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At least 19 recordsLinked to original sources
PubMed1995

Radiation-induced malignant fibrous histiocytoma of the brachial plexus.

Brachial plexopathy is a common and disabling complication in cancer patients most often attributed to metastasis or radiation-induced fibrosis. Occasionally, other rare but potentially treatable causes are found. A 73 year old woman had a left radical mastectomy followed by radiation to the chest wall and axilla 24 years ago. She recently presented with left arm pain, chronic, nonprogressive lymphedema, profound distal arm sensory loss and progressive severe hand weakness. There was moderate atrophy of all intrinsic hand muscles, anesthesia of the hypothenar eminence and 4th and 5th digits, and no adenopathy or palpable mass in the axilla. EMG confirmed a brachial plexopathy. MRI showed loss of tissue planes consistent with radiation fibrosis, but CT showed a discrete mass in the brachial plexus. Open biopsy showed pleomorphic spindle shaped cells with immunoperoxidase stains consistent with malignant fibrous histiocytoma. Radiation-induced malignant fibrous histiocytoma may present with a brachial plexopathy in the absence of a palpable mass and should be considered in the differential diagnosis of brachial plexus lesions in cancer patients. CT scanning through the plexus may be useful when MRI is normal or equivocal.

Aged↗
PubMed1984

Brachial plexus injury following brachial plexus block.

A patient developed paralysis over the left upper limb 2 days after an otherwise uneventful supraclavicular brachial plexus block. Symptoms continued for 8 weeks after the block. The various possible causes for this complication are discussed. Although brachial plexus injury following the block is rare, some recommendations are made to reduce the incidence of this complication.

Adult↗
PubMed1988

A study of the renal responses in the rat to electrical stimulation of the afferent nerves of the brachial plexus.

Brachial nerve stimulation at 3 Hz in sodium pentobarbitone-anaesthetized rats, with constant renal arterial pressure, increased systemic blood pressure, did not alter glomerular filtration rate but reduced renal blood flow, absolute and fractional sodium excretions and urine flow. In renally denervated animals, stimulation caused similar changes in blood pressure and renal haemodynamics but significantly smaller reductions in sodium and water excretions. Brachial nerve stimulation at 30 Hz caused changes in blood pressure and renal function identical to those obtained with low-frequency stimulation but these responses were not modified by renal denervation. The results show that renal nerves are necessary to promote sodium and water reabsorption in response to low- but not high-frequency stimulation of the brachial nerves in the rat.

Afferent Pathways↗
PubMed2003

A systematic review of brachial plexus surgery for birth-related brachial plexus injury.

OBJECTIVE: Brachial plexus injury complicates 0.6-2.6 per 1,000 live births. Surgery is sometimes advocated for patients who fail to improve with conservative management. We reviewed the available literature on birth-related brachial plexus palsy in order to provide recommendations for surgical management, using evidence-based criteria. METHODS: Studies were identified by searching Medline (1966-2002) and the Cochrane Library using the terms brachial plexus, neonate or infant, surgery and natural history. The reference lists of relevant articles were also reviewed. The search was restricted to articles published in English. Each article was classified according to its methodology. Management recommendations were suggested based on the results of the studies identified and the degree of certainty of the available literature. RESULTS: Twenty-three papers were selected for detailed analysis. There are no randomized controlled trials that have investigated the role of brachial plexus surgery in the management of birth-related brachial plexus palsy. Two prospective studies of relevance were found, one describing the natural history of birth-related brachial plexus injury and one evaluating surgery for these patients. The remainder consisted of retrospective case series. Outcomes from surgical series are generally favorable (level III and V evidence). Direct comparison with the natural history could not be inferred from the series reviewed given the lack of controls. CONCLUSION: There is no conclusive evidence showing a benefit of surgery over conservative management approaches in the treatment of patients with birth-related brachial plexus injuries. Surgery remains a valid practice option given the level III and V evidence suggesting a possible benefit of surgery.

Birth Injuries↗
PubMedDate not supplied

Brachial plexus stretching injuries: microcirculation of the brachial plexus.

This study was undertaken to investigate the pathogenesis of brachial plexus stretching injuries at an intensity level not severe enough to cause avulsion injury. While we performed traction on 64 forelegs of 32 rats, we evaluated changes in the blood flow in the extrinsic and intrinsic microvascular systems of the brachial plexus. While we laterally stretched the brachial plexus during 80 degree shoulder abduction, we measured the blood flow at the bifurcation of the brachial plexus and at the median nerve with the hydrogen washout technique. During weak traction the blood flow decreased markedly in the extrinsic system, causing an imbalance in the two systems. In the median nerve, however, no such imbalance occurred. On histologic examination the axon and myelin in the brachial plexus and the median nerve showed no morphologic change. However, in parts of the brachial plexus we noted hypertrophic connective tissue or granulomatous inflammation in tissue surrounding the extrinsic system. The extrinsic system's apparent susceptibility to injury by acute traction may be a factor in the pathogenesis of the brachial plexus stretching injuries.

Animals↗
PubMed1987

[High continuous axillary-brachial plexus anesthesia. Comparison of a new method with perivascular axillary-brachial plexus anesthesia].

High axillary brachial plexus anaesthesia was performed in 25 patients. This technique employs simple, straight forward axillary access, and produces an infraclavicular brachial plexus block which is adequate for anaesthesia of the entire arm. The technique and the equipment required are described in the text and illustrated by the figures. Twenty patients who received high axillary brachial plexus anaesthesia were compared with 20 patients who received conventional axillary brachial plexus anaesthesia. The arm anaesthesia attained was classified as being of the analgesic or the anaesthetic stage by pin-prick testing at 4-min intervals, and the motor block, as paretic or the paralytic stage. Five incorrect catheter placements (i.e., 20%) were observed in the group with high axillary brachial plexus anaesthesia; however, they could be revised to produce conventional axillary brachial plexus blocks. Blood mepivacaine level determinations performed over a 90-min period showed that the relatively high dosage used (with average 7.29 gm/kg body weight) did not result in toxic blood levels. This technique involves advancing the catheter 8.3-20 cm (mean 13.9 cm) beyond the puncture site. In 11 cases, it was necessary to overcome resistance when advancing the needle. The site of placement was determined by electrostimulation and cold-temperature-testing. Comparison of both groups revealed that the block is faster and more complete, and the nerves which are usually difficult to block with plexus anaesthesia are anaesthetized better with the high axillary block than with the conventional technique. The anaesthesia of the axillary and musculocutaneous nerves showed an impressive improvement. Whereas the usually difficult block of the radial nerve in the hand was greatly improved, the median and ulnar nerves were blocked equally well using either method. The only complication that occurred was an intravenous catheter placement, which was diagnosed and corrected. No other early or late complications were observed following the use of this technique in a large group of patients. This new technique is simple and easy to master.

Adolescent↗
PubMedDate not supplied

The role of surgery in the management of closed injuries to the brachial plexus.

Complete brachial plexus lesions occur infrequently and have until recently been treated by amputation followed by fitting of a prosthesis. The results of such treatment are unsatisfactory. Recently, surgical repair of the plexus has been reintroduced; our experience with complete brachial plexus lesions treated by exploration and nerve grafts are as follows. Early surgical repair of the plexus does produce reasonable results, while late repair is unrewarding. The future of the management of brachial plexus lesions lies in early diagnosis and exploration of these lesions. In medical institutions with personnel interested in the problem of brachial plexus injury, further surgical research is bound to lead to new and improved treatment.

Brachial Plexus↗
PubMed2002

Clinical analysis of 16 patients with brachial plexus injury.

Brachial plexus injury is very rare in neurosurgical practice, so many neurosurgeons have never experienced this problem in Japan. This study describes a clinical analysis of 16 patients aged 5 to 62 years (mean 32.9 years) who presented at our institution with brachial plexus injuries. Nine patients presented with paralysis and seven with paresis. Head injury was the most common associated injury in eight of 16 patients. Six patients were managed conservatively. All patients with C8-T1 paresis spontaneously recovered to a useful level. Surgery was performed in 10 patients: six neurolysis, two neurotization, and three nerve grafting procedures. All six patients who underwent neurolysis of the brachial plexus attained useful recovery. Four of five patients achieved useful recovery after nerve repair. Nerve grafting achieved a better outcome than neurotization in this study. The difference of outcome was attributed to the graft length. The management of brachial plexus injury is a great challenge, but surgical outcome can be improved if the optimal repair procedure is selected for brachial plexus injury.

Adolescent↗
PubMed1996

The brachial plexus.

The brachial plexus arises from the lower cervical and upper thoracic spinal nerve roots. It courses between the anterior and middle scalene muscles and adjacent to the subclavian artery. The brachial plexus may be visualized by both MRI and CT. Symptoms of a brachial plexopathy commonly are nonlocalizing. Traumatic injuries and involvement by tumors probably account for the majority of etiologies responsible for these plexopathies. Inflammatory processes also involve the brachial plexus. This article reviews the anatomy of the brachial plexus from both surgical and radiographic approaches and also addresses the symptomatology of brachial plexopathy underlying it.

Brachial Plexus↗
PubMed2000

A comparison of coracoid and axillary approaches to the brachial plexus.

BACKGROUND: Brachial plexus block by the coracoid approach does not require arm abduction and may be more effective than the axillary approach because of a more proximal injection of local anaesthetic. However, the clinical usefulness of the coracoid approach has not been tested in prospective controlled trials. The present randomized, observer-blinded study compared success rates, time to obtain a complete block, frequency of adverse effects and block discomfort in two groups of 30 patients, anaesthetized for hand surgery using either the coracoid or the axillary approach to the brachial plexus. METHODS: After subcutaneous infiltration with 5 ml of 1% mepivacaine/adrenaline the brachial plexus was located using a nerve stimulator and an insulated pencil-point needle. Ropivacaine 0.75%, 20-40 ml, depending on body weight, was used for the initial block. In the coracoid (C) group two plexus cords, and in the axillary (A) group four terminal nerves were electrolocated and the volume of ropivacaine was divided equally between them. Spread of analgesia to the arm was assessed every 5 min, by an anaesthetist unaware of the block technique. The block was defined as effective (complete) when analgesia was present in all five sensory nerve areas distal to the elbow. Incomplete blocks were supplemented 30 min after the initial block. RESULTS: In the C group a median 11 min was required for block performance as compared to 12 min in the A group (NS). Onset of block was shorter and the frequency of incomplete blocks lower in the A group (median 17 min and 17%) than in the C group (30 min and 47%, respectively). Lack of analgesia of the ulnar nerve was the main cause of incomplete initial blocks in the C group. All incomplete blocks were successfully supplemented. However, total time to obtain complete block was shorter in the A group than in the C group (29 min vs. 41 min, P<0.05). Accidental arterial puncture occurred in seven patients (five in C and two in A group), which resulted in two haematomas, both in the C group (NS). No permanent sequelae were observed. CONCLUSION: The axillary approach to the brachial plexus using four injections of ropivacaine results in a faster onset of block and a better spread of analgesia than the coracoid approach using two injections.

Adolescent↗
PubMed2004

MR imaging of brachial plexus.

The brachial plexus is a complex anatomic component originating from ventral rami of the lower cervical nerve roots from C5 to C8 and upper thoracic spinal nerve roots from T1, providing sensory and motor innervation to the upper extremities. As it is inaccessible to palpation, clinical evaluation of the brachial plexus is very challenging and localizing lesions along its course is very difficult. The gamut of pathologic conditions involving the brachial plexus includes primary tumor, direct extension of adjacent tumor, metastasis, trauma, or an inflammatory condition. MR imaging provides superior diagnostic ability due to its ability of multiplanar imaging and greater soft tissue contrast. This article discusses MR imaging findings in a variety of pathologic conditions, with special emphasis on neoplastic process.

Brachial Plexus↗
PubMed1988

Tendon transfers for brachial plexus injury.

Brachial plexus injuries result in severe functional deficits in the upper limb. The authors review a group of 74 patients with brachial plexus injuries who underwent 160 tendon transfer operations, as well as 94 additional procedures, in an attempt to augment lost function. Following evaluation of functional recovery, 58 percent of the patients were rated Good, 34 percent Improved, and 8 percent Unimproved. The authors conclude that significant benefit can be obtained by peripheral reconstruction and tendon transfers in patients with brachial plexus injuries.

Arm Injuries↗
PubMed1978

Brachial plexus injuries.

Brachial plexus injuries are uncommon. They are, however, complicated lesions because of the concomitant injury to adjacent structures and the imposing anatomy of the brachial plexus. Physicians who will be consulted in the management of such injuries should periodically consider the principles of management. Diagnosis of these injuries is based on clinical examination, myelography, axon reflex testing, and electrophysiologic studies. The lesion may be open or closed and supraclavicular or infraclavicular. It may be in continuity or there may be nerve disruption or root avulsion from the spinal cord. The anatomic relationships of the brachial plexus are reviewed, the pathophysiology of direct trauma, secondary trauma, and iatrogenic trauma is discussed, and the treatment of the various types of traumatic brachial palsy is surveyed.

Brachial Plexus↗