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At least 127 records · Page 7Linked to original sources

PubMed1989

Stretching of the brachial plexus in rabbits.

The brachial plexus of rabbits was stretched until mechanical failure. The level and site of rupture varied according to the direction of the stretching force. Upward and lateral traction of the forelimbs caused spinal nerve-root avulsions combined with nerve-trunk ruptures distal to the dorsal root ganglions. In such tractions the C5 nerves consistently exhibited postganglionic nerve-trunk rupture. The C6, C7, and C8 nerves had root avulsions. The T1 nerve was avulsed from the spinal cord in 7 cases out of 10; the other 3 cases had postganglionic nerve-trunk rupture. Downward traction of the forelimbs caused nerve avulsions from the scapulohumeral muscles innervated by the terminal branches of the brachial plexus and peripheral nerve ruptures in the course of the arm. The force producing trunk rupture of the C6 nerve was twice as great as that for root avulsion. The required stain was similar for nerve trunk rupture and root avulsion.

Animals↗

PubMed2002

[MRI diagnosis of tumor involving brachial plexus].

BACKGROUND & OBJECTIVE: The incidence rate of tumor involving brachial plexus was rare and its clinical diagnosis is difficult. Several foreign authors have reported that magnetic resonance imaging (MRI) is the best imaging diagnosis method. Howev, there was little report about this in China. This study was designed to investigate the diagnostic value of MRI in tumor involving brachial plexus. METHODS: The MRI manifestations in 13 patients with tumor involving brachial plexus (including 3 neurofibromatosis, 4 Pancoast's tumor, 6 metastatic tumor; 8 confirmed pathologically, 2 confirmed by biopsy, 3 neurofibromatosis confirmed clinically) were analyzed retrospectively. RESULTS: In 3 patients with neurofibromatosis, 2 cases showed growing along brachial plexus and represented spindle-shape; 1 cases showed growing crushing and encircling brachial plexus and represented ball-shape. There were middle or poor even signals on T1WI, and overt high and high-low mixed signals on T2WI (intense with even or uneven after enhancement). All 4 cases of Pancoast's tumor infiltrated brachial plexus. In 6 cases of metastatic tumor, 5 cases represented that localized bump encircled and infiltrated brachial plexus. 1 case represented that the tumor tissue effusively infiltrate brachial plexus. No special manifestation was shown on MRI of Pancoast's tumor and metastatic tumor. There were the similar or lower signals on T1WI, and high signals on T2WI (intense with even or uneven after enhancement). CONCLUSION: The coronal position of T1WI could clearly represent the relationship between brachial plexus and tumor, the involving extent of brachial plexus. Therefore, MRI is a effective imaging method for diagnosis of primary or secondary tumor involving brachial plexus.

Adolescent↗

PubMed2005

Adult traumatic brachial plexus injuries.

Adult traumatic brachial plexus injuries are devastating, and they are occurring with increasing frequency. Patient evaluation consists of a focused assessment of upper extremity sensory and motor function, radiologic studies, and, most important, preoperative and intraoperative electrodiagnostic studies. The critical concepts in surgical treatment are patient selection as well as the timing and prioritizing of restoration of function. Surgical techniques include neurolysis, nerve grafting, neurotization, and free muscle transfer. Results are variable, but increased knowledge of nerve injury and repair, as well as advances in microsurgical techniques, allow not only restoration of elbow flexion and shoulder abduction but also of useful prehension of the hand in some patients.

Adult↗

PubMed2004

[Surgery of post-traumatic brachial plexus lesions (personal approach in 2003)].

The surgery of traumatic brachial plexus lesions has developed extensively. At present (in the year 2003), five different approaches are utilised: A simple nerve transfer to restore elbow flexion without exploration of the brachial plexus is still recommended. In contrast to this technique, in many centres an extensive exploration of the brachial plexus is performed, to clarify an exact anatomical diagnosis. The treatment depends on the findings and consists of neurolysis, interfascicular nerve grafting, or nerve transfers in case of root avulsions. The surgery of the brachial plexus is followed by an intensive physiotherapy and, when the result of the plexus surgery can be evaluated, by a series of reconstructive procedures to maximise the functional result. The dorsal approach by David Kline is is indicated in special situations. The re-implantation of avulsed roots according to Carlstedt is still in an experimental phase. Doi recommended primary free functional muscle transplantation without exploration of the brachial plexus, which is a waste of muscles which have the potential of regeneration. The free muscle transplantation should be limited to inveterated cases. In the past ten years, the nerve fibre transfer from contralateral C7 according to Gu (1991) has opened a new source for axon sprouts. With this technique very good results can be achieved in elected cases, especially in young patients with a short interval between accident and surgery. The termino-lateral coaptation according to Fausto Viterbo provides axon sprouts from other nerves, without the necessity to sacrifice the function of the donor nerve. Excellent results can be achieved if the donor nerve is a small pure motor nerve, and the recipient nerve as well, in order to avoid a dilution of axon sprouts. Knowledge of the different fascial systems around the brachial plexus helps to facilitate the exploration. This is especially important in the area of the cuppula pleurae (membrana suprapleuralis Sibson). A detailed description of this system is provided. Pathology of the root-nerve complex is more complicated and cannot be reduced to the simple alternative "either root avulsion or rupture". Inspite of improvement of diagnostic means, cases are seen frequently in which--under the diagnosis "complete root avulsion"--non-avulsed roots have not been recognized and have not been used as donors for axons. MR-imaging has a failure rate and cannot be relied upon for surgical decision making. If the continuity of a root is proven, it is not sure that this root is really conducting and that there is a sufficient potential for regeneration. The only way to gain knowledge about the conductivity of roots in continuity is the "Central stimulation according to Turkof". This technique should be improved and one should get a quantitative answer. A surgical exploration of the brachial plexus, even if root avulsions are suspected, is mandatory. The most important point, as far as the brachial plexus lesion is concerned, is a combined approach: The brachial plexus lesion should be attacked directly, and as much reconstruction should be performed at the level of the brachial plexus as is possible. In elected cases, a C7 transfer might be indicated in a second stage. Surgery on the brachial plexus is followed by a period of intensive physiotherapy. When the result of the surgery on the brachial plexus can be evaluated, all possibilities of reconstructive surgery have to be applied to maximise the result.

Adult↗

PubMed2002

Tension pneumothorax: a pulmonary complication secondary to regional anesthesia from brachial plexus interscalene nerve block.

Interscalene brachial plexus anesthesia is often used for surgeries involving the shoulder and upper arm. This method of regional anesthesia decreases pain, nausea, and vomiting associated with general anesthesia. One infrequent complication of interscalene brachial plexus block is tension pneumothorax. Recognition of early signs and symptoms of tension pneumothorax and expeditious treatment for rapid decompression before physiologic decompensation is mandatory. This article discusses the interscalene brachial plexus block procedure leading to the pathogenesis, clinical presentation, diagnosis, and treatment of tension pneumothorax.

Brachial Plexus↗

PubMed2004

Birth injuries of the brachial plexus.

Birth injuries of the brachial plexus are fairly common, but most affected newborns make quick recoveries without any specific intervention. A minority suffer more severe injuries that lead to varying degrees of life-long disability. Modem microsurgical techniques permit reconstruction of certain plexus injuries and, in carefully selected patients, can restore voluntary activity to target muscle groups. The degree to which reanimation of paralyzed muscles improves function and quality of life for these children is a more important matter that has not yet been addressed using modern standards of evidence. Brachial plexus reconstruction is only a first step in the multidisciplinary process needed to optimize long-term functional outcomes for severely affected infants.

Birth Injuries↗

PubMed2005

Birth injuries of the brachial plexus.

Birth injuries of the brachial plexus are fairly common, but the majority of affected newborns make quick recoveries without any specific intervention. A minority suffer more severe injuries that lead to varying degrees of life-long disability. Happily, modern microsurgical techniques permit reconstruction of certain plexus injuries and, in carefully selected patients, can restore voluntary activity to target muscle groups. To what degree reanimation of paralyzed muscles improves function and quality of life for these children is a more important matter that has not yet been addressed at the level of modern standards of evidence. Brachial plexus reconstruction is only a first step in the multidisciplinary process needed to optimize long-term functional outcomes for severely affected infants.

Birth Injuries↗

PubMed2000

The anatomy of the pectoral nerves and their significance in brachial plexus reconstruction.

Twenty-nine brachial plexuses from 13 embalmed and 5 fresh cadavers were examined under x3.5 loupe magnification to collect systematic and topographic anatomical data regarding the lateral and medial pectoral nerves. Additionally, nerve biopsy specimens were harvested in 5 fresh cadavers to obtain histomorphometric data. In all dissections the pectoral nerves exited at the trunk level as 3 distinct nerves. The superior pectoral nerve (from the anterior division of the superior trunk) commences just distal to the suprascapular nerve and courses laterally to innervate the lateral clavicular portion of the pectoralis major muscle (PM) with 2 to 4 branches. The middle pectoral nerve (from the anterior division of the middle trunk) courses distally and enters the infraclavicular fossa with 2 constant branches. The superficial branch terminates in the medial clavicular and upper sternal parts of the PM. The deep branch always forms a plexus with the medial pectoral or inferior pectoral nerve (from the anterior division of the inferior trunk), which courses at a right angle around the the lateral thoracic artery. From this plexus several branches terminate in the Pm. The branch to the lower aspect of the PM pierces the pectoralis minor muscle in two thirds of cases, whereas it passes its inferior border to reach the lower aspects of the PM with an average length of 15 cm in one third of cases. Knowledge of the detailed anatomy of the pectoral nerves, as outlined in this study, clarifies the obscure anatomic relationship of the lateral and medial pectoral nerves and allows easy intraoperative location of the medial pectoral nerve at the exit of the lateral thoracic artery. The length of the inferior pectoral nerve, the number of motor axons, and the anatomical proximity of this nerve make it an expendable but powerful source of reinnervation to the musculocutaneous nerve in upper brachial plexus injuries.

Adult↗

PubMed1995

[Blocking of the brachial plexus: which technique(s) should be chosen?].

Brachial plexus blocks for upper extremity surgery: what are the preferred techniques? Brachial plexus anaesthesia for all types of upper extremity surgical procedures cannot be adequately achieved with a single technique. At least, two approaches are required: above the clavicle, Winnie's interscalene brachial plexus block, using a neurostimulator, has become the standard technique for shoulder surgery. Below the clavicle, midhumerus approach is the most successful approach for elbow, fore arm and hand surgery, especially for outpatient surgery. The best approach for catheter insertion along brachial plexus nerves/trunks remain controversial. The supraclavicular approach using surface landmarks might be the best approach due to its efficacy in achieving complete anaesthesia of the upper extremity and the rarity of secondary displacement of the catheter. Whatever the selected approach(es) to brachial plexus nerves, nerve location it best achieved by neurostimulation and often multiple neurostimulation. Insulated needles are being increasingly used due to accuracy but, currently, there is no general agreement concerning the type of needle bevel to be preferred in regard to both safety and accuracy.

Arm↗

PubMed2006

Collagen nerve guides for surgical repair of brachial plexus birth injury.

OBJECT: Standard brachial plexus repair techniques often involve autologous nerve graft placement and neurotization. However, when performed to treat severe injuries, this procedure can sometimes yield poor results. Moreover, harvesting the autologous graft is time-consuming and exposes the patient to additional surgical risks. To improve surgical outcomes and reduce surgical risks associated with autologous nerve graft retrieval and placement, the authors use collagen matrix tubes (Neurogen) instead of autologous nerve graft material. METHODS: Between 1991 and 2005, the authors surgically treated 65 infants who had suffered brachial plexus injury at birth. During this time, seven patients were treated using collagen matrix tubes (Neurogen). This study is a retrospective analysis of the initial five patients who were treated using the tubes. Two patients underwent tube placement recently and were excluded from the analysis because of the inadequate follow-up period. Four of the five patients experienced a good recovery (motor scale composite [MSC] > 0.6), and three exhibited an excellent recovery (MSC > 0.75) at 2 years postoperatively. The MSC improved by an average of 69 and 78% at 1 and 2 years, respectively. The movement scores improved to greater than or equal to 50% range of motion in most patients, and the contractures were usually mild or moderate. Follow-up physical and occupational therapy evaluations confirm these patients' functional status. When last seen, four of five of these children could feed and dress themselves. CONCLUSIONS: Technically, the use of the collagen matrix tubes was straightforward and efficient, and there were no complications. The outcomes in this small series are encouraging.

Brachial Plexus↗

PubMed1996

[Magnetic resonance of the brachial plexus: anatomy and study technique].

Brachial plexopathies are a common diagnostic problem: conventional imaging techniques can be useful in the detection of associated conditions (Pancoast tumors, first rib or clavicle fractures, etc.) but they cannot visualize brachial plexus structures directly. Also Computed Tomography (CT) is limited in the study of the retroclavicular region because of the artifacts due to the presence of the humeral heads in the slice. CT myelography exhibits very high accuracy in posttraumatic brachial plexopathies but fails to reveal the postganglionic plexus. In contrast, Magnetic Resonance Imaging (MRI) allows the direct detection of the brachial plexus, from spine to axilla, thanks to its multiplanarity and high contrast resolution. However, MR images are so rich in anatomical details (particularly on the oblique planes) that sometimes they become very difficult to interpret. To better define the anatomical relationships of the brachial plexus and to assess the best planes to study its different portions, 9 healthy volunteers were examined with MRI and MR images were compared with anatomical drawings and frozen cadaver sections. MRI depicts the brachial plexus from its origin to the axilla, but none of the investigated planes is sufficient, alone, to study the whole plexus adequately. The paraganglionic portion is clearly depicted on oblique sagittal images, while coronal and sagittal images are more useful for primary trunks and spinal nerves; the distal portion is perfectly visualized on sagittal images. Thus, we conclude that different examination protocols are necessary for every specific plexus portion, which means that brachial plexus MRI must be performed to try to solve a specific question by the orthopedic surgeon or the clinician.

Brachial Plexus↗

PubMed2003

Brachial plexus injuries and the electrodiagnostic examination.

Brachial plexus injuries represent a complex clinical challenge from both a diagnostic and treatment standpoint. Given the potential etiologic mechanisms of injury, as well as the varied number of anatomic sites vulnerable to such injury, it is essential that a precise diagnostic approach be utilized. From a neurophysiologic perspective, the electrodiagnostic examination has been shown to be the most powerful tool to evaluate brachial plexus injuries in all of their complexity. This article summarizes the more recent literature with regard to the electrodiagnostic approach to brachial plexus injuries, and discusses its clinical relevance.

Axons↗

PubMed2005

[Analysis of risk factors for perinatal brachial plexus palsy].

OBJECTIVES AND DESIGN: Risk factors of obstetrical brachial plexus palsy include: (1) large birth weight, (2) shoulder dystocia and prolonged second stage of labour, (3) instrumental vaginal delivery (forceps delivery, vacuum extraction), (4) diabetes mellitus and mother's obesity, (5) breech presentation, (6) delivery and infant with obstetrical brachial plexus palsy in antecedent delivery. The purpose was analysis of the classical risk factors for brachial plexus palsy based on our own clinical material. MATERIAL AND METHODS: Clinical material consists of 83 children with obstetrical brachial plexus palsy treated at the Department of Trauma and Hand Surgery (surgically--54, conservatively--29). Control group consists of 56 healthy newborns. Data recorded included: birth weight, body length, head and chest circumference, Apgar test at 1 min., type of brachial palsy and side affected, type of birth, presentation, duration of delivery (II stage), age of mother, mother's diseases, parity. RESULTS: The infants treated surgically have had a significantly higher birth weight, body height, head and chest circumference, in compression with control group and group treated conservatively. The differences were statistically important. Shoulder dystocia occurred in 32.9% of all vaginal delivery. Instrumental vaginal delivery was observed in 11.3% and breech presentation in 4.9% cases. There were no incidences of obstetrical brachial plexus palsy recurrence. Diabetes mellitus and mother's obesity was found in 3 cases. CONCLUSIONS: (1) Fetal macrosomia is the important risk factor of the obstetrical brachial plexus palsy. (2) Obstetrical brachial plexus palsy may occur also in the absence of the classical risk factors.

Birth Injuries↗

PubMed1999

Cross-chest radial nerve transfer in brachial plexus injuries. Experimental and anatomical basis.

Brachial plexus avulsion injuries are devastating injuries to the upper limb, and nerve transfer remains the only option in reconstruction. Despite the encouraging results concerning recovery of shoulder and elbow function, no option is available for treatment of the paralytic hand. In rats, we sectioned the radial nerve in the elbow region and transferred it across the chest to reinnervate the lesioned contralateral medial cord of the brachial plexus. Rats were then evaluated for motor and sensory recovery, electrophysiologically, behaviorally and morphologically. Forepaw functional recovery was estimated to be 90%. In cadavers, the radial nerve and profunda brachii artery were dissected. It was observed that the radial nerve vascularized by the profunda brachii artery was able to reach the contralateral brachial plexus distal to the shoulder region without nerve grafts. After sectioning the radial nerve, sensory loss is minimal and motor palsy can be easily restored by tendon transfers. The results of tendon transfer for radial nerve palsy are better than for any other nerve. Cross-chest radial nerve transfer might be of clinical interest in the reconstruction of hand function in entire injury to the brachial plexus.

Analysis of Variance↗

PubMed1982

Brachial plexus injury following median sternotomy. Part II.

Brachial plexus injury may be a consequence of median sternotomy. In a previous study, we documented that median sternotomy can cause first rib fractures and that the first rib fractures may be associated with brachial plexus injury. In the current study, two groups of patients were compared for the incidence of brachial plexus injury and first rib fracture. In Group A, an Ankeney retractor was used with the crossbar placed caudal to the incision: in Group C, a Cooley sternal retractor was used with the crossbar placed cephalad to the incision. The major effective difference between these two retractors was the more caudal placement of the retractor blades with the Cooley retractor than with the Ankeney retractor. Our previous study showed that first rib fractures were caused by high placement of the sternal retractor and that they could be avoided by placing the retractor at a lower position. In the present study, 33% in Group A and 14% in Group C sustained first rib fractures (p = 0.024). Signs of brachial plexus injury occurred in 18% of Group A and 12% of Group C (p = 0.52). We found no correlation between the presence of rib fracture and the presence of neurologic symptoms, but all patients who had both neurologic symptoms and a rib fracture had the symptoms only on the same side as the rib fracture. We also found that standard chest x-ray films identified only 15% of the rib fractures seen on special first rib views. The study demonstrates that the incidence of first rib fractures following median sternotomy is reduced when the sternal retractor is placed at a lower position and that the incidence of brachial plexus injury may also thereby be reduced.

Age Factors↗

PubMed2006

Medical and legal issues related to brachial plexus injuries in neonates.

Injuries to the brachial plexus in neonates present a malpractice dilemma not only for physicians who provide obstetric care, but also for those who administer immediate postnatal treatment for newborns who have these injuries and comorbid medical conditions. Although trauma remains the probable etiology for many brachial plexus injuries, other, nontraumatic etiologies need to be considered. The authors review current medical and legal principles related to brachial plexus injuries-principles that are of concern to all practitioners who provide obstetric and newborn care. They also make a number of recommendations for practitioners to reduce the risk of malpractice lawsuits related to these injuries. Among these recommendations are increasing one's awareness of nontraumatic origins; making sure that appropriate testing (eg, electromyography) is performed for infants whose conditions fail to improve within several months after birth; and taking a proactive role in discussing brachial plexus injuries with patients' families.

Brachial Plexus↗

PubMed2005

Comparison of two different techniques for brachial plexus block: infraclavicular versus axillary technique.

BACKGROUND: Brachial plexus block via the axillary approach is problematic in patients with limited arm mobility. In such cases, the infraclavicular approach may be a valuable alternative. The purpose of our study was to compare axillary and infraclavicular techniques for brachial plexus block in patients undergoing arm or forearm surgery. METHODS: After institutional approval and informed consent were obtained, 30 patients (ASA physical status I or II) scheduled for forearm and hand surgery under brachial plexus anesthesia were included in the study. Patients were randomly allocated into two groups. Brachial plexus block was performed via the axillary approach in the Group A patients and via the infraclavicular approach in the Group I patients using a peripheral nerve stimulator. All blocks were performed with a total dose of 40 ml 0.375% bupivacaine. RESULTS: In each nerve territory (radial, ulnar, median, and musculocutaneous), the mean values of the degree and the duration of the sensory block and motor block were not significantly different between the two groups (P > 0.05). Inadvertent vessel puncture was significantly more frequent in the axillary approach (P < 0.05). CONCLUSION: Brachial plexus block performed via the infraclavicular approach is as safe and effective as the axillary approach. Infraclavicular approach may be preferred to the axillary approach when the upper arm mobility is impaired or not desired.

Adult↗

PubMed2002

Surgical strategy for improving forearm and hand function in late obstetric brachial plexus palsy.

For the purpose of treatment, obstetric brachial plexus palsy can be subdivided into two distinct phases: initial obstetric brachial plexus palsy, and late obstetric brachial plexus palsy. In the latter, nerve surgery is no longer practical, and treatment often requires palliative surgery to improve function of the shoulder, elbow, forearm, and hand. Late obstetric brachial plexus palsy in the forearm and hand includes weakness or absence of wrist or metacarpophalangeal or interphalangeal joint extension; weakness or absence of finger flexion; forearm supination, or less commonly pronation contracture; ulnar deviation of the wrist; dislocation of the radial or ulnar head; thumb instability; or sensory disturbance of the hand. Palliative reconstruction for these forearm and hand manifestations is more difficult than for the shoulder or elbow because of the lack of powerful regional muscles for transfer. This report reviews the authors' experience performing more than 100 surgical procedures in 54 patients over a 9-year period (between 1988 and 1997) with a minimum of 2 years' follow-up. Surgical treatment is highly individualized, but the optimal age for forearm and hand reconstruction is usually later than for shoulder and elbow reconstruction because of the requirement for a preoperative exercise program. Multiple procedures for forearm and hand function were often performed on any given patient. Frequently, these were done simultaneously with reconstructive procedures for improving shoulder and/or elbow function. Traditional tendon transfer techniques do not provide satisfactory reconstruction for those deformities. Many of the authors' patients required more complex techniques such as nerve transfer and functioning free-muscle transplantation to augment traditional techniques of tendon and/or bone management. Sensory disturbance of the forearm and hand in late obstetric brachial plexus palsy seems a minor problem and further sensory reconstruction is unnecessary.

Adolescent↗