Cases Of Brachial Plexus Injury Research Articles

Associated Factors in 1611 Cases of Brachial Plexus Injury

In Brief Objective To identify risk factors associated with brachial plexus injury in a large population. Methods A computerized data set containing records from hospital discharge summaries of mothers and infants and birth certificates was examined. The deliveries took place in more than 300 civilian acute care hospitals in California between January 1, 1994, and December 31, 1995. Cases of brachial plexus injury were evaluated for additional diagnoses and procedures of pregnancy, such as mode of delivery, gestational diabetes, and shoulder dystocia. Those complications were stratified by birth weight and analyzed, using bivariate and multivariate techniques to identify specific risk factors. Results Among 1,094,298 women who delivered during the 2 years, 1611 (0.15%) had diagnoses of brachial plexus injury. The frequency of diagnosis increased with the addition of gestational diabetes (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.7, 2.1), forceps delivery (OR 3.4, 95% CI 2.7, 4.3), vacuum extraction (OR 2.7, 95% CI 2.4, 3.1), and shoulder dystocia (OR 76.1, 95% CI 69, 84). In cases of brachial plexus injury, the frequency of shoulder dystocia increased from 22%, when birth weight ranged between 2.5 and 3.5 kg, to 74%, when birth weight exceeded 4.5 kg. The frequency of diagnosis of other malpresentation (non-breech) (OR 73.6, 95% CI 66, 83) was increased for all birth weight categories. Severe (OR 13.6, 95% CI 8.3, 22.5) and mild (OR 6.3, 95% CI 3.9, 10.1) birth asphyxia were increased. Prematurity (OR 0.8, 95% CI 0.67, 0.98) and fetal growth restriction (OR 0.1, 95% CI 0.03, 0.40) were protective against brachial plexus injury. Conclusion In macrosomic newborns, shoulder dystocia was associated with brachial plexus injury, but in low- and normal-weight infants, “other malpresentation” was diagnosed more frequently than shoulder dystocia. Our study findings suggest that brachial plexus injury has causes in addition to shoulder dystocia and might result from an abnormality during the antepartum or intrapartum period. Because shoulder dystocia is reported in approximately half the cases of brachial plexus injury, other causes might be important.

Associated factors in 1611 cases of brachial plexus injury

Objective: To identify risk factors associated with brachial plexus injury in a large population. Methods: A computerized data set containing records from hospital discharge summaries of mothers and infants and birth certificates was examined. The deliveries took place in more than 300 civilian acute care hospitals in California between January 1, 1994, and December 31, 1995. Cases of brachial plexus injury were evaluated for additional diagnoses and procedures of pregnancy, such as mode of delivery, gestational diabetes, and shoulder dystocia. Those complications were stratified by birth weight and analyzed, using bivariate and multivariate techniques to identify specific risk factors. Results: Among 1,094,298 women who delivered during the 2 years, 1611 (0.15%) had diagnoses of brachial plexus injury. The frequency of diagnosis increased with the addition of gestational diabetes (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.7, 2.1), forceps delivery (OR 3.4, 95% CI 2.7, 4.3), vacuum extraction (OR 2.7, 95% CI 2.4, 3.1), and shoulder dystocia (OR 76.1, 95% CI 69, 84). In cases of brachial plexus injury, the frequency of shoulder dystocia increased from 22%, when birth weight ranged between 2.5 and 3.5 kg, to 74%, when birth weight exceeded 4.5 kg. The frequency of diagnosis of other malpresentation (nonbreech) (OR 73.6, 95% CI 66, 83) was increased for all birth weight categories. Severe (OR 13.6, 95% CI 8.3, 22.5) and mild (OR 6.3, 95% CI 3.9, 10.1) birth asphyxia were increased. Prematurity (OR 0.8, 95% CI 0.67, 0.98) and fetal growth restriction (OR 0.1, 95% CI 0.03, 0.40) were protective against brachial plexus injury. Conclusion: In macrosomic newborns, shoulder dystocia was associated with brachial plexus injury, but in low- and normal-weight infants, “other malpresentation” was diagnosed more frequently than shoulder dystocia. Our study findings suggest that brachial plexus injury has causes in addition to shoulder dystocia and might result from an abnormality during the antepartum or intrapartum period.

An uncommon mechanism of brachial plexus injury. A case report

To report a case of brachial plexus injury occurring on the contralateral side in a patient undergoing surgery for acoustic neuroma through translabrynthine approach. A 51-yr-old woman underwent surgery for acoustic neuroma through translabrynthine approach in the left retroauricular area. She had a short neck with a BMI of 32. Under anesthesia, she was placed in supine position with Sugita pins for head fixation. The head was turned 45 degrees to the right side and the neck was slightly flexed for access to the left retroauricular area, with both arms tucked by the side of the body. Postoperatively, she developed weakness in the right upper extremity comparable with palsy of the upper trunk of the brachial plexus. Hematoma at the right internal jugular vein cannulation site was ruled out by CAT scan and MRI. The only remarkable finding was considerable swelling of the right sternocleidomastoid and scalene muscle group, with some retropharyngeal edema. An EMG confirmed neuropraxia of the upper trunk of brachial plexus. She made a complete recovery of sensory and motor power in the affected limb over the next three months with conservative treatment and physiotherapy. Brachial plexus injury is still seen during anesthesia despite the awareness about its etiology. Malpositioning of the neck during prolonged surgery could lead to compression of scalene muscles and venous drainage impedance. The resultant swelling in the structures surrounding the brachial plexus may result in a severe compression.

手指，手関節の伸展障害に対するけん移行術の検討

In this report, we discuss nine patients with extension disturbance of the wrist, thumb, and fingers that were treated by the tendon transfer operation. There were five cases of brachial plexus injury and four cases of crush injury of the extensor tendons. The average age of the patients at operation was 23 years. The mean length of the postoperative follow-up was 4.1 years. The improvement of joint motion was acquired in 67% of the wrist cases, 86% of the thumb cases, and 75% of the finger cases. The results were poor in three cases, three in which two cases were brachial plexus injury and one was incomplete amputation of the wrist. The operation was unsuccessful due to evaluation failure of the mover in the two brachial plexus injury cases and adhesion of the transferred tendon in the incomplete amputation case.

NERVE GRAFTING IN BRACHIAL PLEXUS INJURIES

We have assessed the efficacy of free nerve grafts in 90 cases of brachial plexus injury. Relatively good recovery of the elbow flexor and extensor muscles and of those of the shoulder girdle was found but recovery of the flexors and extensors of the forearm and of the intrinsic muscles of the hand was extremely poor. Poor results were found when spinal nerve roots seemed normal to the touch and appeared intact but had abnormal somatosensory evoked potentials or myelography. Recovery of the deltoid and infraspinatus muscles was better when injury had occurred to the circumflex and suprascapular nerves rather than to the plexus itself, perhaps because these nerves were explored in their entirety to determine the presence of multiple lesions. It is important to visualise the entire nerve thoroughly to assess the overall condition. Thorough exploration of the plexus and the use of intraoperative recording of somatosensory evoked potentials are essential.

大太鼓の固定バンドにより生じたリュックサック麻ひの１例

大太鼓の固定バンドにより生じたリュックサック麻ひの１例

A histochemical study of the biceps brachii muscle cross-innervated by intercostal nerves. 6 cases of brachial plexus injuries operated with nerve-crossing.

Direct nerve-crossing of intercostal nerves from the lateral thorax to the musculocutaneous nerve was performed in 6 patients after spinal nerve root avulsion with brachial plexus palsy. Elbow flexion power was regained well enough to move against gravity and some resistance in all cases. The muscles were examined histochemically 4 (1-9) years after the operation. The intercostally-innervated biceps brachii muscle showed motor predominance of slow-twitch Type 1 fiber regeneration much more than that of fast-twitch Type 2 fiber in 5 of our patients. Our study suggests that the motor nerves of slow-twitch fibers may have priority in peripheral nerve regeneration over those of fast-twitch fibers.

Intraoperative Histopathologic Nerve Examination in Brachial Plexus Injury

A new method of indirect intraoperative evaluation of axonal quality in a proximal nerve stump by immediate observation of the myelin sheath is presented. Using this method in 18 cases of brachial plexus injuries, the proximal stumps of particular roots or trunks were classified as unfavorable, favorable, or fair. This histologic grading was compared to the clinical result obtained after surgical repair of these nerves in the corresponding territory. In three cases, the proximal stump of the brachial plexus root was sacrificed because of an unfavorable grade, and a nerve transfer was performed: the results were useful in two cases and "academic" in one case. Among 12 cases with favorable histologic grades, nine were associated with useful function and three were "academic". Among three cases with a fair histologic grade, two were associated with an "academic" result and one was useful in a nine-year-old child. Retrospective comparison with classic examination after axon staining showed that intraoperative histopathologic grading was somewhat too optimistic in six cases and was relevant in 12 cases. This method may be helpful in choosing proper methods for brachial plexus repair. A normal or almost normal histopathologic condition in the proximal stump of the nerve is mandatory for obtaining a useful clinical result after repair.

MR evaluation of brachial plexus injuries.

Ten cases of brachial plexus injury were subjected to magnetic resonance (MR) to demonstrate the roots, trunks, divisions or cord abnormalities. Both normal and abnormal brachial plexuses were imaged in sagittal, axial, coronal and axial oblique planes. Myelography, using water soluble contrast agents, was performed in seven cases. MR demonstrated one traumatic meningocele, one extradural cerebrospinal fluid (CSF) collection, trunk and/or root neuromas in four, focal root fibrosis in two and diffuse fibrosis in the remaining two cases. Results of MR were confirmed at surgery in four cases with neuromas, while myelography was normal in two and was not carried out in the remaining two. In two cases, where MR demonstrated diffuse fibrosis of the brachial plexus, myelography showed C7 and T1 traumatic meningocele in one and was normal in the other. Both these patients showed excellent clinical and electrophysiological correlation with MR findings and in one of them surgical confirmation was also obtained. In the other two cases with focal nerve root fibrosis, myelography was normal in one and showed a traumatic meningocele in another. Operative findings in these cases confirmed focal root fibrosis but no root avulsion was observed although seen on one myelogram. Focal fibrosis, however, was noted at operation in more roots than was observed with MR. Initial experience suggests that MR may be the diagnostic procedure of choice for complete evaluation of brachial plexus injuries.

Shoulder Arthrodesis by External Fixation

The choice of pin site in shoulder arthrodesis after brachial plexus injury is important for efficient external fixation. The pins are inserted into the coracoid process from the anterior aspect and the scapular spine from the acromion. This insertion method holds the scapula more rigid and allows the patient to lie supine. Moreover, it makes it possible to correct the fixation angle after the operation. In 11 cases of brachial plexus injury, solid bony arthrodesis was obtained within three months.

Brachial plexus injury occurring during oral and maxillofacial surgery: A case report

A case of brachial plexus injury occurring during bilateral temporomandibular joint reconstruction is reported. Patient positioning during surgery is the key to prevention of such injuries.

The Prevention of Injuries of the Brachial Plexus Secondary to Malposition of the Patient During Surgery

Brachial plexus injuries that occur secondary to malposition of the patient during general anesthesia have been described in the medical literature for nearly a century. However, little can be found in the orthopedic literature. Of the peripheral nerve groups, the brachial plexus may be the most vulnerable to injury from malpositioning. This study presents three such cases of brachial plexus injury and reviews the literature concerning the subject. Pertinent anatomy, etiology, and pathogenesis of injury to the brachial plexus reveal that injury can occur from stretch or compression of nerves and is usually caused by a combination of the two. With awareness of risk factors and the positions which are likely to cause injury to the brachial plexus, careful positioning of the upper extremity can prevent injury and potential disability to the patient.

Deafferentation pain in man.

Pains of various etiologies are described in so many overlapping ways that verbal descriptions alone do not permit a valid distinction between those pains associated with neurological injury (with or without sensory loss) and those associated with neurological compression. Nor does the fact of some sensory loss plus pain constitute a useful classification to determine either the mechanism of the pain or its treatment. Progress is more likely to ensue if we seek to characterize in detail each type of painful lesion. Evidence for these conclusions is drawn from cases of brachial plexus injury, trigeminal rhizotomy and tractotomy, postcordotomy dysesthesia and central pain treated by regional guanethidine block. Examples of the value of totally innovative approaches are drawn from the physics of elementary particles.

ちゅう関節屈筋形成術の経験

Restoration of elbow flexion in paralytic disorders is a most important problem.Three cases of poliomyelitis and seven cases of brachial plexus injury in which muscle transplantations had been performed to restore elbow flexion have been reviewed.The average follow-up period was five and a half years.The results were graded by active range of motion, muscle power and Mayer & Green's criteria.The results of seven cases of Steindler's operation are excellent and good except for one case.The mean of flexion contracture is thirty degrees and active flexion is one hundred twenty-five degrees.The results of two cases of Clark's operation are excellent and good.The result of one case of sternocleidomastoid transplantation is poor.

Injury to the brachial plexus as a result of diagnostic Arteriography

Six cases of brachial plexus injury within the brachial sheath are reported following axillary-brachial arteriography. Direct compression resulted from leakage of arterial blood into the space formed by the fascial sheath. In one, hemorrhage occurred several days after arteriotomy. Early decompression and arteriorrhaphy resulted in restoration of normal function. Permanent nerve damage resulted when surgical decompression was delayed.

Rucksack Palsy

In recent years there has been an increase in the use of backpacks and rucksacks by nonmilitary ary personnel. An estimated 3 million individuals engage in hiking and mountain climbing, and countless others use these packs on campus. We report a case of brachial plexus injury sustained by an individual wearing such a pack. CASE REPORT A 15-year-old right-handed white boy was examined for pain in the left shoulder of two weeks' duration. The youngster had been well, but two weeks' before evaluation was on a hiking expedition. During this trip he wore a rucksack which when filled weighed 20.4 kg (Fig. 1).

Treatment of paralysis of the flexors of the elbow.

1 . Twenty-one cases of poliomyelitis and twenty cases of brachial plexus injury in which muscle transplantations had been performed to restore elbow flexion have been reviewed. The average follow-up period was four and a half years. 2. The results were graded objectively and subjectively. They were better when passive extension of the elbow was limited; such limitation always occurs after Steindler's operation, but infrequently after pectoral transplantation. 3. The results of pectoral transplantation are good when there is no significant shoulder paralysis; if there is shoulder weakness arthrodesis of the joint may be required to control medial rotation and adduction of the shoulder on flexion of the elbow. In brachial plexus lesions the results of pectoral transplantation may be marred by simultaneous contraction of the triceps. This can be overcome by transplanting triceps into the flexor apparatus. Triceps transplantation is rarely indicated because loss of active extension of the elbow is a grave disability. 4. Subjective results tended to be worse than objective results in brachial plexus lesions because impairment of sensibility in the hand often limited the usefulness of the limb. In striking contrast the subjective results were in general far better than the objective in patients who had had poliomyelitis. In them the smallest gain can be of functional value.