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Case 1.14
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
The brachial plexus is a nerve network with motor and sensory components that control the composite function of the upper limb. It consists of spinal roots, trunks, divisions, cords, and terminal branches – with named nerves arising from the roots, trunks, and cords but not the divisions.
Brachial Plexus Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Janice He, Bassem Elhassan, Rohit Garg
Brachial plexus injuries are devastating injuries and cause significant disability. An accurate physical examination is critical in making a diagnosis. Physical examination forms the backbone of decision-making by determining the level of injury, presence of functioning muscle groups, donors and recipients for treatment. To be able to perform a thorough physical examination, one needs to have a complete understanding of the anatomy of the brachial plexus and upper extremity. The purpose of this chapter is to outline the anatomy and physical examination of brachial plexus injuries.
Peripheral Nerve Examination in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Combined and mixed nerve lesions can occur in brachial plexus lesions and ischemic contractures. Sometimes partial recovered nerve lesions present with such a picture. In upper brachial plexus palsy (Erb’s palsy) involving the C5 and C6 nerve roots, the affected muscles will be the deltoid, biceps, brachialis, and brachioradialis. Sensory deficit may not be minimal and restricted to the area over the deltoid muscle and on the radial (lateral) side of the arm and hand. Lower brachial plexus palsy (Klumpke’s palsy) involves lesions of the C8 and T1 nerve roots and will have an effect on the long flexors of the fingers, intrinsic muscles of the hand, and sometimes the wrist flexors. The triceps brachii is usually spared. The child may have concomitant Horner syndrome. Sensory deficit is present on the ulnar side of the forearm, hand, and fingers. Muscle and nerve involvement in ischemic contractures can be variable depending upon the severity of the condition.
An unusual case of lower trunk brachial plexus zoster reactivation
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Samantha J. Burch, Elizabeth Shepard, Angelo B. Lipira
Initially, due to the ipsilateral shoulder discomfort, a diagnosis of Parsonage Tuner Syndrome (PTS) was considered. PTS, also referred to as brachial plexus neuritis or neuralgic amyotrophy, typically presents as severe pain across the shoulder preceding weakness of the muscles of the shoulder, arm, wrist, or hand [10]. The mechanism remains incompletely understood, but many studies attribute PTS to an immune-mediated response to triggers such as exertion, pregnancy, or surgery [11]. Recent studies have identified hourglass-like fascicular contractions on imaging studies which were confirmed intra-operatively as well as inflammation with perivascular lymphoid cells on perineurial biopsies. One study by ArAnyi et al. found 30% of patients with PTS had an event of mechanical stress within 3 weeks of symptom onset [12]. While our patient did demonstrate some signs and symptoms of PTS, it became evident at the two-week interval that her primary process was VZV reactivation. This case highlights potential overlap of presentation of PTS symptomatology and viral mediated neuritis.
Long-term functional recovery in C5-C6 avulsions treated with distal nerve transfers
Published in Neurological Research, 2023
Irene Fasce, Pietro Fiaschi, Andrea Bianconi, Carlo Sacco, Guido Staffa, Crescenzo Capone
Isolated preganglionic C5-C6 palsy has a relatively low incidence among stretch injuries involving brachial plexus, but these cases are excellent candidates for surgical treatment, with encouraging functional results. In these patients, shoulder abduction and elbow flexion are restorable, thanks to the previously cited surgical techniques. As previously described by Brandt and Mackinnon [15], nerve transfers have a remarkably better outcome over muscle transfers since they provide no alteration of the patient’s muscle biomechanics. Outcome depends on many factors, above all surgical timing [4,16]. It is broadly demonstrated that surgical treatment has a better outcome if performed in the first few months and that delay of 6 months or more considerably decreases reinnervation possibilities because of muscular atrophy, fibrosis and joint stiffness. Moreover, the decreasing nervous cell regenerative response plays a fundamental role in post-surgical recovery [17,18].
Is there any difference between anterior and posterior approach for the spinal accessory to suprascapular nerve transfer? A systematic review and meta-analysis
Published in Neurological Research, 2023
Michal Makel, Andrej Sukop, David Kachlík, Petr Waldauf, Adam Whitley, Radek Kaiser
The majority of brachial plexus injuries are associated with suprascapular and axillary nerve palsies and result in loss of shoulder abduction and external rotation of the arm [1]. In 2001, Merrel et al. suggested that neurotization of both nerves leads to better outcomes [2]. Currently, the dual neurotization technique is the method of choice and has very good results when sufficient donor nerves are available for reconstruction [3]. Spinal accessory to suprascapular nerve transfer is the most commonly used method for restoration of the function of the supraspinatus and infraspinatus muscles [4]. According to a recent systematic review and meta-analysis of the current literature, the radial nerve branch for the triceps muscle is the best donor for axillary nerve reconstruction in dual neurotization techniques [5].