superiority of a single stage combined anterior (first posterior (second approach and end-to-side side-to-side grafting neurorrhaphy in direct cord implantation was investigated as to providing adequate exposure to both the cervical cord and the brachial plexus, as to causing less tissue damage and as to being more extensible than current surgical approaches. Methods The front and back of the neck, the front and back of the chest up to the midline and the whole affected upper limb were sterilized while the patient was in the lateral position; the patient was next turned into the supine position, the plexus explored anteriorly and the grafts were placed; the patient was then turned again into the lateral position, and a posterior cervical laminectomy was done. The grafts were retrieved posteriorly and side grafted to the anterior cord. Using this approach, 5 patients suffering from complete traumatic brachial plexus palsy, 4 adults and 1 obstetric case were operated upon and followed up for 2 years. 2 were C5,6 ruptures and C7,8T1 avulsions. 3 were C5,6,7,8T1 avulsions. C5,6 ruptures were grafted and all avulsions were cord implanted. Results Surgery in complete avulsions led to Grade 4 improvement in shoulder abduction/flexion and elbow flexion. Cocontractions occurred between the lateral deltoid and biceps on active shoulder abduction. No cocontractions occurred after surgery in C5,6 ruptures and C7,8T1 avulsions, muscle power improvement extended into the forearm and hand; pain disappeared. Limitations include spontaneous recovery despite MRI appearance of avulsions, fallacies in determining intraoperative avulsions (wrong diagnosis, wrong level; small sample size; no controls rule out superiority of this technique versus other direct cord reimplantation techniques or other neurotization procedures; intra- and interobserver variability in testing muscle power and cocontractions. Conclusion Through providing proper

  18. Brachial artery injury due to closed posterior elbow dislocation: case report☆

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    Alberto Naoki Miyazaki

    2016-04-01

    Full Text Available An association between closed posterior elbow dislocation and traumatic brachial artery injury is rare. Absence of radial pulse on palpation is an important warning sign and arteriography is the gold-standard diagnostic test. Early diagnosis is essential for appropriate treatment to be provided. This consists of joint reduction and immobilization, along with urgent surgical restoration of arterial flow. Here, a case (novel to the Brazilian literature of an association between these injuries (and the treatment implemented in a 27-year-old male patient is reported. These injuries were sustained through physical assault.

  19. Nova técnica de bloqueio do plexo braquial em cães New technique of brachial plexus block in dogs

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    Fábio Futema

    1999-03-01

    Full Text Available O objetivo do presente estudo foi analisar a viabilidade e a eficácia de uma nova técnica para o bloqueio do plexo braquial em cães. Para tanto, foram utilizados 11 cães, machos e fêmeas, idade e peso variáveis e mestiços. Os animais foram pré-tratados com acepromazina e a indução da anestesia foi realizada com propofol. Posteriormente, os animais foram submetidos ao bloqueio do plexo braquial que constou da associação da técnica de múltiplas injeções com o emprego do estimulador de nervos e a técnica da palpação arterial como ponto de referência para a localização dos nervos. Utilizou-se como anestésico local, a bupivacaína com vasoconstritor administrado na dose total de 4mg/kg a 0,375% . O volume total foi dividido em 4 partes iguais, administradas na velocidade de 30 segundos cada, com o objetivo de se atingir a maior quantidade de nervos. O tempo necessário para realização da técnica foi de 11,30 ± 4,54 minutos; o período de latência para o bloqueio motor foi de 9,70 ± 5,52 minutos e para o bloqueio sensitivo foi de 26,20 ± 8,86 min. , sendo a duração da analgesia de 11:00 ± 0:45 horas. Em 90% dos animais, o bloqueio foi efetivo, constatado através da anestesia de todo membro torácico distal à articulação escápulo-umeral. A única complicação observada foi a hipotensão arterial desenvolvida em um animal. Mediante os resultados obtidos, pode-se pressupor que as cirurgias envolvendo o membro torácico distal à articulação escápulo-umeral poderão ser utilizadas com auxílio desta nova técnica do bloqueio do plexo braquial, bem como na analgesia pós-operatória de longa duração.The aim of this study was to evaluate the viability and efficacy of a new technique of brachial plexus block in dogs. Eleven mongrel dogs of different ages and weight, both male and female were used. Animals were pre-medicated with acepromazine and induction of anesthesia was performed with propofol. The brachial

  20. The effect of metrics-based feedback on acquisition of sonographic skills relevant to performance of ultrasound-guided axillary brachial plexus block.

    Science.gov (United States)

    Ahmed, O M A; Niessen, T; O'Donnell, B D; Gallagher, A G; Breslin, D S; DunnGalvin, A; Shorten, G D

    2017-09-01

    The objective of this study was to examine the effect of metrics-based vs. non-metrics-based feedback on novices learning predefined competencies for acquisition and interpretation of sonographic images relevant to performance of ultrasound-guided axillary brachial plexus block. Twelve anaesthetic trainees were randomly assigned to either metrics-based-feedback or non-metrics-based feedback groups. After a common learning phase, all participants attempted to perform a predefined task that involved scanning the left axilla of a single volunteer. Following completion of the task, all participants in each group received feedback from a different expert in regional blocks (consultant anaesthetist) and were allowed to practise the predefined task for up to 1 h. Those in the metrics-based feedback group received feedback based on previously validated metrics, and they practised each metric item until it was performed satisfactorily, as assessed by the supervising consultant. Subsequently, each participant attempted to perform ultrasonography of the left axilla on the same volunteer. Two trained consultant anaesthetists independently scored the video recording pre- and post-feedback scans using the validated metrics list. Both groups showed improvement from pre-feedback to post-feedback scores. Compared with participants in the non-metrics-based feedback group, those in the metrics-based feedback group completed more steps: median (IQR [range]) 18.8 (1.5 [17-20]) vs. 14.3 (4.5 [11-18.5]), p = 0.009, and made fewer errors 0.5 (1 [0-1.5]) vs. 1.5 (2 [1-6]), p = 0.041 postfeedback. In this study, novices' sonographic skills showed greater improvement when feedback was combined with validated metrics. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

  1. Addition of a third field significantly increases dose to the brachial plexus for patients undergoing tangential whole-breast therapy after lumpectomy

    Energy Technology Data Exchange (ETDEWEB)

    Stanic, Sinisa; Mathai, Mathew; Mayadev, Jyoti S.; Do, Ly V.; Purdy, James A. [Department of Radiation Oncology, University of California, Davis, Sacramento, CA (United States); Chen, Allen M., E-mail: allen.chen@ucdmc.ucdavis.edu [Department of Radiation Oncology, University of California, Davis, Sacramento, CA (United States)

    2012-07-01

    Our goal was to evaluate brachial plexus (BP) dose with and without the use of supraclavicular (SCL) irradiation in patients undergoing breast-conserving therapy with whole-breast radiation therapy (RT) after lumpectomy. Using the standardized Radiation Therapy Oncology Group (RTOG)-endorsed guidelines delineation, we contoured the BP for 10 postlumpectomy breast cancer patients. The radiation dose to the whole breast was 50.4 Gy using tangential fields in 1.8-Gy fractions, followed by a conedown to the operative bed using electrons (10 Gy). The prescription dose to the SCL field was 50.4 Gy, delivered to 3-cm depth. The mean BP volume was 14.5 {+-} 1.5 cm{sup 3}. With tangential fields alone, the median mean dose to the BP was 0.57 Gy, the median maximum dose was 1.93 Gy, and the irradiated volume of the BP receiving 40, 45, and 50 Gy was 0%. When the third (SCL field) was added, the dose to the BP was significantly increased (P = .01): the median mean dose to the BP was 40.60 Gy, and the median maximum dose was 52.22 Gy. With 3-field RT, the median irradiated volume of the BP receiving 40, 45, and 50 Gy was 83.5%, 68.5%, and 24.6%, respectively. The addition of the SCL field significantly increases dose to the BP. The possibility of increasing the risk of BP morbidity should be considered in the context of clinical decision making.

  2. Utility of ultrasound-guided injection of botulinum toxin type A for muscle imbalance in children with obstetric brachial plexus palsy: Description of the procedure and action protocol.

    Science.gov (United States)

    García Ron, A; Gallardo, R; Huete Hernani, B

    2017-03-24

    Obstetric brachial plexus palsy (OBPP) usually has a favourable prognosis. However, nearly one third of all severe cases have permanent sequelae causing a high level of disability. In this study, we explore the effectiveness of ultrasound-guided injection of botulinum toxin A (BoNT-A) and describe the procedure. We designed a prospective, descriptive study including patients with moderate to severe OBPP who were treated between January 2010 and December 2014. We gathered demographic data, type of OBPP, and progression. Treatment effectiveness was assessed with the Active Movement Scale (AMS), the Mallet classification, and video recordings. We gathered a total of 14 133 newborns, 15 of whom had OBPP (1.6 per 1000 live births). Forty percent of the cases had severe OBPP (0.4/1000), a dystocic delivery, and APGAR scores treatment onset was 11.5 months. The muscles most frequently receiving BoNT-A injections were the pronator teres, subscapularis, teres major, latissimus dorsi, and pectoralis major. All the patients who completed the follow-up period (83%) experienced progressive improvements: up to 3 points on the AMS and a mean score of 19.5 points out of 25 on the Mallet classification at 2 years. Treatment improved muscle function and abnormal posture in all cases. Surgery was avoided in 3 patients and delayed in one. Adverse events were mild and self-limited. Due to its safety and effectiveness, BoNT-A may be used off-label as an adjuvant to physical therapy and/or surgery in moderate to severe OBPP. Ultrasound may increase effectiveness and reduce adverse effects. Copyright © 2017 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Sensory neuronopathy involves the spinal cord and brachial plexus: a quantitative study employing multiple-echo data image combination (MEDIC) and turbo inversion recovery magnitude (TIRM)

    Energy Technology Data Exchange (ETDEWEB)

    Bao, Yi-Fang; Tang, Wei-Jun; Li, Yu-Xin; Geng, Dao-Ying [Fudan University, Department of Radiology, Huashan Hospital, Shanghai (China); Zhu, Dong-Qing; Chen, Xiang-Jun [Fudan University, Department of Neurology, Huashan Hospital, Shanghai (China); Zee, Chi-Shing [University of Southern California Keck School of Medicine, Department of Radiology, Los Angeles, CA (United States)

    2013-01-15

    Sensory neuronopathy (SNN) is a distinctive subtype of peripheral neuropathies, specifically targeting dorsal root ganglion (DRG). We utilized MRI to demonstrate the imaging characteristics of DRG, spinal cord (SC), and brachial plexus at C7 level in SNN. We attempted multiple-echo data image combination (MEDIC) and turbo inversion recovery magnitude (TIRM) methods in nine patients with sensory neuronopathy and compared with those in 16 disease controls and 20 healthy volunteers. All participants underwent MRI for the measurement of DRG, posterior column (PC), lateral column, and spinal cord area (SCA) at C7 level. DRG diameters were obtained through its largest cross section, standardized by dividing sagittal diameter of mid-C7 vertebral canal. We also made comparisons of standardized anteroposterior diameter (APD) and left-right diameters of SC and PC in these groups. Signal intensity and diameter of C7 spinal nerve were assessed on TIRM. Compared to control groups, signal intensities of DRG and PC were higher in SNN patients when using MEDIC, but the standardized diameters were shorter in either DRG or PC. Abnormal PC signal intensities were identified in eight out of nine SNN patients (89 %) with MEDIC and five out of nine (56 %) with T2-weighted images. SCA, assessed with MEDIC, was smaller in SNN patients than in the other groups, with significant reduction of its standardized APD. C7 nerve root diameters, assessed with TIRM, were decreased in SNN patients. MEDIC and TIRM sequences demonstrate increased signal intensities and decreased area of DRG and PC, and decreased diameter of nerve roots in patients with SNN, which can play a significant role in early diagnosis. (orig.)

  4. Avulsão do plexo braquial em cães -1: aspectos clínicos e neurológicos Brachial plexus avulsion in dogs -1: clinical and neurological aspects

    Directory of Open Access Journals (Sweden)

    Mônica Vicky Bahr Arias

    1997-03-01

    Full Text Available A avulsão do plexo braquial é afecção de ordem traumática relativamente comum, ocasionando paralisia grave do membro torácico. É freqüentemente confundida com paralisia do nervo radial, havendo controvérsias sobre o tratamento. O objetivo deste trabalho foi: avaliar clinica e neurologicamente cães com avulsão do plexo braquial, demonstrando os aspectos significativos para o diagnóstico desta afecção. Observou-se predominância de cães sem raça definida, fêmea, com menos de três anos de idade, sendo o atropelamento a etiologia principal. As alterações clinicam/neurológicas mais freqüentes foram: paralisia flácida, ausência do reflexo dopanículo, ausência dos reflexos tricipital, bicipital e extensor do carpo radial, atrofia dos músculos tríceps, bíceps, supra-espinhal, infra-espinhal e extensores do carpo, anestesia cutânea abaixo do nível do cotovelo e abrasão/ulceração em face dorsal da mão. A associação destes resultados com os aspectos da histologia e da eletroneuroestimulação (relatados na parte 2 e 3 deste trabalho, respectivamente sugeriu envolvimento quase que total das raízes do plexo braquial em todos os casos.Brachial plexus avulsion is a relatively common affection, causing serious paralysis of the thoracic limb. It is often misdiagnosed as radial paralysis and there are controversies about the treatment. The main purposes of this work were: to evaluate clinically and neurologically dogs with brachial plexus avulsion and to demonstrate the relevant aspects in the diagnosis of this affection. Predominantly mixed breed dogs, females under three years of age were observed, and the brachial plexus avulsion was mainly a result of road accidents. The more frequent clinical and neurological signs were: flacid paralysis, loss of the panniculus, triceps, biceps and extensor carpi radial muscle reflexes, atrophy of the muscles triceps, biceps, extensor carpi radial, supraspinatus and infraespinatus

  5. MR neurography in traumatic brachial plexopathy

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-05-15

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

  6. 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

    Directory of Open Access Journals (Sweden)

    Sílvia Helena Brendolan Gerbasi

    2008-12-01

    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

  7. Bases anatômicas para o bloqueio anestésico do plexo braquial por via infraclavicular Bases anatómicas para el bloqueo anestésico del plexo braquial por vía infraclavicular Anatomical basis for infraclavicular brachial plexus block

    Directory of Open Access Journals (Sweden)

    Luiz Carlos Buarque de Gusmão

    2002-06-01

    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.

  8. Prompt Referral in the Nonoperative Treatment of Obstetrical Brachial Plexus Injuries

    Directory of Open Access Journals (Sweden)

    Alain Joe Azzi, MD

    2017-12-01

    Conclusions:. The subgroup of newborns with an Apgar score <7 at 5 minutes shows improved long-term shoulder function when promptly examined by an OBPI clinic. We recommend a “fast-track” referral for this time-sensitive population.

  9. The effect of low serum bicarbonate values on the onset of action of local anesthesia with vertical infraclavicular brachial plexus block in patients with End-stage renal failure

    Directory of Open Access Journals (Sweden)

    Al-mustafa Mahmoud

    2010-01-01

    Full Text Available Vertical infraclavicular brachial plexus block is utilized in patients with chronic renal failure at the time of creation of an arterio-venous fistula (AVF. The aim of this study is to test the effect of impaired renal function, with the resulting deranged serum electrolytes and blood gases, on the success rate and the onset of action of the local anesthetics used. In this prospective clinical study, we investigated the effect of the serum levels of sodium, potassium, urea, crea-tinine, pH, and bicarbonate on the onset of action of a mixture of lidocaine and bupivacaine administered to create infraclavicular brachial plexus block. A total of 31 patients were studied. The success rate of the block was 93.5 % (29 patients. The mean onset time for impaired or re-duced sensation was found to be 8.9 ± 4.7 mins and for complete loss of sensation, was 21.2 ± 6.7 mins. There was no significant association with serum sodium, potassium, urea, creatinine or the blood pH level (P> 0.05. The bivariate correlation between serum bicarbonate level and the partial and complete sensory loss was -0.714 and -0.433 respectively, with significant correlation (P= 0.00, 0.019. Our study suggests that infraclavicular block in patients with chronic renal failure carries a high success rate; the onset of the block is delayed in patients with low serum bicarbonate levels.

  10. Clonidine as an adjuvant in axillary brachial plexus block for below elbow orthopedic surgeries: A comparison between local and systemic administration.

    Science.gov (United States)

    Ghoshmaulik, Sumanta; Bisui, Bikash; Saha, Debasish; Swaika, Sarbari; Ghosh, Arun K

    2012-01-01

    Axillary brachial plexus block for below elbow orthopedic surgery provides a safe and low-cost technique with the advantage of prolonged postoperative analgesia. Clonidine, with selective partial agonist activity on α2 adrenergic receptors, has significantly demonstrated its role in this regard as an adjuvant to local anesthetics. The current study compares the locally administered clonidine with systemically administered control group in terms of onset and duration of sensory block, motor block, and analgesia; hemodynamic variability; sedation; and other side effect profile. Seventy patients (ASA I or II) scheduled for below elbow orthopedic surgeries were randomly allocated in equal numbers to receive either 30 ml of 0.5% plain bupivacaine with 150 μg (1 ml) of inj. clonidine locally in the axillary sheath and 1 ml of normal saline (NS) subcutaneously (Group L) or 30 ml of 0.5% plain bupivacaine with 1 ml of NS locally and 150 μg (1 ml) of inj. clonidine subcutaneously (Group S). Standard monitoring of vital parameters was done. Duration of sensory and motor block, analgesia, hemodynamic changes, and any adverse effects were observed and recorded for different duration up to 24 h. Duration of sensory block (625 ± 35 min), motor block (690 ± 38 min), and analgesia (930 ± 45 min) was significantly longer in Group L than in Group S [sensory block (480 ± 30 min), motor block (535 ± 25 min), and analgesia (720 ± 30 min)] (P < 0.05). Significant alteration of heart rate, systolic blood pressure and diastolic blood pressure, and mean arterial pressure in Group S was observed compared to Group L (P < 0.05). Side effects like nausea and vomiting were comparable, but highly significant sedation score (χ(2) = 47.75 and 49.51 at 120 and 240 min, respectively; P < 0.01) was observed between the two groups. Compared to systemic administration, local clonidine as an adjuvant in axillary block resulted in significant prolongation of duration of sensory and motor

  11. Effects of arthroscopy-guided suprascapular nerve block combined with ultrasound-guided interscalene brachial plexus block for arthroscopic rotator cuff repair: a randomized controlled trial.

    Science.gov (United States)

    Lee, Jae Jun; Hwang, Jung-Taek; Kim, Do-Young; Lee, Sang-Soo; Hwang, Sung Mi; Lee, Na Rea; Kwak, Byung-Chan

    2017-07-01

    The aim of this study was to compare the pain relieving effect of ultrasound-guided interscalene brachial plexus block (ISB) combined with arthroscopy-guided suprascapular nerve block (SSNB) with that of ultrasound-guided ISB alone within the first 48 h after arthroscopic rotator cuff repair. Forty-eight patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled. The 24 patients in group 1 received ultrasound-guided ISB and arthroscopy-guided SSNB; the remaining 24 patients in group 2 underwent ultrasound-guided ISB alone. Visual analogue scale pain score and patient satisfaction score were checked at 1, 3, 6, 12, 18, 24, and 48 h post-operatively. Group 1 had a lower visual analogue scale pain score at 3, 6, 12, 18, 24, and 48 h post-operatively (1.7  6.0, 6.2 > 4.3, 6.4 > 5.1, 6.9 > 5.9, 7.9 > 7.1). Six patients in group 1 developed rebound pain twice, and the others in group 1 developed it once. All of the patients in group 2 had one rebound phenomenon each (p = 0.010). The mean timing of rebound pain in group 1 was later than that in group 2 (15.5 > 9.3 h, p  4.0, p = 0.001). Arthroscopy-guided SSNB combined with ultrasound-guided ISB resulted in lower visual analogue scale pain scores at 3-24 and 48 h post-operatively, and higher patient satisfaction scores at 6-36 h post-operatively with the attenuated rebound pain compared to scores in patients who received ultrasound-guided ISB alone after arthroscopic rotator cuff repair. The combined blocks may relieve post-operative pain more effectively than the single block within 48 h after arthroscopic cuff repair. Randomized controlled trial, Level I. ClinicalTrials.gov Identifier: NCT02424630.

  12. Interscalene brachial plexus block for open-shoulder surgery: a randomized, double-blind, placebo-controlled trial between single-shot anesthesia and patient-controlled catheter system.

    Science.gov (United States)

    Goebel, Sascha; Stehle, Jens; Schwemmer, Ulrich; Reppenhagen, Stephan; Rath, Beatrice; Gohlke, Frank

    2010-04-01

    Interscalene brachial plexus block (ISB) is widely used as an adjuvant regional pain therapy in patients undergoing major shoulder surgery and has proved its effectiveness on postoperative pain reduction and opioid-sparing effect. This single-center, prospective, double-blind, randomized and placebo-controlled study was to compare the effectiveness of a single-shot and a patient-controlled catheter insertion ISB system after major open-shoulder surgeries. Seventy patients were entered to receive an ISB and a patient-controlled interscalene catheter. The catheter was inserted under ultrasound guidance. Patients were then assigned to receive one of two different postoperative infusions, either 0.2% ropivacaine (catheter group) or normal saline solution (single-shot group) via a disposable patient-controlled infusion pump. The study variables were amount of rescue medication, pain at rest and during physiotherapy, patient satisfaction and incidence of unwanted side effects. The ropivacaine group revealed significantly less consumption of rescue medication within the first 24 h after surgery. Incidence of side effects did not differ between the two groups. Based on our results, we recommend the use of interscalene plexus block in combination with a patient-controlled catheter system under ultrasound guidance only for the first 24 h after major open-shoulder surgery.

  13. Anomalous patterns of formation and distribution of the brachial ...

    African Journals Online (AJOL)

    block Background: Structural variations in the patterns of formation and distribution of the brachial plexus have drawn attentions both in anatomy and anaesthesia. Method: An observational study. Results: The brachial plexus was carefully inspected in both the right and left arms in 90 Nigerian cadavers, comprising of 74 ...

  14. Análise comparativa da origem do plexo branquial de catetos (Tayassu tajacu Comparative analysis of the origin of the brachial plexus of the collared peccary (Tayassu tajacu

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    Carlos Eduardo B. Moura

    2007-09-01

    .Collared peccary (Tayassu tajacu belongs to the Tayassuidae family, characterized by a "collar" of white hairs that cross behind the neck and extend bilaterally in front of the shoulders. It can be found from south-western United States to Argentina. In the literature a shortage of data is verified regarding the functional anatomy of the collared peccaries, especially of studies that involve the anatomy of the brachial plexus. To elucidate the behavior of this plexus of collared peccaries and with the purpose to contribute for the development of compared anatomy, this study was accomplished. Thirty animals of different ages were used (17 males and 13 females coming from the Wild Animal Multiplication Center of the "Universidade Federal Rural do Semiárido" Mossoró, Rio Grande do Norte, Brazil. After slaughter bilateral dissection of the brachial plexuses took place, and the results were registered in schematic drawings and the dispositions grouped in tables for subsequent statistical analysis based on the percentile frequency. It was found that the Plexus brachialis of collared peccaries is the result of established communications, mainly among the Rami ventrales of the last three cervical nerves and of the first two thoracic nerves, having a contribution of the fourth and fifth cervical nerves in 16.67% and 50.00% of the cases, respectively. In 40.00% of the dissections the most frequent plexus was of the type C6, C7, C8, T1 and T2. The main nerves derived from brachial plexus of the collared peccaries and its respective origins had been: Nervus suprascapularis (C6, C7, Nn. subscapulares (C5, C6 e C7 or C6 e C7, N. axillaris (C6, C7, N. musculocutaneus (C7, C8, N. medianus (C7, C8, T1, T2, N. radialis (C8, T1, T2, N. ulnaris (C8, T1, T2, cranialis (C7, and caudalis (C7, C8 Nn. pectorales , N. thoracodorsalis (C6, C7, C8, N. thoracicus longus (C7, C8, and N. thoracicus lateralis (C8, T1, T2.

  15. Choroid Plexus

    Science.gov (United States)

    ... of Tumors Astrocytoma Atypical Teratoid Rhaboid Tumor (ATRT) Chondrosarcoma Choroid Plexus Craniopharyngioma Cysts Ependymoma Germ Cell Tumor ... of Tumors Astrocytoma Atypical Teratoid Rhaboid Tumor (ATRT) Chondrosarcoma Choroid Plexus Craniopharyngioma Cysts Ependymoma Germ Cell Tumor ...

  16. Case Report- Une cause rare de plexopathie brachiale : une ...

    African Journals Online (AJOL)

    Nous rapportons le cas d'une patiente de 50 ans ayant une histoire de cancer du sein et qui accuse une symptomatologie d'atteinte du plexus brachial. L'IRM montre une masse qui envahie le plexus brachial compatible avec une métastase. L'IRM est très utile pour le diagnostic et l'orientation thérapeutique des ...

  17. Rhabdomyolysis resulting in concurrent Horner's syndrome and brachial plexopathy: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Susan C.; Geannette, Christian; Sneag, Darryl B. [Hospital for Special Surgery, Department of Radiology and Imaging, New York, NY (United States); Wolfe, Scott W. [Hospital for Special Surgery, Hand and Upper Extremity, Department of Orthopedics, New York, NY (United States); Feinberg, Joseph H. [Hospital for Special Surgery, Physical Medicine and Rehabilitation, New York, NY (United States)

    2017-08-15

    This case report describes a 29-year-old male who presented with immediate onset of Horner's syndrome and ipsilateral brachial plexopathy after sleeping with his arm dangling outside a car window for 8 h. Outside workup and imaging revealed rhabdomyolysis of the left neck musculature. Subsequent electrodiagnostic testing and high-resolution brachial plexus magnetic resonance imaging at the authors' institution attributed the Horner's syndrome and concurrent brachial plexopathy to rhabdomyolysis of the longus colli and scalene musculature, which had compressed - and consequently scar tethered - the cervical sympathetic trunk and brachial plexus. This case of co-existent Horner's syndrome and brachial plexopathy demonstrates the role of high-resolution brachial plexus MRI in diagnosing plexopathy and the importance of being familiar with plexus and paravertebral muscle anatomy. (orig.)

  18. Seizure complicating interscalene brachail plexus block | Idehen ...

    African Journals Online (AJOL)

    We describe a case of seizure occurring immediately after completion of interscalene brachial plexus block, using 20mls mixture of 10mls of 0.5% bupivacaine and 10mls of 2% lidocaine with adrenaline for post operative analgesia. Seizure occurred despite negative test aspiration and non response to the use of 0.5mls of ...

  19. Ultrasound-guided supraclavicular brachial plexus anaesthesia ...

    African Journals Online (AJOL)

    arteriovenous fistula flow characteristics in end-stage renal disease patients. Shyam Meenaa* ... Diameter of the vessels, peak systolic velocity, mean diastolic velocity, and blood flow at 30 minutes, 48 ... predictors of successful RCAVF function.1,3 .... underlying diseases like diabetes, hypertension, peripheral vascular.

  20. Skin temperature after interscalene brachial plexus blockade

    NARCIS (Netherlands)

    Hermanns, Henning; Braun, Sebastian; Werdehausen, Robert; Werner, Andreas; Lipfert, Peter; Stevens, Markus F.

    2007-01-01

    Background and Objectives: In neuraxial anesthesia, increase of skin temperature is an early sign of successful block. Yet, during peripheral nerve block of the lower extremity, increase in skin temperature is a highly sensitive, but late sign of a successful block. We hypothesized that after

  1. Ultrasound-Guided Supraclavicular Brachial Plexus Block

    Directory of Open Access Journals (Sweden)

    M. S. Sinitsin

    2011-01-01

    Full Text Available Objective: to evaluate the efficiency of cardiotropic therapy in neonates with severe posthypoxic myocardial ischemia and to improve severity rating criteria that would allow a differentiated approach to therapy for this condition. Subjects and methods. The efficiency of cardiotropic therapy was evaluated in 53 newborn infants with posthypoxic myocardial ischemia. Thirty (56.6% neonates received phosphocreatinine in a dose of 30 mg/kg/day for 3 days as cardiotropic support; 23 (43.4% babies had riboxine in a dose of 15—20 mg/kg. Results. The use of phosphocreatinine was found to be more effective than that of riboxine and to favor better blood biochemical composition parameters and lower ECG and intracardiac hemodynamic changes, which in turn reduced the time of mechanical ventilation from 11 to 8.25 days and that of administration of dopamine from 8 to 6 days, and its dose from 2 to 5 mg/kg/min. Conclusion. This investigation has led to the conclusion that there is a need for a comprehensive approach to diagnosing postischemic myocardial damages, including not only their clinical picture, but also a set of biochemical markers for ischemia and ECG and EchoCG changes on the 1st, 3rd, and then every 5—7 days and for the concomitant use of cardiotonic (dopamine and cardiotrophic (phosphocreatinine therapy; the administration of phosphocreatinine on intensive care unit admission (after prior hypoxia as early as possible improves neonatal heart performance values. There are positive changes in both ECG and EchoCG and biochemical parameters (LDH, ALT, AST, De Ritis ratio. Key words: posthypoxic myocar-dial ischemia, neonates, phosphocreatinine.

  2. Neonatal Brachial Plexus Palsy and Causation

    LENUS (Irish Health Repository)

    Turner, M J

    2016-07-01

    A vaginal childbirth is the result of the internal (endogenous) expulsive forces of uterine contractions, usually supplemented by active maternal pushing1. Depending on the clinical circumstances, additional external (exogenous) traction forces may be required from the birth attendant. This blend of internal and external forces varies from birth to birth. Women who have had a previous vaginal delivery, for example, may deliver successfully with uterine contractions alone and the role of the birth attendant may be simply to control and slow the delivery so that trauma to the maternal perineum from stretching by the fetal head is minimised. In contrast, additional traction may be required by an obstetrician at the time of an operative vaginal delivery for fetal distress or dystocia. The strength of the traction required may be increased by clinical factors, for example, fetal macrosomia or malposition. The traction should be axial in the direction of the birth canal, which is a vector combining horizontal and vertical traction at 25-45 degrees below the horizontal when the woman is in the lithotomy position.

  3. Cell transplantation for the treatment of spinal cord injury - bone marrow stromal cells and choroid plexus epithelial cells

    Directory of Open Access Journals (Sweden)

    Chizuka Ide

    2016-01-01

    Full Text Available Transplantation of bone marrow stromal cells (BMSCs enhanced the outgrowth of regenerating axons and promoted locomotor improvements of rats with spinal cord injury (SCI. BMSCs did not survive long-term, disappearing from the spinal cord within 2-3 weeks after transplantation. Astrocyte-devoid areas, in which no astrocytes or oligodendrocytes were found, formed at the epicenter of the lesion. It was remarkable that numerous regenerating axons extended through such astrocyte-devoid areas. Regenerating axons were associated with Schwann cells embedded in extracellular matrices. Transplantation of choroid plexus epithelial cells (CPECs also enhanced axonal regeneration and locomotor improvements in rats with SCI. Although CPECs disappeared from the spinal cord shortly after transplantation, an extensive outgrowth of regenerating axons occurred through astrocyte-devoid areas, as in the case of BMSC transplantation. These findings suggest that BMSCs and CPECs secret neurotrophic factors that promote tissue repair of the spinal cord, including axonal regeneration and reduced cavity formation. This means that transplantation of BMSCs and CPECs promotes "intrinsic" ability of the spinal cord to regenerate. The treatment to stimulate the intrinsic regeneration ability of the spinal cord is the safest method of clinical application for SCI. It should be emphasized that the generally anticipated long-term survival, proliferation and differentiation of transplanted cells are not necessarily desirable from the clinical point of view of safety.

  4. 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)

    Mônica Vicky Bahr Arias

    1997-03-01

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

  5. Brachial plexopathy

    DEFF Research Database (Denmark)

    Jepsen, Jørgen Riis

    2015-01-01

    or days/week, most physical exposures, in particular upper limb posture and repetition, were significant risk indicators with clear dose–response relationships. These findings were supported by psychophysical responses that also identified perceived work pace and the use of force as risk indicators...... occupational physical exposures and brachial plexopathy. Methods 80 patients with brachial plexopathy according to defined criteria and 65 controls of similar age and sex without upper limb complaints were recruited by general practitioners. Patients and controls completed a questionnaire on physical....... The identified psychosocial relations were limited to measures reflecting physical exposures. Conclusions While the identified risk indicators have previously been associated to upper limb symptoms as well as to diagnosed disorders other than brachial plexopathy, this study indicates an association between...

  6. Imagens ultra-sonográficas do plexo braquial na região axilar Imágenes ultra-sonográficas del plexo braquial en la región axilar Ultrasound images of the brachial plexus in the axillary region

    Directory of Open Access Journals (Sweden)

    Diogo Brüggemann da Conceição

    2007-12-01

    permite la identificación de las estructuras del plexo braquial ¹. Ese estudio buscó describir el posicionamiento de los nervios del plexo braquial con relación a la arteria axilar. MÉTODO: Fueron estudiados 30 voluntarios de los dos sexos, en posición supina con abducción a 90° y rotación externa del hombro y flexión del codo a 90°. Utilizando transductor digital de 5 cm y 5-10 MHz, fueron identificados los nervios mediano, ulnar y radial, y las respectivas posiciones en relación a la arteria fueron marcadas en una carta gráfica seccional de 8 sectores, enumerados en orden creciente a partir de la hora 12 (medial, cuyo centro representaba la arteria axilar. RESULTADOS: El nervio mediano se ubicó predominante en el sector 8 (55% y en el sector 1 (28% (mediales; el nervio radial se ubicó predominantemente en los sectores 4 (59% y 5 (34% (laterales y el nervio ulnar en los sectores 2 y 3 (inferiores en un 69% y un 24% de los casos, respectivamente. Hubo una considerable variación de la localización de los nervios con relación a los aspectos superior e inferior de la arteria. CONCLUSIÓN: La inspección en tiempo real, por ultrasonido, de las estructuras neuro vasculares del plexo braquial en la axila mostró que los nervios mediano, ulnar y radial pueden presentar diferentes relaciones con la arteria axilar.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 plexus¹. 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° abduction and external

  7. MEDIAL BRACHIAL CUTANEOUS NERVE CONDUCTION VELOCITY: A DIAGNOSTIC METHOD FOR MEDIAL CORD LESIONS

    Directory of Open Access Journals (Sweden)

    B TAVANA

    2000-06-01

    Full Text Available Introduction. Regarding to the absence of doccumented studies concerning medial brachial coetaneous nerve conduction, the present study was conducted to evaluate this parameter as a diagnostic method for injuries to medial cord and lower trunk of brachial plexus. Methods. The sensory nerve action potential of median, ulnar and medial antebrachial cutaneous nerves were recorded to show these roots (Cs-TV are intact. Then, the medial brachial cutaneous nerve was stimulated on the line that connects axilla to medial epicondyle (parallel with mid axillary line at the junction site of coracobrachialis muscle to humerus recording was done 2 cm above the medial epicondyle (10 cm under stimulating site. Results. In all cases the wave was biphasic with primary negative phase. The latency was 2±0.3 ms-1 (range 1.4-2.6 ms-1 and the amplitude of SNAP was 30±10 mv (range 10-50 mV. The nerve conduction velocity was 61±4 ms-1 (range 53-69 ms-1. Discussion. With regard to the intensity and site of stimulation and recording area, this wave is not due to compound nerve action potential of median or ulnar nerve. This study may be useful in evaluation of T1 root and in differential diagnosis of medial cord and lower trunk lesions with ulnar and medial part of median nerve injuries.

  8. Tetraplegia or paraplegia with brachial diparesis? What is the most appropriate designation for the motor deficit in patients with lower cervical spinal cord injury?

    Science.gov (United States)

    Figueiredo, Nicandro; Figueiredo, Iara Eberhard; Resnick, Daniel

    2013-02-01

    The authors seek to clarify the nomenclature used to describe cervical spinal cord injuries, particularly the use of the terms "tetraplegia", "quadriplegia", "quadriparesis", "tetraparesis", "incomplete quadriplegia" or "incomplete tetraplegia" when applied to patients with lower cervical cord injuries. A review of the origin of the terms and nomenclature used currently to describe the neurological status of patients with SCI in the literature was performed. The terms "tetraplegia", "quadriplegia", "quadriparesis", "tetraparesis", "incomplete quadriplegia" or "incomplete tetraplegia" have been used very often to describe patients with complete lower cervical SCI despite the fact that the clinical scenario is all the same for most of these patients. Most of these patients have total loss of the motor voluntary movements of their lower trunk and inferior limbs, and partial impairment of movement of their superior limbs, preserving many motor functions of the proximal muscles of their arms (superior limbs). A potentially better descriptive term may be "paraplegia with brachial diparesis". In using the most appropriate terminology, the patients with lower cervical SCI currently referred as presenting with "tetraplegia", "quadriplegia", "quadriparesis", "tetraparesis", "incomplete quadriplegia" or "incomplete tetraplegia", might be better described as having "paraplegia with brachial diparesis".

  9. Epidemiology of Traumatic Peripheral Nerve Injuries Evaluated with Electrodiagnostic Studies in a Tertiary Care Hospital Clinic.

    Science.gov (United States)

    Miranda, Gerardo E; Torres, Ruben Y

    2016-06-01

    To describe the etiologies and frequency of traumatic peripheral nerve injury (TPNI) seen in the electrodiagnostic laboratory of a tertiary care hospital in Puerto Rico. The charts of patients who underwent an electrodiagnostic study for a TPNI were revised. The main outcome measure was the frequency of each injury by anatomic location, specific nerve or nerves affected, injury mechanism, and injury severity. One hundred forty-six charts were included, and in them were listed a total of 163 nerve injuries; 109 (74.7%) cases were men and 37 (25.3%) were women. The mean age was 33.6 years. The facial nerve, the brachial plexus, and the ulnar nerve were more frequently injured than any other nerve or nerve bundle. The ulnar, sciatic, median, and radial nerves and the lumbosacral plexus were more commonly injured as a result of gunshot wounds than of any other mechanism of injury. The brachial plexus was most frequently injured in motor vehicle accidents and the facial nerve injuries most commonly had an iatrogenic cause. In terms of injury severity, 84.2% were incomplete and 15.8% were complete. TPNIs are common in young individuals and potentially can lead to significant disability. Further studies are needed to assess the socioeconomic impact of these injuries on our population.

  10. Elbow dislocation with ipsilateral fracture of the distal radius associated with a brachial artery injury: A new pathological condition of traumatic origin.

    Science.gov (United States)

    Trigo Lahoz, L; Lamas Gomez, C; Sarasquete Reiriz, J; de Caso Rodriguez, J; Proubasta Renart, I

    Elbow dislocation associated with ipsilateral fracture of the distal radius and a brachial artery injury is an uncommon traumatic entity. The two references of this injury combination appeared in 2015, although both authors did not realise that they were the first two cases published in the medical literature. Although mentioned in the text of the articles, no mention was made of the fracture of the distal radius in the titles. The purpose of this paper is to present three cases with this new traumatic pathological entity, explaining its pathogenetic mechanism, the treatment used, and the results obtained. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. 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)

    Lúcia Beato

    2005-08-01

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

  12. Bloqueio do plexo braquial por via supraclavicular: estudo clínico comparativo entre bupivacaína e levobupivacaína Bloqueo del plexo braquial por vía supraclavicular: estudio clínico comparativo entre bupivacaína y levobupivacaína Supraclavicular brachial plexus block: a comparative clinical study between bupivacaine and levobupivacaine

    Directory of Open Access Journals (Sweden)

    José Ricardo Pinotti Pedro

    2009-12-01

    braquial es el territorio potencial para la absorción de anestésicos locales. Estudios de los estereoisómeros de la bupivacaína han venido demostrando un menor potencial de toxicidad de la fracción levógira (levobupivacaína, sobre el sistema cardiovascular. Sin embargo, se discute la eficacia anestésica (bloqueo sensitivo y motor, de la levobupivacaína en anestesia del neuro eje. Este estudio pretende demostrar la eficacia anestésica de la levobupivacaína, comparándola con la bupivacaína racémica en bloqueo de plexo braquial por la vía perivascular subclavia. MÉTODO: Cincuenta pacientes adultos de ambos sexos, ASA I y II, fueron sometidos a la anestesia de plexo braquial vía perivascular subclavia para procedimientos ortopédicos de miembros superiores con la ayuda de un neuroestimulador. Se dividieron de modo aleatorio, en dos grupos: G BUPI - bupivacaína racémica, G LEVO - levobupivacaína, en un volumen de 30 mL a 0,5%. El bloqueo sensitivo fue evaluado por el método de "picada de aguja" en los metámeros de C5 a C8; y el bloqueo motor, en los intervalos en minutos: 1, 2, 5, 10, 15, 20, 25, 30, o hasta la instalación del bloqueo en los movimientos de los dedos, la mano el antebrazo y el brazo. RESULTADOS: No hubo ninguna diferencia estadística entre los dos grupos en cuanto a la latencia, incidencia de fallas, grado del bloqueo motor e incidencia de fallas y grado del bloqueo motor e incidencia de fallas del bloqueo sensitivo, pero sí que se verificó la diferencia estadística de la latencia del bloqueo sensitivo en todos los metámeros analizados. No hubo efectos adversos inherentes a la aplicación del anestésico local. CONCLUSIONES: La levobupivacaína demostró una eficacia anestésica en el bloqueo de plexo braquial, igualable a la solución racémica usualmente utilizada.BACKGROUND AND OBJECTIVES: Brachial plexus block is used in surgical procedures of the upper limbs. The brachial plexus is a potential territory for absorption of local

  13. Estudo comparativo entre ultrassom e neuroestimulação no bloqueio do plexo braquial pela via axilar Estudio comparativo entre ultrasonido y neuroestimulación en el bloqueo del plexo braquial por la vía axilar A comparative study between ultrasound and neurostimulation guided axillary brachial plexus block

    Directory of Open Access Journals (Sweden)

    Diogo Brüggemann da Conceição

    2009-10-01

    seleccionaron 40 pacientes para operaciones por elección en la mano, con bloqueo de plexo braquial vía axilar. Los pacientes se distribuyeron aleatoriamente y electrónicamente en dos grupos de 20 pacientes: Grupo Neuroestimulación (NE y Grupo Ultrasonido (US. Se compararon el tiempo de realización, la tasa de éxito y las complicaciones. RESULTADOS: Las tasas de bloqueo completo, falla parcial y falla total, no presentaron diferencias estadísticas significativa entre los grupos US y NE. El tiempo promedio para la realización del procedimiento en el grupo US (354 segundos no presentó diferencia estadística significativa cuando se le comparó al grupo NE (381 segundos. Los pacientes del grupo NE presentaron una tasa más elevada de punción vascular (40%, cuando se les comparó con el grupo US (10%, p Conceição DB, Helayel PE, Oliveira Filho GR - A Comparative Study between Ultrasound- and Neurostimulation-Guided Axillary Brachial Plexus Block. BACKGROUND AND OBJECTIVES: The use of ultrasound in Regional Blocks is increasingly more frequent. However, very few studies comparing ultrasound and neurostimulation have been conducted. The objective of this study was to compare neurostimulation-guided axillary brachial plexus block with double injection and ultrasound-guided axillary plexus block for hand surgeries. The time to perform the technique, success rate, and complications were compared. METHODS: After approval by the Ethics on Research Committee of the Hospital Governador Celso Ramos, 40 patients scheduled for elective hand surgeries under axillary plexus block were selected. Patients were randomly divided into two groups with 20 patients each: Neurostimulation (NE and Ultrasound (US groups. The time to perform the technique, success rate, and complication rate were compared. RESULTS: Complete blockade, partial failure, and total failure rates did not show statistically significant differences between the US and NE groups. The mean time to perform the technique in

  14. Estudo radiológico da dispersão de diferentes volumes de anestésico local no bloqueio de plexo braquial pela via posterior Estudio radiológico de la dispersión de diferentes volúmenes de anestésico local en el bloqueo de plexo braquial por vía posterior Radiological evaluation of the spread of different local anesthetic volumes during posterior brachial plexus block

    Directory of Open Access Journals (Sweden)

    Marcos Guilherme Cunha Cruvinel

    2005-10-01

    aleatoriamente en tres grupos de cinco: Grupo 1: volumen de 20 mL; Grupo 2: volumen de 30 mL; Grupo 3: volumen de 40 mL. En un paciente, sometido al bloqueo continuado del plexo braquial por la vía posterior, la administración de un volumen de 10 mL fue estudiada. En todos, el anestésico usado fue la ropivacaína a 0,375% asociada a solución radiopaca. Fueron hechas radiografías de la región cervical inmediatamente después el bloqueo que fue evaluado a través de la pesquisa de la sensibilidad térmica utilizándose algodón embebido en alcohol, treinta minutos después de su realización y en la sala de recuperación anestésica. RESULTADOS: El comportamiento radiológico y clínico del bloqueo de plexo braquial por vía posterior es muy semejante de aquél descrito con la técnica de Winnie (interescalénico. Invariablemente hay envolvimiento del plexo cervical y de las raíces más altas (C5-C7 del plexo braquial. CONCLUSIONES: Este estudio muestra que la dispersión del anestésico local en el bloqueo del plexo braquial por la vía posterior se da primariamente en las raíces responsables por la inervación del hombroBACKGROUND AND OBJECTIVES: Local anesthetic spread during interscalenic block has been thoroughly studied, however there are few studies on posterior block. This study aimed at evaluating the spread of different local anesthetic volumes during posterior brachial plexus block using contrasted X-rays. METHODS: Participated in this study 16 patients submitted to posterior brachial plexus block, 15 of whom were randomly divided in three groups of five patients: Group 1: 20 mL; Group 2: 30 mL.; Group 3 40 mL. The volume of 10 mL was studied in one patient submitted to continuous posterior brachial plexus block. All patients received 0.375% ropivacaine associated to radio-opaque solution. X-rays of the cervical region were obtained immediately after blockade that were evaluated by thermal sensitivity using cotton soaked in alcohol 30 minutes after being

  15. Human Embryonic Stem Cell-Derived Progenitors Assist Functional Sensory Axon Regeneration after Dorsal Root Avulsion Injury

    OpenAIRE

    Hoeber, Jan; Trolle, Carl; König, Niclas; Du, Zhongwei; Gallo, Alessandro; Hermans, Emmanuel; Aldskogius, Håkan; Shortland, Peter; Zhang, Su-Chun; Deumens, Ronald; Kozlova, Elena N

    2015-01-01

    Dorsal root avulsion results in permanent impairment of sensory functions due to disconnection between the peripheral and central nervous system. Improved strategies are therefore needed to reconnect injured sensory neurons with their spinal cord targets in order to achieve functional repair after brachial and lumbosacral plexus avulsion injuries. Here, we show that sensory functions can be restored in the adult mouse if avulsed sensory fibers are bridged with the spinal cord by human neural ...

  16. Nitric oxide regulates homeoprotein OTX1 and OTX2 expression in the rat myenteric plexus after intestinal ischemia-reperfusion injury.

    Science.gov (United States)

    Filpa, Viviana; Carpanese, Elisa; Marchet, Silvia; Pirrone, Cristina; Conti, Andrea; Rainero, Alessia; Moro, Elisabetta; Chiaravalli, Anna Maria; Zucchi, Ileana; Moriondo, Andrea; Negrini, Daniela; Crema, Francesca; Frigo, Gianmario; Giaroni, Cristina; Porta, Giovanni

    2017-04-01

    Neuronal and inducible nitric oxide synthase (nNOS and iNOS) play a protective and damaging role, respectively, on the intestinal neuromuscular function after ischemia-reperfusion (I/R) injury. To uncover the molecular pathways underlying this dichotomy we investigated their possible correlation with the orthodenticle homeobox proteins OTX1 and OTX2 in the rat small intestine myenteric plexus after in vivo I/R. Homeobox genes are fundamental for the regulation of the gut wall homeostasis both during development and in pathological conditions (inflammation, cancer). I/R injury was induced by temporary clamping the superior mesenteric artery under anesthesia, followed by 24 and 48 h of reperfusion. At 48 h after I/R intestinal transit decreased and was further reduced by Nω-propyl-l-arginine hydrochloride (NPLA), a nNOS-selective inhibitor. By contrast this parameter was restored to control values by 1400W, an iNOS-selective inhibitor. In longitudinal muscle myenteric plexus (LMMP) preparations, iNOS, OTX1, and OTX2 mRNA and protein levels increased at 24 and 48 h after I/R. At both time periods, the number of iNOS- and OTX-immunopositive myenteric neurons increased. nNOS mRNA, protein levels, and neurons were unchanged. In LMMPs, OTX1 and OTX2 mRNA and protein upregulation was reduced by 1400W and NPLA, respectively. In myenteric ganglia, OTX1 and OTX2 staining was superimposed with that of iNOS and nNOS, respectively. Thus in myenteric ganglia iNOS- and nNOS-derived NO may promote OTX1 and OTX2 upregulation, respectively. We hypothesize that the neurodamaging and neuroprotective roles of iNOS and nNOS during I/R injury in the gut may involve corresponding activation of molecular pathways downstream of OTX1 and OTX2.NEW & NOTEWORTHY Intestinal ischemia-reperfusion (I/R) injury induces relevant alterations in myenteric neurons leading to dismotility. Nitrergic neurons seem to be selectively involved. In the present study the inference that both neuronal and

  17. Psychometric evaluation of the Brachial Assessment Tool Part 1: Reproducibility.

    Science.gov (United States)

    Grad, Bridget Hill; Williams, Gavin; Olver, John; Ferris, Scott; Bialocerkowski, Andrea

    2017-11-06

    To evaluate reproducibility (reliability and agreement) of the Brachial Assessment Tool (BrAT) a new patient-reported outcome measure for adults with traumatic Brachial Plexus Injury (BPI) DESIGN: Prospective repeated measure design SETTING: Outpatient clinics PARTICIPANTS: Adults with confirmed traumatic BPI INTERVENTION: 43 people (age range 19-82) with BPI completed the 31-item 4-response BrAT twice, 2 weeks apart. Results for the 3 subscales and summed score were compared at time 1 and time 2 to determine reliability including systematic differences using paired t tests; test retest using Intraclass Correlation Coefficient (ICC 1,1) and internal consistency using Cronbach alpha. Agreement parameters included standard error of measurement, minimal detectable change and limits of agreement. The BrAT RESULTS: Test retest reliability was excellent (ICC [1,1] = 0.90 - 0.97). Internal consistency was high (Cronbach alpha 0.90 - 0.98). Measurement error was relatively low (SEM range 3.1 - 8.8). A change of >4 for subscale 1, >6 for subscale 2, >4 for subscale 3 and >10 for the summed score is indicative of change over and above measurement error. Limits of agreement ranged from ± 4.4 (subscale 3) to 11.61 (summed score). These findings support the use of the BrAT as a reproducible patient reported outcome measure for adults with traumatic BPI with evidence of appropriate reliability and agreement for both individual and group comparisons. Further psychometric testing is required to establish the construct validity and responsiveness of the BrAT. Copyright © 2017. Published by Elsevier Inc.

  18. Injury to peribiliary glands and vascular plexus before liver transplantation predicts formation of non-anastomotic biliary strictures

    NARCIS (Netherlands)

    Op den Dries, Sanna; Westerkamp, Andrie C.; Karimian, Negin; Gouw, Annette S. H.; Bruinsma, Bote G.; Markmann, James F.; Lisman, Ton; Yeh, Heidi; Uygun, Korkut; Martins, Paulo N.; Porte, Robert J.

    Background & Aims: The peribiliary glands of large bile ducts have been identified as a niche of progenitor cells that contribute to regeneration of biliary epithelium after injury. We aimed to determine whether injury to the peribiliary glands of donor livers is a risk factor for development of

  19. Epidemiology of Traumatic Peripheral Nerve Injuries Evaluated by Electrodiagnostic Studies in a Tertiary Care Hospital Clinic.

    Science.gov (United States)

    Torres, Ruben Y; Miranda, Gerardo E

    2015-01-01

    Describe the etiology and frequency of traumatic peripheral nerve injuries (TPNI) in the electrodiagnostic laboratory of a tertiary care hospital. The charts of patients who underwent an electrodiagnostic study for a TPNI were revised. The main outcome measure was the frequency of each injury by anatomic location, involved nerve, mechanism, and severity. 146 charts were included for a total of 163 injured nerves; 109 (74.7%) males and 37 (25.3%) females. The mean age was 33.6 years. The facial nerve and the brachial plexus followed by the ulnar nerve were more frequently involved. The ulnar, sciatic, median, radial nerve, and the lumbosacral plexus were more commonly injured by gunshot wounds, the brachial plexus by motor vehicle accidents, and the facial nerve by iatrogenic causes. The majority of the injuries were incomplete or partial (84.2% were incomplete and 15.8% complete injuries). TPNIs can lead to significant disability, but further investigation is needed to better understand their socio-economic impact.

  20. 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)

    Mônica Vicky Bahr Arias

    1997-03-01

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

  1. A lesão do trato de Lissauer e do corno posterior da substância cinzenta da medula espinal e a estimulação elétrica do sistema nervoso central para o tratamento da dor por avulsão de raízes do plexo braquial DREZ lesions and electrical stimulation of the central nervous system for treatment of brachial plexus avulsion pain

    Directory of Open Access Journals (Sweden)

    MANOEL JACOBSON TEIXEIRA

    1999-03-01

    Full Text Available Descrevemos os resultados do tratamento operatório de 10 doentes com dor resultante de avulsão de raízes do plexo braquial. Sete foram tratados pela técnica de lesão do trato de Lissauer (TL e do corno posterior da medula espinal (CPME, 4 pela técnica de estimulação elétrica da medula espinal (EM e 2 pela técnica de estimulação talâmica (ET. Três doentes foram tratados por ambos os procedimentos. Foi observada melhora imediata em 50% dos doentes com a técnica de estimulação medular e em apenas 25% dos casos, a longo prazo. Ocorreu melhora imediata, mas recorrência tardia da dor nos 2 doentes tratados pela ET. Houve melhora imediata de todos os doentes tratados pela técnica da lesão e recidiva parcial da dor em 23% dos casos, a longo prazo. Complicações temporárias foram observadas em 28,6% dos casos tratados pela técnica de lesão. Conclui-se que a lesão do TL e do CPME proporcionam resultados mais satisfatórios a longo prazo que a técnica de estimulação (p = 0,0046; entretanto, esta última é mais segura.We analyze the effectiveness of the treatment of 10 patients of brachial plexus avulsion pain. Seven underwent dorsal root entry zone lesions (DREZ, 3, dorsal column stimulation (DCS and, 2 thalamic stimulation (TS. DCS resulted in immediate improvement of pain in 50% of the patients. After a long term follow up period, just 25% of the patients were still better. TS resulted the in temporary improvement of 2 patients. Both had full recurrence few months after the operation. Immediate improvement of the symptoms occurred in all patients treated by DREZ. After a long term follow up period, excellent results were observed in 71.4% of the patients and good results in the remainder. The complication rate was higher among DREZ patients. It is concluded that DREZ is a better procedure for treatment of brachial plexus avulsion pain than DCS and TS (p = 0,0046; however, DCS and TS are safer.

  2. Contribution of plexus MRI in the diagnosis of atypical chronic inflammatory demyelinating polyneuropathies.

    Science.gov (United States)

    Lozeron, Pierre; Lacour, Marie-Christine; Vandendries, Christophe; Théaudin, Marie; Cauquil, Cécile; Denier, Christian; Lacroix, Catherine; Adams, David

    2016-01-15

    Nerve enlargement has early been recognized in CIDP and plexus MRI hypertrophy has been reported in typical CIDP cases. Our aim is to determine plexus MRI value in the diagnosis of CIDP with an initial atypical presentation, which, up to now, has not been demonstrated. Retrospective study of 33 consecutive patients suspected of CIDP. Plexus MRI was performed on the most affected territory (brachial or lumbar). Were assessed: plexus trophicity, T2-STIR signal intensity and gadolinium enhancement. Final CIDP diagnosis was made after comprehensive workup. A histo-radiological correlation was performed. Final CIDP diagnosis was made in 25 (76%) including 21 with initial atypical clinical presentation. Eleven CIDP patients (52%) with initial atypical clinical presentation had abnormal plexus MRI including 9 suggestive of CIDP (43%) and none of the patients with an alternative diagnosis. Hypertrophy of the proximal plexus and/or extraforaminal roots was found in 8 cases and Gadolinium enhancement in 2 cases. Abnormalities were more frequent on brachial (86%) than lumbosacral MRIs (29%) and asymmetrical (72%) and most often associated with histological signs of demyelination. The nerve biopsy was suggestive of CIDP in 9/13 patients with normal MRI. Plexus MRI seems useful in the diagnostic strategy of patients with suspicion of CIDP with atypical presentation. Nerve biopsy remains important when other investigations are inconclusive. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Biomedical and psychosocial factors associated with disability after peripheral nerve injury.

    Science.gov (United States)

    Novak, Christine B; Anastakis, Dimitri J; Beaton, Dorcas E; Mackinnon, Susan E; Katz, Joel

    2011-05-18

    The purpose of this study was to evaluate the biomedical and psychosocial factors associated with disability at a minimum of six months following upper-extremity nerve injury. This cross-sectional study included patients who were assessed between six months and fifteen years following an upper-extremity nerve injury. Assessment measures included patient self-report questionnaires (the Disabilities of the Arm, Shoulder and Hand Questionnaire [DASH]; pain questionnaires; and general health and mental health questionnaires). DASH scores were compared by using unpaired t tests (sex, Workers' Compensation/litigation, affected limb, marital status, education, and geographic location), analysis of variance (nerve injured, work status, and income), or correlations (age and time since injury). Multivariable linear regression analysis was used to evaluate the predictors of the DASH scores. The sample included 158 patients with a mean age (and standard deviation) of 41 ± 16 years. The median time from injury was fourteen months (range, six to 167 months). The DASH scores were significantly higher for patients receiving Workers' Compensation or involved in litigation (p = 0.02), had a brachial plexus injury (p = 0.001), or were unemployed (p disability, pain, and cold sensitivity. Disability as measured with the DASH was predicted by brachial plexus injury, older age, pain intensity, work status, time since injury, cold sensitivity, and pain catastrophizing.

  4. Soldier occupational load carriage: a narrative review of associated injuries.

    Science.gov (United States)

    Orr, Robin Marc; Pope, Rodney; Johnston, Venerina; Coyle, Julia

    2014-01-01

    This narrative review examines injuries sustained by soldiers undertaking occupational load carriage tasks. Military soldiers are required to carry increasingly heavier occupational loads. These loads have been found to increase the physiological cost to the soldier and alter their gait mechanics. Aggregated research findings suggest that the lower limbs are the most frequent anatomical site of injury associated with load carriage. While foot blisters are common, other prevalent lower limb injuries include stress fractures, knee and foot pain, and neuropathies, like digitalgia and meralgia. Shoulder neuropathies (brachial plexus palsy) and lower back injuries are not uncommon. Soldier occupational load carriage has the potential to cause injuries that impact on force generation and force sustainment. Through understanding the nature of these injuries targeted interventions, like improved physical conditioning and support to specialised organisations, can be employed.

  5. Bupivacaine 0,25% versus ropivacaine 0,25% in brachial plexus block in dogs of beagle breedBupivacaína 0,25% versus ropivacaína 0,25% no bloqueio do plexo braquial em cães da raça beagle

    Directory of Open Access Journals (Sweden)

    Thiago Ignácio Wakoff

    2013-06-01

    Full Text Available The brachial plexus block (BPB is a regional anesthesia technique which enables the attainment of surgical procedures distal scapulohumeral articulation. This study aimed to compare the efficacy of ropivacaine and bupivacaine 0.25% without vasoconstrictor in BPB guided by electrical stimulation in dogs. Thirteen male and female beagle dogs underwent a BPB using bupivacaine and ropivacaine 0.25% (4mg/kg, both alone and in different times. The anesthesic block was performed in the right forelimb and as control group the block proceeded in the left forelimb using a solution of sodium chloride 0.9% in volume corresponding to the drug in the contralateral limb. The block was performed after the localization of the radial nerve with the aid of eletrical stimulation, which was infiltrated half the volume of anesthetic calculated and subsequently the remaining solution was administered on the median nerve. We evaluated sensitive and motor latencies and sensitive and motor block total time by clamping technique. In the present study, a technique for electrical stimulation was effective in 100% of animals. Bupivacaine had lower motor latency period, however, the sensitive latency between the two groups showed no statistically significant differences. In the block total time, bupivacaine obtained time significantly higher. Clinical signs characteristic of Horner’s syndrome were present in 15% of animals treated with bupivacaine. Furthermore, two animals presented signs of cardiotoxicity in bupivacaine group. The use of bupivacaine (4mg/kg without vasoconstrictor in dogs brachial plexus block provided longer analgesia and motor blockade, however, ropivacaine at the same dose and concentration was found to be free of deleterious effects associated of cardiovascular instability, hemodynamic and respiratory. O bloqueio do plexo braquial (BPB é uma técnica de anestesia regional que possibilita a realização de procedimentos cirúrgicos distais a articula

  6. Which is your choice for prolonging the analgesic duration of single-shot interscalene brachial blocks for arthroscopic shoulder surgery? intravenous dexamethasone 5 mg vs. perineural dexamethasone 5 mg randomized, controlled, clinical trial

    National Research Council Canada - National Science Library

    Chun, Eun Hee; Kim, Youn Jin; Woo, Jae Hee

    2016-01-01

    The aim of this study was to compare the effect of intravenous (I.V.) dexamethasone with that of perineural dexamethasone on the prolongation of analgesic duration of single-shot interscalene brachial plexus blocks (SISB...

  7. Het plexus brachialis letsel. Een retrospectief onderzoek naar de functionele gevolgen.

    NARCIS (Netherlands)

    Emmelot, Cornelis Hendrik

    1994-01-01

    The central issue of this study is accidental damage to the brachial plexus. In terms of medical rehabilitation, an understanding of the factors which determine the functional abilities is a prerequisite, since this understanding will eventually have an effect on therapeutic procedures. In a

  8. brachial plexus blocks for upper extremity surgeries in a nigerian ...

    African Journals Online (AJOL)

    2011-04-04

    Apr 4, 2011 ... PNS technique and 11 had PNS with ultrasound guidance. In patients who had BPB, a successful block was achieved when no supplementary local anaesthetic was administered intra-operatively nor conversion to a general anaesthetic. Sedation was administered before instituting blocks in children.

  9. Schwannoma of the left brachial plexus mimicking a ...

    African Journals Online (AJOL)

    The history was of a painless anterior neck swelling of 4 years duration devoid of symptoms of hyperthyroidism with associated dysphagia and weakness of the left hand. Examination showed an asthenic young woman. Her voice was hoarse but there was no eye signs suggestive of thyrotoxicosis. On the anterior neck was ...

  10. Brachial plexus lesions: Anatomical knowledge as an essential ...

    African Journals Online (AJOL)

    This clinical feature was in conformity with a lesion of inferior primary trunk. All diagnoses were made based on the clinical findings. These cases demonstrate the significance of a through anatomical knowledge in the clinical examination if one has to avoid confusing the signs of terminal nerves lesion with the trunk's lesion.

  11. Variations in the formation of supraclavicular brachial plexus among ...

    African Journals Online (AJOL)

    Surg. 2006;. 72(2): 188-192. 14. Bigeleisen P.E. Anatomical variations of the phrenic nerve and its clinical implication for supraclavicular block. Brit. J. Anaesthesia. 2003; 91(6): 916-917. 15. Abdelazeem Ali El-Dawlatly. Phrenic nerve paralysis after subclavian revascularization surgery: A case report. Internet J. Anesthesiol.

  12. Prevalência de paralisia diafragmática após bloqueio de plexo braquial pela via posterior com ropivacaína a 0,2% Prevalencia de parálisis diafragmática después del bloqueo del plexo braquial por la vía posterior con ropivacaína a 0,2% Prevalence of diaphragmatic paralysis after brachial plexus blockade by the posterior approach with 0.2% ropivacaine

    Directory of Open Access Journals (Sweden)

    Marcos Guilherme Cunha Cruvinel

    2006-10-01

    consecuencias es la parálisis diafragmática. En pacientes con algún grado de disfunción pulmonar previa, esa parálisis puede conllevar a la insuficiencia respiratoria. El abordaje del plexo braquial por vía posterior ha conquistado espacio. El objetivo de este estudio fue el de determinar la prevalencia de parálisis diafragmática, después del bloqueo de plexo braquial interescalénico por vía posterior con el uso de ropivacaína a 0,2%. MÉTODO: Veinte y dos pacientes sometidos al bloqueo del plexo braquial interescalénico por vía posterior con ropivacaína a 0,2% fueron evaluados en el postoperatorio con el objetivo de identificar señales radiológicas de elevación de la cúpula diafragmática sugestivas de parálisis hemidiafragmática. En 20 pacientes se utilizó 40 mL de ropivacaína a 0,2%, en ellos fue realizada la radiografía de tórax en inspiración. En dos fueron utilizados 20 mL de ropivacaína a 0,2%, con la siguiente evaluación fluoroscópica. RESULTADOS: No hubo complicaciones relacionadas con la realización del bloqueo. En todos los pacientes, el bloqueo fue efectivo y proporcionó una buena analgesia postoperatoria. Se observó una elevación de la cúpula diafragmática compatible con la parálisis hemidiafragmática en todos los casos estudiados. CONCLUSIONES: En las condiciones de este estudio se pudo observar que el bloqueo del plexo braquial por vía posterior es una técnica que está asociada a la alta prevalencia de parálisis diafragmática, incluso cuando se utilizan bajas concentraciones de anestésico local.BACKGROUND AND OBJECTIVES: Brachial plexus blockade by the interscalene approach, described by Winnie, is one of the most effective techniques in promoting postoperative analgesia in surgeries of the shoulder. Diaphragmatic paralysis is one of the consequences of this technique. This paralysis can cause respiratory failure in patients with prior lung dysfunction. Brachial plexus blockade by the posterior approach has become

  13. Bloqueio do plexo braquial por via interescalênica: efeitos sobre a função pulmonar Bloqueo del plexo braquial por vía interescalénica: efectos sobre la función pulmonar Interscalene brachial plexus block: effects on pulmonary function

    Directory of Open Access Journals (Sweden)

    Alexandre Hortense

    2010-04-01

    demostrado una asociación de esa técnica con el bloqueo del nervio frénico ipsilateral. La disfunción diafragmática de resultas de esa asociación, provoca alteraciones en la mecánica pulmonar, potencialmente perjudiciales en pacientes con una limitación de la reserva ventilatoria. El objetivo del estudio fue evaluar la repercusión del bloqueo interescalénico sobre la función pulmonar por medio de la medida de la capacidad vital forzada (CVF. MÉTODO: Estudio doble ciego, con 30 pacientes, estado físico I o II (ASA, distribuidos aleatoriamente en dos grupos de 15. Se administró solución a 0,5% de ropivacaína (Grupo Ropi o bupivacaína a 0,5% con epinefrina (Grupo Bupi. El bloqueo fue realizado utilizando estimulador de nervio periférico e inyectando 30 mL de anestésico local. Cuatro espirometrías se hicieron en cada paciente: antes del bloqueo, 30 minutos, 4 y 6 horas después. Los pacientes no recibieron sedación. RESULTADOS: Un paciente del Grupo Ropi y tres pacientes del Grupo Bupi, quedaron excluidos del estudio por fallos de bloqueo. La reducción de la CVF en el Grupo Ropi se hizo máxima a los 30 minutos (25,1% y a partir de entonces, hubo una tendencia progresiva a la recuperación. Ya con la bupivacaína, la reducción de la CVF pareció ser menos acentuada en los diversos momentos estudiados; se observó una reducción adicional entre 30 minutos (15,8% y 4 horas (17,3%, siendo esa sin diferencia estadística. A partir de 4 horas, se notó una tendencia a la recuperación. En los dos grupos, después de 6 horas de bloqueo, la CVF todavía estaba por debajo de los valores previos. CONCLUSIONES: El bloqueo interescalénico reduce la CVF en la mayoría de los casos; las alteraciones fueron más acentuadas en el Grupo Ropivacaína.BACKGROUND AND OBJECTIVES: The interscalene is one of the most common approaches used in brachial plexus block. However, the association of this approach with the ipsilateral blockade of the phrenic nerve has been

  14. Algorithm for bionic hand reconstruction in patients with global brachial plexopathies.

    Science.gov (United States)

    Hruby, Laura A; Sturma, Agnes; Mayer, Johannes A; Pittermann, Anna; Salminger, Stefan; Aszmann, Oskar C

    2017-11-01

    OBJECTIVE Global brachial plexus lesions with multiple root avulsions are among the most severe nerve injuries, leading to lifelong disability. Fortunately, in most cases primary and secondary reconstructions provide a stable shoulder and restore sufficient arm function. Restoration of biological hand function, however, remains a reconstructive goal that is difficult to reach. The recently introduced concept of bionic reconstruction overcomes biological limitations of classic reconstructive surgery to restore hand function by combining selective nerve and muscle transfers with elective amputation of the functionless hand and its replacement with a prosthetic device. The authors present their treatment algorithm for bionic hand reconstruction and report on the management and long-term functional outcomes of patients with global brachial plexopathies who have undergone this innovative treatment. METHODS Thirty-four patients with posttraumatic global brachial plexopathies leading to loss of hand function consulted the Center for Advanced Restoration of Extremity Function between 2011 and 2015. Of these patients, 16 (47%) qualified for bionic reconstruction due to lack of treatment alternatives. The treatment algorithm included progressive steps with the intent of improving the biotechnological interface to allow optimal prosthetic hand replacement. In 5 patients, final functional outcome measurements were obtained with the Action Arm Research Test (ARAT), the Southampton Hand Assessment Procedure (SHAP), and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. RESULTS In all 5 patients who completed functional assessments, partial hand function was restored with bionic reconstruction. ARAT scores improved from 3.4 ± 4.3 to 25.4 ± 12.7 (p = 0.043; mean ± SD) and SHAP scores improved from 10.0 ± 1.6 to 55 ± 19.7 (p = 0.042). DASH scores decreased from 57.9 ± 20.6 to 32 ± 28.6 (p = 0.042), indicating decreased disability. CONCLUSIONS The authors

  15. 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)

    Luis Henrique Cangiani

    2008-04-01

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

  16. MUSCLE-FIBER CONDUCTION-VELOCITY IN AMYOTROPHIC-LATERAL-SCLEROSIS AND TRAUMATIC LESIONS OF THE PLEXUS BRACHIALIS

    NARCIS (Netherlands)

    VANDERHOEVEN, JH; ZWARTS, MJ; VANWEERDEN, TW

    1993-01-01

    Muscle fiber conduction velocity (MFCV) in biceps brachii was studied in traumatic brachial plexus lesions (16 patients) and amyotrophic lateral sclerosis (ALS) (22 patients) by means of an invasive (S-MFCV) and a surface (S-MFCV) method. After complete denervation an exponential decrease of the

  17. A review of 10 years of scapula injuries sustained by UK military personnel on operations.

    Science.gov (United States)

    Roberts, Darren C; Power, D M; Stapley, S A

    2017-09-11

    Scapula fractures are relatively uncommon injuries, mostly occurring due to the effects of high-energy trauma. Rates of scapula fractures are unknown in the military setting. The aim of this study is to analyse the incidence, aetiology, associated injuries, treatment and complications of these fractures occurring in deployed military personnel. All UK military personnel returning with upper limb injuries from Afghanistan and Iraq were retrospectively reviewed using the Royal Centre for Defence Medicine database and case notes (2004-2014). Forty-four scapula fractures out of 572 upper limb fractures (7.7%) were sustained over 10 years. Blast and gunshot wounds (GSW) were leading causative factors in 85%. Over half were open fractures (54%), with open blast fractures often having significant bone and soft tissue loss requiring extensive reconstruction. Multiple injuries were noted including lung, head, vascular and nerve injuries. Injury Severity Scores (ISS) were significantly higher than the average upper limb injury without a scapula fracture (pmilitary personnel with GSW have a favourable chance of nerve recovery, 75% of brachial plexus injuries that are associated with blast have poorer outcomes. Fixation occurred with either glenoid fractures or floating shoulders (10%); these were as a result of high velocity GSW or mounted blast ejections. There were no cases of deep soft tissue infection or osteomyelitis and all scapula fractures united. Scapula fractures have a 20 times higher incidence in military personnel compared with the civilian population, occurring predominantly as a result of blast and GSW, and a higher than average ISS. These fractures are often associated with multiple injuries, including brachial plexus injuries, where those sustained from blast have less favourable outcome. High rates of union following fixation and low rates of infection are expected despite significant contamination and soft tissue loss. © Article author(s) (or their

  18. Intraoperative peripheral nerve injury in colorectal surgery. An update.

    Science.gov (United States)

    Colsa Gutiérrez, Pablo; Viadero Cervera, Raquel; Morales-García, Dieter; Ingelmo Setién, Alfredo

    2016-03-01

    Intraoperative peripheral nerve injury during colorectal surgery procedures is a potentially serious complication that is often underestimated. The Trendelenburg position, use of inappropriately padded armboards and excessive shoulder abduction may encourage the development of brachial plexopathy during laparoscopic procedures. In open colorectal surgery, nerve injuries are less common. It usually involves the femoral plexus associated with lithotomy position and self-retaining retractor systems. Although in most cases the recovery is mostly complete, treatment consists of physical therapy to prevent muscular atrophy, protection of hypoesthesic skin areas and analgesics for neuropathic pain. The aim of the present study is to review the incidence, prevention and management of intraoperative peripheral nerve injury. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Bipolar physeal injuries of the clavicle in a child

    Directory of Open Access Journals (Sweden)

    Vrisha Madhuri

    2012-01-01

    Full Text Available This article reports a type II Salter and Harris injury at either ends of the clavicle in a 13-year-old child with postero-inferior displacement at the lateral and antero-superior displacement at the medial end of the clavicle shaft. He was treated in a shoulder immobilizer. The mechanism of injury is postulated as pivoting of the clavicle on the first rib with shearing at either ends leading to a bipolar injury. The brachial plexus and subclavian vessels are at a risk of damage at the pivot as they lie in close vicinity to the first rib. In view of the intact periosteal sleeve as well as joint articulation at both ends, the fracture healed with no functional loss.

  20. Etiology and mechanisms of ulnar and median forearm nerve injuries

    Directory of Open Access Journals (Sweden)

    Puzović Vladimir

    2015-01-01

    Full Text Available Bacgraund/Aim. Most often injuries of brachial plexus and its branches disable the injured from using their arms and/or hands. The aim of this study was to investigate the etiology and mechanisms of median and ulnar forearm nerves injuries. Methods. This retrospective cohort study included 99 patients surgically treated in the Clinic of Neurosurgery, Clinical Center of Serbia, from January 1st, 2000 to December 31st, 2010. All data are obtained from the patients' histories. Results. The majority of the injured patients were male, 81 (81.8%, while only 18 (18.2% were females, both mainly with nerve injuries of the distal forearm - 75 (75.6%. Two injury mechanisms were present, transection in 85 patients and traction and contusion in 14 of the patients. The most frequent etiological factor of nerve injuries was cutting, in 61 of the patients. Nerve injuries are often associated with other injuries. In the studied patients there were 22 vascular injuries, 33 muscle and tendon injuries and 20 bone fractures. Conclusion. The majority of those patients with peripheral nerve injuries are represented in the working age population, which is a major socioeconomic problem. In our study 66 out of 99 patients were between 17 and 40 years old, in the most productive age. The fact that the majority of patients had nerve injuries of the distal forearm and that they are operated within the first 6 months after injury, promises them good functional prognosis.

  1. Curva de aprendizado da sonoanatomia do plexo braquial na região axilar Curva de aprendizaje de la sonoanatomía del plexo braquial en la región axilar Learning curve for the ultrasound anatomy of the brachial plexus in the axillary region

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    Pablo Escovedo Helayel

    2009-04-01

    : Proficiency in ultrasound-guided blocks demands four skills: recognition of the ultrasound anatomy, capacity to generate images, aligning the needle with the ultrasound beam, and recognizing the dispersion of the local anesthetic. The objective of this study was to construct and evaluate learning curves for image generation and ultrasound identification of the neurovascular structures in the axilla. METHODS: Seven Anesthesiology residents received theoretical and practical notions on the basic principles of ultrasound and the ultrasound anatomy of the axillary region with the objective to identify the terminal branches of the brachial plexus and axillary vessels. Each resident performed six exams. The accuracy and the time to identify the structures were evaluated. The success rate of each exam was calculated. Simple linear regression evaluated the time necessary to identify each structure in relation to the number of the exam. RESULTS: The axillary vessels were identified in 100% of the exams. The median nerve was identified in 83% of the cases from the first to the fifth exams. The radial nerve was identified in 100% of the exams. The ulnar nerve was identified in 67% of the cases in the first exam, and in 83% of the cases from the second to the fifth exams. The musculocutaneous nerve was identified in 50% of the cases in the first exam and in 83% of the cases in the fourth and fifth exams. All structures were identified correctly on the sixth exam. The mean time for the correct identification of the structures decreased considerably from the first to the sixth exam (r = - 0.37. CONCLUSIONS: Learning progression required the memorization of the ultrasound anatomy of the axillary region and acquisition of manual ability, and increasing success rates were associated with a significant reduction in the time to identify the structures.

  2. SUPERFICIAL CERVICAL PLEXUS BLOCK

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    Komang Mega Puspadisari

    2014-01-01

    Full Text Available Superficial cervical plexus block is one of the regional anesthesia in  neck were limited to thesuperficial fascia. Anesthesia is used to relieve pain caused either during or after the surgery iscompleted. This technique can be done by landmark or with ultrasound guiding. The midpointof posterior border of the Sternocleidomastoid was identified and the prosedure done on thatplace or on the level of cartilage cricoid.

  3. [Ultrasound guidance improves the success rate of axillary plexus block: a meta-analysis].

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    Qin, Qin; Yang, Debao; Xie, Hong; Zhang, Liyuan; Wang, Chen

    2016-01-01

    To evaluate the value of real-time ultrasound (US) guidance for axillary brachial plexus block (AXB) through the success rate and the onset time. The meta-analysis was carried out in the Anesthesiology Department of the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China. A literature search of Medline, Embase, Cochrane database from the years 2004 to 2014 was performed. The literature searches were carried out using medical subject headings and free-text word: "axilla", "axillary", "brachial plexus", "ultrasonography", "ultrasound", "ultrasonics". Two different reviewers carried out the search and evaluated studies independently. Seven randomized controlled trials, one cohort study and three retrospective studies were included. A total of 2042 patients were identified. 1157 patients underwent AXB using US guidance (US group) and the controlled group included 885 patients (246 patients using traditional approach (TRAD) and 639 patients using nerve stimulation (NS)). Our analysis showed that the success rate was higher in the US group compared to the controlled group (90.64% vs. 82.21%, p<0.00001). The average time to perform the block and the onset of sensory time were shorter in the US group than the controlled group. The present study demonstrated that the real-time ultrasound guidance for axillary brachial plexus block improves the success rate and reduce the mean time to onset of anesthesia and the time of block performance. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  4. Ultrasound guidance improves the success rate of axillary plexus block: a meta-analysis

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    Qin Qin

    2016-04-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the value of real-time ultrasound (US guidance for axillary brachial plexus block (AXB through the success rate and the onset time. METHODS: The meta-analysis was carried out in the Anesthesiology Department of the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China. A literature search of Medline, EMBASE, Cochrane database from the years 2004 to 2014 was performed. The literature searches were carried out using medical subject headings and free-text word: "axilla", "axillary", "brachial plexus", "ultrasonography", "ultrasound", "ultrasonics". Two different reviewers carried out the search and evaluated studies independently. RESULTS: Seven randomized controlled trials, one cohort study and three retrospective studies were included. A total of 2042 patients were identified. 1157 patients underwent AXB using US guidance (US group and the controlled group included 885 patients (246 patients using traditional approach (TRAD and 639 patients using nerve stimulation (NS. Our analysis showed that the success rate was higher in the US group compared to the controlled group (90.64% vs. 82.21%, p < 0.00001. The average time to perform the block and the onset of sensory time were shorter in the US group than the controlled group. CONCLUSION: The present study demonstrated that the real-time ultrasound guidance for axillary brachial plexus block improves the success rate and reduce the mean time to onset of anesthesia and the time of block performance.

  5. Ultrasound guidance improves the success rate of axillary plexus block: a meta-analysis.

    Science.gov (United States)

    Qin, Qin; Yang, Debao; Xie, Hong; Zhang, Liyuan; Wang, Chen

    2016-01-01

    To evaluate the value of real-time ultrasound (US) guidance for axillary brachial plexus block (AXB) through the success rate and the onset time. The meta-analysis was carried out in the Anesthesiology Department of the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China. A literature search of Medline, EMBASE, Cochrane database from the years 2004 to 2014 was performed. The literature searches were carried out using medical subject headings and free-text word: "axilla", "axillary", "brachial plexus", "ultrasonography", "ultrasound", "ultrasonics". Two different reviewers carried out the search and evaluated studies independently. Seven randomized controlled trials, one cohort study and three retrospective studies were included. A total of 2042 patients were identified. 1157 patients underwent AXB using US guidance (US group) and the controlled group included 885 patients (246 patients using traditional approach (TRAD) and 639 patients using nerve stimulation (NS)). Our analysis showed that the success rate was higher in the US group compared to the controlled group (90.64% vs. 82.21%, p<0.00001). The average time to perform the block and the onset of sensory time were shorter in the US group than the controlled group. The present study demonstrated that the real-time ultrasound guidance for axillary brachial plexus block improves the success rate and reduce the mean time to onset of anesthesia and the time of block performance. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  6. [Plexus lesions following radiation therapy. Report of nineteen cases (author's transl)].

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    Contamin, F; Mignot, B; Ecoffet, M; Ollat, H; Jouneau, P

    Nineteen patients with plexus lesions following radiation therapy were investigated: fifteen with brachial plexus, 4 with lumbar or sacral plexus involvement. Symptoms at onset are usually sensory. Motor disturbances occur either simultaneously or after some delay, their course is generally gradual and unfavourable. Areflexia appears early and was present in every case. Important cutaneous lesions (radiodermitis) and considerable induration of soft tissues were observed in every patient. Diagnosis is a relapse of the mitotic process. Severity of prognosis makes imperative a definite technique of radiation therapy. In all the patients included in this study, dosage had exceded 1,600 rets. Patients were tentatively treated with D-penicillamine, an inhibitor of collagen synthesis.

  7. Clinical anatomy and 3D virtual reconstruction of the lumbar plexus with respect to lumbar surgery

    Science.gov (United States)

    2011-01-01

    Background Exposure of the anterior or lateral lumbar via the retroperitoneal approach easily causes injuries to the lumbar plexus. Lumbar plexus injuries which occur during anterior or transpsoas lumbar spine exposure and placement of instruments have been reported. This study aims is to provide more anatomical data and surgical landmarks in operations concerning the lumbar plexus in order to prevent lumbar plexus injuries and to increase the possibility of safety in anterior approach lumbar surgery. Methods To study the applied anatomy related to the lumbar plexus of fifteen formaldehyde-preserved cadavers, Five sets of Virtual Human (VH) data set were prepared and used in the study. Three-dimensional (3D) computerized reconstructions of the lumbar plexus and their adjacent structures were conducted from the VH female data set. Results The order of lumbar nerves is regular. From the anterior view, lumbar plexus nerves are arranged from medial at L5 to lateral at L2. From the lateral view, lumbar nerves are arranged from ventral at L2 to dorsal at L5. The angle of each nerve root exiting outward to the corresponding intervertebral foramen increases from L1 to L5. The lumbar plexus nerves are observed to be in close contact with transverse processes (TP). All parts of the lumbar plexus were located by sectional anatomy in the dorsal third of the psoas muscle. Thus, access to the psoas major muscle at the ventral 2/3 region can safely prevent nerve injuries. 3D reconstruction of the lumbar plexus based on VCH data can clearly show the relationships between the lumbar plexus and the blood vessels, vertebral body, kidney, and psoas muscle. Conclusion The psoas muscle can be considered as a surgical landmark since incision at the ventral 2/3 of the region can prevent lumbar plexus injuries for procedures requiring exposure of the lateral anterior of the lumbar. The transverse process can be considered as a landmark and reference in surgical operations by its relative

  8. Accuracy of Physical Examination, Ankle-Brachial Index, and Ultrasonography in the Diagnosis of Arterial Injury in Patients With Penetrating Extremity Trauma: A Systematic Review and Meta-analysis.

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    deSouza, Ian S; Benabbas, Roshanak; McKee, Sean; Zangbar, Bardiya; Jain, Ashika; Paladino, Lorenzo; Boudourakis, Leon; Sinert, Richard

    2017-08-01

    Penetrating Extremity Trauma (PET) may result in arterial injury, a rare but limb- and life-threatening surgical emergency. Timely, accurate diagnosis is essential for potential intervention in order to prevent significant morbidity. Using a systematic review/meta-analytic approach, we determined the utility of physical examination, Ankle-Brachial Index (ABI), and Ultrasonography (US) in the diagnosis of arterial injury in emergency department (ED) patients who have sustained PET. We applied a test-treatment threshold model to determine which evaluations may obviate CT Angiography (CTA). We searched PubMed, Embase, and Scopus from inception to November 2016 for studies of ED patients with PET. We included studies on adult and pediatric subjects. We defined the reference standard to include CTA, catheter angiography, or surgical exploration. When low-risk patients did not undergo the reference standard, trials must have specified that patients were observed for at least 24 hours. We used the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) to evaluate bias and applicability of the included studies. We calculated positive and negative likelihood ratios (LR+ and LR-) of physical examination ("hard signs" of vascular injury), US, and ABI. Using established CTA test characteristics (sensitivity = 96.2%, specificity = 99.2%) and applying the Pauker-Kassirer method, we developed a test-treatment threshold model (testing threshold = 0.14%, treatment threshold = 72.9%). We included eight studies (n = 2,161, arterial injury prevalence = 15.5%). Studies had variable quality with most at high risk for partial and double verification bias. Some studies investigated multiple index tests: physical examination (hard signs) in three studies (n = 1,170), ABI in five studies (n = 1,040), and US in four studies (n = 173). Due to high heterogeneity (I(2)  > 75%) of the results, we could not calculate LR+ or LR- for hard signs or LR+ for ABI. The

  9. Estudo comparativo da eficácia analgésica pós-operatória de 20 mL de ropivacaína a 0,5, 0,75 ou 1% no bloqueio de plexo braquial pela via posterior Estudio comparativo de la eficacia analgésica postoperatoria de 20 mL de ropivacaina a 0,5, 0,75 ó 1% en el bloqueo de plexo braquial por la vía posterior Comparative study for the postoperative analgesic efficacy of 20 mL at 0.5, 0.75, and 1% ropivacaine in posterior brachial plexus block

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    Marcos Guilherme Cunha Cruvinel

    2008-10-01

    ía posterior se dividieron aleatoriamente en tres grupos de 30. Grupo 1: 20 mL de ropivacaina a 0,5%; Grupo 2: 20 mL de ropivacaina a 0,75%; Grupo 3: 20 mL de ropivacaina a 1%. El bloqueo se evaluó a través de la investigación de sensibilidad térmica utilizando algodón con alcohol y el dolor postoperatorio se evaluó según una escala numérico verbal (ENV en las primeras 48 horas. RESULTADOS: En los tres grupos la analgesia postoperatoria fue similar según los parámetros evaluados; ENV de dolor medio, tiempo hasta el primer quejido de dolor y consumo de opioides en el postoperatorio. CONCLUSIONES: Este estudio mostró que el bloqueo del plexo braquial por la vía posterior es una técnica que promueve una analgesia eficaz para intervenciones quirúrgicas en el hombro. Utilizando 20 mL de ropivacaina, las tres diferentes concentraciones estudiadas promueven analgesia similar.BACKGROUND AND OBJECTIVES: Arthroscopic shoulder surgeries are associated with severe postoperative pain. Among the analgesic techniques available, brachial plexus block has the best results. The objective of this study was to determine which concentration of local analgesic used in the posterior brachial plexus block provides longer postoperative analgesia. METHODS: Ninety patients undergoing posterior brachial plexus block were randomly divided into three groups of 30 patients each. Group I: 20 mL of 0.5% ropivacaine; Group 2: 20 mL of 0.75% ropivacaine; and Group 3: 20 mL of 1% ropivacaine. The blockade was evaluated by assessing the thermal sensitivity using a cotton pad with alcohol and postoperative pain was evaluated according to a Verbal Numeric Scale (VNS in the first 48 hours. RESULTS: Postoperative analgesia was similar in all three groups according to the parameters evaluated: mean VNS, time until the first complaint of pain, and postoperative opioid consumption. CONCLUSIONS: This study demonstrated that posterior brachial plexus block provides effective analgesia for shoulder surgeries

  10. Diagnostic Value of Magnetic Resonance Neurography in Cervical Radiculopathy: Plexus Patterns and Peripheral Nerve Lesions.

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    Schwarz, Daniel; Kele, Henrich; Kronlage, Moritz; Godel, Tim; Hilgenfeld, Tim; Bendszus, Martin; Bäumer, Philipp

    2017-10-02

    The aim of this study was to assess the imaging appearance and diagnostic value of plexus and peripheral nerve magnetic resonance neurography (MRN) in cervical radiculopathy. This prospective study was approved by our institutional ethics committee and written informed consent was obtained from all participants. A total of 24 patients were included with a diagnosis of cervical radiculopathy based on clinical examination, supporting electrophysiological examinations and spinal imaging consistent with the clinical syndrome. All patients then underwent a high-resolution MRN protocol including the brachial plexus from nerve roots to plexus cords using a 3-dimensional turbo spin echo with variable flip angle short tau inversion recovery and sagittal-oblique T2-weighted spectral adiabatic inversion recovery sequence, and ulnar, median, and radial nerves at the upper arm and elbow in T2-weighted fat saturated sequences. Two readers independently rated plexus elements regarding the presence of lesions at neuroforaminal levels, roots, trunks, and cord segments. Median, ulnar, and radial nerves were likewise rated. Findings were then compared to a referenced standard of cervical radiculopathy that was defined as the combined diagnosis of clinical syndrome including supporting electrophysiological exams and matching positive spinal imaging, and diagnostic performance parameters were calculated. Additional quantitative and qualitative analysis assessed peripheral nerve caliber and normalized T2-signal at arm level in cervical radiculopathy and compared them to 25 inflammatory neuropathy controls. Cervical radiculopathy resulted in distinct plexus lesion patterns for each level of neuroforaminal stenosis. Overall, brachial plexus MRN in cervical radiculopathy reached a sensitivity of 81%, a specificity of 96%, a positive predictive value of 87%, and overall diagnostic accuracy of 87%. Initial spinal magnetic resonance imaging showed multiple positive findings for clinically

  11. The Choroid Plexus in Healthy and Diseased Brain.

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    Kaur, Charanjit; Rathnasamy, Gurugirijha; Ling, Eng-Ang

    2016-03-01

    The choroid plexus is composed of epithelial cells resting on a basal lamina. These cells produce the cerebrospinal fluid (CSF), which has many functions including rendering mechanical support, providing a route for some nutrients, removing by-products of metabolism and synaptic activity, and playing a role in hormonal signaling. The choroid plexus synthesizes many growth factors, including insulin-like, fibroblast, and platelet-derived growth factors. The tight junctions located between the apical parts of the choroid plexus epithelial cells form the blood-CSF barrier (BCSFB), which is crucial for the homeostatic regulation of the brain microenvironment along with the blood-brain barrier (BBB). Morphological changes such as atrophy of the epithelial cells and thickening of the basement membrane suggest altered CSF production occurs in aging and in Alzheimer disease. In brain injuries and infections, leukocytes accumulate in the CSF by passing through the choroid plexus. In inflammatory CNS diseases (eg, multiple sclerosis), pathogenic autoreactive T lymphocytes may migrate through the BBB and BCSFB into the CNS. The development of therapeutic strategies to mitigate disruption of the BCSFB may be helpful to curtail the entry of inflammatory cells into the CSF and hence reduce inflammation, thereby overcoming choroid plexus dysfunction in senescence and in various diseases of the CNS. © 2016 American Association of Neuropathologists, Inc. All rights reserved.

  12. Peripheral nerve injuries: A retrospective survey of 1124 cases.

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    Kouyoumdjian, João A; Graça, Carla R; Ferreira, Vanessa F M

    2017-01-01

    Peripheral nerve injuries (PNIs) remain an important health problem often leading to severe motor disabilities predominantly in the younger population. To analyze our experience of clinical and electrodiagnostic evaluation (EDX) of PNIs over a 26-year period. Between 1989 and 2014, 1124 consecutive patients with 1418 PNIs were referred for clinical as well as EDX evaluation. These PNIs involved upper and lower limbs as well as the facial nerves. Patients with iatrogenic lesions and spinal cord/spinal root lesions were excluded from this analysis. Brachial plexus (BP) injuries with associated or not with root avulsions were considered as one particular nerve and was include in the study as BP. The etiological categories of the sustained trauma included vehicular accidents, penetrating injuries, falls, gunshot wounds, car accidents involving pedestrians, sports injuries, and miscellaneous injuries. The mean age of our patients was 34.2 years and most were males (76.7%). Majority (80.9%) of the PNIs were isolated injuries. Combined lesions most commonly involved the ulnar and median nerves. Upper-limb PNIs accounted for 72.6% of our patients. The ulnar nerve was injured most often, either singly or in combination. Vehicular accidents were the most common causes of injury (46.4%), affecting the brachial BP or the radial, fibular, or sciatic nerves. Penetrating trauma (23.9%) commonly affected the ulnar and the median nerves. Falls and gunshot wounds frequently affected the ulnar, radial, and median nerves. Sports injuries, mostly soccer related, affected predominantly the fibular nerves. BP injuries were considerably more common in accidents involving motorcycles than those involving cars (46.1% vs. 17.1%), and root avulsions was more frequently associated in these cases. Most PNIs were caused by vehicular accidents and penetrating trauma, and affected young men. Overall, ulnar nerve, primary BP, and median nerve PNIs were the most prevalent lesions.

  13. Anatomy of the spinal accessory nerve plexus: relevance to head and neck cancer and atherosclerosis.

    Science.gov (United States)

    Brown, Henry

    2002-09-01

    The term spinal accessory nerve plexus may be defined as the spinal accessory nerve with all its intra- and extracranial connections to other nerves, principally cranial, cervical, and sympathetic. The term is not new. This review examines its applied anatomy in head and neck cancer and atherosclerosis. Over the centuries, general studies of neural and vascular anatomy and embryology formed a basis for the understanding upon which the plexus is described. During the past century, its anatomy and blood supply have come to be better understood. The importance of almost all of the plexus to head, neck, and upper extremity motor and sensory functions has come to be realized. Because of this understanding, surgical neck dissection has become progressively more conservative. This historical progression is traced. Even the most recent anatomic studies of the spinal accessory nerve plexus reveal configurations, new to many of us. They were probably known to classical anatomists, and not recorded in readily available literature, or not recorded at all. Human and comparative anatomic studies indicate that the composition of this plexus and its blood supply vary widely, even though within the same species their overall function is very nearly the same. Loss of any of these structures, then, may have very different consequences in different individuals. As a corollary to this statement, data are presented that the spinal accessory nerve itself need not be cut during surgical neck dissections for severe impairment to occur. In addition, data are presented supporting the theory that atherosclerosis by obstructing vessels to this plexus and its closely connected brachial plexus will very likely result in their ischemic dysfunction, often painful. Finally evidence, as well as theory, is stated concerning anatomic issues, methodology, outcome, and possible improvements in surgical procedures emphasizing conservatism.

  14. DOES THE ADDITION OF DEXAMETHASON TO LOCAL ANESTHETIC PROLONG THE ANALGESIA OF INTERSCALEN PLEXUS BRACHIALIS BLOCK IN PATIENTS WITH SHOULDER SURGERY?

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    Nancheva Jasminka

    2016-07-01

    Full Text Available Abstract: Introduction: Peripherial nerve blocks is a suitable alternative to general anesthesia especially for one-day case surgery. Interscalene approach of plexus brachialis block as much as supraclavicular and infraclavicular provide reliable, safe, effective, low cost and most complete anesthesia with satisfactory postoperative analgesia for upper limb surgery. Postoperative analgesia of plexus brachialis blocks can be prolonged by using different drugs as adjuvants with local anesthetics. Dexamethasone has been shown to prolong the duration of postoperative analgesia when given as an adjunct for peripheral nerve blocks. The investigation was randomized, prospective, double blinded and controlled study. Objective: The study was designed to compare the effects of dexamethasone administered as an adjunct to bupivacaine in interscalene brachial plexus block on the onset, duration and postoperative analgesia in patients under the shoulder surgery. Methods: A prospective, double-blind study was undertaken in patients scheduled for shoulder surgeries under the interscalene brachial plexus block. We enrolled 60 patients, ASA I-II both sexes, aged 19-65 years, weighing 54-89 kg, divided to two groups G1 and G2. The brachial plexus block was performed by interscalene approach and mixture of 2% lidocaine (12ml and 0.5% bupivacaine (22 ml either alone or combined with dexamethasone (4 mg. The block was performed by using double technique neurostimulator/ultrasound technique. Results: In our investigation we found a significant increase in onset and duration of motor and sensory block in Group G2 (with dexamethasone as compared to Group G1 patients (p < 0.01. Conclusion: Addition of dexamethasone to local anesthetic drugs in interscalene plexus brachialis block, significantly prolongs the duration of analgesia and motor block in patients undergoing shoulder arthroscopy. Moreover, it is a remarkably safe and costeffective method of providing

  15. Estudo comparativo da eficácia analgésica pós-operatória de 20, 30 ou 40 mL de ropivacaína no bloqueio de plexo braquial pela via posterior Estudio comparativo de la eficacia analgésica postoperatoria de 20, 30 o 40 mL de ropivacaína en el bloqueo de plexo braquial por la vía posterior A comparative study on the postoperative analgesic efficacy of 20, 30, or 40 mL of ropivacaine in posterior brachial plexus block

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    Marcos Guilherme Cunha Cruvinel

    2007-10-01

    fue determinar cuál volumen de anestésico local en el bloqueo de plexo braquial por la vía posterior propicia analgesia postoperatoria para esas operaciones de manera más eficiente. MÉTODO: Noventa pacientes sometidos al bloqueo del plexo braquial por vía posterior fueron divididos aleatoriamente en tres grupos de 30. Grupo 1 - volumen de 20 mL; Grupo 2 - volumen de 30 mL; Grupo 3 - volumen de 40 mL. En todos los grupos, el anestésico usado fue la ropivacaína a 0,375%. El bloqueo se evaluó a través de la investigación de sensibilidad térmica utilizando algodón con alcohol y el dolor postoperatorio se evaluó secundando una escala numérica verbal (ENV en las primeras 24 horas. RESULTADOS: En los tres grupos la analgesia postoperatoria fue similar según los parámetros evaluados; ENV de dolor promedio,tiempo hasta el primer quejido de dolor y consumo de opioides en el postoperatorio. En el grupo de 20 mL hubo un mayor consumo de analgésicos no opioides después de la 12ª hora de postoperatorio. En los grupos de 30 y 40 mL la extensión del bloqueo fue significativamente mayor. CONCLUSIONES: Este estudio mostró que el bloqueo del plexo braquial por la vía posterior es una técnica que promueve analgesia eficaz para intervenciones quirúrgicas en el hombro. Los tres diferentes volúmenes estudiados promovieron analgesia similar. La mayor extensión del bloqueo con volúmenes mayores no se tradujo en una mejor analgesia.BACKGROUND AND OBJECTIVES: Arthroscopic surgeries of the shoulder are accompanied by severe postoperative pain. Among the analgesic techniques, brachial plexus block offers the best results. The objective of this study was to determine which volume of local anesthetic in the posterior brachial plexus block offers more adequate analgesia for those procedures. METHODS: Ninety patients undergoing posterior brachial plexus block were randomly divided in three groups of 30 patients: Group 1 – volume of 20 mL; Groups 2 – volume of 30 m

  16. Isolated Subclavian Vein Injury: A Rare and High Mortality Case

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    Sahin Iscan

    2013-01-01

    Full Text Available Isolated subclavian vein injuries are rarely seen without concomitant arterial injury, bone fracture, damage to brachial plexus, and thoracal traumas. Our case was brought to the emergency service 6 hours after he had been shot at the shoulder with a firearm. After detection of extravasation from the left axillary and subclavian vein on arteriographic and venographic examinations, he was operated on. An autogenous saphenous vein graft was interposed between subclavian and axillary veins. Cardiac arrest developed twice because of hypovolemia, which was resolved with medical therapy. Subclavian vein injuries have a more mortal course when compared with the injuries to the subclavian arteries. Its most important reason is excessive blood loss and air embolism because of delayed arrival to hospital. As is the case in all vascular injuries, angiography is the most important diagnostic examination. If the general health state of the patient permits, arteriography and venography should be performed in patients potentially exposed to vascular injuries. In patients with extreme blood loss and deteriorated health state, direct surgical exploration of the injury site, containment of the bleeding, and venous repair are life-saving approaches.

  17. X-ray diagnosis of the abruption of brachial plexal roots from the spinal cord

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    Ogleznev, K.Ya.; Lebedev, A.N.; Akhmetov, K.K. (Tsentral' nyj Inst. Usovershenstvovaniya Vrachej, Moscow (USSR))

    An oily radiographic agent was introduced suboccipitally to 38 patients 4 to 18 months after the trauma for diagnosis of the damage site in the brachial plexus both within the range of the vertebral canal (intradurally, preganglionarly), and beyond it (extradurally, postganglionarly). The abruption of the brachial plexal roots from the spinal cord was characterized on the cervical myeloradiculograms by the contrasting of traumatic meningocele (23 observations), deformation and compression of the subdural space by the cicatricialcystic process. Symptoms of concurrent arachnoidith were often revealed (peripachymeningitis, epiduritis). Ruptures of the radicular saccular walls are accompanied by a change of their shape, manifested by its elongation, bicontour outlines, the obliteration or the formation of the ''false traumatic meningocele''.

  18. Medical Rehabilitation and Occupational Therapy in Patients with Lesion of Plexus Brachialis

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    Vacheva D.

    2015-05-01

    Full Text Available Causes for plexus brachialis damage are versatile, and in some cases remain unknown, but mostly result from degenerative and inflammatory processes. Treatment of brachial plexus dysfunction is often conservative and is subject to a team of specialists - neurologists, traumatologists, rehabilitation physicians, kinesitherapists and occupational therapists. The objective of the research is to report the recovery of patients with lesion of plexus brachialis after a complex physiotherapy and rehabilitation treatment program that includes electrostimulation, remedial massage, kinesitherapy, electrotherapy and occupational therapy. A total of 159 patients, treated at the Clinic of Physical Therapy, University Hospital of Pleven, were included in the study. Improvement of measured indexes: pain assessment, centimetry, assessment of upper limb muscle weakness, dynamometry and functional test of activities of daily living, was registered in all patients under observation. In order to achieve good results in the rehabilitation of patients with injured plexus brachialis, timely diagnosis, good medication therapy and early start of complex physiotherapy and rehabilitation are of crucial importance, so that performance of daily living activities improves. The good results come slowly and with difficulties, but the quality of life of patients and the quality of labor performed by them, improves significantly.

  19. Optimal timing for repair of peripheral nerve injuries.

    Science.gov (United States)

    Wang, Eugene; Inaba, Kenji; Byerly, Saskya; Escamilla, Diandra; Cho, Jayun; Carey, Joseph; Stevanovic, Milan; Ghiassi, Alidad; Demetriades, Demetrios

    2017-11-01

    Data regarding outcomes after peripheral nerve injuries is limited, and the optimal management strategy for an acute injury is unclear. The aim of this study was to examine timing of repair and specific factors that impact motor-sensory outcomes after peripheral nerve injury. This was a single-center, retrospective study. Patients with traumatic peripheral nerve injury from January 2010 to June 2015 were included. Patients who died, required amputation, suffered brachial plexus injury, or had missing motor-sensory examinations were excluded. Motor-sensory examinations were graded 0 to 5 by the Modified British Medical Research Council system. Operative repair of peripheral nerves was analyzed for patient characteristics, anatomic nerve injured, level of injury, associated injuries, days until repair, and repair method. Three hundred eleven patients met inclusion criteria. Two hundred fifty-eight (83%) patients underwent operative management, and 53 (17%) underwent nonoperative management. Those who required operative intervention had significantly more penetrating injuries 85.7% versus 64.2% (p Injury Severity Score less than 15 (p = 0.013) and male sex (p = 0.006). Upper arm level of injury was a predictor of poor outcome (p = 0.041). Multivariate analysis confirmed male sex as a predictor of good motor outcome (p = 0.014; Adjusted Odds Ratio, 3.88 [1.28-11.80]). Univariate analysis identified distal forearm level of injury (p = 0.026) and autograft repair (p = 0.048) as predictors of poor sensory outcome. Damage control surgery for unstable patients undergoing laparotomy (p = 0.257) and days to nerve repair (p = 0.834) did not influence motor-sensory outcome. Outcomes did not differ significantly in patients who underwent repair 24 hours or longer versus those who were repaired later. Outcomes were primarily influenced by patient characteristics and injury level rather than operative characteristics. Peripheral nerve injuries can be repaired after damage control

  20. Ganglion block. Celiac plexus neurolysis; Ganglienblockade. Neurolyse des Plexus coeliacus

    Energy Technology Data Exchange (ETDEWEB)

    Kraemer, S.C.; Seifarth, H. [Klinikum Esslingen gGmbH, Klinik fuer diagnostische und interventionelle Radiologie und Nuklearmedizin, Esslingen (Germany); Meier, R. [Universitaetsklinikum Ulm, Klinik fuer diagnostische und interventionelle Radiologie, Ulm (Germany)

    2015-06-15

    Pain originating from the organs of the upper abdomen, especially in patients suffering from inoperable carcinoma of the pancreas or advanced inflammatory conditions, is difficult to treat in a significant number of patients. Computed tomography (CT) guided neurolysis is the most commonly used technique for neurolysis of the celiac plexus. Ethanol is used to destroy the nociceptive fibers passing through the plexus and provides an effective means of diminishing pain arising from the upper abdomen. Using either an anterior or posterior approach, a 22 G Chiba needle is advanced to the antecrural space and neurolysis is achieved by injecting a volume of 20-50 ml of ethanol together with a local anesthetic and contrast medium. In up to 80 % of patients suffering from tumors of the upper abdomen, CT-guided celiac plexus neurolysis diminishes pain or allows a reduction of analgesic medication; however, in some patients the effect may only be temporary necessitating a second intervention. In inflammatory conditions, celiac neurolysis is often less effective in reducing abdominal pain. The CT-guided procedure for neurolysis of the celiac plexus is safe and effective in diminishing pain especially in patients suffering from tumors of the upper abdomen. The procedure can be repeated if the effect is only temporary. (orig.) [German] Therapierefraktaere und schwere rezidivierende Schmerzen im Oberbauch stellen insbesondere beim nicht operablen Pankreaskarzinom, aber auch bei fortgeschrittenen entzuendlichen Erkrankungen eine Herausforderung dar. Die CT-gesteuerte Neurolyse/Blockade des Plexus coeliacus schaltet durch eine gezielte Zerstoerung der afferenten und efferenten Nervenfasern mit Alkohol die Schmerzweiterleitung aus. Mittels unterschiedlicher Zugaenge von ventral oder dorsal wird eine 22-G-Chiba-Nadel CT-durchleuchtungsgesteuert nach prae- und/oder paraaortal auf Hoehe des Truncus coeliacus vorgebracht. An der entsprechenden Lokalisation erfolgt die Injektion von 20

  1. CLINICAL COMPARISON BETWEEN 0.25% BUPIVACAINE AND BUPIVACAINE 0.25% AND TRAMADOL (2MG/KG IN BRACHIAL PHLEXUS BLOCK BY SUPRACLAVICULAR APPROACH

    Directory of Open Access Journals (Sweden)

    Suresh

    2015-06-01

    Full Text Available BACKGROUND AND OBJECTIVES : Adjunc ts to local anaesthetics for brachial plexus block may enhance the quality and duration of analgesia. Tramadol a synthetic 4 - phenylpiperidine analog of codeine is known to produce antinociception and enhance the effect of local anaesthetics when given epid urally , intrathecally or in various peripheral nerve blocks. The purpose of this study was to assess the effect of Tramadol added to brachial plexus block by supraclavicular approach. METHODS : A prospective , randomized , single blinded study was conducted o n 60 ASA I or II adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly divided into two groups. Patients in Group I (n=30 were given 38mL of 0.25% Bupivacaine plus 2ml NS and Group II (n = 30 w ere given 38 mL of 0.25% Bupivacaine plus 2 ml Tramadol (2mg/kg. The onset time and duration of sensory and motor blockade were recorded. Haemodynamic variables (i.e. heart rate , noninvasive blood pressure , oxygen saturation , and rescue analgesic require ments were recorded for 24 hrs postoperatively. RESULTS: the onset of sensory and motor block was significantly faster in Group II compared to Group I (P <0.05. Rescue analgesic requirements were significantly less in Group II compared to Group I (P , 0.05 . Haemodynamic variables did not differ between groups in the post - operative period. CONCLUSION: Tramadol (2mg/kg in combination with 38mL of Bupivacaine (0.25% hastened onset of sensory and motor block , and improved postoperative analgesia when used in brachial plexus block , without producing any adverse events.

  2. Radiation Therapy to the Plexus Brachialis in Breast Cancer Patients: Analysis of Paresthesia in Relation to Dose and Volume

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    Lundstedt, Dan, E-mail: dan.lundstedt@gu.se [Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Gustafsson, Magnus [Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg (Sweden); Steineck, Gunnar [Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm (Sweden); Sundberg, Agnetha [Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg (Sweden); Wilderäng, Ulrica [Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Holmberg, Erik [Regional Cancer Center, Sahlgrenska University Hospital, Gothenburg (Sweden); Johansson, Karl-Axel [Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg (Sweden); Karlsson, Per [Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden)

    2015-06-01

    Purpose: To identify volume and dose predictors of paresthesia after irradiation of the brachial plexus among women treated for breast cancer. Methods and Materials: The women had breast surgery with axillary dissection, followed by radiation therapy with (n=192) or without irradiation (n=509) of the supraclavicular lymph nodes (SCLNs). The breast area was treated to 50 Gy in 2.0-Gy fractions, and 192 of the women also had 46 to 50 Gy to the SCLNs. We delineated the brachial plexus on 3-dimensional dose-planning computerized tomography. Three to eight years after radiation therapy the women answered a questionnaire. Irradiated volumes and doses were calculated and related to the occurrence of paresthesia in the hand. Results: After treatment with axillary dissection with radiation therapy to the SCLNs 20% of the women reported paresthesia, compared with 13% after axillary dissection without radiation therapy, resulting in a relative risk (RR) of 1.47 (95% confidence interval [CI] 1.02-2.11). Paresthesia was reported by 25% after radiation therapy to the SCLNs with a V{sub 40} {sub Gy} ≥ 13.5 cm{sup 3}, compared with 13% without radiation therapy, RR 1.83 (95% CI 1.13-2.95). Women having a maximum dose to the brachial plexus of ≥55.0 Gy had a 25% occurrence of paresthesia, with RR 1.86 (95% CI 0.68-5.07, not significant). Conclusion: Our results indicate that there is a correlation between larger irradiated volumes of the brachial plexus and an increased risk of reported paresthesia among women treated for breast cancer.

  3. COMPARATIVE STUDY OF ROPIVACAINE V/S ROPIVACAINE WITH MAGNESIUM SULPHATE FOR BRACHIAL PLUXUS BLOCK

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    Nagarjuna Reddy

    2015-09-01

    Full Text Available BACKGROUND : The prime duty of any anesthesiologist is to relive pain in the perioperative period. Today regional anesthesia is well established as equal to general anesthesia in effectiveness and patient acceptability. Regional anesthesia is blocking of peripheral ner ve conduction in a reversible way using local anesthetic agents. For surgeries on upper extremities, particularly in emergency surgeries, regional anesthesia has many advantages over general anesthesia. The brachial plexus is approached at the level of tru nks and the compact arrangement of trunks at the supraclavicular level gives a high success rate with minimum local anesthetic drug volume and a dense and fast onset of the block. To prolong the duration of analgesia various drugs have been studied as adju vants to the local anesthetics. AIM : To compare the efficacy of Ropivacaine and Ropivacaine with Magnesium Sulphate for Brachial Plexus Block by Supraclavicular technique, for upper limb orthopedic surgeries. DESIGN : A Prospective randomized comparative st udy . METHODS : Sixty adult patients of both sexes in the age group of 20 - 60 years belonging to ASA I/II category posted for various types of upper limb surgeries. The patients were randomly allocated into two groups. Supraclavicular brachial plexus block wa s performed. Group – I (Ropivacaine alone – 30 patients received 29ml of 0.75% Ropiva caine with 1ml of normal saline .Group – II (Ropivacaine+Magnesium – 30 patients received 29ml of 0.75% Ropivacaine with Magnesium Sulphate 250mg (1ml of 500mg drug diluted wi th 1ml of distilled water. The following parameters were observed after performing Supraclavicular Brachial Plexus block in both the groups: 1. Time of onset of block (Sensory and Motor 2. Total Duration of Analgesia 3. Total Duration of Motor Blockade 4 . Dermatomes/Nerves blocked 5. Complications if any. RESULTS : There was no significant difference in onset of sensory blockade between Group I ( 4

  4. Cervical spine injuries in American football.

    Science.gov (United States)

    Rihn, Jeffrey A; Anderson, David T; Lamb, Kathleen; Deluca, Peter F; Bata, Ahmed; Marchetto, Paul A; Neves, Nuno; Vaccaro, Alexander R

    2009-01-01

    American football is a high-energy contact sport that places players at risk for cervical spine injuries with potential neurological deficits. Advances in tackling and blocking techniques, rules of the game and medical care of the athlete have been made throughout the past few decades to minimize the risk of cervical injury and improve the management of injuries that do occur. Nonetheless, cervical spine injuries remain a serious concern in the game of American football. Injuries have a wide spectrum of severity. The relatively common 'stinger' is a neuropraxia of a cervical nerve root(s) or brachial plexus and represents a reversible peripheral nerve injury. Less common and more serious an injury, cervical cord neuropraxia is the clinical manifestation of neuropraxia of the cervical spinal cord due to hyperextension, hyperflexion or axial loading. Recent data on American football suggest that approximately 0.2 per 100,000 participants at the high school level and 2 per 100,000 participants at the collegiate level are diagnosed with cervical cord neuropraxia. Characterized by temporary pain, paraesthesias and/or motor weakness in more than one extremity, there is a rapid and complete resolution of symptoms and a normal physical examination within 10 minutes to 48 hours after the initial injury. Stenosis of the spinal canal, whether congenital or acquired, is thought to predispose the athlete to cervical cord neuropraxia. Although quite rare, catastrophic neurological injury is a devastating entity referring to permanent neurological injury or death. The mechanism is most often a forced hyperflexion injury, as occurs when 'spear tackling'. The mean incidence of catastrophic neurological injury over the past 30 years has been approximately 0.5 per 100,000 participants at high school level and 1.5 per 100,000 at the collegiate level. This incidence has decreased significantly when compared with the incidence in the early 1970s. This decrease in the incidence of

  5. Transport across the choroid plexus epithelium.

    Science.gov (United States)

    Praetorius, Jeppe; Damkier, Helle Hasager

    2017-06-01

    The choroid plexus epithelium is a secretory epithelium par excellence. However, this is perhaps not the most prominent reason for the massive interest in this modest-sized tissue residing inside the brain ventricles. Most likely, the dominant reason for extensive studies of the choroid plexus is the identification of this epithelium as the source of the majority of intraventricular cerebrospinal fluid. This finding has direct relevance for studies of diseases and conditions with deranged central fluid volume or ionic balance. While the concept is supported by the vast majority of the literature, the implication of the choroid plexus in secretion of the cerebrospinal fluid was recently challenged once again. Three newer and promising areas of current choroid plexus-related investigations are as follows: 1) the choroid plexus epithelium as the source of mediators necessary for central nervous system development, 2) the choroid plexus as a route for microorganisms and immune cells into the central nervous system, and 3) the choroid plexus as a potential route for drug delivery into the central nervous system, bypassing the blood-brain barrier. Thus, the purpose of this review is to highlight current active areas of research in the choroid plexus physiology and a few matters of continuous controversy. Copyright © 2017 the American Physiological Society.

  6. Brachial Plexopathy in Apical Non-Small Cell Lung Cancer Treated With Definitive Radiation: Dosimetric Analysis and Clinical Implications

    Energy Technology Data Exchange (ETDEWEB)

    Eblan, Michael J.; Corradetti, Michael N.; Lukens, J. Nicholas; Xanthopoulos, Eric [Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Mitra, Nandita [Department of Biostatistics and Epidemiology, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Christodouleas, John P.; Grover, Surbhi; Fernandes, Annemarie T. [Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Langer, Corey J.; Evans, Tracey L.; Stevenson, James [Department of Medical Oncology, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Rengan, Ramesh [Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Apisarnthanarax, Smith, E-mail: apisarns@uphs.upenn.edu [Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States)

    2013-01-01

    Purpose: Data are limited on the clinical significance of brachial plexopathy in patients with apical non-small cell lung cancers (NSCLC) treated with definitive radiation therapy. We report the rates of radiation-induced brachial plexopathy (RIBP) and tumor-related brachial plexopathy (TRBP) and associated dosimetric parameters in apical NSCLC patients. Methods and Materials: Charts of NSCLC patients with primary upper lobe or superiorly located nodal disease who received {>=}50 Gy of definitive conventionally fractionated radiation or chemoradiation were retrospectively reviewed for evidence of brachial plexopathy and categorized as RIBP, TRBP, or trauma-related. Dosimetric data were gathered on ipsilateral brachial plexuses (IBP) contoured according to Radiation Therapy Oncology Group atlas guidelines. Results: Eighty patients were identified with a median follow-up and survival time of 17.2 and 17.7 months, respectively. The median prescribed dose was 66.6 Gy (range, 50.4-84.0), and 71% of patients received concurrent chemotherapy. RIBP occurred in 5 patients with an estimated 3-year rate of 12% when accounting for competing risk of death. Seven patients developed TRBP (estimated 3-year rate of 13%), comprising 24% of patients who developed locoregional failures. Grade 3 brachial plexopathy was more common in patients who experienced TRBP than RIBP (57% vs 20%). No patient who received {<=}78 Gy to the IBP developed RIBP. On multivariable competing risk analysis, IBP V76 receiving {>=}1 cc, and primary tumor failure had the high