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Compression Neuropathies
Published in Gary W. Jay, Practical Guide to Chronic Pain Syndromes, 2016
A lower trunk (medial cord) injury will affect the C8—T1 innervated muscles. Sensation will be reduced in the medial forearm. Posterior cord injuries may affect the muscles innervated by the axillary and radial nerves. Brachial plexopathy may result from a variety of injuries. These may encompass compressive tumors, for example, Pancoast tumor, compressive lymphadenopathy, radiation therapy—induced scarring, direct surgical trauma, and various motor vehicle accidents.
The Axilla and Brachium
Published in Gene L. Colborn, David B. Lause, Musculoskeletal Anatomy, 2009
Gene L. Colborn, David B. Lause
The anterior divisions of the upper and middle trunks combine to form the lateral cord; the anterior division of the lower trunk continues as the medial cord. The posterior divisions of the three trunks coalesce to produce the posterior cord of the brachial plexus (Fig. 6:8). Study the manner of origin of each cord on the cadaver, noting any variations.
Complications after Spinal Cord Injury
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Michael Y. Wang, Barth A. Green
Specific neurological syndromes have been described for particular partial cord injuries. The anterior cord syndrome is characterized by complete paralysis and hypalgesia (anterior and anterolateral column function) below the level of injury with preservation of position sense, vibration, and light touch (posterior column function). This syndrome occurs most commonly after ischemia in the territory supplied by the anterior spinal artery which supplies the corticospinal and spinothalamic tracts. The central cord syndrome is characterized by motor dysfunction more pronounced in the distal upper extremities accompanied by varying degrees of sensory loss and bladder dysfunction. This injury occurs characteristically following a hyperextension injury in an elderly patient and can be seen in the absence of any clear radiographic disruption of the bones or ligaments. Most patients recover the ability to walk, with partial restoration of upper extremity strength. The posterior cord syndrome is an uncommon presentation where position and vibration are impaired due to injury to the dorsal columns. The Brown–Sequard syndrome, or hemi-section cord syndrome, presents with ipsilateral paresis and loss of proprioception below the level of the lesion and contralateral loss of pain and temperature sensation. This can be the result of penetrating injuries or tumor compression and is usually not seen in a pure form. The conus medullaris syndrome occurs with injuries at the thoracolumbar junction. This syndrome has components of both spinal cord and nerve root injury due to the dense population of lower nerve roots emerging from the caudal end of the spinal cord. Symmetrical lower extremity motor impairment and anesthesia with bowel and bladder dysfunction are typically seen. Recovery from this syndrome is unlikely, unlike the cauda equina syndrome where partial recovery is possible with early decompression. Cauda equina injuries occur at spinal levels below the termination of the cord at L1 or L2.
Posterior cord syndrome associated with postoperative seroma: The case to perform a complete neurologic exam
Published in The Journal of Spinal Cord Medicine, 2020
Meghan Cochrane, Marika Hess, Natalie Sajkowicz
The posterior column transmits the sensations of vibration, position sense, deep pressure and two-point discrimination. Loss of vibration and proprioception below the level of the lesion are hallmarks of posterior cord syndrome which are not routinely tested during the standard ISNCSCI examination.4 Therefore disorders that are limited to the posterior column can easily be missed or overlooked when performing the standard ISNCSCI examination. Dorsal column pathology resulting in posterior cord syndrome causes sensory ataxia and unstable gait, which can have a huge impact on function. Though this patient’s motor examination remained stable, his functional impairments changed significantly from his preoperative baseline. His balance deficits resulted in an inability to stand and remain in his home. With rehabilitation, he was able to return to baseline function and return home.
Radial nerve palsy following humeral shaft fracture: a theoretical PNF rehabilitation approach for tendon and nerve transfers
Published in Physiotherapy Theory and Practice, 2022
Lauren Fader, John Nyland, Hao Li, Brandon Pyle, Kei Yoshida
The radial nerve is a terminal brachial plexus posterior cord branch, receiving contributions from cervical nerve roots 5–8 and thoracic nerve root 1. The superficial radial nerve provides sensory innervation to the dorsal wrist and hand. The posterior interosseous nerve provides sequential motor innervation to the supinator, extensor carpi radialis brevis, extensor digitorum communis, extensor digiti minimi, extensor carpi ulnaris, abductor pollicis, extensor pollicis brevis, extensor pollicis longus, and extensor indicis (Figure 1). Radial nerve injury from humerus fractures can create prolonged, severe, and often permanent disabilities (Ricci et al., 2015).
Morphological basis of radial nerve dysfunction in newborns differs from that of no radial nerve dysfunction in adults in C5–C6–C7 injuries to the brachial plexus: a cadaveric study
Published in British Journal of Neurosurgery, 2021
Jiayu Sun, Liang Chen, Shaonan Hu, Jie Song, Jixin Wu, Yudong Gu
Anatomically one of the major terminal branches of the posterior cord of the brachial plexus, the radial nerve receives nerve fibers from posterior divisions of the upper (composed of C5–C6 spinal nerves), middle (C7) and lower trunks (C8–T1) of the brachial plexus, with C7 contributing more fibers than C5–C6 or C8–T1.1 The function of the radial nerve is to extend the elbow, wrist and fingers. In obstetrical brachial plexus palsy (OBPP), injuries to C5–C6–C7 (extended Erb’s palsy) with normal C8–T1 or injuries to C5–C6 (Erb’s palsy) induce loss of shoulder abduction and of elbow flexion, and also falling off the wrist and fingers in the former.2 Intra-operatively in those babies who have the surgical indication,3 the upper trunk is usually found to have a neuroma-in-continuity, and also in extended Erb’s palsy, the avulsion injury of C7 is much commoner than rupture.4,5 Most groups have now believed that the conductivity of this neuroma-in-continuity showed by intra-operative neurophysiologic investigations does not necessarily demonstrate sufficient functional nerve fibers crossing the neuroma,6 and so resection of the neuroma-in-continuity followed by nerve grafting becomes the choice of most groups.4,7 In adult brachial plexopathy with injuries to upper plexus, which is often caused by high energy trauma such as motorcycle accident, clinical appearances of injuries to C5–C6–C7 are similar to those to C5–C6, with radial nerve function basically preserved in the former owing to functional compensation from the lower trunk.8 Intraoperatively, avulsion injury of involved spinal nerves is often detected, in which intra-operative neurophysiologic investigations do not show any response of the target muscles and somatosensory evoked potentials of the scalp to the stimulation to the avulsed spinal nerves.9 So nerve transfer is usually the first choice for reconstruction of shoulder abduction and external rotation and of elbow flexion. Although triple nerve transfers with spinal accessory nerve to suprascapular nerve, Oberlin procedure and Leechavengvongs procedure are often performed,10 alternatively in those with C5–C6 avulsion injury and normal C7, besides spinal accessory to suprascapular nerve transfer, the ipsilateral C7 can be cut and transferred to the upper trunk without significant functional loss of the radial nerve.11–13 In contrast to this, however, ipsilateral C7 transfer does result in functional loss of the radial nerve in infants, though it can recover spontaneously years later.14 These facts demonstrate that functional C7 is indispensable to maintain radial nerve function in newborns who have upper trunk injuries to the brachial plexus, but not in adults, thus implying minor functional contribution of the lower trunk of the brachial plexus to the radial nerve in newborns relative to in adults.