Lateral Cutaneous Nerve Research Articles

Lateral Antebrachial Cutaneous Nerve as a Donor Source for Digital Nerve Grafting: A Concept Revisited.

Objective:The main objective of this study is to evaluate the availability of lateral antebrachial cutaneous nerve (LACN) autograft for acute or delayed repair of segmented digital nerve injuries.Patients and Methods:13 digital nerve defects of 11 patients; treated with interposition of LACN graft that harvested from ipsilateral extremity were included in the study. Mean follow up period was 35, 7 months. The mean time from injury to grafting is 53, 3 days. The results of the mean 2PDT and SWMT values of injured /uninjured finger at the end of follow up period were evaluated with Paired T test. The correlation between the defect length and the difference of 2PDT, SWMT values between the uninjured and injured finger at the end of follow up period; were evaluated with Pearson - correlation analysis.Results:The mean value of our 2PDT and SWMT results are ~5,923, ~3, 52, respectively in which can be interpreted between the normal and diminished light touch. The defect length and difference percentage of SWMT values is positively and significantly correlated statistically. Mean length of interposed nerve grafts was 18.5 mm. The age of the patient and the mean values of 2PDT and SWMT with the difference % of 2PDT and % of SWMT are not statistically correlated.Conclusion:Based on results regarding sensory regaining at recipient side and negligible sensory deficit at harvesting side, we suggest that lateral antebrachial cutaneous nerve might be a valuable graft option for digital nerve defects.

Surgical Treatment of Distal Biceps Tendon Ruptures: An Analysis of Complications in 784 Surgical Repairs

Background: Distal biceps brachii tendon ruptures lead to substantial deficits in elbow flexion and supination; surgical repair restores muscle strength and endurance. Purpose: To examine clinical and surgical outcomes for distal biceps tendon repairs in a large, multispecialty, integrated health care system. Study Design: Cohort study; Level of evidence, 3. Methods: Retrospective cohort study of distal biceps tendon repairs performed between January 1, 2008, and December 31, 2015. The repair methods were classified as double-incision approach using bone tunnel–suture fixation or anterior single-incision approach. Anterior single incisions were further classified according to the fixation method: cortical button alone, cortical button and interference screw, or suture anchors alone. Patient demographics, surgeon characteristics, range of motion, and complications were analyzed for all repair types. Results: Of the 784 repairs that met the inclusion criteria, 639 (81.5%) were single-incision approaches. When comparing double-incision and single-incision repairs, there was a significantly higher rate of posterior interosseous nerve palsy (3.4% vs 0.8%, P = .010), heterotopic bone formation (7.6% vs 2.7%, P = .004), and reoperation (8.3% vs 2.3%, P < .001). The most common nerve complication encountered was a lateral antebrachial cutaneous nerve palsy (n = 162), which was significantly more common in the single-incision repairs than in the double-incision repairs (24.4% vs 4.1%, P < .001). When excluding lateral antebrachial cutaneous nerve palsies, there was no significant difference in the overall nerve palsies between single-incision and double-incision (5.8% vs 6.9%, P = .612). The overall rate of tendon rerupture was 1.9% (single incision, 1.6%; double incision, 2.8%; P = .327). The overall rate of postoperative wound infection was 1.5% (single incision, 1.3%; double incision, 2.8%; P = .182). The average time from surgery to release from medical care was 14.4 weeks (single incision, 14 weeks; double incision, 16 weeks; P = .286). Patients treated with cortical button plus interference screw were released significantly sooner than were patients with other single-incision repair types (13.1 ± 8.01 weeks, P = .011). There were no significant differences in rates of motor neurapraxia, infection, rerupture, and reoperation with regard to surgeon’s years of practice, fellowship training, or case volume. Conclusion: The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, the double-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and reoperation rate. Surgeon’s years of practice, fellowship training, and case volume do not affect the rate of major complications.

Sural Nerve Splitting in Reverse Sural Artery Perforator Flap: Anatomical Study in 40 Cadaver Legs.

The reverse sural artery perforator flap has been widely used in reconstruction of the lower extremity. However, along with the high rate of flap necrosis, sural nerve injury is one of the most frequent complications. This cadaveric study investigated a simple sural nerve preservation technique during reverse sural artery perforator flap surgery. Cadaver dissection was performed on 40 cadaver lower legs, to investigate the pattern of sural nerve distribution. The points where the lateral and medial sural cutaneous nerves penetrate the deep fascia were measured. The converging point of these nerves into the sural nerve was also recorded. Furthermore, the sural nerve was split until no tethering was observed, to simulate the sural nerve-sparing reverse sural artery perforator flap. Twenty-nine legs (72.5 percent) showed the lateral and medial sural cutaneous nerves converging to become the sural nerve (combined pattern); seven (17.5 percent) and four legs (10.0 percent) demonstrated the diminished and parallel types, respectively. The distances between the lateral malleolus and the fascia-penetrating point of the lateral and medial sural cutaneous nerves were 29.9 ± 3.3 cm and 18.8 ± 5.6 cm, respectively. In the combined type, the point of convergence was 13.6 ± 4.2 cm from the lateral malleolus. Nerve splitting was successfully performed in all combined cases, without injuring the nerve fascicles. The medial sural cutaneous nerve enters the deep fascia significantly more distally than does the lateral sural cutaneous nerve. Furthermore, using nerve splitting, the medial sural cutaneous nerve can be kept intact during reverse sural artery perforator flap surgery.

Intramedullary Cortical Button Fixation Of Distal Biceps Tendon Rupture: Long-term Patient Outcomes

Objectives:No consensus currently exists for optimal distal biceps rupture fixation. Dorsal cortical button (DCB) and dual incision transosseous (DITO) provide the greatest biomechanical load-to-failure, permitting earlier mobilization to prevent arthrofibrosis. Both methods have associated complications, restricted range of motion (ROM) from heterotopic ossification and proximal radioulnar synostosis for DITO while DCB has increased incidence of cutaneous and posterior interosseous nerve (PIN) injuries despite different techniques to reduce their frequency. The intramedullary cortical button (ICB) fixation technique aims to decrease PIN palsy risk, decrease implant costs and provide strong tendon-bone fixation allow for early ROM. We set out to determine the long-term efficacy of this technique and any difference in complication rates including re-rupture.Methods:31 patients underwent ICB fixation of chronic and acute distal biceps tendon ruptures without allograft with more than 1 year follow up. 21 patients completed a questionnaire and Disabilities of the Arm, Shoulder and Hand (DASH) survey. Elbow and forearm ROM, cosmesis, pain, strength, motor nerve neuropraxia, cutaneous sensory changes and other complications were obtained from the chart and questionnaire. The ICB technique utilizes a 4cm transverse anterior incision 2cm distal to the distal antecubital flexion crease. The tuberosity is prepared, creating a clean, bleeding bony surface. A #2 high-strength braided suture is passed through the toggle hole at both ends of a Smith and Nephew Endobutton. A needle passes one suture pair in the 4.7mm hole and out the 2mm hole drilled with mild convergence in the distal and proximal tuberosity footprint with a 1.5cm bony bridge. This suture pair shuttles the Endobutton into the intramedullary canal, both limbs of each suture exits their respective hole. One limb from each suture is whipstitched proximally and back distally. Tensioning the free suture limb exiting the 2mm hole and tying to its free suture pair compresses the biceps stump against the radial tuberosity and secures the Endobutton against the intramedullary cortex at the 2mm hole. Finally the free suture limb exiting the 4.7mm hole is tensioned and tied to its suture pair limb, distributing tendon compression over the entire tuberosity footprint.Results:At an average of 4 (1.3-7.4) years postoperatively, 81% were extremely and 10% very satisfied with their overall outcome. 81% reported no strength or ROM limitations, 76% had pain-free activity, 86% and 81% were extremely satisfied with postoperative elbow ROM and forearm ROM respectively. The mean DASH and sports DASH score were 3.52 and 2.5. Transient sensory changes were noted in the lateral antebrachial cutaneous nerve and superficial radial nerve distributions in 38% and 19% of patients respectively. Excluding workers compensation patients improved the percent of extremely satisfied patients to 93% and the average DASH score to 0.93. No biceps re-ruptures or PIN palsies were observed.Conclusion:The ICB technique provides secure distal biceps tendon fixation with excellent long-term patient satisfaction and comparable functional outcomes to existing fixation techniques with restoration of normative DASH scores. The ICB technique has a cutaneous nerve complication rate comparable to other single incision studies and no observed PIN palsies or wound complications were noted while decreasing the implant costs.

Treatment of complex acetabular fractures through supra-ilioinguinal approach by the use of 3D printing technique

Objective To investigate the clinical outcomes in the treatment of complex acetabular fractures through a single supra-ilioinguinal approach after the application of preoperative 3D printing and rapid prototyping simulating the operative procedure. Methods From January 2013 to January 2016, 24 cases of complex pelvic and acetabular fractures in our hospital were retrospectively analyzed. Among them 18 cases were male and 6 were female. The average age was 39.2±13.8 years (range, 24-68 years). According to Letournel-Judet’s classification, there were 6 cases of transverse, 4 cases of T shaped, 4 cases of combined anterior column and posterior hemi-transverse (ACPHT) and 10 cases of 2-column fractures. The time from injured to operation averaged 9 days (range, 4-18 days). Before operation, pelvic AP view, three-dimensional CT as well as CTA of iliac blood vessels was taken routinely in all cases. The CT and CTA scan data were then imported into Mimics software for 3D reconstruction. Surgical simulation and optimal placement of internal fixations were performed on computer. After that, the individual simulated model of the pelvis was printed by the use of 3D printing and rapid prototyping technique. The order of reduction, selection and optimal position of the implants were determined. The plates were bent before operation and the length and direction of the screws were recorded. A uniform supra-ilioinguinal approach was used in all cases. Results The length of incision averaged 9 cm (range, 8-13 cm). The operative time average 130 min (range, 90-220 min). The blood loss averaged 600 ml (range, 300-1 500 ml). Once a satisfactory reduction was obtained, single placement of the plates was achieved. In accordance with the preoperative plan, the plates were perfectly fitted to the bone surface. The 24 patients were followed for an average time of 18.3 months (range, 15-30 months). The fractures healed in all cases. The average healing time was 4.2 months (range, 3-6 months). According to Matta criteria, there were 16 cases of excellent, 6 cases of good, 2 cases of poor and the excellent rate was 91.7% (22/24). The average modified Merle d'Aubigne score was 16.5 (range, 13-18). The functional outcome was excellent in 13 cases, good in 6 cases and poor in 5 cases. The excellent rate of hip functions was 79.2% (19/24). There were 2 cases of femoral lateral cutaneous nerve injury (recovered one month later) and another 1 case of fat liquefaction of the incision happened three days postoperatively (the wound healed completely after several dressing changes). No inguinal hernia or abdominal wall hernias was found. No other postoperative complications was found. Conclusion The application of 3D printing and rapid prototyping technique allows preoperatively simulating reduction in vitro, determining the optimal position of the implants, bending the plates and measuring the length of the screws in advance, which could largely reduce the operative time, intraoperative blood loss and occurrence of postoperative complications. Adopting supra-ilioinguinal approach for the treatment of complex acetabular fractures with a small incision and less trauma, a full exposure could be obtained, so the reduction and fixation of the anterior, posterior and middle column (also named pubo-ischiatic column) could be completed in a direct visualization, resulting in a satisfactory clinical outcomes. Key words: Imaging, three-dimensional; Acetabulum; Fractures, bone; Fracture fixation; Internal fixators

Transfer of the lateral antebrachial cutaneous nerve to the dorsal branch of the ulnar nerve without nerve graft in case of lower brachial plexus injuries: Anatomical and feasibility study

In the context of lower (C8–T1) brachial plexus injury, transfer of the lateral antebrachial cutaneous nerve (LABCN) to the dorsal branch of the ulnar nerve (DBUN) with an interposed sural nerve graft has been proposed to restore sensitivity on the ulnar side of the hand. The purpose of this study was to assess the feasibility of performing this transfer directly – without interposition of a nerve graft – by intraneural dissection of the DBUN. An anatomical study was performed with 20 upper limbs from adult human cadavers. The LABCN and the DBUN were dissected. The LABCN emerged from the lateral side of the biceps brachii muscle at an average of 2.6±0.4cm from the interepicondylar line and was 13.5±2.6cm long, on average. The DBUN arose from the ulnar nerve 8.2±1.6cm from the styloid process of the ulna. The maximum length of DBUN intraneural dissection relative to the ulnar nerve was 7.5±2.1cm, on average. The LABCN could be transferred to the DBUN in a tension-free manner with end-to-end suturing. Intraneural dissection of the DBUN allows LABCN nerve transfer without interposition of a graft.

Treatment of ulna coronoid process fracture with mini-plate internal fixation through modified anterior approach of elbow joint

Objective To investigate the curative effects of mini-plate internal fixation through modified anterior approach of elbow joint for the treatment of ulna coronoid process fracture. Methods From January 2013 to December 2015, 11 cases of ulna coronoid process fracture were treated by mini-plate internal fixation through modified anterior approach of elbow joint. The functional recovery of elbow joint was evaluated after the operation. Results All the patients were follow-up for 8 to 25 months with an average of 15.4 months. Bone healing was achieved in all the cases showed by X-ray. The range of motion was (115.00±8.56)° for elbow flexion and extension, (130.00±6.58)° for forearm rotation. According to Mayo Elbow Performance Score, the elbow function was rated as excellent in 6 cases, good in 4 cases, fair in 1 case. Mild heterotopic ossification occurred in 1 case. Lateral brachial cutaneous nerve injury occurred in 1 case. No infection, vascular injury, joint dislocation, traumatic arthritis and stiffness occurred. Conclusion In the treatment of ulna coronoid process fracture, elbow joint can be fully exposed by modified anterior approach and mini-plate internal fixation is reliable to achieve good clinical effect. Key words: Elbow joint; Fracture fixation, internal; Surgical approach; Mini plate

3-2-03. Does cervical radiculopathy complicate brachial plexopathy? An electrophysiological analysis

It is well known that cervical radiculopathy (CR) and neuralgic amyotrophy (NA) show very similar phenotype and sometimes difficult to differentiate each other. In 2015, we reported brachial plexus abnormality on three tesla magnetic resonance neurography (3T-MRN) in patients with CR. The purpose of this study is, to investigate signs of brachial plexus involvement with electrophysiological tests. We underwent retrospective chart review of 24 patients with CR from 2009 to 2014. In all patients, we performed 3T-MRN and nerve conduction study (NCS) to evaluate brachial plexus involvement. Mean age is 58 years old, and male patients dominated. Median disease duration was 60 days. Weakness and intervertebral foraminal stenosis were most frequent in C5 and C6 level. On 3T-MRN, brachial plexus involvement was detected in 70% of patients. Among NCS, Abnormal lateral antebrachial cutaneous nerve amplitude was most frequently detected (45%). Possible explanation for the brachial plexus involvement in patients with CR includes damage to dorsal root ganglion by herniated disc, and secondary immune-mediated mechanism involving brachial plexus, as suggested by van Alfen. We suggest phenotype of CR and NA may significantly overlap and we need to be cautious when making a diagnosis of NA.

Surgical Management of Acute Distal Biceps Tendon Ruptures.

➤ Acute distal biceps tendon ruptures are uncommon injuries that often affect young active males and typically result from an eccentric load on the dominant upper extremity.➤ Surgical treatment may be indicated to prevent substantial weakness in supination and flexion that can occur with nonoperative treatment.➤ Nonoperative management should be reserved for elderly or less active patients with multiple comorbidities, especially when the injury involves the nondominant arm.➤ Operative management can be performed using a single-incision or dual-incision technique, with multiple surgical options for tendon-to-bone fixation.➤ Single-incision repair techniques are more likely to be complicated by a transient neurapraxia, most often involving the lateral antebrachial cutaneous nerve, while dual-incision repair techniques are more likely to be complicated by heterotopic ossification and stiffness.

Variations in sural nerve formation pattern and distribution on the dorsum of the foot.

The sural nerve, a cutaneous nerve, is clinically important because it is frequently for nerve conduction testing, biopsy, and harvesting for nerve grafts. This nerve exhibits a wide variety of variation in formation, distribution on the dorsum of the foot, and so on, depending on the population observed. In this study, we examined the variation in the sural nerve in 110 Korean cadavers. Of these cadavers, 86.1% of the sural nerves corresponded to type A, where tibial and peroneal components were united to form the sural nerve. These two components most frequently united (65.9%) in the third quarter of the calf, and when the union position was expressed as a ratio to calf length, it corresponded to 0.408 in men and 0.346 in women, with a statistically significant difference. Due to this sexual dimorphism in addition to shorter calf length in females, the length of the sural nerve was shorter in females (male average length: 14.5 ± 4.8 cm; female average length: 11.4 ± 2.9 cm). In terms of distribution of the lateral dorsal cutaneous nerve, the distal continuation of the sural nerve on the dorsum of the foot, it showed variation in association with the superficial peroneal nerve. The innervation of the sural nerve extended most frequently up to the lateral two and a half toes, solely or in conjunction with the superficial peroneal nerve. Obtaining further information regarding sural nerve variation will be useful for various clinical procedures and interpretation of sural nerve conduction results. Clin. Anat. 30:525-532, 2017. © 2017 Wiley Periodicals, Inc.

Assessment of the potential efficacy of blind perineural injection techniques for blockade of the saphenous, obturator, and lateral cutaneous femoral nerves in dog cadavers.

OBJECTIVE To evaluate the potential efficacy of blind perineural injection techniques to provide nerve blockade of the saphenous, obturator, and lateral cutaneous femoral nerves by assessing the distribution along those nerves of 3 volumes of an injected staining solution in dog cadavers. ANIMALS 18 canine cadavers. PROCEDURES The anatomic characteristics of the target nerves were evaluated by dissection in 3 cadavers. The saphenous nerve was located by the use of superficial anatomic landmarks and a loss-of-resistance test. The obturator and lateral cutaneous femoral nerves were located by the use of superficial anatomic landmarks. Following perineural administration of 3 volumes (0.1, 0.2, and 0.3 mL/kg) of staining solution near the target nerves in 15 cadavers, the distribution of the staining solution along the nerves was evaluated. Staining that extended ≥ 2 cm along the target nerves was considered to be compatible with an effective clinical nerve block. RESULTS In all cadavers, nerves were appropriately stained by the blind techniques used here. The staining distribution along the nerves was considered to be optimal after perineural injection of 0.2 mL of staining solution/kg in the obturator and lateral cutaneous femoral nerves and 0.3 mL of staining solution/kg in the saphenous nerve. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that the evaluated blind perineural injection techniques may be an inexpensive, safe, and clinically effective method to block the saphenous, obturator, and lateral cutaneous femoral nerves in dogs.

An extensive study and review of literature about multiple variations of the lumbar plexus

Abstract Introduction: Lumbar plexus involves the L1 - L5 spinal segments for the formation of the nerves which supply parts of the abdominal wall, pelvis and the upper part of the thigh (both sensory and motor). Our aim in this study was to compile all the rare variations found in a single cadaver, which is of the rarest possible kind. Methods: During the dissection of the abdomen and pelvis in approximately 70 year old cadaver, there were multiple variations observed in the anatomy of the lumbar plexus. The entire region was cleaned for visibility of the variations and all those were clearly documented for compiling purpose. Results: The following variations in the formation of the lumbar and sacral nerves were observed. 1. The genitofemoral nerve bifurcated at a higher level; genital branch of genitofemoral nerve gave branches to the anterior abdominal wall muscles, 2. A communicating branch was given from the lateral cutaneous nerve of thigh to the medial cutaneous nerve of thigh, 3. A muscular branch was given from femoral nerve to psoas major, 4. There was absence of contribution of L4 spinal nerve in the formation of the lumbosacral trunk, and 5. Lumbosacral trunk gave communicating branches to the femoral and obturator nerves. Most of the variations found were rare and finding all the above said variations in a single cadaver is even rare. Conclusion: Knowledge of the normal anatomy and any possible variations would help the clinicians and surgeons dealing with this region and avoid possible complications beforehand.

Relevant Insertion Site Anatomy of the Conventus Distal Radius System.

The Conventus Distal Radius System (DRS) is an intramedullary fixation scaffold inserted into the lateral aspect of the distal radius. The purpose of this study was to identify insertion site anatomy to illustrate risks associated with the minimally invasive nature of radial-sided implant application. Ten cadavers were utilized. Using fluoroscopy, the 1.1-mm Kirschner wire and template was introduced per manufacturer's guidelines, access guide assembled, and dissection carried out to the superficial radial nerve (SRN) with preservation of the native location. The access guide marked the insertion location for the side-cut drill. This point was measured in relationship to structures nearby, including the SRN, brachioradialis (BR), lateral antebrachial cutaneous nerve (LABCN), and radial styloid (RS). The large guide contacted the SRN in 4 of 10 cadavers and was volar to it in 6 of 10. When volar, the mean distance was 1.7 mm. The tip of the RS to the large access guide averaged 44.5 mm. The small guide contacted the SRN in 2 of 10, was volar to it in 4 of 10, and between the bifurcation in 4 of 10. When volar, the distance averaged 3.25 mm. When bifurcated, the distance from the small guide to both the dorsal and volar branches was 3.5 mm. The distance from the RS to the small guide averaged 37.8 mm. The LABCN was found in the field of dissection in 4 of 10 cadavers. Several structures are at risk during insertion of the Conventus DRS; thus, knowledge of the relevant anatomy of this minimally invasive approach is crucial to optimize outcomes and patient satisfaction, and to avoid nerve injury.

Anomalous Innervation of the Median Nerve in the Arm in the Absence of the Musculocutaneous Nerve.

The brachial plexus innervates the upper extremities. While variations in the formation of the brachial plexus and its terminal branches are quite common, it is uncommon for the median nerve to innervate the muscles of the arm. During the dissection of an elderly male cadaver at the Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India, in 2016, the coracobrachialis muscle was found to be supplied by a direct branch from the lateral root of the median nerve and the musculocutaneous nerve was absent. The branches of the median nerve supplied the biceps brachii and brachialis muscles and the last branch continued as the lateral cutaneous nerve of the forearm. These variations may present atypically in cases of arm flexor paralysis or sensory loss on the lateral forearm. Knowledge of these variations is important in surgeries and during the administration of regional anaesthesia near the shoulder joint and upper arm.

Radial Nerve Injury after Venipuncture.

Venipuncture is the most commonly performed invasive procedure in hospitals daily.[1] Nerves in the antecubital fossa classically lie on a plane just beneath and in close proximity to the veins, making them susceptible to injury during phlebotomy.[1] Cadaveric studies have demonstrated a great deal of variability in the nerves of the antecubital fossa in relationship to veins, suggesting that even a nontraumatic, straightforward venipuncture can directly damage a cutaneous nerve.[2] Despite this, there remains a relative paucity in the literature reporting cases of peripheral nerve injury secondary to venipuncture. Of the few reported cases, an even smaller percentage of these have been validated with electrodiagnostic evidence of injury. The majority of these studies report injury to the lateral antebrachial cutaneous nerve. To the best of our knowledge, there has been only one reported case in current literature of radial nerve injury.

Estudo dos nervos do membro pélvico do Tamandua tetradactyla / Study of the nerves of the pelvic limb of Tamandua tetradactyla

O objetivo deste estudo foi descrever a distribuição dos nervos do membro pélvico do T. tetradactyla. Para tanto, foram utilizados quatro cadáveres de animais adultos cedidos pelo IBAMA-GO. Cada animal teve o membro pélvico de ambos os antímeros dissecados após fixação em solução de formaldeído a 10%. Os nervos genitofemoral e cutâneo femoral lateral distribuíram-se na pele medial e craniomedial e craniolateral da coxa, respectivamente. O nervo femoral emitiu ramos para os músculos psoas menor, iliopsoas, sartório e pectíneo; terminando por penetrar no músculo quadríceps femoral. Emitiu o nervo safeno, que em seu trajeto, inervou a pele da face medial da coxa e perna e região dorsomedial do pé. O nervo obturador emitiu ramos para músculos mediais da coxa. Os nervos glúteos cranial e caudal inervaram a musculatura glútea. O nervo isquiático inervou os músculos gêmeos, quadrado femoral, semimembranoso, semitendinoso, bíceps femoral longo e curto e terminou dividindo-se nos nervos cutâneo lateral da sura, tibial, e fibular comum. O nervo cutâneo lateral da sura inerva a região cutânea craniolateral do joelho e perna, enquanto os nervos fibular comum e tibial inerva a musculatura da perna e terminam distribuindo-se no pé.

Comparison of the anesthetic effect of ultrasound-guided brachial plexus block by different approaches in distal radius surgery

Objective To compare the anaesthetic effect of ultrasound-guided brachial plexus block by different approaches (interscalene, axillary, supraclavicular) in distal radius surgery. Methods Ninety adult patients undergoing elective surgery for distal radius fracture open reduction and internal fixation, distal radius fracture after implant removal surgery distal radius fracture, were randomly divided into interscalene group(group A), axillary group(group B) and supraclavicular group (group C) for brachial plexus block under ultrasound-guided(n=30). The performance time and complications were recorded. Besides, the onset time and block execution time of median nerve, ulnar nerve, radial nerve, lateral medial cutaneous nerve, forearm medial cutaneous nerve were evaluated. Results There is no significant difference in performance time(P>0.05) and the onset time of pain block in median nerve, radial nerve, lateral medial cutaneous nerve (P>0.05). As for ulnar nerve and medial antebrachial cutaneous nerve, there were no difference in onset time of pain block between group A[(21±6) min] and group C[(20±5) min] (P>0.05), but they were longer than group B[(8±5) min] (P 0.05), but they were longer than group B[(10±6) min] (P<0.05). The complete suceess rate of group B(90%) were higher than other two groups. We found that two patients in group A and one patient in group C were complicated with phrenic nerve block and one patient in group B showed little tolerance of tourniquet. Conclusions Ultrasound-guided axillary brachial plexus block in the distal radius surgery is recommended because of better blockage of ulnar nerve and medial antebrachial cutaneous nerve and fewer complications. Key words: Ultrasound; Brachial plexus block; Distal radius

Ultrasound-guided interventions on the peripheral nervous system

Up to the advent of high-resolution ultrasound, interventions on the peripheral nervous system, including local anesthesia and pain treatment were performed without visual guidance, which in some cases led to treatment failure or local tissue and nerve damage. Progress in the field of ultrasound has enabled the functional visualization, anesthesia and anti-inflammatory or neurolytic treatment of many peripheral nerves, such as the brachial plexus, nerves of the upper and lower extremities and various nerves of the trunk. Contrast medium-guided biopsies have also become feasible. This article discusses the general prerequisites for such interventions and details the visualization and the interventional algorithms for interventions on the brachial plexus, on large nerves often affected by compression neuropathies, such as the median, ulnar, sciatic and femoral nerves and small nerves, such as the lateral cutaneous nerves of the thigh. Furthermore, contrast medium-aided biopsies of intraneural and perineural masses are discussed. Finally, the treatment of stump neuromas via phenol instillation is described. Innovations in high-resolution ultrasound allow the reliable and safe diagnosis and treatment of various pathologies of the peripheral nervous system with few side effects. Compared to older methods, which did not use visual guidance ultrasound provides higher success rates and lower adverse event rates in many instances.

Cicatrical and adhesive deformation of the right lateral cutaneous nerve after laparoscopic preperitoneal hernioplasty

Cicatrical and adhesive deformation of the right lateral cutaneous nerve after laparoscopic preperitoneal hernioplasty

Human Cadaveric Study of Lumbar Plexus and its Clinical Implication

Abstract Background &amp; Aims: The Lumbar plexus describes the origins of 4 of the nerves supplying the lower limb (femoral, lateral cutaneous nerve of the thigh, obturator and genitofemoral) along with the ilioinguinal and iliohypogastric nerves. Aim of this study is to study the abnormalities in formation of lumbar plexus and communication between the branches of lumbar plexus and its clinical implication. Material &amp; Method: This study was conducted on 100 cadavers (67 male and 33 female) with an age range of 50 – 90 years. Results: No abnormality was found related to roots and trunk. Post fixed lumbar plexus (bilateral) were found in 6 cadavers. Genital branch and femoral branch was found to arise separately from the root in 22 cadavers (bilaterally). Accessory lateral femoral cutaneous nerve was observed on both sides in 4 cadavers. Femoral nerve was found to arise from dorsal division of L3-4-5 in 8 cadavers (bilateral). Accessory obturator nerve was found bilaterally in 26 cadavers and it was arising from L3-4. Conclusion:Knowledge of variations in the formation and branching pattem of lumbar plexus is very important during lumbar plexus block for various surgical and palliative procedures.