Traumatic Plexus Injury Research Articles

Effects of a New Sensory Re-Education Training Tool on Hand Sensibility, Manual Dexterity and Functional Activities of Daily Living in People with Traumatic Brachial Plexus Injury (Pilot Study)

The protocols of sensory re-education programs have not changed in recent decades even with the advancement in Neuroscience and cognitive science. Based on the current knowledge and developments in neuro physiology to enhance cortical mapping, this study describe and evaluate the effects of a modified clinical-based sensory re-education training tool not only on hand sensibility and manual dexterity but also functional ADL as well. The study was conducted on ten participants (N=10) with Traumatic brachial Plexus injury (TBPI) with upper extremity sensory deficits participate in the study. Participants were divided equally into control group (n=5) and experimental group (n=5). The experimental group were assigned to 8-week of 12-session intervention phase of sensory re-education program. Measurements used were the Semmes Weinstein monofilaments test, nine-hole peg test, turning fork test, Nottingham Extended activities of daily living and the Michigan Hand Outcome questionnaire. Measurements were collected at baseline, following the control phase and at the end of the intervention. Outcome of this study shows that, Compared to control group, experimental group demonstrated significant improvement in both Nottingham extended ADL scale and Michigan Hand Outcomes Questionnaire (MHQ) in functional Activities of Daily Living (fADL) with (p<0.05). However, No significant differences were observed as to the nine hole peg test and the monofilament tests. In conclusion, sensory re-education training not necessarily affects the level of sensory impairment in the hand but may lead to improvement in functional ADL measures.

A clinical study on the pain following brachial plexus injury and its correlative factors

Objective To evaluate the characteristic and correlative factors of pain following traumatic brachial plexus injury and the impact of surgery on pain. Methods This study was a prospective, self-controlled study. Each enrolled patient was asked to respond to the revised short form McGill pain (SF-MPQ-2) and neuropathic pain symptom inventory (NPSI) questionnaire before and after surgery. Multiple factors analysis on pain was carried out and the effect of surgery on pain was evaluated. Results The total number of the study was 100 patients. Both of the SF-MPQ-2 38.33±30.38 and NPSI 15.62±14.84 scores after surgery were significantly lower than those before surgery SF-MPQ-2 50.13±36.55; NPSI 20.24±16.84. The highest score appeared in affective descriptors of the four subscales in SF-MPQ-2 and the score of paresthesia was the highest in the 5 divisions of NPSI, no matter before or after surgery. The postoperative scores of deep pain, evoked pain and paresthesia were significantly lower than the preoperative scores. Preoperative pain was related to whether nerve continuity existed or not (SF-MPQ-2: r=-0.2198, P=0.0280; NPSI: r=-0.2322, P=0.0201). The postoperative SF-MPQ-2 and NPSI scores were significantly lower than preoperative scores in motorcycle accident and weight dropping groups. The SF-MPQ-2 and NPSI scores were the highest in global brachial plexus injury group before and after operation. The SF-MPQ-2 and NPSI scores in global brachial plexus injury group or upper and middle trunks injury group after surgery were significantly lower than those before surgery. The postoperative SF-MPQ-2 and NPSI scores in nerve transfer or neurolysis group were significantly lower than preoperative scores. Conclusion In the study, according to SF-MPQ-2 and NPSI evaluation, affective descriptors and paresthesia accounted for the largest proportion in pain expression. Nerve transfer or neurolysis might have a positive effect on prognosis of neuropathic pain for traumatic brachial plexus injury. Surgery might relieve deep pain and evoked pain and paresthesia. Key words: Brachial plexus; Prospective studies; Neuropathic pain; SF-MPQ-2; NPSI

Acral necrosis and upper brachial plexus palsy after prenatal fetal thrombosis

Abstract Intrauterine fetal thrombosis is an extremely rare event with a devastating outcome. The etiology of the condition often remains unclear. A 29-year-old 2nd gravida 1st para presented with mild preeclampsia at 34 weeks of gestation with pathological cardiotocography (CTG), but normal resistance indices in the umbilical and the uterine arteries. The fetal middle cerebral artery (MCA) displayed a significantly reduced pulsatility index (PI). An immediate cesarean section was performed and a male neonate with a birth weight of 2300 g was delivered. Immediately after birth, a progressive necrosis of the neonate’s 4th right final finger link and a palsy of the right brachial plexus were observed. MRI and ultrasound imaging did not display mechanical injuries. The Doppler ultrasound showed a thrombus in the right common carotid and subclavian artery with poststenotic decreased blood flow of the right middle cerebral artery. Further analysis did not reveal inherited or acquired thrombophilias of the neonate. The puzzling prenatal finding of a markedly decreased PI in the MCA as well as the initially suspected postnatal diagnosis of traumatic plexus injury were clarified by the diagnosis of the thrombosis.

An Approach to the Supraclavicular and Infraclavicular Aspects of the Brachial Plexus

The surgical approach to the brachial plexus is of great importance during surgery for brachial plexus injuries--obstetric or traumatic. A number of different approaches have been described over the years for these injuries, with each 1 having its own advantages and disadvantages. We describe a novel approach to the supra-clavicular and infra-clavicular aspects of the brachial plexus, which has been used by senior author successfully for the past 15 years. It involves creation of 2 windows, 1 above and 1 below the clavicle in case of adult traumatic plexus injuries. A slight variation of joining the 2 incisions and creation of a laterally based cervicopectoral flap is used for obstetric brachial plexus injuries along with the use of clavicular osteotomy. The advantages of this approach are that it gives rapid access to the brachial plexus; wide exposure can be obtained for all regions of the plexus and donor nerves such as the spinal accessory nerve can be harvested in the same incision.

New approaches in imaging of the brachial plexus

Imaging plays an essential role for the detection and analysis of pathologic conditions of the brachial plexus. Currently, several new techniques are used in addition to conventional 2D MR sequences to study the brachial plexus: the 3D STIR SPACE sequence, 3D heavily T2w MR myelography sequences (balanced SSFP = CISS 3D, True FISP 3D, bFFE and FIESTA), and the diffusion-weighted (DW) neurography sequence with fiber tracking reconstruction (tractography). The 3D STIR sequence offers complete anatomical coverage of the brachial plexus and the ability to slice through the volume helps to analyze fiber course modification and structure alteration. It allows precise assessment of distortion, compression and interruption of postganglionic nerve fibers thanks to the capability of performing maximum intensity projections (MIP) and multiplanar reconstructions (MPRs). The CISS 3D, b-SSFP sequences allow good visualization of nerve roots within the spinal canal and may be used for MR myelography in traumatic plexus injuries. The DW neurography sequence with tractography is still a work in progress, able to demonstrate nerves tracts, their structure alteration or deformation due to pathologic processes surrounding or located along the postganglionic brachial plexus. It may become a precious tool for the understanding of the underlying molecular pathophysiologic mechanisms in diseases affecting the brachial plexus and may play a role for surgical planning procedures in the near future.