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At least 145 records · Page 8Linked to original sources

PubMed1997

Birth weight as a predictor of brachial plexus injury.

OBJECTIVE: To examine the relationship between birth weight and brachial plexus injury and estimate the number of cesareans needed to reduce such injuries. METHODS: All 80 neonatal records coded for brachial plexus injury from October 1985 to September 1993 at the Brigham and Women's Hospital in Boston, Massachusetts, were studied along with linked maternal files. Birth weight, method of delivery, presence or absence of shoulder dystocia, and any diagnosis of maternal gestational or nongestational diabetes were abstracted. Data for the group with brachial plexus injury were compared with data for live-born infants without this injury during the same period. The sensitivity and specificity of birth weight as a predictor of brachial plexus injury were calculated. Further, the number of cesarean deliveries necessary to prevent a single brachial plexus injury was estimated using various weight cutoffs (4000, 4500, and 5000 g) for elective cesarean delivery. RESULTS: Among 77,616 consecutive deliveries, there were 80 brachial plexus injuries identified, for an incidence of 1.03 per 1000 live births. The incidence of brachial plexus injury increased with increasing birth weight, operative vaginal delivery, and the presence of glucose intolerance. In the group of women without diabetes, between 19 and 162 cesarean deliveries would have been necessary to prevent a single immediate brachial plexus injury. Among women with diabetes, between five and 48 additional cesareans would have been required. CONCLUSION: Although birth weight is a predictor of brachial plexus injury, the number of cesarean deliveries necessary to prevent a single injury is high at most birth weights. Because of the large number of cesarean deliveries needed to prevent a single brachial plexus injury in infants born to women without diabetes, it is difficult to recommend routine cesarean delivery for suspected macrosomia in these women.

Birth Injuries↗

PubMed2007

Trapezius transfer to treat flail shoulder after brachial plexus palsy.

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 injured; 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 degrees; the gain in shoulder flexion average 37.4 degrees. 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.

Journal Article↗

PubMed1987

MR imaging in clinically suspected brachial plexus tumor.

We performed MR studies on 47 patients who were suspected of having brachial plexus involvement with tumor. Twenty-two of these patients had signs and symptoms suggesting brachial plexus tumor; 25 had known tumors that were juxtaposed to the brachial plexus but that could easily extend into the brachial plexus. These patients had no signs or symptoms. Using a 1.5-T clinical imaging system, we obtained single echo (T1- and T2-weighted) or double-echo (intermediate-weighted and T2-weighted) images in the coronal plane and supplemented these by images in the axial or sagittal planes. MR imaging encompassed the entire brachial plexus including roots, trunks, and cords. The imager body coil and a variety of surface coils were used for signal reception. MR findings were confirmed by surgery (n = 12) or response to radiation therapy on follow-up imaging (n = 3) in cases in which there was tumor involving the brachial plexus and by surgery (n = 9) or follow-up (n = 23) in cases in which there was no brachial plexus tumor. MR correctly identified all 15 cases of tumor involving the brachial plexus in patients with suggestive signs and symptoms; MR also correctly showed no tumor involvement in seven patients who had suggestive signs and symptoms. In 25 patients with no neurologic signs or symptoms, MR correctly identified tumor outside the brachial plexus that did not involve the brachial plexus. This study indicates that MR may have substantial clinical utility in evaluating patients for suspected brachial plexus tumor, particularly in patients with suggestive neurologic signs and symptoms.

Brachial Plexus↗

PubMed2005

Spatial mapping of the brachial plexus using three-dimensional ultrasound.

Imaging of the brachial plexus with MRI and standard two-dimensional (2D) ultrasound has been reported, and 2D ultrasound-guided regional anaesthetic block is an established technique. The aim of this study was to map the orientation of the brachial plexus in relation to the first rib, carotid and subclavian arteries, using three-dimensional (3D) ultrasound. A free-hand optically tracked 3D ultrasound system was used with a 12 MHz transducer. 10 healthy volunteers underwent 3D ultrasound of the neck. From the 3D ultrasound data sets, the outlines of the brachial plexus, subclavian artery and first rib were manually segmented. A surface was interpolated from the series of outlines to produce a spatially orientated 3D reconstruction of the brachial plexus. The brachial plexus could be mapped in all volunteers, although a variation in image resolution between individuals existed. Anatomical variations were demonstrated between the 10 volunteers; the most notable and clinically relevant was the alignment of the plexus divisions. 3D reconstructions illustrated the plexus, changing its orientation from a vertical alignment in the interscalene region to a more horizontal alignment in the supraclavicular fossa. Spatial mapping of the brachial plexus is possible with 3D ultrasound using the subclavian artery and first rib as landmarks. There is a deviation from the conventionally described anatomy and this may have implications for the administration of regional anaesthesia.

Adult↗

PubMed2005

Brachial plexus injury during open heart surgery--controlled prospective study.

BACKGROUND: Postoperative brachial plexus injury is often reported because the brachial plexus is stretched by sternotomy and the use of sternal retractors during open heart surgery. In many studies, brachial plexus injuries have been demonstrated by postoperative electrophysiological studies in susceptible patients. In this study, we estimated the incidence, severity, and type of brachial plexus injuries by routine preoperative and postoperative electrophysiological studies of patients undergoing open heart surgery. METHODS: Patients undergoing coronary artery bypass grafting (CABG) surgery (Group 1), heart valve surgery (Group 2), or peripheral vascular surgery (Group 3) were included in the investigation. Electrophysiological studies of both upper extremities were performed five days before and three weeks after the operation. RESULTS: Peripheral nerve problems were found preoperatively in 23 of the 112 patients (21 %). These problems persisted, but similar findings were obtained postoperatively from the left upper extremities of six of the 42 CABG (14 %) and two of the 24 heart valve (8 %) patients who had had normal preoperative evaluations. The patients with injured nerves were older and had undergone longer operation times. There were no differences between the patients with injured nerves and the others with respect to mammary artery harvesting or other operative variables. CONCLUSIONS: There are no reports in the literature of routine preoperative and postoperative electrophysiological studies in large patient groups to evaluate brachial plexus injury during open heart surgery. It is known that heart surgery sometimes causes partial brachial plexus injury, especially in the lower trunk. However, these peripheral nerve problems are usually not considered clinically important and are not investigated. Patients undergoing open heart surgery must be closely followed up for peripheral nerve injury during the postoperative period.

Adult↗

PubMed2006

Long-term results of primary repair of brachial plexus lesions in children.

The results of brachial plexus reconstruction in adults are poor, despite the sophistication of the various methods used. However, the same methods used in neonates after obstetrical brachial plexus injury will give far better results because of the shorter distance, stronger potential of regeneration, and capacity of brain adaptation. Complete paralyses, associated root ruptures, and avulsions are very severe, and the end results cannot be evaluated before the end of growth. Although the end results show that the shoulder and elbow do not do as well as in upper-type lesions, the results at the level of the hand are encouraging, showing 75% with useful function after 8 years, even in patients with avulsion injuries of the lower roots. These results demonstrate the value of the early exploration and repair of the obstetric plexus. We also review our series of traumatic brachial plexus palsy in children. The results are poorer than in neonates, where may be related, in part, to a greater percentage of associated lesions in these patients.

Brachial Plexus↗

PubMed2005

Management of birth brachial plexus palsy.

INTRODUCTION: The indications for surgical repair of congenital brachial plexus palsy are controversial. Our objective was to determine the results of early brachial plexus surgery following obstetric-induced brachial plexus palsy. METHODS: We performed a retrospective analysis of the outcome of 58 cases of brachial plexus surgery. The indication for operation consisted of the presence of less than antigravity strength in the biceps, triceps, and deltoid muscle groups at 6 months of age. Data gathered prospectively, previously, showed the likelihood of improvement with less than antigravity strength in these cases to be poor. RESULTS: Follow-up data were obtained on 52 of the 58 cases. Overall mean follow-up was 2 years. Twelve patients had more than 3 years follow-up (mean 5.5 years, range 3-11.5 years). Significant improvement was seen in all injury patterns i.e., C5-C6, C5-C7, and C5-C8, T1. Greater than antigravity strength in the biceps, triceps, and deltoid muscle groups was seen in the majority of cases at follow-up. CONCLUSIONS: Repair of obstetrical brachial plexus palsy in children at 6 months of age that is based on less than antigravity strength in the biceps, triceps, and deltoid muscle groups produces improvement in functional capabilities. Children with obstetrical brachial plexus palsy should be referred soon after birth to a center that specializes in the treatment of this type of palsy.

Brachial Plexus Neuropathies↗

PubMed2001

Brachial plexus root avulsions.

The majority of adult brachial plexus palsies are posttraumatic injuries caused by high-energy forces, usually involving motor vehicles. In infants, brachial plexus palsies commonly represent obstetrical injuries following excessive traction on the plexus during complex or difficult delivery. Most adult injuries, and occasionally those in infants, represent brachial plexus root avulsion injuries that carry serious ramifications from the standpoint of permanent disability of a paralyzed extremity, prolonged recuperation, and significant socioeconomic impact. Modern-day management of root avulsions should focus on early, aggressive microsurgical reconstruction of the brachial plexus, combining various neurotizations with intraplexus and extraplexus ipsilateral and contralateral nerve donors, utilization of vascularized nerve grafts, and finally the use of free vascularized and neurotized muscles. When these multistage microsurgical management techniques are applied early (with complete avulsions) they may often result in significant return of neurologic function, especially in young patients. Amputation should be looked upon as an option only when these newer microsurgery techniques have failed.

Adolescent↗

PubMed1999

Associated factors in 1611 cases of brachial plexus injury.

OBJECTIVE: To identify risk factors associated with brachial plexus injury in a large population. METHODS: A computerized data set containing records from hospital discharge summaries of mothers and infants and birth certificates was examined. The deliveries took place in more than 300 civilian acute care hospitals in California between January 1, 1994, and December 31, 1995. Cases of brachial plexus injury were evaluated for additional diagnoses and procedures of pregnancy, such as mode of delivery, gestational diabetes, and shoulder dystocia. Those complications were stratified by birth weight and analyzed, using bivariate and multivariate techniques to identify specific risk factors. RESULTS: Among 1,094,298 women who delivered during the 2 years, 1611 (0.15%) had diagnoses of brachial plexus injury. The frequency of diagnosis increased with the addition of gestational diabetes (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.7, 2.1), forceps delivery (OR 3.4, 95% CI 2.7, 4.3), vacuum extraction (OR 2.7, 95% CI 2.4, 3.1), and shoulder dystocia (OR 76.1, 95% CI 69, 84). In cases of brachial plexus injury, the frequency of shoulder dystocia increased from 22%, when birth weight ranged between 2.5 and 3.5 kg, to 74%, when birth weight exceeded 4.5 kg. The frequency of diagnosis of other malpresentation (nonbreech) (OR 73.6, 95% CI 66, 83) was increased for all birth weight categories. Severe (OR 13.6, 95% CI 8.3, 22.5) and mild (OR 6.3, 95% CI 3.9, 10.1) birth asphyxia were increased. Prematurity (OR 0.8, 95% CI 0.67, 0.98) and fetal growth restriction (OR 0.1, 95% CI 0.03, 0.40) were protective against brachial plexus injury. CONCLUSION: In macrosomic newborns, shoulder dystocia was associated with brachial plexus injury, but in low- and normal-weight infants, "other malpresentation" was diagnosed more frequently than shoulder dystocia. Our study findings suggest that brachial plexus injury has causes in addition to shoulder dystocia and might result from an abnormality during the antepartum or intrapartum period.

Birth Injuries↗

PubMed1990

Neck dissection injury of a brachial plexus anatomical variant.

We describe an unusual brachial plexus anatomical variant that renders it vulnerable to injury in radical or modified neck dissection. It is represented by a looping redundant course of the most cephalad cervical division contribution to the brachial plexus. Unless recognized during development of the inferior surgical plane by blunt dissection techniques, injury to this portion of the brachial plexus may occur. An awareness of this infrequent variation in brachial plexus anatomy should be maintained.

Aged↗

PubMed1995

Diagnosis and management of brachial plexus lesions in cancer patients.

Brachial plexus dysfunction is a well-known complication of cancer. Metastatic brachial plexus (RBP) are the most common causes. The distinction between MBP and RBP is very important but is not easy to make. This article presents in detail the distinguishing features of these types of brachial dysfunction. In regard to treatment, radiation, chemotherapy, narcotic analgesics, paravertebral nerve blocks, dorsal rhizotomy, dorsal root entry zone procedure, and high contralateral cordotomy are helpful in managing the symptoms of MBP. Transdermal electrical nerve stimulation, dorsal column stimulators, neurolysis, and neurolysis with omentoplasty have been tried in RBP. Good physical therapy, tricyclics, antiarrhythmics, anti-convulsants, nonsteroidal anti-inflammatory drugs and steroids are helpful in both conditions.

Brachial Plexus↗

PubMed1988

Emergency versus delayed repair of severe brachial plexus injuries.

Emergency or early surgery for brachial plexus injury is advisable because emergency nerve surgery is technically easier and because the overall results are better. In cases involving vascular injury, preoperative arteriography is indispensable. The blood supply must be reestablished and the brachial plexus completely explored and, if possible, repaired. In cases not involving vascular injury, violent trauma with fractures of the shoulder often produces lesions in the same brachial plexus. Regardless of associated vascular or bone injuries, brachial plexus lesions should be repaired within the first days after injury (provided that there are no contraindications related to age or general health). If combined vascular and nerve injuries are involved, immediate emergency surgery is mandatory. With early surgery, exploration is easier, shorter grafts are needed, and neurotization is possible in lesions in which the roots have been pulled out.

Angiography↗

PubMed1993

Ultrasound imaging aids infraclavicular brachial plexus block.

Infraclavicular approach to the brachial plexus provides adequate anesthesia of the entire arm. Local anesthetics can be deposited over cords and branches of brachial plexus above the formation of musculocutaneous and axillary nerves. The approach can also easily block ulnar segment of medial cord and intercostobrachial nerve, which helps preventing tourniquet pain. However, distance to the plexus is deeper than the other approaches so that current blind method using anatomical landmarks requires anesthesiologists' delicate manipulation and experience. Through ultrasonography, the location of subclavian artery, as an anatomical landmark, can be easily identified. It is then very easy and safe to perform infraclavicular brachial plexus block. Our new method showed 89% (n = 9) successful rate. The time for the block was 4.2 +/- 1.5 min and there was an average of 3.2 +/- 0.6 needle penetrations. Thirty three percent (n = 3) had subclavian artery been punctured without formation of hematoma clinically. No patient had clinical postoperative pneumothorax.

Adult↗

PubMed2004

Macro- and microanatomical characterization of the cat brachial plexus.

The anatomy of the cat brachial plexus is poorly documented despite its importance for reparative surgery. The present work aims to study the anatomy of the brachial plexus of 20 European cats and to analyze the radicular constituents of 10 of them using histological techniques. The plexus radicular constitution is very homogeneous and is mainly composed of the ventral rami (also called ventral branches) arising from C6, C7, C8 and T1 spinal nerves. The fascicular and axonal structure is more variable. C8 is the ventral ramus that contains the largest number of axons (16,673 +/- 3,307), and is composed of 6.7 +/- 3.5 fascicles. The radial nerve is the peripheral nerve that contains the largest number of axons (11,245 +/- 2,217), and is composed of 7.3 +/- 3.8 fascicles. The number of nervous fibers does not differ proportionally to the weight of the cat, or between the right or the left side. Our data could help neurotization and entubulation repair after brachial plexus injury.

Animals↗

PubMed2005

Planning brachial plexus surgery: treatment options and priorities.

Brachial plexus injuries are devastating and usually result from high-energy trauma in young patients. Clinicians treating brachial plexus injuries need to recognize the pattern of injury presenting in each patient. Most injuries can be described as either supraclavicular or infraclavicular. The specific injury is determined by means ofa precise workup, including careful physical examination, electrodiagnostic studies, and imaging studies; a thorough workup is essential for successful preoperative planning. Priorities need to be identified and matched with available resources in each patient. A growing number of good treatment alternatives are available. Finally,counseling patients toward realistic expectations isa critical component of preparation for surgery.

Brachial Plexus↗

PubMed2001

[Continuous brachial plexus blockade for shoulder surgery].

Continuous brachial plexus block is the technique of choice for postoperative shoulder pain treatment. The localization of the plexus is usually obtained drawing landmarks on the skin and using the electrical nerve stimulator; these and other different modalities are applied in order to reach safely and precisely nerve roots to be blocked with an anaesthetic solution. The Author presents a new anatomical perspective to guide the localization of the brachial plexus. It is shown how it is possible to detect the pathway of the brachial plexus from the cutaneous surface, linking between each other various landmarks: a) the apex of the scalene triangle, at the cross of a line leaving from the cricoid process and directed posterior to the posterior border of the sternocleidomastoid muscle, b) the midline of the clavicle c)the deltoid-pectoral sulcus d) the midpoint between the coracoid process and the chest profile e) the pulsation of the artery in the axylla. Following the guide of the so formed anesthetic line, is possible to place the needle, with a direction from distal to proximal, in a tangential route towards the interscalenic groove, thus allowing to perform a block of the plexus in a simple and efficacious way.

Brachial Plexus↗

PubMed1993

Behavioral evaluating methods in the objective clinical assessment of motor function after experimental brachial plexus reconstruction in the rat.

Unfortunately, the results of brachial plexus surgery have not fulfilled expectations. Although the components of the rat brachial plexus are similar to those of the human plexus, experimental work in this field is limited. No functional test to assess experimental brachial plexus reconstruction has so far been published. We worked out a method of evaluating brachial plexus impairment in rats in the laboratory. It consists of a simple test in which a bowl of water is projected over the animal's head, eliciting grooming movements of the forepaws towards the head. This test is therefore called the 'grooming test'. A system of scoring the animals' performance is suggested. Rats were also submitted to walking tracks analysis, but this was of limited value in assessing brachial plexus impairment.

Animals↗

PubMed2003

A comparison of shoulder dystocia-associated transient and permanent brachial plexus palsies.

OBJECTIVE: To estimate differences between shoulder dystocia-associated transient and permanent brachial plexus palsies. METHODS: We performed a retrospective case-control analysis from national birth injury and shoulder dystocia databases. Study patients had permanent brachial plexus palsy and had been entered into a national birth injury registry. Cases of Erb or Klumpke palsy with documented neonatal neuromuscular deficits persisting beyond at least 1 year of life were classified as permanent. Cases of transient brachial plexus palsy were obtained from a shoulder dystocia database. Non-shoulder dystocia-related cases of brachial plexus palsy were excluded from analysis. Cases of permanent brachial plexus palsy (n=49) were matched 1:1 with cases of transient brachial plexus palsy. RESULTS: Transient brachial plexus palsy cases had a higher incidence of diabetes mellitus than those with permanent brachial plexus palsy (34.7% versus 10.2%, odds ratio [OR] 4.68, 95% confidence interval [CI] 1.42, 16.32). Patients with permanent brachial plexus palsies had a higher mean birth weight (4519+/-94.3 g versus 4143.6+/-56.5 g, P<.001) and a greater frequency of birth weight greater than 4500 grams (38.8% versus 16.3%, OR, 0.31, 95% CI 0.11, 0.87). There were, however, no statistically significant differences between the two groups with respect to multiple antepartum, intrapartum, and delivery outcome measures. CONCLUSION: Transient and permanent brachial plexus palsies are not associated with significant differences for most antepartum and intrapartum characteristics.

Acute Disease↗