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At least 253 records · Page 14Linked to original sources
PubMed1997

Split pectoralis major transfer for serratus anterior palsy.

The results of split pectoralis major tendon transfer (sternal head) for symptomatic scapular winging because of palsy of the serratus anterior muscle were reviewed. Eleven consecutive patients, whose average age was 34 years, had a duration of preoperative symptoms ranging from 12 to 60 months. Ten patients had electromyograms documenting a long thoracic nerve injury. Using an inferior axillary incision, the tendon of the sternal head of the pectoralis major is mobilized and transferred to the inferior angle of the scapula. The tendon transfer is reinforced with autogenous fascia lata. After surgery, a scapulothoracic orthosis is worn for 6 weeks, and restriction of vigorous activities is recommended for 6 months. At an average followup of 41 months, 10 of 11 (91%) patients had satisfactory results with significant improvement in function and reduction of pain. Each of these 10 patients had improved scapular tracking with no scapular winging or mild, dynamic winging at latest followup. One patient had an unsatisfactory result with a full recurrence of scapular winging secondary to noncompliance with the postoperative physical therapy regimen. The split pectoralis major tendon transfer provides a reasonable substitute for a paralyzed serratus anterior muscle in scapular stabilization. Strict adherence to technical principles and postoperative rehabilitation reliably leads to satisfactory clinical results.

Adult↗
PubMed1999

Results of transfer of the pectoralis major tendon to treat paralysis of the serratus anterior muscle.

BACKGROUND: Paralysis of the serratus anterior muscle can be functionally disabling. As a result of the scapular winging associated with such paralysis, the scapula does not remain apposed to the thorax when the upper extremity is elevated forward at the shoulder. This produces functional disability associated with pain and loss of a stable base for movement of the upper extremity. METHODS: We reviewed the results of transfer of the pectoralis major tendon with the addition of a fascial graft in sixteen patients who had paralysis of the serratus anterior. The average age of the patients at the time of the operation was thirty-three years (range, twenty to fifty-five years). Electrodiagnostic studies confirmed the presence of an isolated injury of the long thoracic nerve. The index operation was performed sixteen months to eleven years after the onset of pain and weakness. The etiology of the paralysis was idiopathic in two patients, traumatic in seven, and secondary to operative intervention in seven. All patients had pain in the shoulder on the side of the paralysis. RESULTS: The result was excellent for eight patients, good for five, and fair for one at an average of four years and three months (range, two years and one month to nine years) postoperatively. There were two failures, both of which occurred after a traumatic event. Of the fourteen patients in whom the procedure did not fail, eight were asymptomatic and had normal function, five had intermittent mild discomfort, and one had frequent mild pain without any winging of the scapula. The average Constant and Murley score for the fourteen patients in whom the procedure did not fail increased from 36 points preoperatively to 92 points postoperatively. CONCLUSIONS: The index procedure successfully alleviated the functional disability caused by paralysis of the serratus anterior muscle.

Adult↗
PubMed2000

Retroambiguus projections to the cutaneus trunci motoneurons may form a pathway in the central control of mating.

Our laboratory has proposed that the nucleus retroambiguus (NRA) generates the specific motor performance displayed by female cats during mating and that it uses direct pathways to the motoneurons of the lower limb muscles involved in this activity. In the hamster a similar NRA-projection system could generate the typical female mating posture, which is characterized by lordosis of the back as well as elevation of the tail. The present study attempted to determine whether this elevation of the tail is also part of the NRA-mating control system. The basic assumption was that elevation of the tail is a function of the cutaneous trunci muscle (CTM), which was verified by bilateral tetanic stimulation of the lateral thoracic nerves innervating the CTM. It resulted in upward movement of the tail to a position similar to the tail-up position during the lordosis posture. Retrograde tracing results showed that CTM motoneurons are located in the ventral and ventrolateral part of the C(7)-C(8) ventral horn, those innervating the tail region ventrolateral to those innervating the axillary region. Anterograde tracing studies showed that NRA fibers terminate bilaterally in both parts of the CTM motoneuronal cell groups. Electron microscopical studies revealed that labeled NRA terminals make monosynaptic contacts with retrogradely labeled dendrites of CTM motoneurons. Almost all of these terminal profiles had asymmetric synapses and contained spherical vesicles, which suggests an excitatory function. The observation that 15% of the labeled NRA terminals make more than one synaptic contact with a retrogradely labeled CTM motoneuronal dendrite within the same section indicates how powerful the NRA-CTM projection is. The results indicate that during mating the NRA not only could generate the lordosis posture but also the elevation of the tail.

Animals↗
PubMed1996

Iatrogenic serratus anterior paralysis. Long-term outcome in 26 patients.

STUDY OBJECTIVE: To evaluate the treatment, extent of recovery, and residual disability in 26 iatrogenic cases of serratus paralysis. PATIENTS AND STUDY DESIGN: Seventeen cases of serratus anterior paralysis had occurred following a local invasive procedure along the course of the long thoracic nerve, including seven first-rib resections, four mastectomies with axillary dissection, two scalenotomies, two surgical treatments of spontaneous pneumothorax, and two infraclavicular plexus anesthesia. Eight cases of paralysis had occurred after general anesthesia for patients who had undergone surgery for diverse clinical reasons. One case of paralysis occurred after spinal anesthesia. The length of sick leave, treatment with a shoulder brace, amount of physical therapy, long-term symptoms, and residual disability were evaluated from the medical records and from the questionnaire sent to the patients on average 6 years (range, 2 to 11 years) after the onset of the paralysis. RESULTS: Despite comprehensive and lengthy treatment, all but one had residual symptoms, as well as limitations in the use of the affected limb. Twenty-one (81%) of the patients could not lift or pull heavy objects, 15 (58%) could not play sports, such as tennis or golf, and 14 (54%) found it impossible to work with hands above shoulder level. CONCLUSION: Serratus anterior paralysis, following anesthesia or local invasive procedures on the anterolateral aspect of the thorax, may cause considerable and long-term dysfunction of the shoulder girdle and affect the function of the whole upper limb.

Adolescent↗
PubMed2002

[Pain management with nerve root block under ct and neurostimulator guidance].

PURPOSE: To evaluate the efficacy of nerve roots block under CT and neurostimulator guidance for the management of pain. MATERIAL: and method. Nerve root blocks were performed in 27 patients (pudendal nerve, intercostal nerve, ilio-hypogastric nerve, thoracic and lumbar sympatholysis). These were performed with corticosteroids (Altim((R))) (20 patients) or phenol (7 patients). RESULTS: Seventeen patients (63%) had pain reduction during at least 15 days. The pain relief was longer with phenol. Complications appeared in the 3 lumbar sympatholysis (inguinal pain) and one of the thoracic sympatholysis (Claude Bernard Horner syndrome). CONCLUSION: The nerve root blocks seem to have some efficacy and a further evaluation is necessary to assess their impact on the ability of patients to return to work and their need for pain medication. When performing these procedures, one must be careful to avoid potential complications and verify that the procedure is needed.

Adult↗
PubMed1994

The rostrocaudal organization in the dorsal root ganglia of the rat: a consequence of plexus formation?

The dorsal root ganglia (DRGs) of the rat have a rostrocaudal organization. This organization can most easily be demonstrated in fetal and neonatal rats because the spatial relationships of their DRGs are maintained better in tissue sections than those of mature rats. This review is concerned with the way in which the rostrocaudal organization of the DRGs is generated. Wheat germ agglutinin--horseradish peroxidase/horseradish peroxidase labeling of peripheral nerves of the brachial and lumbar plexuses shows that the position of the somata of the sensory neurons of the labeled nerves can be restricted to rostral or caudal halves of DRGs. Labeling of the thoracic nerve or its branches always results in labeling throughout the entire thoracic DRG. After application of the marker to forelimb nerves, it was observed that whenever a DRG is labeled only partially, its spinal nerve is correspondingly labeled partially as well. These data suggest that the rostrocaudal organization in the DRG is related to the formation of the plexuses. During development nerve fibers can be segmentally labeled, using the subdivision of the DRGs into a rostral and a caudal half to keep together as they find their way through the plexus. Application of label to forelimb skin, hindlimb skin and even thoracic skin can result in labeling of rostral or caudal halves of a DRG. A possible explanation might be that each dermatome can be divided into a skin area innervated by the rostral half of a DRG and a skin area innervated by the caudal half of the same dorsal root ganglion. In the rat, the segmental sensory innervation of muscles during development has not yet been investigated. The question of whether the segmental unit of innervation of a muscle is a whole DRG or half a DRG therefore still remains unanswered.

Animals↗
PubMed1980

Electrophysiologic studies of cutaneous nerves of the thoracic limb of the dog.

The cutaneous innervation of the thoracic limb was investigated in 36 barbiturate-anesthetized dogs, using electrophysiologic techniques. The cutaneous area (CA) innervated by each cutaneous nerve was delineated in at least five dogs by stroking the hair in the area with a small watercolor brush while recording from the nerve. Mapping of adjacent CA revealed areas of considerable overlapping. The part of the CA of a given nerve supplied by only that nerve is referred to as its autonomous zone. Of all nerves arising from the brachial plexus, only the suprascapular, subscapular, lateral thoracic, thoracodorsal, and cranial and caudal pectoral nerves lacked cutaneous afferents. The dorsal cutaneous branch of C6 had a CA, but no grossly demonstrable dorsal cutaneous branches for C7 C8, or T1 were found. The cervical nerves had ventral cutaneous branches, but no lateral cutaneous branches. Thoracic nerves T2-T4 had dorsal, ventral, and lateral cutaneous branches. The cutaneous branches of the brachiocephalic, axillary, musculocutaneous, radial, median, and ulnar nerves all had CA which were overlapped by adjacent CA, thus their autonomous zones were much smaller than the cutaneous areas usually depicted for these nerves in anatomy and neurology textbooks.

Animals↗
PubMed1999

Surgical management of superior sulcus tumors.

Superior sulcus tumor refers to any primary lung cancer presenting with constant pain in the nerve distribution of the eighth cervical, first and second thoracic nerve roots and Horner's syndrome caused by invasion of the stellate ganglion. The pain is steady, severe, and unrelenting, involving the shoulder, the vertebral margin of the scapula and ulnar distribution of the arm to the elbow and finally to the ulnar surface of the forearm, and the small and ring fingers of the hand (Pancoast-Tobias syndrome). Weakness and atrophy of the hand muscles can also occur as the lesions spreads to involve the first and second ribs and vertebrae. Radiologically, there is a small shadow at the extreme apex of the lung with rib and possible vertebral body invasion. Pulmonary symptoms are less frequent because of the peripheral location of the lesions. Since Shaw and Paulson approached superior sulcus tumors in 1961 by using preoperative radiation-therapy (30 to 45 Gy in four weeks including the primary tumor, mediastinum and supraclavicular region) followed by surgical resection, this radiosurgical approach shortly became the standard treatment yielding better disease control and survival than that offered by other treatment modalities. It has now become evident that en bloc resection of the chest wall, involved adjacent structures as well as lobectomy must be considered the standard surgical approach for superior sulcus tumors combined with external radiation (preoperative, postoperative, or both). The goal of the operation is the complete and en bloc resection of the upper lobe in continuity with the invaded ribs, transverse processes, subclavian vessels, T1 nerve root, upper dorsal sympathetic chain and prevertebral muscles.

Arm↗
PubMed1997

Upper plexus thoracic outlet syndrome: optimal therapy.

BACKGROUND: Previously, transaxillary first rib resection alone was not considered adequate therapy for "upper plexus" (median nerve) thoracic outlet syndrome. It was thought that the "combined" approach with upper plexus dissection through a supraclavicular incision in addition to the transaxillary approach was necessary. However, with better understanding of anatomy--that the median nerve receives fibers from C8 and T1 as well as the upper plexus and that muscles that compress the upper plexus attach to the first rib--it is now recognized that first rib removal alone will relieve upper plexus compression. METHODS: Assessment of 2,210 operations for thoracic outlet syndrome revealed 250 patients (11%) had symptoms and nerve conduction velocity slowing of the median nerve only (upper plexus), whereas 452 (20%) patients had both median and ulnar nerve compression (upper and lower), and 1,508 patients exhibited compression symptoms and nerve conduction velocity slowing of the ulnar nerve alone (lower plexus). RESULTS: Transaxillary first rib resection relieved symptoms of median nerve (upper plexus) compression as well as it did for ulnar nerve (lower plexus) compression. Treatment outcome comparisons of patients with median and ulnar compression show no significant differences. CONCLUSIONS: These data refute the need for supraclavicular or combined supraclavicular and transaxillary approaches to treat patients with upper plexus (median) thoracic outlet syndrome compression as previously recommended. The transaxillary approach alone is satisfactory.

Adolescent↗
PubMed1986

Electron microscopic analysis of infection patterns for Venezuelan equine encephalomyelitis virus in the vector mosquito, Culex (Melanoconion) taeniopus.

The infectious process for Venezuelan equine encephalomyelitis virus in an enzootic vector mosquito, Culex (Melanoconion) taeniopus, was examined by transmission electron microscopy. Following large dose oral infection, virus was seen in the abdominal fat body and epidermis within 1 hr of engorgement. Replicated virus appeared to leave the mesenteron 3-4 hr post-infection. Dissemination to other organs occurred between days 1 and 2 of extrinsic incubation, when the hindgut and abdominal nerve ganglia were found to be infected. Virus reached the thoracic nerve ganglia, brain and salivary glands by 4 days post-infection, and flight muscles contained virus by day 6. Virus was never detected in the malphigian tubules or ovaries of infected mosquitoes within 21 days of extrinsic incubation. These results suggest that virus particles penetrate the mesenteron and accumulate in the abdominal fat body prior to replication within the vector. This pattern differs from that reported for other arbovirus-vector pairs.

Adipose Tissue↗
PubMed2001

Mobilization of the phrenic nerve in the thoracic cavity by video-assisted thoracic surgery. Techniques and initial experience.

BACKGROUND: The use of video-assisted thoracic surgery (VATS) techniques to mobilize the phrenic nerve in the thoracic cavity for neurotization after brachial plexus injury was studied. METHODS: From August 1999 to January 2000, 10 men and 1 woman with brachial plexus injury (left side in 5 and right side in 6) joined the study group. Their ages ranged from 20 to 38 years (average, 28 years). Supine after general anesthesia, all the patients had double-lumen trachea cannulas to guarantee complete lung collapse on the operative side. Three port incisions were made to allow introduction of the following: a 10-mm Stryker endoscope through the sixth intercostal space 2 cm medial to the anterior axillary line, one instrument for manipulation in the anterior axillary line of the third intercostal space, and another in the second intercostal space about 2 cm lateral to the parasternal line. The nerve was mobilized with two common long Mixter clamps and some endoscopic instruments by blunt and sharp dissection. RESULTS: All patients were managed successfully without severe complications. The mean additional length of phrenic nerves by this technique was 16 cm. CONCLUSIONS: Mobilization of the phrenic nerve by VATS is a safe and minimally invasive method for elongating the nerve for neurotization after brachial plexus injury.

Adult↗
PubMed1995

Putative neurohemal areas in the peripheral nervous system of an insect, Gryllus bimaculatus, revealed by immunocytochemistry.

The morphology and position of putative neurohemal areas in the peripheral nervous system (ventral nerve cord and retrocerebral complex) of the cricket Gryllus bimaculatus are described. By using antisera to the amines dopamine, histamine, octopamine, and serotonin, and the neuropeptides crustacean cardioactive peptide, FMRFamide, leucokinin 1, and proctolin, an extensive system of varicose fibers has been detected throughout the nerves of all neuromeres, except for nerve 2 of the prothoracic ganglion. Immunoreactive varicose fibers occur mainly in a superficial position at the neurilemma, indicating neurosecretory storage and release of neuroactive compounds. The varicose fibers are projections from central or peripheral neurons that may extend over more than one segment. The peripheral fiber varicosities show segment-specific arrangements for each of the substances investigated. Immunoreactivity to histamine and octopamine is mainly found in the nerves of abdominal segments, whereas serotonin immunoreactivity is concentrated in subesophageal and terminal ganglion nerves. Immunoreactivity to FMRFamide and crustacean cardioactive peptide is widespread throughout all segments. Structures immunoreactive to leucokinin 1 are present in abdominal nerves, and proctolin immunostaining is found in the terminal ganglion and thoracic nerves. Codistribution of peripheral varicose fiber plexuses is regularly seen for amines and peptides, whereas the colocalization of substances in neurons has not been detected for any of the neuroactive compounds investigated. The varicose fiber system is regarded as complementary to the classical neurohemal organs.

Amines↗
PubMed1997

Topographic relationship of neurotensin-containing axon terminals with cardiac and noncardiac principal ganglion cells in the stellate ganglia of the cat.

The pattern of association between neurotensin (NT)-immunoreactive (NTIR) preganglionic nerve terminals and cardiac and noncardiac neurons in the stellate ganglion of the cat is analyzed, based on the finding of an excitatory modulation effect of exogenous NT on cardiac functions. For this purpose, NT-containing terminals were labeled by immunohistochemistry, and ganglion cells were detected by retrograde labeling of cardiac and vertebral nerves to identify cardiac and noncardiac neurons. To determine a possible regional localization of NTIR terminals and ganglion cells, the ganglia were divided into four areas: caudal, dorsomedial, cranial, and ventromedial, related to the two major afferent nerves (thoracic white rami 3 [T3WR] and 2 [T2WR]) and the two efferent nerves (vertebral and cardiac). NTIR terminals were widespread in the complete ganglion tissue; they covered practically all the regions explored, although two clusters of high concentration of NTIR terminals were detected in the cranial and caudal areas. By retrograde labelling it was found that cardiac cells were arranged around the exit of the cardiac nerve and that the vertebral neurons were extended from the exit of the vertebral nerve to the entrance of T3WR. The finding of association of NTIR terminals with cardiac neurons may account for the cardioregulatory effect of NT; however, since the presence of NTIR terminals close to the noncardiac neurons is notorious, other regulatory functions of NT must be considered.

Animals↗
PubMed1996

Winging of the Scapula in a Young Athlete.

A 15-year-old high school football player noticed asymmetry of his right shoulder and thought that he was losing muscle mass around his right shoulder over the previous 2-3 weeks. There was no history of pain, recent or past direct trauma or surgery of the neck or thorax. He was diagnosed with serologically confirmed infectious mononucleosis about 2 months earlier, and was recovering clinically. Physical examination was normal, except for significant asymmetry and winging of the right scapula, and electromyographic and nerve conduction studies revealed demyealination and axonal damage to the right long thoracic nerve and paralysis of serratus anterior, most likely caused by Epstein-Barr virus infection. Conservative treatment approach allowing continued activity and strengthening exercises resulted in full functional recovery over the next 6-8 months.

Journal Article↗