Traumatic Brachial Plexus Research Articles

Nerve transfers in children with traumatic partial brachial plexus injuries

Brachial plexus trauma is a rare condition in children except for obstetrical lesions, for which nerve grafting is generally proposed. Two children (9 and 12 years old) with C5 and C6 traumatic brachial plexus avulsion lesions are presented, where elbow flexion and shoulder abduction and external rotation were the functions to be restored. Nerve transfers have been performed. Shoulder abduction was restored by an accessory-to-suprascapular nerve transfer in one patient, while the triceps long head motor branch was transferred to the axillary nerve in both patients. Fascicles of the ulnar and median nerve were transferred respectively to the biceps muscle nerve and the brachialis motor branch. At 11 months follow-up, the elbow flexion scored M4 and the shoulder abduction recovered in both patients. No complications were observed. Nerve transfers currently used in adult patients may be applied in children with traumatic partial brachial plexus palsies.

Magnetic resonance neurography in children with birth-related brachial plexus injury

Magnetic resonance neurography (MRN) enables visualization of peripheral nerves. Clinical examination and electrodiagnostic studies have been used in the evaluation of birth-related brachial plexus injury. These are limited in their demonstration of anatomic detail and severity of injury. We investigated the utility of MRN in evaluating birth-related brachial plexus injury in pediatric patients, and assessed the degree of correlation between MRN findings and physical examination and electromyographic (EMG) findings. The MRN findings in 11 infants (age 2 months to 20 months) with birth-related brachial plexus injury were evaluated. A neuroradiologist blinded to the EMG and clinical examination findings reviewed the images. Clinical history, examination, EMG and operative findings were obtained. All infants had abnormal imaging findings on the affected side: seven pseudomeningoceles, six neuromas, seven abnormal nerve T2 signal, four nerve root enlargement, and two denervation changes. There was greater degree of correlation between MRN and physical examination findings (kappa 0.6715, coefficient of correlation 0.7110, P < 0.001) than between EMG and physical examination findings (kappa 0.5748, coefficient of correlation 0.5883, P = 0.0012). MRN in brachial plexus trauma enables localization of injured nerves and characterization of associated pathology. MRN findings demonstrated a statistically significant correlation with physical examination and EMG findings, and might be a useful adjunct in treatment planning.

Transfer of the Accessory Nerve to the Suprascapular Nerve in Brachial Plexus Reconstruction

Transfer of the accessory nerve to the suprascapular nerve is a common procedure, performed to reestablish shoulder motion in patients with brachial plexus palsy. We propose dissecting both nerves via a distal oblique supraclavicular incision, which can be prolonged up to the scapular notch. The results of the transfer to the suprascapular nerve are compared with those of the combined repair of the suprascapular and axillary nerves. Thirty men between the ages of 18 and 37 years with brachial plexus trauma had reparative surgery within 3 to 10 months of their injuries. In partial injuries with a normal triceps, a triceps motor branch transfer to the axillary nerve was performed. The suprascapular and accessory nerves were dissected via an oblique incision, extending from the point at which the plexus crosses the clavicle to the anterior border of the trapezius muscle. In 10 patients with fractures or dislocations of the clavicle, the trapezius muscle was partially elevated to expose the suprascapular nerve at the suprascapular notch. In all cases, transfer of the accessory to the suprascapular nerve was performed without the need for nerve grafts. A double lesion of the suprascapular nerve was identified in 1 patient with clavicular dislocation. In those with total palsy, the average improvement in range of abduction was 45 degrees , but none of the patients with total palsy recovered any active external rotation. Patients with upper-type injury recovered an average of 105 degrees of abduction and external rotation. If only patients with C5-C6 injuries were considered, the range of abduction and external rotation increased to 122 degrees and 118 degrees , respectively. Use of the accessory nerve for transfer to the suprascapular nerve ensured adequate return of shoulder function, especially when combined with a triceps motor branch transfer to the axillary nerve. The supraclavicular exposure proposed here for the suprascapular and accessory nerves is advantageous and can be extended easily to explore the suprascapular nerve at the scapular notch.

Guillain-Barré syndrome after brachial plexus trauma: case report

The Guilllain-Barré syndrome (GBS) is an acute predominantly demyelinating polyneuropathy. In many cases GBS is preceding by infection, immunization, surgery or trauma. Although there are a few reports of GBS after head trauma, there is no report of this syndrome after brachial plexus injury. We report on a 51 years-old man who presented GBS fifteen days after a brachial plexus trauma. The polineuropathy resolved completely in a few weeks. We believe that GBS was triggered by the trauma that evoked an immune mediated disorder producing inflammation and demyelination of the peripheral nerves.

Сombination damage of brachial plexus and craniocerebral trauma. Peculiarity of diagnostics and clinical symptoms

Сombination damage of brachial plexus and craniocerebral trauma. Peculiarity of diagnostics and clinical symptoms

Nerve fibers in lumbar spine structures and injured spinal roots express the sensory neuron-specific sodium channels SNS/PN3 and NaN/SNS2.

This prospective study examined the innervation of lumbar spine in tissues from patients with lower back pain and spine nerve roots from patients with traumatic brachial plexus injuries. To demonstrate the presence of nerve fibers in lumbar spine structures and spine nerve roots, and to determine whether they express the sensory neuron-specific sodium channels SNS/PN3 and NaN/SNS2. The anatomic and molecular basis of low back pain and sciatica is poorly understood. Previous studies have demonstrated sensory nerves in the facet joint capsule and prolapsed intervertebral disc, but not in the ligamentum flavum. The voltage-gated sodium channels SNS/PN3 and NaN/SNS2 are expressed by sensory neurone that mediate pain, but their presence in the lumbar spine is unknown. Tissue samples of ligamentum flavum (n = 32), facet joint capsule (n = 20), intervertebral disc (n = 15), and spine roots (n = 8) were immunostained with specific antibodies to protein gene product 9.5 (a panneuronal marker), SNS/PN3, and NaN/SNS2. Protein gene product 9.5 immunoreactive nerve fibers were detected in 72% of the ligamentum flavum specimens and 70% of the facet joint capsule specimens, but in only 20% of the intervertebral disc specimens. The study detected SNS/PN3- and NaN/SNS2-positive fibers, respectively, in 28% and 3% of the ligamentum flavum specimens and 25% and 15% of the facet joint capsule specimens. Numerous SNS/PN3- and NaN/SNS2-positive fibers were found in the acutely injured spine roots, and some were still present in the dorsal roots in the chronic state. As the findings showed, SNS/PN3- and NaN/SNS2-immunoreactivity is present in a subset of nerve fibers in lumbar spine structures, including ligamentum flavum, and in injured spine roots. Selective SNS/PN3- and NaN/SNS2-blocking agents may provide new therapy for back pain and sciatica.

Upper root brachial plexus trauma; patient selection and reconstruction

Injury to the brachial plexus is increasingly common and the initial management of these patients is usually focused on associated life threatening injuries. Appreciation of the management of the brachial plexus injury can greatly assist with subsequent reconstruction and thus we review our experience in this field. A total of nine patients who underwent upper root brachial plexus reconstruction over the period 1980–1998 were reviewed. Causes of injury included road traffic accidents ( n = 6), open injuries ( n = 2) and the remaining case was iatrogenic. All patients had cabled grafting of the plexus while one patient had neurotization of the plexus in addition to grafting. Sixty six percent ( n = 6/9) of patients had a good outcome with return of elbow flexion. Patients with an open injury to the plexus had a better prognosis than those who had a closed injury. Polytrauma patients and those with penetrating neck injuries should be assessed to exclude brachial plexus injury. Baseline assessment and early involvement of surgeons with an interest in this area will help select those patients who will benefit from brachial plexus reconstruction.

Restoration of elbow flexion after brachial plexus injury: the role of nerve and muscle transfers.

Brachial plexus trauma results in a variable loss of upper extremity function. The restoration of this function requires elbow flexion of adequate strength and range of motion. A proper evaluation of brachial plexus lesions is a prerequisite to any reconstructive procedure, and appropriate guidelines are presented. One option for restoring elbow flexion is a nerve transfer. The best results with this procedure are obtained in young patients treated within 6 months of injury. Another option is a free or pedicled muscle transfer, which should be considered in older patients or patients treated more than 6 months after an injury. Muscle transfers may also be used to augment the results of nerve transfer procedures. Choices and clinical results of donor nerves and muscle for transfer are discussed, and an algorithm for treatment is presented.

The odontoid synchondrotic slip: an injury unique to young children

We report seven children (three female, four male) diagnosed with traumatic synchondrotic slip of the odontoid. The clinical records, plain films and CT scans were evaluated retrospectively. The patients ranged in age between 3 and 5 years. Their injuries resulted from a motor vehicle accident in four cases and from a fall from a height in three. The injury was isolated in five; it was associated with a closed head injury in one and with facial and brachial plexus trauma in another. Radiographs showed anterior angulation with or without displacement in all seven cases. Axial CT with sagittal reformation and 3D reconstructions were performed in six cases. This confirmed the synchondrotic slip and, in addition, identified a rotary component to the injury in three cases, with compromise of the canal in two. Other additional injuries were also noted. All cases were treated conservatively and the injuries healed. Only one child had a neurological deficit attributable to her head injury rather than her cervical injury (MR of the cervical cord was normal). The presence of the synchondrosis between the dens and the body of C-2 makes this injury unique to children under 7 years of age; by the age of 7 the synchondrosis has fused.

Modern aspects of the treatment of traumatic brachial plexus injury

In the domestic literature, the issues of modern treatment of traumatic injury to the brachial plexus were not widely covered. Among peripheral nerve injuries, brachial plexus trauma ranks third in frequency, and first in terms of the degree and severity of disability. Due to the anatomical structure of the brachial plexus trunks, a variety of mechanisms and levels of damage, clinical forms of their manifestations, as well as various concomitant lesions create difficulties in the diagnosis of localization, the extent of the pathological process and its treatment. Modern diagnostic methods and the introduction of microsurgical techniques have significantly improved the results of the restoration of the functions of the upper limb.

La main plexique (l'atteinte de la main dans les lésions traumatiques du plexus brachial de l'adulte)

After spontaneous recovery following brachial plexus injuries, or after nerve regeneration following nervous surgery on traumatic brachial plexus, there usually is a variable residual distal deficit involving the hand and wrist. This deficit is defined by both a functional approach, and its anatomical nervous correspondence, in order to predict which motor muscles will be available for palliative surgery, and to establish the most reasonable therapeutic plan. Total palsy of the hand will only be mentioned, whereas three main presentations of the "plexic hand" are of a greater surgical interest and will be detailed: the "wrist drop", due to C5 C6 +/- C7 supra-clavicular lesions, the hand presenting with a deficit of digit flexion, pinch and intrinsic functions, due to C8 T1 +/- C7 supra-clavicular lesions, non-standardized deficits due to infra- and retro-clavicular lesions, whose therapeutic indications and prognosis are closer to more classical trunk palsies. The review of 44 "plexic hands" after distal palliative surgery indicates the need to modify the fundamental rules of tendinous transfer surgery, and suggests new principles properly adapted to the surgery of plexic hand palsies.

The investigation of traumatic lesions of the brachial plexus by electromyography and short latency somatosensory potentials evoked by stimulation of multiple peripheral nerves.

A study of 10 patients with brachial plexus trauma was performed to determine whether the diagnostic accuracy of sensory evoked potentials (SEPs) may be improved by using stimulation of multiple peripheral nerves (median, radial, musculocutaneous and ulnar). In addition, the relative advantages of SEPs and peripheral electrophysiological studies were considered. SEP patterns following most common brachial plexus lesions were predictable. Injuries to the upper trunk affected the musculocutaneous and radial SEPs predominantly. Lower trunk or medial cord lesions primarily affected ulnar SEPs. Diffuse brachial plexus lesions affected SEPs from all stimulation sites. In the majority of cases, the necessary information was obtainable from conventional EMG: however, for lesions involving the upper segments only, SEP techniques were more useful. It is suggested that selective SEPs from appropriate peripheral nerves when interpreted in combination with conventional EMG may add useful additional information.

BRACHIAL PLEXUS INJURIES

The Journal of Bone and Joint Surgery. British volumeVol. 31-B, No. 1 EditorialsFree AccessBRACHIAL PLEXUS INJURIESH. J. SeddonH. J. SeddonSearch for more papers by this authorPublished Online:1 Feb 1949https://doi.org/10.1302/0301-620X.31B1.3-aAboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byParalytic DisordersParalytic DisordersUpper root brachial plexus trauma; patient selection and reconstructionInjury, Vol. 33, No. 1Nonobstetric brachial plexus injuriesJournal of the American Society for Surgery of the Hand, Vol. 1, No. 2Strategies in the Microsurgical Management of Brachial Plexus InjuriesClinics in Plastic Surgery, Vol. 16, No. 3Surgical Management of Brachial Plexus Birth Injuries12 November 2008 | Developmental Medicine & Child Neurology, Vol. 30, No. 6 Vol. 31-B, No. 1 Metrics History Published online 1 February 1949 Published in print 1 February 1949 InformationCopyright © 1949, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download