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Muscular and glenohumeral changes in the shoulder after brachial plexus birth palsy: an MRI study in a rat model  [cached]
Soldado Francisco,Benito-Castillo David,Fontecha Cesar G,Barber Ignasi
Journal of Brachial Plexus and Peripheral Nerve Injury , 2012, DOI: 10.1186/1749-7221-7-9
Abstract: Background Shoulder abnormalities are the major cause of morbidity in upper brachial plexus birth palsy (BPBP). We developed a rat model of upper trunk BPBP and compared our findings to previously reported animal models and to clinical findings in humans. Methods Forty-three 5-day-old newborn rats underwent selective upper trunk neurectomy of the right brachial plexus and were studied 3 to 20 weeks after surgery. The passive shoulder external rotation was measured and the shoulder joint was assessed bilaterally by a 7.2T MRI bilaterally. Results We found a marked decrease in passive shoulder external rotation, associated with a severe subscapularis muscle atrophy and contracture. None however developed the typical pattern of glenohumeral dysplasia. Conclusions In contradiction with previous reports, our study shows that the rat model is not adequate for preclinical studies of shoulder dysplasia. However, it might serve as a useful model for studies analyzing shoulder contracture occurring after upper BPBP.
An MRI study on the relations between muscle atrophy, shoulder function and glenohumeral deformity in shoulders of children with obstetric brachial plexus injury
Valerie M van Gelein Vitringa, Ed O van Kooten, Margriet G Mullender, Mirjam H van Doorn-Loogman, Johannes A van der Sluijs
Journal of Brachial Plexus and Peripheral Nerve Injury , 2009, DOI: 10.1186/1749-7221-4-5
Abstract: This is a prospective study on 24 children with unilateral OBPL, who had internal rotation contractures of the shoulder (mean age 3.3 years, range 14.7 months to 7.3 years). Using MR imaging from both shoulders the following parameters were assessed: glenoid form, glenoscapular angle, subluxation of the humeral head, thickness and segmental volume of the subscapularis, infraspinatus and deltoid muscles. Shoulder function was assessed measuring passive external rotation of the shoulder and using the Mallet score for active function. Statistical tests used are t-tests, Spearman's rho, Pearsons r and logistic regression.The affected shoulders showed significantly reduced muscle sizes, increased glenoid retroversion and posterior subluxation. Mean muscle size compared to the normal side was: subscapularis 51%, infraspinatus 61% and deltoid 76%. Glenoid form was related to infraspinatus muscle atrophy. Subluxation was related to both infraspinatus and subscapularis atrophy. There was no relation between atrophy of muscles and passive external rotation. Muscle atrophy was not related to the Mallet score or its dimensions.Muscle atrophy was more severe in the subscapularis muscle than in infraspinatus and deltoid. As the muscle ratios are not related to passive external rotation nor to active function of the shoulder, there must be other muscle properties influencing shoulder function.The incidence of obstetric Brachial Plexus Lesion (OBPL) is 0.42–5.1 in 1000 live births [1,2]. Although 80–90% of the babies recover spontaneously, in 10–20% recovery is incomplete and upper limb functions do not develop normally. A substantial number of children with an OBPL will develop shoulder abnormalities consisting of contractures and/or skeletal deformities [2-6]. The typical abnormalities are internal rotation adduction contracture, posterior humeral head subluxation and deformities of humeral head and glenoid. A conventional theory proposes that these abnormalities are caused by mu
Brachial Plexus Injuries in Adults: Evaluation and Diagnostic Approach  [PDF]
Vasileios I. Sakellariou,Nikolaos K. Badilas,George A. Mazis,Nikolaos A. Stavropoulos,Helias K. Kotoulas,Stamatios Kyriakopoulos,Ioannis Tagkalegkas,Ioannis P. Sofianos
ISRN Orthopedics , 2014, DOI: 10.1155/2014/726103
Abstract: The increased incidence of motor vehicle accidents during the past century has been associated with a significant increase in brachial plexus injuries. New imaging studies are currently available for the evaluation of brachial plexus injuries. Myelography, CT myelography, and magnetic resonance imaging (MRI) are indicated in the evaluation of brachial plexus. Moreover, a series of specialized electrodiagnostic and nerve conduction studies in association with the clinical findings during the neurologic examination can provide information regarding the location of the lesion, the severity of trauma, and expected clinical outcome. Improvements in diagnostic approaches and microsurgical techniques have dramatically changed the prognosis and functional outcome of these types of injuries. 1. Introduction Brachial plexus is a complex network of nerves, which is responsible for the innervation of the upper extremity. It is formed in the posterior cervical triangle by the union of ventral rami of 5th, 6th, 7th, and 8th cervical nerve roots and 1st thoracic nerve root. This composite nerve network can be divided into roots, trunks, divisions, and cords. The roots, trunks, and divisions lie in the posterior triangle of the neck, whereas the cords lie in the axillary fossa. Cords are further divided in the major nerve branches of the upper extremity [1] (Figure 1). Figure 1: Classic form of brachial plexus. Roots and trunks lie in the supraclavicular space; the divisions are located posterior to the clavicle, while cords and branches lie infraclavicularly [2]. Branches that arise from different portions of brachial plexus are shown in the following figure (Figure 2). Figure 2: Roots, trunks, divisions, cords, and terminal branches of brachial plexus. All three cords of the plexus lie above and laterally to the medial portion of axillary artery. Medial cord crosses the artery, passing inferiorly, to reach the medial surface of the middle portion of the artery. Posterior cord is located behind the middle portion of the artery and lateral cord lies laterally to the middle portion of the artery. The names of the cords of brachial plexus imply their relationship to the middle portion of the axillary artery (Figure 3). Figure 3: Relationships of brachial plexus and its portions of the axillary artery. Anatomic variants of brachial plexus are observed in more than 50% of the cases [3]. Most common variants are associated with the contribution of C4 (prefixed) or with the contribution of T2 nerve root to the plexus (postfixed) (Figure 4). It is estimated that C4 nerve root
Results and current approach for Brachial Plexus reconstruction
Jayme A Bertelli, Marcos F Ghizoni
Journal of Brachial Plexus and Peripheral Nerve Injury , 2011, DOI: 10.1186/1749-7221-6-2
Abstract: Brachial plexus lesions are a tragic condition that usually affects young adults, with significant socioeconomic implications. Only four decades ago, brachial plexus surgery still was approached with considerable pessimism. As recently as the 1996 International Society for Orthopaedic Surgery and Traumatology (SICOT) in Paris, it was concluded that surgical repair of these lesions was almost impossible and, even when performed, did not guarantee a useful result [1]. However, the ongoing increase in the number of civilian brachial plexus lesions due to motorcycle accidents has, without a doubt, promoted interest in this field, and recent years have witnessed tremendous progress in surgical techniques for brachial plexus repair. At our institution, between January 2002 and December 2008, 335 patients suffering from supraclavicular brachial plexus palsy underwent surgical repair. In the present report, we review our results and current approach to treatment. Written informed consent were obtained from patients for publication of clinical cases and accompanying images. In advance of any data collection, the protocol of the present study was approved by the local ethics committee. All patients provided their written informed consent prior to their participation, in accordance with the Declaration of Helsinki guiding biomedical research involving human subjects.In half of our patients, electrophysiological studies were available preoperatively. In 102 patients, magnetic resonance imaging (MRI) of the brachial plexus, including the spinal cord, was obtained, whereas computed tomomyelography (CT myelography) was performed in all cases. The clinical diagnosis of root involvement was correct in 85% of our patients. Extremely reliable tests or signs were a supraclavicular Tinel's sign to indicate a graft-able root, and a Horner's sign to indicate lower root avulsion [2]. Electrophysiological studies did not contribute, in any way, to identifying indications for surgery or to s
Bilateral Obstetric Palsy of Brachial Plexus  [cached]
?zlem Alt?nda?,Sava? Gürsoy,Ahmet Mete
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2009,
Abstract: Obstetric Brachial Plexus Palsy (OBPP) is one of the devastating complications of difficult or assisted deliveries. Brachial plexus palsy with upper root involvement most commonly affects the external rotators and abductors. Twenty percent of obstetrical brachial plexus palsies are bilateral and they represent a more severe condition. An eight-year-old girl patient with bilateral brachial plexus palsy was described and discussed in this report. Turk J Phys Med Rehab 2009;55:126-7.
Desmoid Tumour of the Brachial Plexus  [PDF]
Orege Juliette,Koech Florentius,Ndiangui Francis,Benson Ndegwa Macharia,Mbaruku Neema
Case Reports in Surgery , 2013, DOI: 10.1155/2013/575982
Abstract: Desmoid tumours of the brachial plexus are rare and may occur in extra-abdominal sites. The tumours are of fibroblastic origin and, although benign, are locally aggressive. Their relationship to critical neurovascular structures in their anatomic locations presents a challenge to the operating surgeons trying to adhere to the principles of surgery. Surprisingly little neurosurgical literature exists which was devoted to this topic despite the challenge these lesions present in surgery both at surgery and in choosing adjuvant therapies. We report a case of a large brachial plexus tumour in a patient which was diagnosed radiologically and histopathologically and the patient underwent surgical excision with good outcome. Desmoid tumours histologically are benign and are usually composed of proliferating, benign fibroblasts in an abundant matrix of collagen. They do not transform into malignant tumours or metastasize. Surgery is the mainstay of treatment; however, adjuvant radiation and chemotherapy remain controversial. 1. Introduction Many terms have been used to refer to desmoids tumours over the years, including fibromatosis, desmoid tumors, and aggressive fibromatosis. However, “Desmoid-type fibromatosis” has emerged as the designation of choice by the World Health Organization [1]. A review of the literature identified three case series reporting the treatment of desmoids tumours involving the brachial plexus. The first series, reported by Binder et al. [2] in June 2004, served to ascertain the rarity of these tumours. Twenty-four patients were treated at the University of California, San Francisco, CA, USA, who had primary brachial plexus tumours and only one (4%) had a desmoid tumour. The second case series reported by Seinfeld et al. [3] in 2006 included four cases of desmoid-type fibromatosis involving the brachial plexus. This series additionally assessed these lesions for mutations in the c-KIT oncogene in hopes of establishing a basis for predicting which of these lesions would respond to the chemotherapy agent imatinib mesylate. In the third case series, Dafford et al. [4] in June 2007 undertook a retrospective study of 15 desmoid tumors in 11 women and four men (ranging in age from 32 to 67 years; median 48 years) treated at their institution. In this study, the results were that there were 13 patients (86%) with brachial plexus lesions. In this review, we document the clinical presentation, neuroimaging, surgical, and pathological findings in a patient with a desmoid tumour arising from the brachial plexus. 1.1. Age and Gender Incidences of
Malignant brachial plexopathy: A pictorial essay of MRI findings  [cached]
Iyer Veena,Sanghvi Darshana,Merchant Nikhil
Indian Journal of Radiology and Imaging , 2010,
Abstract: For imaging, the brachial plexus is a technically and anatomically challenging region of the peripheral nervous system. MRI has a central role in the identification and accurate characterization of malignant lesions arising here, as also in defining their extent and the status of the adjacent structures. The purpose of this pictorial essay is to describe the MRI features of primary and secondary malignant brachial plexopathies and radiation-induced brachial nerve damage.
Axillary Brachial Plexus Block  [PDF]
Ashish R. Satapathy,David M. Coventry
Anesthesiology Research and Practice , 2011, DOI: 10.1155/2011/173796
Abstract: The axillary approach to brachial plexus blockade provides satisfactory anaesthesia for elbow, forearm, and hand surgery and also provides reliable cutaneous anaesthesia of the inner upper arm including the medial cutaneous nerve of arm and intercostobrachial nerve, areas often missed with other approaches. In addition, the axillary approach remains the safest of the four main options, as it does not risk blockade of the phrenic nerve, nor does it have the potential to cause pneumothorax, making it an ideal option for day case surgery. Historically, single-injection techniques have not provided reliable blockade in the musculocutaneous and radial nerve territories, but success rates have greatly improved with multiple-injection techniques whether using nerve stimulation or ultrasound guidance. Complete, reliable, rapid, and safe blockade of the arm is now achievable, and the paper summarizes the current position with particular reference to ultrasound guidance. 1. Introduction The axillary approach to brachial plexus was first demonstrated in 1884 by William Halsted when he injected cocaine under direct vision [1]. In 1911, G. Hirschel performed the first percutaneous axillary block [2]. It was only after Burnham’s publication in 1959 [3] that this block gained popularity among anaesthetists. Since then, it has become the most used peripheral nerve block for forearm and hand surgery, especially due the low incidence of complications compared to the more proximal approaches to the brachial plexus. 2. The Brachial Plexus in the Axilla [4] The brachial plexus supplies the nerve supply to the upper limb and is formed by the ventral rami of the lower four cervical nerves and the first thoracic nerve. It consists of roots, trunks, divisions, and cords. The roots are arranged between the scalenus anterior and medius muscles, and they combine in the posterior triangle to form three trunks: upper, middle, and lower. On approaching the clavicle, each of the three trunks divides into an anterior and posterior division to supply the flexor and extensor compartments of the arm, respectively. Anterior divisions of the upper and middle trunk unite to form the lateral cord, anterior division of the lower trunk continues as the medial cord, and posterior divisions of all the three trunks assemble to from the posterior cord. The three cords enter the axilla at the apex and are arranged, according to the names, around the second and third parts of the axillary artery. In relation to the first part of the artery, however, the lateral and posterior cords are lateral, and
MRI diagnosis of neurolymphomatosis of the brachial plexus  [cached]
Chaturvedi Arti,Singh J,Rastogi Vikas
Neurology India , 2008,
Angiosomes of medial cord of brachial plexus  [cached]
D. Suseelamma,S. Deepthi,K. Krishna Chaitanya,H. R. Sharada
International Journal of Research in Medical Sciences , 2013, DOI: 10.5455/2320-6012.ijrms20130508
Abstract: This anatomical study analyzed the neurovascular relationship of the brachial plexus. Ten formalized specimens of brachial plexuses were examined after injection of lead oxide in to the subclavian artery. The vascular, anatomical features of the brachial plexus were documented .The specimens were analyzed by dissection method, subjected for microscopic study. The vascular supply was markedly rich, often with true anastomotic channels found within the nerves. There was much variation in supply, depending on the branching pattern of subclavian artery. [Int J Res Med Sci 2013; 1(2.000): 79-82]
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