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At least 163 records · Page 9Linked to original sources
PubMed2005

Restoration of elbow flexion by performing contralateral lateral thoracic and thoracodorsal nerve transfers after experimental musculocutaneous nerve transection.

OBJECT: The immediate transfer of the right lateral thoracic nerve (LTN) and the thoracodorsal nerve (TDN) to the transected left musculocutaneous nerve (MCN), leading to nerve cross-neurotization, was performed in cats to evaluate reinnervation of the biceps brachii muscle (BBM). METHODS: Surgery to produce cross-neurotization of the MCN was performed in 12 cats (treatment group). Transection of the MCN was performed without attempts at neurotization in three cats (control group). Reinnervation of the BBM was assessed by performing electromyography (EMG) 6 months (14 cats) and 26 months (one cat) postsurgery. True Blue retrograde axonal tracing studies, tensile force measurements (muscle extensometry), and histopathological analyses were performed. All cats in the treatment group recovered voluntary contraction of the BBM and regained elbow flexion. Electromyography revealed no abnormal spontaneous activity in the BBM. Muscle evoked potentials were recorded in that muscle after right C-8 ventral branch stimulation. The muscle contraction strength in the left BBM varied from 108 to 557 g. The BBMs regained their normal appearances. The region of the MCN distal to the anastomosis displayed a normal histological appearance. Fluorescence was detected in the ventral horn of the spinal cord in the right C-8 and T-1 segments. In contrast, in all cats in the control group there was atrophy of the BBM, no EMG signal, and no clinical sign of recovery. There was no contraction of the BBM, no labeled neuron in the spinal cord, and the MCN displayed major degenerative changes. CONCLUSIONS: These findings demonstrate that the LTN and TDN can be used to neurotize injured contralateral brachial plexus nerves and obtain successful reinnervation in cats.

Animals↗
PubMed2006

Diabetic neuropathy.

Diabetic neuropathy (DN) refers to symptoms and signs of neuropathy in a patient with diabetes in whom other causes of neuropathy have been excluded. Distal symmetrical neuropathy is the commonest accounting for 75% DN. Asymmetrical neuropathies may involve cranial nerves, thoracic or limb nerves; are of acute onset resulting from ischaemic infarction of vasa nervosa. Asymmetric neuropathies in diabetic patients should be investigated for entrapment neuropathy. Diabetic amyotrophy, initially considered to result from metabolic changes, and later ischaemia, is now attributed to immunological changes. For diagnosis of DN, symptoms, signs, quantitative sensory testing, nerve conduction study, and autonomic testing are used; and two of these five are recommended for clinical diagnosis. Management of DN includes control of hyperglycaemia, other cardiovascular risk factors; alpha lipoic acid and L carnitine. For neuropathic pain, analgesics, non-steroidal anti-inflammatory drugs, antidepressants, and anticonvulsants are recommended. The treatment of autonomic neuropathy is symptomatic.

Aldehyde Reductase↗
PubMed2002

Postherpetic ophthalmic neuralgia.

Postherpetic ophthalmic neuralgia is the final stage of a varicella zoster infection. Many years after chickenpox infection, patients can develop herpes zoster in one or more specific dermatomal regions. The ophthalmic branch of the trigeminal nerve and the thoracic nerves are most commonly affected. Younger patients are less prone to postherpetic neuralgia than the older. Patients with a depression in cell-mediated immunity are more susceptible to develop postherpetic pain. Postherpetic ophthalmic neuralgia is a neuropathic pain and can be treated by anticonvulsants and tricyclic antidepressants. Neurodestructive procedures are not recommended as they enhance destruction and neuropathic pain. Sympathetic nerve blocks can be helpful. Neurostimulation is the last therapeutic resort.

Anesthetics, Local↗
PubMed1979

Serratus anterior paralysis in the young athlete.

Ten cases of isolated, complete paralysis of the serratus anterior muscle were diagnosed in young athletes during a three-year period. One patient had recurrent partial paralysis of the serratus anterior muscle, the first such case reported. From studies on cadavera and clinical observations, we concluded that paralysis of the serratus anterior muscle results from a traction injury to the long thoracic nerve of Bell. Since full recovery usually occurs in an average of nine months, surgical methods of treatment should be reserved for patients in whom function fails to return after a two-year period. Non-strenuous use of the involved extremity with avoidance of the precipitating activity, followed by exercises designed to maintain the range of motion of the shoulder and to increase the strength of associated muscles, is advocated for treatment of acute or repetitive injuries to the long thoracic nerve of Bell.

Adult↗
PubMed1986

[The 2 key muscles in thoracotomy for excision of the lung. The latissimus dorsi and the levator scapulae muscles].

Anatomical data related to the thoracotomies performed most frequently in lung surgery are described in some detail: continuity between serratus anterior and levator scapulae as a vide muscular sheet possessing a common deep aponeurosis (thoracolumbar fascia) extending Gilis' space to the vertebral column as the levator scapulae-thoraci space; presence of a "composite aponeurosis" in the posterior angle between serratus anterior and levator scapulae, covering the 8th rib triangle or triangle of auscultation; long costal insertion area and presence of two differently orientated muscle layers for the digitations, particularly of apical bundle. Supplied by a rich vascularization of multiple sources, the serratus anterior and latissimus dorsi are two muscles with single longitudinal nerve pedicles derived from brachial plexus. It is certainly the denervation which is responsible for the distal atrophy of these muscles "sectioned on the right of the selected ribs" following conventional thoracotomy. To avoid esthetic and functional sequelae this innervation must be preserved as far as possible by: interrupting division of serratus anterior anterior to long thoracic nerve and avoiding inclusion of axillary border of latissimus dorsi during lateral thoracotomy; sectioning the latissimus dorsi as low as possible--the other muscles being simply freed and inclined--during lateral thoracotomy.

Arteries↗
PubMed1987

[The morphology and innervation of the levator muscles of the ribs in the dog, cat, horse, and pig].

In the anatomical literature there are inconsistencies in the description of the levatores costarum muscles in man and in the domestic animals, and their innervation either by the dorsal or the ventral branches of the thoracic nerves. Therefore we studied the form, structure and, with the aid of the dissecting microscope, the innervation of these muscles in 7 dogs, 8 cats, 5 horses and 12 pigs. In the dog, cat and horse, mm. levatores costarum are present from the second to the last rib. In the pig, these muscles are present from the second to the 15th rib, even in individuals with 16 pairs of ribs. Mm. levatores costarum longi and a levator of the first rib could not be found in the domestic animals although these muscles are described in man. All mm. levatores costarum are innervated by branches of the lateral branch of the ramus dorsalis of the respective thoracic nerve. An additional branch of the r. muscularis proximalis of the intercostal nerves 1-3 innervates the lateral part of the levator muscles of the second to the fourth rib.

Animals↗
PubMed2003

Absence of scalenus anterior muscle.

A rare anomaly of the scalenus muscles is described. In this case, the right scalenus anterior muscle was absent. As a substitute for this muscle, some aberrant muscle slips arose from the lower vertebrae and descended in front of the ventral rami of the lower cervical nerves. These aberrant slips then ran between the ventral rami of the the eighth cervical and first thoracic nerves, and were fused with the right scalenus medius muscle. Thus, the subclavian artery and vein ran in front of the aberrant slips, together with the ventral ramus of the first thoracic nerve. The aberrant muscle slips issued 2 accessory bundles. One bundle ran between the ventral rami of the fourth and fifth cervical nerves and was fused with the scalenus medius muscle; the other bundle ran between the ventral rami of the fifth and sixth cervical nerves and was fused with the scalenus medius muscle.

Aged↗
PubMed1998

Serratus anterior dysfunction. Recognition and treatment.

Recognition of scapular winging may be difficult, and potential errors in treatment can result. Such treatment errors may cause morbidity for the patient. In addition, electrical evidence of long thoracic nerve injury usually is required to confirm the etiology of scapular winging as being caused by serratus anterior dysfunction. Although various conditions may result in scapular winging, primary serratus anterior dysfunction can be treated effectively by transfer of the pectoralis major tendon; however, this surgical approach sometimes may given an unacceptable cosmesis, and there may be local morbidity to the donor site of the iliotibial band graft that is used to augment the tendon transfer. The authors report eight patients with primary chronic scapulothoracic winging refractory to conservative treatment. Five of these patients had an incorrect diagnosis, and this resulted in 17 surgical procedures without resolution of their pain or improvement of function. Of the eight patients who required additional surgery to stabilize the scapula, only five patients had an electromyographic study that showed long thoracic nerve palsy, although all patients had profound scapulothoracic winging. All patients underwent a modified pectoralis major transfer with autogenous semitendinosus and gracilis tendon augmentation using two small incisions. Although one patient had a postoperative infection develop, the remaining seven patients had resolution of their winging, improved function, and satisfactory cosmesis.

Adult↗
PubMed1980

The non-myelinated fibers of the phrenic and the intercostal nerves in the cat.

The aim of this work was obtaining quantitative data relative to the non-myelinated fibers of some thoracic nerves of the cat. The study has been done both through the utilization of the light and the electron microscope. A comparative analysis of the results obtained from the muscle nerves (external intercostal nerve and phrenic nerve), cutaneous nerve (lateral collateral branch of the internal intercostal nerve) and mixed nerves (internal intercostal) has been made. The C muscle fibers have a smaller diameter than the C cutaneous fibers. Some of the non-myelinated fibers of the phrenic nerve are probably involved in the innervation of the pleura or of the peritoneum. The relative number of non-myelinated fibers varies according to the nerves. The factor linking the diameter of the non-myelinated fibers to their conduction velocity is approximately equal to 0.7.

Animals↗
PubMedDate not supplied

Acquired winged scapula in a patient with systemic lupus erythematosus.

A 34-year-old woman presented with a right winged scapula 8 months after developing systemic lupus erythematosus (SLE) with subacute cutaneous manifestations. The patient experienced severe shoulder pain followed by weakness of the right arm in the typically winged scapula fashion. Electromyography of the serratus anterior showed long thoracic nerve palsy. Clinical and laboratory signs did not reveal any associated disease. Paralysis of the long thoracic nerve has never been described before in SLE.

Adult↗
PubMed1990

Spinal anaesthesia with hypobaric 0.19% or plain 0.5% bupivacaine.

Hypobaric 0.19% bupivacaine (plain 0.5% bupivacaine 3 ml + distilled water 5 ml) was compared with 0.5% plain bupivacaine 3 ml for spinal anaesthesia in 29 healthy patients undergoing orthopaedic surgery of the lower extremities. The solutions were injected at the L3-4 interspace in 40 s, and patients were kept sitting for 2 min after injection. The mean maximal cephalad spread of sensory block was to the T1 segment (SD 3.6) and to T8 (4.1) in the hypobaric and plain bupivacaine groups, respectively (P less than 0.0001). The study was interrupted after observing the sensory block of the 29th patient (hypobaric bupivacaine) spread to C2 within 5 min of injection. In most patients, the hypobaric bupivacaine block affected the upper thoracic nerves, and in three patients the cervical nerves also. The high levels of block were accompanied by marked hypotension. The extensive spread of the blocks makes this hypobaric spinal anaesthesia technique unsuitable for routine use.

Adult↗
PubMed1990

[A case of mediastinal schwannoma originating from the thoracic vagal nerve complicated by early stomach cancer].

Most of primary tumors of the nerves arising in the mediastinum originate from the sympathetic or intercostal nerves. Schwannoma developing from the vagal nerve is very rare. The patient was a 73-year-old male referred to us with abnormal chest X-rays and stomach cancer. One-staged operation was performed by thoracic and upper abdominal median incision. The tumor was removed, which measured 6 X 5 X 4 cm and involved the origin of the left recurrent nerve, by neurectomy. To our knowledge, this was the 18th reported case of schwannoma of the intrathoracic vagal nerve in Japan. A similar schwannoma was observed also in the celiac plexus, and this case was also a rare instance of multiple schwannoma.

Aged↗
PubMed1997

Galactorrhoea and amenorrhoea due to an intradural neurinoma originating from a thoracic intercostal nerve radicle.

A 42-year-old woman had galactorrhoea and amenorrhoea. Four years previously she complained of sensory disturbance of her legs, with galt disturbance. Serum PRL level was 1408 mU/l. Magnetic resonance imaging showed a spindle-shaped mass in the spinal canal at the level of the ninth thoracic vertebra. The tumour was removed and histologically was found to be a neurinoma originating from the right ninth intercostal nerve radicle. Soon after the operation, galactorrhoea, amenorrhoea and neurological symptoms disappeared. Prolactin levels normalized at 346 mU/l. These findings indicate that hyperprolactinaemia occurred as a result of the stimulation of afferent fibres from an intercostal nerve in a patient with intradural neurinoma of the intercostal nerve radicle.

Adult↗
PubMed2006

Winged scapula as the presenting symptom of Chiari I malformation and syringomyelia.

CASE REPORT: We report a 19-year-old girl with a 4-month history of an inability to fully elevate her upper extremity past the horizontal position. Physical examination revealed a winged scapula. MRI was demonstrative of a Chiari I malformation with a small cervical syrinx eccentrically placed to the same side as the dysfunctional extremity. DISCUSSION: We believe this to be the first report of dysfunction of the long thoracic nerve via a hindbrain hernia-induced syrinx with a resultant winged scapula. We would hypothesize that enough anterior horn motor neurons and their axons destined for the long thoracic nerve were injured by the syringomyelia to result in isolated deinnervation of the serratus anterior muscle. CONCLUSION: The clinician may wish to include syringomyelia in the differential diagnosis of a winged scapula.

Adult↗
PubMed1993

Peripheral nerve injuries in athletes. Treatment and prevention.

Peripheral nerve lesions are uncommon but serious injuries which may delay or preclude an athlete's safe return to sports. Early, accurate anatomical diagnosis is essential. Nerve lesions may be due to acute injury (e.g. from a direct blow) or chronic injury secondary to repetitive microtrauma (entrapment). Accurate diagnosis is based upon physical examination and a knowledge of the relative anatomy. Palpation, neurological testing and provocative manoeuvres are mainstays of physical diagnosis. Diagnostic suspicion can be confirmed by electrophysiological testing, including electromyography and nerve conduction studies. Proper equipment, technique and conditioning are the keys to prevention. Rest, anti-inflammatories, physical therapy and appropriate splinting are the mainstays of treatment. In the shoulder, spinal accessory nerve injury is caused by a blow to the neck and results in trapezius paralysis with sparing of the sternocleidomastoid muscle. Scapular winging results from paralysis of the serratus anterior because of long thoracic nerve palsy. A lesion of the suprascapular nerve may mimic a rotator cuff tear with pain a weakness of the rotator cuff. Axillary nerve injury often follows anterior shoulder dislocation. In the elbow region, musculocutaneous nerve palsy is seen in weightlifters with weakness of the elbow flexors and dysesthesias of the lateral forearm. Pronator syndrome is a median nerve lesion occurring in the proximal forearm which is diagnosed by several provocative manoeuvres. Posterior interosseous nerve entrapment is common among tennis players and occurs at the Arcade of Froshe--it results in weakness of the wrist and metacarpophalangeal extensors. Ulnar neuritis at the elbow is common amongst baseball pitchers. Carpal tunnel syndrome is a common neuropathy seen in sport and is caused by median nerve compression in the carpal tunnel. Paralysis of the ulnar nerve at the wrist is seen among bicyclists resulting in weakness of grip and numbness of the ulnar 1.5 digits. Thigh injuries include lateral femoral cutaneous nerve palsy resulting in loss of sensation over the anterior thigh without power deficit. Femoral nerve injury occurs secondary to an iliopsoas haematoma from high energy sports. A lesion of the sciatic nerve may indicate a concomitant dislocated hip. Common peroneal nerve injury may be due to a direct blow or a traction injury and results in a foot drop and numbness of the dorsum of the foot. Deep and superficial peroneal nerve palsies could be secondary to an exertional compartment syndrome. Tarsal tunnel syndrome is a compressive lesion of the posterior tibial nerve caused by repetitive dorsiflexion of the ankle--it is common among runners and mountain climbers.(ABSTRACT TRUNCATED AT 400 WORDS)

Accessory Nerve Injuries↗
PubMed1988

Intercostal nerve blockade producing analgesia after appendicectomy.

Intercostal nerve blockade of the 10th, 11th and 12th thoracic nerves on the right side was compared with i.m. papaveretum as analgesia after appendicectomy. Patients with intercostal nerve blockade had significantly less pain at 0, 4, 8 and 12 h after operation and required less papaveretum (mean 0.26 mg kg-1/24 h) compared with the controls (mean 0.62 mg kg-1/24 h). There were no complications in either group. Intercostal nerve blockade may provide better quality analgesia following appendicectomy than i.m. papaveretum alone.

Adolescent↗