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Search Results: 1 - 10 of 141106 matches for " Rahul K Nath "
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The journal: one year later
Rahul K Nath
Journal of Brachial Plexus and Peripheral Nerve Injury , 2007, DOI: 10.1186/1749-7221-2-20
Abstract: As Editor-in-Chief, it is my pleasant duty to celebrate the first year anniversary publication of the Journal of Brachial Plexus and Peripheral Nerve Injury. Only a year has passed since the inaugural issue and many significant events have occurred in this brief time. We have surpassed expectations as far as quality and breadth of submitted articles and we are setting the standard for publications in this field.I believe that in the past year we have published more scientific articles about the brachial plexus than any other journal. This is a critical point as it signifies that the scientific community is accepting our journal as an important outlet for brachial plexus research. To have this large volume in such a short time also validates the underlying premise behind developing the journal, namely that there was an unmet need for a specialty academic publication. I believe that we have met that need.There have been many interesting submissions, and they have come from all corners of the globe. Countries that have been represented are: The Republic of South Africa, India, Cuba, Iran, Colombia, Japan, Brazil, Slovenia, Germany, The United States, Italy, Greece, Egypt, Australia, and Turkey.In addition to standard scientific format, we have also published video findings from Professor Roman Bo?njak (additional file 1, Bo?njak et al. [1]) and Powerpoint presentations sent by Professor Sayed Rayegani from the Iranian Congress of Electrodiagnosis (additional file 1, Rayegani et al. [2]). Both of these are exciting formats that allow in-depth presentation of complex ideas in ways that enhance our insight. I think that the use of video and other visual techniques will be increasingly important in presenting comprehensive descriptions of new concepts to our audience, and as an online publication Journal of Brachial Plexus and Peripheral Nerve Injury is ideally suited to publish movies and other image files. I am very pleased that our initial forays into the use of these n
Editorial for inaugural issue of Journal of Brachial Plexus and Peripheral Nerve Injury
Rahul K Nath
Journal of Brachial Plexus and Peripheral Nerve Injury , 2006, DOI: 10.1186/1749-7221-1-1
Abstract: Our aim is that the journal will be the pre-eminent repository of knowledge for brachial plexus and peripheral nerve injury science. Injury in this context does not imply trauma alone, but any derangement of the anatomy, physiology or biochemistry that results in an altered state of functioning, truly an unlimited scope for a fascinating and important field.The journal is in open access format, in my view the only relevant such model in these times where information must be freely available to all. The traditional subscription-based model inherently denies free access to knowledge and seems contrary to the spirit of scientific thought. In support of this concept, we have arranged with BioMed Central to subsidize the costs of publication for the first two years of publication. Therefore, there are no barriers to publication of high quality science or to access to this knowledge.It is very important to note that all submissions, upon approval by our peer review process, are immediately indexed in PubMed and archived in PubMed Central, the full-text repository of the United States National Library of Science. Many other growing indexers such as Google Scholar will also display our articles, making them more widely read and accessible than any other system. Our goal is to have a rapid peer review process, and we will make every effort to make an initial decision within 6 weeks of submission.The peer review process will match knowledgeable reviewers with submitted manuscripts to produce high quality articles of interest and scientific merit. The process is confidential so that criticisms and revisions are made in the fairest manner possible. The final decision on publication will be made by the editors in chief.We will look for submissions of interesting and important scientific information that hopefully will have clinical application. This focus does not deny the relevance of basic research, it embraces it: the future of nerve injury management lies in manipulation of
Comparing the Surgical Outcomes of Modified Quad and Triangle Tilt Surgeries to other Procedures Performed in Obstetric Brachial Plexus Injury  [PDF]
Rahul K. Nath, Juan-Carlos Pretto, Chandra Somasundaram
Surgical Science (SS) , 2013, DOI: 10.4236/ss.2013.49A003

Purpose: To compare results from our surgical treatment experiences in children with obstetric brachial plexus injuries (OBPI), to those who have had other surgical treatments. Methods: We conducted a retrospective study in our medical records consisting of two groups of OBPI patients. Group 1: 26 OBPI children (16 girls and 10 boys), age range between 2.0 and 12.0 (mean age 6.9), who have undergone surgical treatments at other institutions between 2005 and 2010. Group 2: 45 OBPI children (20 boys and 25 girls), age between 0.7 and 12.9 (mean age 3.7), who have had modified Quad and triangle tilt surgical treatment between 2005 and 2010 at our institution. In both groups Mean modified Mallet scores and radiological scores were measured and compared. All measurements were made at least one year post surgery in both groups. Results: Post-operative mean modified Mallet score was 11.8 ± 2.4 in group 1 patients, whereas post-mean modified Mallet score was 20 ± 2.7 (P < 0.0001) following modified Quad and triangle tilt surgeries in group 2 patients. Further, their radiological scores such as posterior subluxation, and glenoid version were 13.4 ± 21.3 and 30.2 ± 19.1 in group 1, whereas 32.1 ±13.5 (P < 0.0004), and 16.3 ± 11.5 (P < 0.008) in group 2 patients, when compared to normal values of 50, and 0 respectively. Conclusion: Patients who have had mod Quad and triangle tilt for OBPI obtained significantly better functional outcomes in modified total Mallet score as well as in radiological scores, when compared to those OBPI children, who underwent other procedures such as posterior glenohumeral capsulorrhaphy, biceps tendon lengthening, humeral osteotomy, anterior capsule release, nerve transfer/graft, botox and muscle/tendon transfer and release.

Computed tomography of the shoulders in patients with obstetric brachial plexus injuries: a retrospective study
Rahul K Nath, Andrea D Humphries
Annals of Surgical Innovation and Research , 2008, DOI: 10.1186/1750-1164-2-4
Abstract: We conducted a retrospective study to investigate the accuracy of radiologic reports in the diagnosis of SHEAR or posterior subluxation of the humeral head in OBPI patients. CT studies from 43 consecutive patients over a 33-month period were used in the study. For each patient, we compared the results from the radiologic report to those from a clinical examination given by the attending surgeon and to measurements taken from the CT studies by biomedical researchers.A comparison of SHEAR measured from the 3-D CT images to the diagnoses from the radiologists, revealed that only 40% of the radiological reports were accurate. However, there was a direct correlation between the use of the 3-D CT images and an accurate SHEAR diagnosis by the radiologists (p < 0.0001). When posterior subluxation was measured in the affected and contralateral shoulders, 93% of the patients that had greater than a 10% difference between the two shoulders did not have their deformity diagnosed. The radiological reports diagnosed 17% of these patients with a 'normal' shoulder. Only 5% of the reports were complete, accurately diagnosing SHEAR in addition to posterior subluxation.Due to the low incidence rate of OBPI, many radiologists may be unfamiliar with the sequelae of these injuries. It is therefore critical that radiologists are made aware of the importance of an accurate measurement and diagnosis of the SHEAR deformity. Due to their lack of completeness, the radiological reports in this study did not significantly contribute to the clinical care of the patients. In order for OBPI patients to receive the highest standard of care, the final diagnosis from their radiological imaging should be deferred to a brachial plexus specialist who is experienced with these types of injuries.The upper nerve roots of the brachial plexus are commonly injured in patients with obstetric brachial plexus injuries. This results in the diminished development of external rotators and abductors which no longer c
Rapid recovery of serratus anterior muscle function after microneurolysis of long thoracic nerve injury
Rahul K Nath, Sonya E Melcher
Journal of Brachial Plexus and Peripheral Nerve Injury , 2007, DOI: 10.1186/1749-7221-2-4
Abstract: Serratus anterior function was restored through decompression, neurolysis, and tetanic electrical stimulation of the long thoracic nerve. This included partial release of constricting middle scalene fibers and microneurolysis of epineurium and perineurium of the long thoracic nerve under magnification. Abduction angle was measured on the day before and the day following surgery.In this retrospective study of 13 neurolysis procedures of the long thoracic nerve, abduction is improved by 10% or greater within one day of surgery. The average improvement was 59° (p < 0.00005). Patients had been suffering from winging scapula for 2 months to 12 years. The improvement in abduction is maintained at last follow-up, and winging is also reduced.In a notable number of cases, decompression and neurolysis of the long thoracic nerve leads to rapid improvements in winging scapula and the associated limitations on shoulder movement. The duration of the injury and the speed of improvement lead us to conclude that axonal channel defects can potentially exist that do not lead to Wallerian degeneration and yet cause a clear decrease in function.Scapular winging due to injury of the long thoracic nerve (LTN) can have significant and debilitating effects on arm mobility. The serratus anterior muscle, innervated by the LTN, is responsible for stabilizing the scapula against the thoracic wall. Additionally, during abduction of the arm, the scapula is moved and stabilized by the serratus anterior to allow the humeral head to rotate. In studies of scapulothoracic motion, an increasing angle of humeral elevation correlates with increasing serratus anterior contraction[1,2]. Patients with injury of the LTN may be unable to abduct and flex the arm into upward rotation above 90° at the shoulder, and this is exacerbated when significant weight is added. This functional problem does not always resolve upon conservative treatment with physical therapy, and the literature is unclear on the role of th
Finger movement at birth in brachial plexus birth palsy
Rahul K Nath,Mohamed Benyahia,Chandra Somasundaram
World Journal of Orthopedics , 2013, DOI: 10.5312/wjo.v4.i1.24
Abstract: AIM: To investigate whether the finger movement at birth is a better predictor of the brachial plexus birth injury. METHODS: We conducted a retrospective study reviewing pre-surgical records of 87 patients with residual obstetric brachial plexus palsy in study 1. Posterior subluxation of the humeral head (PHHA), and glenoid retroversion were measured from computed tomography or Magnetic resonance imaging, and correlated with the finger movement at birth. The study 2 consisted of 141 obstetric brachial plexus injury patients, who underwent primary surgeries and/or secondary surgery at the Texas Nerve and Paralysis Institute. Information regarding finger movement was obtained from the patient’s parent or guardian during the initial evaluation. RESULTS: Among 87 patients, 9 (10.3%) patients who lacked finger movement at birth had a PHHA > 40%, and glenoid retroversion < -12°, whereas only 1 patient (1.1%) with finger movement had a PHHA > 40%, and retroversion < -8° in study 1. The improvement in glenohumeral deformity (PHHA, 31.8% ± 14.3%; and glenoid retroversion 22.0° ± 15.0°) was significantly higher in patients, who have not had any primary surgeries and had finger movement at birth (group 1), when compared to those patients, who had primary surgeries (nerve and muscle surgeries), and lacked finger movement at birth (group 2), (PHHA 10.7% ± 15.8%; Version -8.0° ± 8.4°, P = 0.005 and P = 0.030, respectively) in study 2. No finger movement at birth was observed in 55% of the patients in this study group. CONCLUSION: Posterior subluxation and glenoid retroversion measurements indicated significantly severe shoulder deformities in children with finger movement at birth, in comparison with those lacked finger movement. However, the improvement after triangle tilt surgery was higher in patients who had finger movement at birth.
Microneurolysis and decompression of long thoracic nerve injury are effective in reversing scapular winging: Long-term results in 50 cases
Rahul K Nath, Andrew B Lyons, Gabriel Bietz
BMC Musculoskeletal Disorders , 2007, DOI: 10.1186/1471-2474-8-25
Abstract: Winging was bilateral in 3 of the 47 patients (26 male, 21 female), yielding a total of 50 procedures. The mean age of the patients was 33.4 years, ranging from 24–57. Causation included heavy weight-lifting (31 patients), repetitive throwing (5 patients), deep massage (2 patients), repetitive overhead movement (1 patient), direct trauma (1 patient), motor bike accident (1 patient), and idiopathic causes (9 patients). Decompression and microneurolysis of the long thoracic nerve were performed in the supraclavicular space. Follow-up (average of 25.7 months) consisted of physical examination and phone conversations. The degree of winging was measured by the operating surgeon (RKN). Patients also answered questions covering 11 quality-of-life facets spanning four domains of the World Health Organization Quality of Life questionnaire.Thoracic nerve decompression and neurolysis improved scapular winging in 49 (98%) of the 50 cases, producing "good" or "excellent" results in 46 cases (92%). At least some improvement occurred in 98% of cases that were less than 10 years old. Pain reduction through surgery was good or excellent in 43 (86%) cases. Shoulder instability affected 21 patients preoperatively and persisted in 5 of these patients after surgery, even in the 5 patients with persistent instability who experienced some relief from the winging itself.Surgical decompression and neurolysis of the long thoracic nerve significantly improve scapular winging in appropriate patients, for whom these techniques should be considered a primary modality of functional restoration.Winging of the scapula due to long thoracic nerve palsy is a common diagnosis [1-10] and a significant functional problem, not simply an aesthetic issue. Secondary pain and spasm result from muscle imbalances and tendonitis around the shoulder joint caused by muscular activity that compensates for impaired shoulder stability. Winging also leads to adhesive capsulitis, subacromial impingement, and brachial p
Surgical correction of unsuccessful derotational humeral osteotomy in obstetric brachial plexus palsy: Evidence of the significance of scapular deformity in the pathophysiology of the medial rotation contracture
Rahul K Nath, Sonya E Melcher, Melia Paizi
Journal of Brachial Plexus and Peripheral Nerve Injury , 2006, DOI: 10.1186/1749-7221-1-9
Abstract: Four patients with Scapular Hypoplasia, Elevation And Rotation (SHEAR) deformity who had undergone unsuccessful humeral osteotomies to treat internal rotation underwent acromion and clavicular osteotomy, ostectomy of the superomedial border of the scapula and posterior capsulorrhaphy in order to relieve the torsion developed in the acromio-clavicular triangle by persistent asymmetric muscle action and medial rotation contracture.Clinical examination shows significant improvement in the functional movement possible for these four children as assessed by the modified Mallet scoring, definitely improving on what was achieved by humeral osteotomy.These results reveal the importance of recognizing the presence of scapular hypoplasia, elevation and rotation deformity before deciding on a treatment plan. The Triangle Tilt procedure aims to relieve the forces acting on the shoulder joint and improve the situation of the humeral head in the glenoid. Improvement in glenohumeral positioning should allow for better functional movements of the shoulder, which was seen in all four patients. These dramatic improvements were only possible once the glenohumeral deformity was directly addressed surgically.Obstetric brachial plexus injury (OBPI) has been described as a discrete entity since 1754 [1]. The pathophysiology of the secondary deformities encountered in this population was described succinctly in 1905 by Whitman who wrote that the large majority of internal rotation and subluxation deformities of the shoulder in children with obstetric brachial plexus injuries were caused by fibrosis and contractures developed as a consequence of the neurological injury [2]. The medial rotation contracture (MRC) is the most significant secondary shoulder deformity in children with severe OBPI, requiring surgery in more than one third of patients whose injury did not resolve spontaneously [3].The current surgical approach to treating persistent MRC in OBPI patients is derotational humeral ost
Risk Factors at Birth for Permanent Obstetric Brachial Plexus Injury and Associated Osseous Deformities
Rahul K. Nath,Nirupama Kumar,Meera B. Avila,Devin K. Nath
ISRN Pediatrics , 2012, DOI: 10.5402/2012/307039
Risk Factors at Birth for Permanent Obstetric Brachial Plexus Injury and Associated Osseous Deformities
Rahul K. Nath,Nirupama Kumar,Meera B. Avila,Devin K. Nath,Sonya E. Melcher,Mitchell G. Eichhorn,Chandra Somasundaram
ISRN Pediatrics , 2012, DOI: 10.5402/2012/307039
Abstract: Purpose. To examine the most prevalent risk factors found in patients with permanent obstetric brachial plexus injury (OBPI) to identify better predictors of injury. Methods. A population-based study was performed on 241 OBPI patients who underwent surgical treatment at the Texas Nerve and Paralysis Institute. Results. Shoulder dystocia (97%) was the most prevalent risk factor. We found that 80% of the patients in this study were not macrosomic, and 43% weighed less than 4000?g at birth. The rate of instrument use was 41% , which is 4-fold higher than the 10% predicted for all vaginal deliveries in the United States. Posterior subluxation and glenoid version measurements in children with no finger movement at birth indicated a less severe shoulder deformity in comparison with those with finger movement. Conclusions. The average birth weight in this study was indistinguishable from the average birth weight reported for all brachial plexus injuries. Higher birth weight does not, therefore, affect the prognosis of brachial plexus injury. We found forceps/vacuum delivery to be an independent risk factor for OBPI, regardless of birth weight. Permanently injured patients with finger movement at birth develop more severe bony deformities of the shoulder than patients without finger movement. 1. Introduction The incidence of obstetric brachial plexus injury (OBPI) is about 1.51 [1] per 1000 live births in the United States and reports vary from 0.38 [2] to 5.8 [3] per 1000 live births. Many of these injuries are transient; however, most of the OBPI patients never recover full function and develop permanent injuries [2, 4, 5]. In reports conducted by pediatricians and specialists, with follow-up times greater than 3 years, the reported proportion of injuries that remain permanent varies from 50 to 90% [6–8]. Risk factors for injury include shoulder dystocia, macrosomia (defined as birth weight greater than 4500?g [9–12]) instrument-assisted delivery, and downward traction of the fetal head [1, 7, 8]. Yet in a database search of over 11 million births, it was found that most children with neonatal brachial plexus palsy did not have known risk factors [1]. In obstetrics, presentation of shoulder dystocia is often emergent because the reported risk factors for its occurrence are not good predictors of it [13, 14]. Therefore we seek to examine the most prevalent risk factors found in a population of patients with permanent OBPI that necessitated surgical treatment to attempt to identify better predictors of injury and to elucidate the pathophysiology of OBPI.
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