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Brachial Plexus Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Janice He, Bassem Elhassan, Rohit Garg
The posterior cord gives off the upper subscapular nerve, the thoracodorsal nerve and the lower subscapular nerve. The upper and lower subscapular nerves innervate the upper and lower portions of the subscapularis respectively, which provides shoulder internal rotation. The lower subscapular nerve also innervates the teres major which is a shoulder adductor. The thoracodorsal nerve innervates the latissimus muscle, which helps to adduct, extend and internally rotate the shoulder (Table 12.1).
Upper Limb
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The four “tricks” that allow nerves from the ventral rami to innervate posterior (dorsal) muscles, shown in Plate 4.7b, are Axillary nerve (lateral trick): To reach the posterior shoulder, the axillary nerve branches from the distal bifurcation of the posterior cord to pass inside the laterally located quadrangular space of the back.Dorsal scapular nerve (medial trick): To reach the medial side of the back, the dorsal scapular nerve branches early (i.e., medially) from the brachial plexus, running posteriorly (dorsally, as its name indicates) to pass medially to the scapula.Suprascapular nerve (superior trick): To reach the posterior aspect of the pectoral girdle, this nerve, as its name indicates, passes through the suprascapular notch of the scapula, which is located on the superior aspect of the scapula the scapula.Subscapular nerves (inferior): To reach posterior muscles, these nerves run inferiorly, passing anterior (ventral) to the scapula, some of them reaching a region that lies inferior to the scapula (i.e., the thoracodorsal nerve, or middle subscapular nerve, that innervates the latissimus dorsi).
Focal Treatments, Including Botulinum Toxin
Published in Valerie L. Stevenson, Louise Jarrett, Spasticity Management, 2016
Rachel Farrell, Katrina Buchanan
Phenol blocks have been used to successfully treat spasticity in a number of conditions, including stroke, SCI, MS and cerebral palsy.55,117,120–122 The most commonly applied are tibial (medial popliteal) nerve blocks, particularly in the management of children with developing foot deformities, and obturator nerve blocks in ambulatory patients with scissoring gait or to improve ease of perineal hygiene and aid in seating posture.123 Less frequently, focal injections of the musculocutaneous or subscapular nerves are performed in upper-limb spasticity to improve shoulder pain,124, 125 BoNT is, however, generally preferred in the arms in more recent times.
Anatomical feasibility study of the infraspinatus muscle neurotization by lower subscapular nerve
Published in Neurological Research, 2023
Aneta Krajcová, Michal Makel, Gautham Ullas, Veronika Němcová, Radek Kaiser
LSN seems to be an ideal donor nerve for neurotization, because the larger pectoralis and latissimus dorsi muscles would compensate for the loss of internal rotation typically provided by the subscapularis and teres major muscles [26]. However, if the entire nerve was used for neurotization, the subscapularis muscle would be still partially innervated by upper subscapular nerve [27]. Samardzic et al. found in their clinical series that sectioning of the LSN does not alter shoulder and arm movement significantly [28]. Moreover, Tubbs et al. showed that the teres major branch can be used as a donor for neurotization of musculocutaneous or axillary nerve without disconnecting the branch to the subscapularis muscle. They found that the mean length of the terminal branch of the LSN was 6 cm (3.3–8.9) [5]. These data are similar to our results (mean length 6.64 cm). We found that the nerve transfer was feasible in more than 94% of the cases without denervation of the subscapularis muscle. In one case (No 12), however, both nerve stumps were so short that direct end-to-end suture would not be possible without using a nerve graft.
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
For the 12 cadavers, we made an incision from the supraclavicular level to the lateral edge of the latissimus dorsi to expose the entire brachial plexus. After marking the branches of the brachial plexus, we transected the C5–T1 spinal nerves at the entrances to the intervertebral foraminae, to remove the brachial plexus en bloc. With the aid of a microscope and 10-fold magnification, we separated the radial nerve and its fascicles proximally from the nerve’s main trunk to the posterior divisions of the upper, middle and lower trunks, the isolated length of which was all 5-mm proximal to the origin of the posterior cord. After isolating the fascicles of the axillary, thoracodorsal and subscapular nerves from the posterior cord, we transected fascicles of the radial nerve from the posterior divisions of the upper trunk (FRNUT), the middle trunk (FRNMT) and the lower trunk (FRNLT), to obtain 3-mm length segments of the FRNUT, FRNMT and FRNLT proximal to the origin of the posterior cord (Figure 1).
Epidemiology of Peripheral Nerve Injuries in Sports, Exercise, and Recreation in the United States, 2009 – 2018
Published in The Physician and Sportsmedicine, 2021
Neill Y. Li, Gabriel I. Onor, Nicholas J. Lemme, Joseph A. Gil
This study also found a high incidence of football-related PNI in those 19 years and younger. The risk of PNI in football was also reported by Zuckerman et al. who used the High School Reporting Information Online (RIO) database and found the highest incidence of PNI occurred during football at 1.25/100,000 athlete-exposures followed by wrestling and baseball [35]. Cycling and swimming were also noted to have a relatively high incidence of PNI. In regards to cycling, pudendal nerve injury has been described given prolonged sitting on a bicycle seat [32,36]. Peripheral nerve-related injury was not noted though falls off the bike are likely high risk for such injury. In swimming, overuse shoulder injuries are reported to occur most frequently, as demonstrated in the collegiate population [37–39]. No specific nerve injuries were described, but a high incidence of overuse-related shoulder entrapment and impingement related pathologies may irritate the axillary, suprascapular, and subscapular nerves that innervate the deltoid and rotator cuff. In overuse or acute fashion, peripheral nerve injuries may occur in both individual and team sporting activities thus making it prudent to engage in proper technique, safety, and recovery practices to limit such occurrences.