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At least 19 recordsLinked to original sources
PubMed1999

Utility of vibration thresholds in patients with brachial plexus nerve compression.

The diagnosis of brachial plexus nerve compression is controversial due to the subjective nature of patient symptoms and the lack of objective, quantifiable tests. It has been hypothesized that quantitative sensory evaluation of sensory threshold is the most sensitive method of evaluating nerve compression, particularly in the early stages. This study evaluated the sensitivity and specificity of vibration thresholds for detection of brachial plexus nerve compression. A multiple-frequency vibrometer was used to evaluate 40 control subjects and 35 patients with brachial plexus nerve compression. Calculated sensitivity values were modest (0.49 at 63, 250, and 500 cps) with high specificity values (0.98 at 8 cps) for individual frequencies using a fifth percentile criterion. The low sensitivity values indicate that this instrument is not adequate as a screening device.

Adult↗
PubMed2001

Lowest number of brachial plexus nerve roots required for maintaining normal limb function--an experimental study.

Rat models with different division of nerve roots of the brachial plexus were designed to assess whether single or two nerve roots of the contralateral normal brachial plexus can be divided as donor nerves in treatment of brachial plexus root avulsion. Two hundred and fifty-two SD rats were randomly divided into 13 groups, i.e. five groups with single nerve root division, seven groups with two nerve roots division, and one group with three nerve roots division. Post-operative evaluation by electroneurophysiology and muscular histology was performed at two weeks and two months. Results showed that in groups with single nerve root division, the experimental limb function did not show an apparent damage; in groups with non-neighbouring two nerve roots cutting, it did show a harmful repercussions on the limb at two weeks, but most of them recovered to normal at two months; in groups with neighbouring two nerve roots division and with non-neighbouring three nerve root cutting, the limb function showed a persistent damage. In conclusion, division of nerve root alone or even non- neighbouring two nerve roots of the brachial plexus did not affect the forelimb function of the rat permanently.

Animals↗
PubMed2000

Brachial plexus nerve block with CT guidance for regional pain management: initial results.

Brachial plexus nerve blocks are performed to treat patients with chronic pain referable to the brachial plexus. The needle insertion and trajectory are based on palpation of surface landmarks. Occasionally, the surface landmarks are difficult to identify owing to body habitus or anatomic alterations secondary to surgery or radiation therapy. The intent of this manuscript is to describe a technique for brachial plexus block guided with computed tomography and to report our initial results for regional pain management.

Adult↗
PubMed2002

A case of multiple schwannomas of the trigeminal nerves, acoustic nerves, lower cranial nerves, brachial plexuses and spinal canal: schwannomatosis or neurofibromatosis?

In most cases, while schwannoma is sporadically manifested as a single benign neoplasm, the presence of multiple schwannomas in one patient is usually indicative of neurofibromatosis 2. However, several recent reports have suggested that schwannomatosis itself may also be a distinct clinical entity. This study examines an extremely rare case of probable schwannomatosis associated with intracranial, intraspinal and peripheral involvements. A 63-year-old woman presented with a seven-year history of palpable lumps on both sides of the supraclavicular area and hearing impairment in both ears. On physical examination, no skin manifestations were evident. Facial sensory change, deafness in the left ear and decreased gag reflex were revealed by neurological examination. Magnetic resonance imaging revealed multiple lesions of the trigeminal nerves, acoustic nerves, lower cranial nerves, spinal accessory nerve, brachial plexuses, and spinal nerves. Pathological examination of tumors from the bilateral brachial plexuses, the spinal nerve in the T8 spinal position and the neck mass revealed benign schwannomas. Following is this patient case report of multiple schwannomas presenting with no skin manifestations of neurofibromatosis.

Brachial Plexus Neuropathies↗
PubMed2002

Bilateral vocal cord palsy following interscalene brachial plexus nerve block.

Acute respiratory complications of an interscalene brachial plexus block include ipsilateral phrenic nerve and recurrent laryngeal nerve palsies. A 71-year-old woman who had undergone a total thyroidectomy for papillary carcinoma 35 years ago was administered a right interscalene brachial plexus block for a shoulder hemi-arthroplasty. Subsequently she developed acute respiratory distress associated with marked stridor secondary to an acute right vocal cord palsy, which was superimposed on what was assumed to be a preexisting left-sided vocal cord palsy. On extubation the patient was noted to develop stridor again necessitating reintubation and tracheostomy was performed two weeks later. The vocal cord palsies failed to resolve over the subsequent 18-month follow-up. We describe this case to highlight the significant risk of this procedure in patients with preexisting or suspected contralateral vocal cord palsy.

Aged↗
PubMedDate not supplied

Unintentional neuromuscular blocking agent injection during an axillary brachial plexus nerve block.

OBJECTIVE: We describe the consequences of an unintentional injection of atracurium instead of ropivacaine during an axillary brachial plexus nerve block. CASE REPORT: A 79-year-old woman was scheduled for wrist fracture repair. An axillary brachial plexus block was performed by use of a nerve stimulator. Twenty milliliters of 0.5% ropivacaine with 1:200,000 epinephrine was injected on the radial and then on the median nerves. Two minutes later, the patient became dyspneic and was unable to elevate her head from the pillow. A check of the syringes revealed that one contained 50 mg of atracurium instead of 0.5% ropivacaine. After IV propofol was administered, the trachea was intubated and controlled ventilation started. At the end of surgery (more than 2 hours later), reversal of residual neuromuscular block was performed. The motor and sensory brachial plexus block completely recovered 12 hours after the initial bolus injection. No clinical neurological deficit was reported afterward by the patient. CONCLUSIONS: Unintentional injection of atracurium mixed with ropivacaine during axillary brachial plexus block leads to complete body paralysis that requires general anesthesia and mechanical ventilation. Recovery was complete without any neurological sequela. An analysis of the chain of events that led to the error suggests some recommendations to improve our daily practice.

Aged↗
PubMed1996

Magnetometry of evoked fields from human peripheral nerve, brachial plexus and primary somatosensory cortex using a liquid nitrogen cooled superconducting quantum interference device.

Superconducting Quantum Interference Devices (SQUIDs) can be used to detect neuromagnetic fields evoked in the peripheral and central nervous system. Up to now, such measurements had to be based on SQUIDs with a low critical temperature (Tc) requiring liquid helium cooling. Recent improvements in high-Tc SQUID technology relying on liquid nitrogen cooling led to a significant reduction in the system's noise level. Hare, first high-Tc recordings of weak neuromagnetic fields are demonstrated. In particular, along the entire somatosensory afferent pathway including peripheral nerves, brachial plexus and primary somatosensory neocortex evoked neuromagnetic activities were detected using conventional recording parameters for bandwidth and number of averages. This opens up a wide perspective for cost-effective high-Tc magnetometry in clinical neuroscience.

Brachial Plexus↗
PubMed1991

Exploratory mapping of evoked neuromagnetic activity from human peripheral nerve, brachial plexus and spinal cord.

Upon conventional median nerve stimulation at the wrist early magnetic fields were recorded using a SQUID magnetometer. At the upper arm, mono- and biphasic compound nerve action fields were detected, depending on the subject's distribution of single fiber conduction velocities. At the upper thorax, brachial plexus fields reversed polarity at the level of Erb's point; their distribution was asymmetric, probably due to volume currents. At the upper lateral neck, fields from proximal plexus, spinal cord (P13m) and the primary somatosensory cortex contralateral to the sensor position were detected. The observed P13m field distribution agrees with the electrophysiological concept of a sagittal segmental dorsal horn generator.

Brachial Plexus↗
PubMed1984

Evoked potentials in the investigation of traumatic lesions of the peripheral nerve and the brachial plexus.

Nerve conduction studies using nerve action potential (NAP), sensory nerve action potential (SNAP), evoked muscle action potential (M-response), retrograde conduction in the motor axon (F-response), and cortical and subcortical somatosensory evoked potential (SEP) are useful tools for evaluation of the peripheral nervous system. SEP recording has the advantages of being applicable to severely damaged nerves because of its amplification mechanism and of disclosing proximal root lesions that would not be disclosed by other methods. When SEP recording is used in an operating theater, the amplification mechanism is suppressed by the effect of the anesthetic. Nevertheless, it is valuable for evaluating proximal root lesions in conjunction with NAP recording and M-response. Strong M-response of the serratus anterior and paraspinal muscles is a most encouraging finding if nerve repair is performed more than seven days after brachial plexus injury. SEP recording can clarify the functional continuity of the spinal root to the spinal cord. Thus the presence of SEPs becomes an important positive finding and implies the potential of nerve repair even when an M-response is not provoked by a situation such as prolonged conduction block.

Action Potentials↗
PubMed2002

Brachial plexus nerve block exhibits prolonged duration in the elderly.

BACKGROUND: Upper limb trauma occurs frequently in elderly patients for whom peripheral nerve blocks are often preferred for anesthesia. The characteristics of such regional blocks have, however, never been described in an elderly population. Therefore, the authors assessed prospectively the onset and duration of upper extremity peripheral nerve block (the mid-humeral block) in elderly and young patients undergoing emergency upper extremity surgery. METHODS: Consecutive patients aged > 70 yr or < 70 yr received a mid-humeral block with a small volume of ropivacaine, 0.75%. Five milliliters was injected onto each of the musculocutaneous, radial, ulnar, and median nerves. Time to complete sensory and motor block and durations of complete sensory and motor block were assessed. Results are shown as median and its 95% confidence interval. RESULTS: Median ages were 77 yr (95% CI, 72-81 yr) and 39 yr (95% CI, 27-46 yr) in the two groups. Both groups had similar times to complete sensory blockade. The elderly group had longer durations of complete sensory (390 min [range, 280-435 min] vs.150 min [range, 105-160 min]; P< 0.05) and motor (357 min [range, 270-475 min] vs. 150 min [range, 90-210 min]; P< 0.05) blockade. Duration of complete sensory block was significantly correlated with age (rho = 0.56; P< 0.05). CONCLUSIONS: Age is a major determinant of duration of complete motor and sensory blockade with peripheral nerve block, perhaps reflecting increased sensitivity to conduction failure from local anesthetic agents in peripheral nerves in the elderly population.

Adult↗
PubMed1999

[Rescue of motoneuron from brachial plexus nerve root avulsion induced cell death by Schwann cell derived neurotrophic factor].

OBJECTIVE: To study the protective effects of Schwann cell derived neurotrophic factor (SDNF) on motoneurons of spinal anterior horn from spinal root avulsion induced cell death. METHODS: Twenty SD rats were made the animal model of C6.7 spinal root avulsion induced motoneuron degeneration, and SDNF was applied at the lesion site of spinal cord once a week. After three weeks, the C6.7 spinal region was dissected out for motoneuron count, morphological analysis and nitric oxide synthase (NOS) enzyme histochemistry. RESULTS: 68.6% motoneurons of spinal anterior horn death were occurred after 3 weeks following surgery, the size of survivors was significantly atrophy and NOS positive neurons increased. However, in animals which received SDNF treatment, the death of motoneurons was significantly decreased, the atrophy of surviving motoneurons was prevented, and expression of NOS was inhibited. CONCLUSION: SDNF can prevent the death of motoneurons following spinal root avulsion. Nitric oxide may play a role in these injury induced motoneuron death.

Animals↗
PubMed1988

Brachial plexus injuries. Nerve grafting.

Brachial plexus lesions with complete or partial palsy of the dependent musculature are a severe handicap for the patient. By microsurgery of lesions in continuity and nerve grafting in cases with complete interruption, some recovery can be achieved. Comparing the present-day results with the ones of earlier years, a significant increase of the percentage of useful recoveries has been observed. The quality of the results of the two groups does not differ very much.

Adolescent↗
PubMed1997

[Treatment of nerve root avulsion of brachial plexus by nerve transfer].

The results of nerve transposition for root avulsion of brachial plexas in 21 cases were reported. The methods of the nerve transposition were divided into four groups as followings: By transfer of phrenic nerve, accesory nerve, the motor branches of cervical plexus and intercostal nerves in cease; By transfer of phrenic nerve, accessory nerve and the motor branches of cervical plexus in 6 cases; By transfer of phrenic nerve and accessory nerve in 9 cases, and by transfer of phrenic nerve or the motor branches of cervical plexus or intercostal nerve in 5 cases. During operation, in 1 cases variation of the brachial plexus was found. Injury to the subclavian artery occurred in 4 cases and they were repaired, which is good for the blood circulation of the upper arm and nerve regeneration. Nineteen cases were followed up with good results. The overall excellent and good rate was 73.7%. It was considered that transposition of nerve should be a routine operation for the treatment of root avulsion of brachial plexus and the accompanied arterial injury should be repaired at the same time during operation, and the latter would be advantageous to enhance functional recovery of nerve.

Accessory Nerve↗