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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
While testing the individual muscles of the hand may not always be necessary to determine the pattern of brachial plexus injury, as many of the muscles are innervated by the same terminal nerves, a detailed motor examination may be very useful for planning purposes for tendon and nerve transfers.
Diseases of the Peripheral Nerve and Mononeuropathies
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Diana Mnatsakanova, Charles K. Abrams
Weakness and sensory changes depend on the distribution of nerve involvement (i.e. upper or lower trunk, specific cords, or terminal nerves). The most common pattern involves the upper trunk or a single mononeuropathy or multiple mononeuropathies, primarily the suprascapular, long thoracic, or axillary nerves. Less likely, the phrenic nerve or anterior interosseous nerve may be affected.
Infraclavicular Brachial Plexus Blocks
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
As the three trunks of the brachial plexus pass behind the clavicle, they are located in an almost anteroposterior plane (Figure 1.3A). They then unite and form three cords that surround the second part of the axillary artery. They divide into terminal nerves in the lower part of the axilla, close to the third part of the artery: the ulnar nerve lies medially, the radial nerve posteriorly, and the median nerve laterally to the artery (Figures 1.30 and 1.31).
Neuronal and non-neuronal TRPA1 as therapeutic targets for pain and headache relief
Published in Temperature, 2023
Luigi F. Iannone, Romina Nassini, Riccardo Patacchini, Pierangelo Geppetti, Francesco De Logu
Meningeal vasodilation has also been caused by intranasal administration of TRPA1 agonists, whereas a selective antagonist of the TRPA1 receptor and a topical CGRP antagonist (CGRP8-37) prevented the increases in blood flow [21]. Systemic administration of a headache provoking substance, glyceryl trinitrate (GTN) elicits in migraineurs an early, mild-to-moderate headache, followed by delayed, more severe migraine-like attacks [105]. In rodents, GTN causes an immediate and transient vasodilation and a delayed and sustained mechanical allodynia in the cutaneous periorbital area [106,107]. A TRPA1 antagonist reduced pain biomarkers elicited by GTN and mechanical allodynia produced by the constriction of the infraorbital nerve in rats [108]. The underlying mechanism of the TRPA1 implication in GTN-evoked periorbital mechanical allodynia was recently better clarified. The following series of events was proposed. Nitric oxide (NO), a known TRPA1 agonist [109], generated from GTN by aldehyde dehydrogenase-2 is required to initiate the allodynia, but is not sufficient for its maintenance [105]. In fact, NO-mediated stimulation of TRPA1 in the soma of trigeminal nociceptors increases intracellular calcium, which activates NOX1 and NOX2 to release ROS. ROS promotes a feed-forward ROS/TRPA1-dependent pathway that sustains allodynia. From the stimulated neuron soma, an antidromic action potential propagates to the terminal nerve fibers from which CGRP is released, thus contributing to PMA [105].
Shoulder abduction reconstruction for C5–7 avulsion brachial plexus injury by dual nerve transfers: spinal accessory to suprascapular nerve and partial median or ulnar to axillary nerve
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Gavrielle Hui-Ying Kang, Fok-Chuan Yong
Another factor leading to improved results could be the definitive targeting of both the teres minor and deltoid muscles separately, in the axillary nerve neurotization [15]. If the neurorraphy were performed at a level before the axillary nerve divides into its branches, the teres minor (supplied by the posterior branch of the axillary nerve) may not be reinnervated. Such a phenomenon was observed in single neurotization of the suprascapular nerve (supplying the supraspinatus and infraspinatus muscles) with the spinal accessory nerve – various authors found that the supraspinatus was preferentially reinnervated over the infraspinatus [2,16,17]. Thus, we prefer a neurorraphy to the terminal nerve supplying the target muscle – in the case of the axillary nerve, this refers to its lateral and medial fascicular groups. The inferior border of the subscapularis is a convenient site for neurotization of both the anterior and posterior branches of the axillary nerve before it enters the quadrilateral space. This directly targets the lateral and medial fascicular groups respectively, to innervate both the deltoid and teres minor muscles. Two of our three cases with C5–C6 avulsion injuries had excellent shoulder abduction of 180°. We believe that in these patients, the inferior serratus anterior muscle function may be preserved and its action complements the deltoid muscle function [4,18].
Resolution of persistent traumatic supraorbital pain after neuroma excision
Published in Orbit, 2022
Matthew Tukel, Robert Beaulieu, Alon Kahana
Stump neuromas are almost always fully excised as they lack distal function and pose a low risk of additional functional impairment. Conversely, neuromas in continuity first require intraneural neurolysis with selective neuroma excision to spare remaining nerve function.12 Once neuroma excision is complete, the surgeon must determine the optimal reconstructive strategy that considers the regenerative capacity of the nerve stump and promotes maximal neuronal regeneration.13 Reconstructive strategies following neuroma excision are divided into two broad categories based on the presence or absence of the distal nerve ending.11 In cases where the terminal nerve ending is intact, techniques that include auto or allograft placement and hollow tube reconstruction are commonly employed. In the absence of an identifiable nerve ending, reconstructive techniques include muscular or interosseous implantation, relocation nerve grafting, nerve cap placement, “end-to-side” neurorrhaphy, and targeted muscle reinnervation.11