Upper Trunk Of Brachial Plexus Research Articles

Nerve ultrasound studies in POEMS syndrome.

The aim of our study was to assess the ultrasonographic features of peripheral nerves in patients with POEMS (polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes) syndrome. 34 POEMS syndrome patients and 26 healthy control (HC) participants were recruited prospectively. Cross-sectional area (CSA) was measured in nerves of limbs, trunks of brachial plexus, and cervical nerve roots RESULTS: The CSAs were mildly enlarged at the arm segment of median nerve, elbow segment of ulnar nerve and upper trunk, moderately enlarged at the forearm segment of both median and ulnar nerve, upper trunk of brachial plexus, and C6, C7 cervical nerve roots, and markedly enlarged at the arm segment of ulnar nerve, middle and lower trunk of brachial plexus, as well as C5 cervical root. The CSAs of upper limb nerves were larger in POEMS syndrome patients than in HCs, and the enlargements were most prominent proximally.

Selective blockade of supraclavicular nerves and upper trunk of brachial plexus "The SCUT block" towards a site-specific regional anaesthesia strategy for clavicle surgeries - A descriptive study.

Background and Aims:Commonly, the superficial cervical plexus and interscalene block were combined to provide surgical anaesthesia for procedures on the clavicle, which are neither selective nor site-specific considering the innervation of the clavicle. The aim was to analyse effectiveness and block dynamics of selectively blocking supraclavicular (SC) nerves and upper trunk (UT) of brachial plexus (SCUT BLOCK) as a site-specific regional anaesthesia strategy for clavicle surgery.Methods:SC nerves and UT were blocked with 3-ml and 5-ml local anaesthetic, respectively, in 70 American Society of Anesthesiologists I and II patients aged above 18 years, undergoing clavicle surgery. Sensory-motor conduction blockade was assessed in both the plexus territories, following which surgery ensued. Number of patients who exhibited complete conduction blockade of the targeted nerves, number of surgeries completed under the block, intraoperative rescue analgesics, duration of postoperative analgesia and complications were recorded.Results:Sensory and motor mapping showed complete conduction blockade of the targeted nerves in all patients, all other branches were spared. The surgery was completed exclusively under block in 67 (Strategy success rate 96%) out of 70 patients. Intraoperatively, two patients required supplementation of block with a local infiltration and general anaesthesia was administered for one patient. The mean duration of postoperative analgesia was 5 (1.2) hours [mean (standard deviation)]. Only one patient developed ptosis; no other complications were noted.Conclusions:“The SCUT block” is an effective site-specific regional anaesthesia strategy for clavicle surgery.

Erb’s Palsy in a Newborn Child and Clinicoanatomical Approach

Erb’s palsy is found in upper trunk of brachial plexus. C5, C6 roots join to from upper trunk. Each trunk again divides into anterior and posterior divisions. All trunks and divisions are found above the clavicle in the posterior triangle of neck. Branches from the upper trunk are suprascapular nerve and nerve to subclavius. Suprascapular nerve supplies supraspinatus and infraspinatus muscle along with it a articular trig to capsule of shoulder joint. Supraspinatus helps in initial 15 ºabduction at shoulder joint. Infraspinatus acts as lateral rotator of shoulder joint and assists subscapularis and teres minor muscles to abduct at this joint when there is contraction of middle fibers of deltoid and supraspinatus. Some fibers of C5 also give contribution to accessory phrenic nerve. Lateral cord of brachial plexus giving– musculocutaneous nerve, lateral pectoral nerve, lateral root of median nerve. Musculocutaneous nerve supplies all flexor muscles of arm like biceps brachii, brachialis, coracobrachialis. Brachialis muscle flexes the elbow joint, coracobrachialis is a weak flexor of shoulder joint and biceps brachii is a strong supinator of forearm, flexor of elbow joint only when forearm is supinated. Injury occurs in the Erb’s point found in the upper trunk of brachial plexus where there are emergence of six branches- C5 & C6 nerve roots, suprascapular nerve, nerve to subclavius, anterior and posterior division of upper trunk of the plexus. In this palsy, the arm remains medially rotated and adducted at the shoulder joint, the elbow is extended or semiflexed, forearm is pronated, and the wrist semiflexed. In this case a newborn child was found unable to flex his elbow, and abducted the arm on the right side. The limb is medially rotated, adducted in shoulder joint, semiflexion at the elbow joint and forearm pronated and wrist semiflexed. The child was kept on artificial respiratory ventilation. Plain Chest X-ray done to see if any musculoskeletal abnormality is there but no positive findings found so far. Both the clavicles and all ribs were found intact. Both domes of diaphragm were moving normally. On the other hand left sided upper limb found fully flexed at the elbow joint, supinated at forearm, abducted externally rotated at the shoulder joint and wrist extended. Moros reflex on the right side was absent but on left side it was clearly present. So, there is asymmetrical Moros reflex.

Surgical Outcome of Peripheral Nerve Injury

: Our article focuses on various surgical treatments and outcomes in patients who had upper and or lower extremity musculoskeletal disorders due to peripheral nerve injuries. Here, we mainly discuss the benefits of the Nath method of surgical management in infants, children (preteen and teen), and adult patients in the following four categories of peripheral nerve damage. Brachial Plexus Injury and Upper Extremity Musculoskeletal Dysfunctions: Improvements in detail are discussed in obstetric brachial plexus palsy patients, who had the soft tissue surgical procedure, modified Quad, and the novel osseous operative technique, triangle tilt at our clinic. Upper Trunk of Brachial Plexus and Long Thoracic Nerve Damage and Winging Scapula: There are at least 18 categories of causation/etiology of upper plexus and long thoracic nerve lesions in 575 patients who visited our clinic with winging scapula, limited shoulder movements, and or pain. Further, we discuss the results of the excellent recovery of hundreds of these patients, who had decompression and neurolysis of the upper trunk of brachial plexus and long thoracic nerve. Peroneal Nerve Lesion and Foot Drop:: Our management of foot drop by nerve transfers to the deep peroneal nerve is discussed. Sural Nerve Grafting to Cavernous Nerve Impairment after Prostatectomy or Genital Surgery: We also discuss briefly our experience and results of the sural nerve grafting, which restores the function of cavernous nerves resected during radical prostatectomy. Conclusion: The lead author (RKN) has developed and implemented several innovative new surgical approaches as a reconstructive microsurgeon. These surgical techniques have proven clinical and functional improvements in patients with upper and lower extremity musculoskeletal disorders due to peripheral nerve injuries.

Cadaver dissection study of the pectoral nerves for feasibility in brachial plexus injuries

Injury to upper trunk of Brachial Plexus is the most common injury pattern. Major functions affected those of supra scapular nerve (SSN), axillary nerve (AXN) and musculocutaneous nerve (MCN) which resulting dysfunction of elbow flexion shoulder abduction and internal rotation. Intra‐plexal nerve donors are more efficacious than extra‐plexal nerve donors and expendable.

An Uncommon Variation In The Formation Of Trunks Of The Brachial Plexus A Case Report.

Brachial plexus is the nerve plexus which gives innervation to the upper limb. Variation in the formation of brachial plexus is often reported. But variation in the trunk stage of brachial plexus is very rare. In this case report, we report an unusual variation in the formation of trunks of brachial plexus found in an elderly male cadaver during routine dissection. The upper trunk of brachial plexus was normal. The middle and lower trunks fused to form a common trunk. This was observed bilaterally. The upper trunk divided into anterior and posterior divisions. The common trunk divided into three divisions, anteromedial, anterolateral and posterior. The anterolateral division of common trunk joined with the anterior division of upper trunk and formed the lateral cord. The posterior division of common trunk joined with the posterior division of upper trunk and formed the posterior cord and the anteromedial division of common trunk continued as medial cord. The branches arising from the cords were normal.

English

AIM: The suprascapular nerve arises from the upper trunk of brachial plexus, passes through the suprascapular notch and then through the spinoglenoid notch and supplies the supraspinatus and the infraspinatus muscles. Due to the presence of anatomical variations in the shape of the suprascapular notch, there may be compression of the suprascapular nerve which leads to suprascapular nerve entrapment syndrome. The present study is a simple method to classify the suprascapular notch of dried human scapulae and its clinical significance. MATERIALS & METHOD: 42 dried human scapulae of both sides were examined for variations in the shape of suprascapular notch. RESULT: Mainly three different shapes were observed. They are U, V & J. Some scapulae are having suprascapular foramen instead of notch and some are having absent suprascapular notch.

An experimental study on outcome of ipsilateral C7 nerve root transfer to repair the root avulsion of the brachial plexus

To experimentally compare the treatment outcome of the injured upper limb of the root avulsion of C5 and C6 of the brachial plexus repaired by ipsilateral C7 nerve root transfer and other three multiple nerve transfers. One hundred and twenty SD rats of simulated C5 and C6 root avulsion randomly divided into 4 groups, and 30 each underwent various combined nerve transfers. Group A: the ipsilateral C7 root transferred to the upper trunk of brachial plexus and the spinal accessory nerve to the suprascapular nerve; Group B: partial fascicles of the ulnar nerve transferred to the biceps branch (Oberlin's procedure), the spinal accessory to the suprascapular and branches to the triceps long head to the axillary nerve; Group C: the phrenic transferred to the musculocutaneous, cervical plexus motor branches to the lower trunk (axillary nerve) of brachial plexus and the spinal accessory nerve to the suprascapular nerve; Group D: the phrenic transferred to the musculocutaneous and the spinal accessory nerve to the suprascapular nerve. Neurotization outcomes were evaluated at 3, 6 and 12 weeks postoperatively by comparing changes of behavioral tests (Ochiai clinical scores, Barth Foot-fault test and Terzis grooming test), neurophysiological investigations and muscular histology. At 3 weeks after operation, no significant difference was found between Group A and other three control groups in the three behavioral evaluations. Neurophysiologic investigations of the axillary nerve showed that Group A was superior to the other three groups. Muscular histological outcome of the axillary nerve and deltoid muscle showed that Group A was superior to the Group C and D, while no significant difference was found between Group A and B. Except that the thruput of regenerating medullated musculocutaneous nerve fibers of Group A was superior to Group C, neurophysiological and histological outcome of the musculocutaneous nerve and biceps showed that no significant difference was found between Group A and other three groups. At 12 weeks postoperatively, nearly all the behavioral, neurophysiological and histological determination showed that Group A was superior to the other three groups. Ipsilateral C7 transfer to the upper trunk of brachial plexus combined with the spinal accessory nerve to the suprascapular nerve is found to be significantly effective on treatment of the root avulsion of C5 and C6 of the brachial plexus.

Outcomes analysis of phrenic nerve transfer to anterior division of the upper trunk of brachial plexus

目的 通过对40例采用膈神经移位接上干前股以恢复屈肘功能的臂丛损伤患者的长期随访,分析与疗效相关的不良因素,为进一步提高其疗效及选择最佳手术适应证提供基础.方法 对2002年-2005年在我院进行膈神经移位接上干前股治疗的40例患者进行长期随访,观察其疗效及与疗效相关的因素.结果 40例患者屈肘功能恢复的总有效率为82.5%,其中年龄大于40岁、病程超过1年、术前膈神经诱发电位潜伏期(LAT)衰减≥20%者,疗效较差.结论 膈神经移位接上干前股手术简单、创伤小、疗效满意,适宜在临床上推广应用于臂丛神经股部无损伤的患者.但对年龄大于40岁、病程超过1年、术前膈神经LAT衰减≥20%者,应慎用。

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.