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Examination of a Child with Birth Brachial Plexus Palsy
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Satyaswarup Tripathy, Mohsina Subair
Narakas has classified these common clinical presentations based on the roots involved, and this is the most commonly used classification.5Upper Erb’s palsy, C5, C6.Extended Erb’s palsy, C5, C6, C7.Total palsy without Horner syndrome, C5–T1.Total palsy with Horner syndrome, C5–T1.
Posture and orthopedic impairments
Published in Michael Horvat, Ronald V. Croce, Caterina Pesce, Ashley Fallaize, Developmental and Adapted Physical Education, 2019
Michael Horvat, Ronald V. Croce, Caterina Pesce, Ashley Fallaize
Fifth Cervical (C5) Injuries below the fifth cervical vertebra will allow functioning in the neck muscles, diaphragm, deltoid muscles of the shoulder, rhomboids, and biceps. Flexion of the elbow is possible, as is abduction of the shoulder, although shoulder extension relies on gravity to return to its original position. No functioning is available in the wrist and hand, necessitating manual supports on the wrist and arm as well as projections on the rims to maneuver a wheelchair.
Upper limb
Published in Aida Lai, Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Attachments of teres minor muscle– origin: lat. aspect of inf. angle of scapula (above origin of teres major)– insertion: greater tubercle of humerus– nerve SS: axillary n. (C5 and 6)– function: laterally rotate arm, stabilise shoulder joint
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].
Anterior controllable antidisplacement and fusion surgery for the treatment of extensive cervico-thoracic ossification of posterior longitudinal ligament with severe myelopathy: case report and literature review
Published in British Journal of Neurosurgery, 2023
Chen Yan, Huai-Cheng Jia, Jing-Chuan Sun, Jian-Gang Shi
Recently, a novel surgical technique named anterior controllable antidisplacement and fusion (ACAF) has been proposed for the treatment of multilevel severe OPLL.14 Direct, in situ and sufficient decompression of the spinal cord is obtained by anteriorly hoisting the vertebrae-OPLL complex (VOC) to restore the spinal canal space instead of exposing the spinal canal and resecting the OPLL. Previous studies demonstrated that patients treated with ACAF obtained better recovery of neurologic function and a lower incidence of CSF leakage and neurologic deterioration than those undergoing the standard anterior approach.16,17 As the locations of the spinal cord and nerve roots return to their pre-compressed positions, a lower incidence of C5 palsy is reported in ACAF than that in posterior approaches.18,19 Moreover, ACAF was more effective in the cases with OR of OPLL greater than 60% or K-line (-), compared with the posterior approach.20 Good cervical kyphosis correction was also observed after ACAF.21 Another novel technique named “shelter technique” was proposed to cooperate with ACAF to treat the patients with OPLL involving the C2 segment successfully.22 Additionally, ACAF was proved to be an effective and safe revision surgical technique after initial posterior surgery for OPLL.23 Previous studies about ACAF mainly focused on the cervical OPLL with no greater than 4 segments. However, some special cases with OPLL involving cervico-thoracic or longer segments treated by ACAF have not been reported yet.
Confirming a C5 Palsy with a Motor Evoked Potential Trending Algorithm during Insertion of Cervical Facet Spacers: A Case Study
Published in The Neurodiagnostic Journal, 2022
The use of the trending algorithm in this case report confirmed the visual waveform analyses and gave further confidence in reporting an IONM alert to the surgeon. The warning corroborated the intraoperative CT imaging which revealed potential nerve root compromise and led to the surgeon’s prompt removal of the right DTRAX spacer. Postoperatively, the patient exhibited a new onset of acute right-sided C5 palsy. Fujiwara et al. (2016) had one patient who had a final MEP amplitude decrease of 50% in the biceps and 60% in the triceps. This patent had an immediate C5 palsy with no triceps weakness. They surmised that it was possible that the triceps MEP was affected by a C6 segment disorder. Similarly, in this case, the lack of postoperative biceps weakness is unclear. However, this case report does illustrate that the use of multi-myotomal MEPs was able to detect an acute C5 palsy during insertion of facet cages and places emphasis on this surgical step as a critical period for conducting MEP testing.