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Spine
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Radicular and spinal veins drain into the internal vertebral venous plexus (of Batson) that later drain into the azygos system and the superior vena cava through the vertebral, intercostal and lumbar veins. The plexus communicates with the basilar sinus in the brain and with the pelvic veins and inferior vena cava. In patients with increased intra-abdominal pressure, blood is diverted from the inferior vena cava to the plexus, leading to engorgement of epidural veins. For example, in pregnant women, this increases the risk of accidental venous puncture during the conduct of epidural anaesthesia and decreases the effective epidural space volume, thereby requiring a smaller volume of local anaesthetic.
The Spinal Cord and the Spinal Canal
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
Ventral rami of the trunk divide in a manner similar to dorsal rami, providing metameric innervation to the skin (Figure 1.37) and deep structures. In the cervical, lumbar, and sacral regions, the ventral rami of adjacent spinal nerves unite near their origin and form the cervical (C1 to C4 segments), brachial (C5 to T1), lumbar (L1 to L4), and sacral (L4 to S3) plexuses. Lumbar and sacral plexuses are usually termed the lumbosacral plexus. Such a plexal disposition of nerves has considerable implications for regional anesthesia, and these plexuses are described in Part Two of this book.
Single Best Answer Questions
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
A 20-year-old motor cyclist is involved in a road traffic accident. He is found to have weakness of right shoulder abduction and forearm flexion, as well as some sensory loss over the lateral aspect of his upper arm. The right biceps and brachioradialis reflexes are absent. Which of the following is the likely level of maximal plexus injury?C4/C5 rootC5/C6 rootC6/7 rootC7/C8 rootC8/T1 root
The lived experience following free functioning muscle transfer for management of pan-brachial plexus injury: reflections from a long-term follow-up study
Published in Disability and Rehabilitation, 2021
Sara Brito, Jennifer White, Nikos Thomacos, Bridget Hill
It is well recognized that adjustment to injury, that results in significant physical disability, both generally and of the upper limb is a difficult process [1–4]. Adult brachial plexus injuries (BPIs) can result in a significant reduction in physical functioning [5], with most occurring in young men as a result of motorbike accidents [6]. There is a vast diversity in the presentation of BPI depending on the mechanism of injury as well as level and pattern of lesion [7]. Upper plexus injuries (C5, C6 ± C7) result in motor impairment of shoulder (abduction and external rotation) and elbow (flexion, ± extension) [8]. Lower plexus injuries result in motor impairment of the wrist and hand [8]. A pan-brachial plexus injury damages innervation from C5-T1 and results in impairment of shoulder, elbow and hand motor and sensory function [9]. Pan-brachial plexus injury has been associated with poor recovery outcomes [10] including greater disability and decreased quality of life [9].
MR neurography of the brachial plexus in adult and pediatric age groups: evolution, recent advances, and future directions
Published in Expert Review of Medical Devices, 2020
Alexander T. Mazal, Ali Faramarzalian, Jonathan D. Samet, Kevin Gill, Jonathan Cheng, Avneesh Chhabra
The Brachial plexus is a large network of peripheral nerves arising from the cervicothoracic spine which provides motor and sensory functions to the upper extremities. The clinical differentiation of brachial plexopathy from cervical spine-related radiculopathy or nerve injury has been a longstanding diagnostic challenge, as history, physical examination findings and electrodiagnostic testing are frequently indeterminate in this domain. MR neurography (MRN) of the brachial plexus has emerged in recent years as a useful modality for the identification of brachial plexopathies in both pediatric and adult populations. The article discusses the current state of brachial plexus MRN, including recent advances and future directions, as well as illustrate adult and pediatric brachial plexopathies that can be optimally characterized using these techniques.
Differential diagnosis of knee pain following a surgically induced lumbosacral plexus stretch injury. A case report
Published in Physiotherapy Theory and Practice, 2019
William R. VanWye, Harvey W. Wallmann, Elizabeth S. Norris, Karen E. Furgal
The onset of the patient’s symptoms coincided with the recent D&C procedure, which was performed in the lithotomy position. Lithotomy positioning can result in stretch injuries to the femoral, lateral femoral cutaneous, obturator, sciatic, or common peroneal nerves (Barnett et al, 2007). It can also result in a lumbosacral plexus stretch injury, which is more consistent with the patient’s presentation (Flanagan, Webster, Brown, and Massey, 1985). Identifying the pattern of weakness and numbness clinically after a lumbosacral plexus injury may be difficult (Flanagan, Webster, Brown, and Massey, 1985; Preston and Shapiro, 2013). The patient exhibited hamstring weakness, which is innervated by the sciatic nerve, as well as weakness of the left ankle plantarflexors (i.e. gastrocnemius and soleus muscles), which are innervated by the tibial branch of the sciatic nerve (Kendall, McCreary, Provance, and Kendall, 1999). Yet, the patient also had left gluteus maximus and medius weakness, which are innervated by the inferior and superior gluteal nerve, respectively. The potential pattern in this case; each of these muscles is partially supplied by the S1 nerve root (Kendall, McCreary, Provance, and Kendall, 1999).