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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.
Supraclavicular 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
The brachial plexus is formed by the union of the ventral rami of the spinal nerves emerging from the intervertebral foramina of the fourth (or fifth) cervical to the first (or second) thoracic vertebrae (Figure 1.1). These rami form the roots of the brachial plexus. They emerge from the grooved transverse processes and enter the space between the anterior and middle scalene muscles, known as the interscalene space, where they unite to form three nerve trunks: The upper trunk is formed by the union of the fourth, fifth, and sixth cervical spinal nerves at the lateral border of the middle scalene muscle.The upper trunk is formed by the union of the fourth, fifth, and sixth cervical spinal nerves at the lateral border of the middle scalene muscle.The middle trunk derives from the seventh cervical nerve.The lower trunk results from the union of the eight cervical and first thoracic nerves, behind the anterior scalene muscle.
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
Which is a feature of a cervical rib?A cause of brachial artery aneurysmBest diagnosed by posteroanterior (PA) chest radiographCompresses the upper trunk of the brachial plexusA cause of thoracic outlet syndromeMost commonly symptomatic in the 50–60 years age group
Training high level balance and stepping responses in atypical progressive supranuclear palsy: a case report
Published in Physiotherapy Theory and Practice, 2023
Earllaine Croarkin, Krystle Robinson, Christopher J. Stanley, Cris Zampieri
Progressive supranuclear palsy (PSP) is a neurodegenerative disease and the most common atypical Parkinsonian syndrome (Litvan et al., 1996). It has been referred to as a “Parkinson-plus disorder” (Agarwal and Gilbert, 2020). Initial motor symptoms are symmetrical and axial with associated gait difficulties and falls (Agarwal and Gilbert, 2020). As the condition progresses, a differentiating sign of slowed vertical gaze worsens along with dysarthria, dysphagia, and frontal cognitive difficulties (Agarwal and Gilbert, 2020). It is rare. The highest prevalence rate, found during a brief literature review, was reported at 6.4 per 100,000 (Schrag, Ben-Shlomo, and Quinn, 1999). Multiple PSP phenotypes have been noted, making diagnosis difficult (Agarwal and Gilbert, 2020; Lopez, Bayulkem, and Hallett, 2016). Thus, diagnosis is usually made by the presence and progression of multiple signs including, but not limited to: postural instability, supranuclear opthalmoplegia primarily of vertical gaze, pseudobulbar dysfunction, dystonic rigidity of the neck and upper trunk and mild cognitive dysfunction (Richardson, Steele, and Olszewski, 1963). Additionally, ruling out other diagnoses by noting treatment response, is a common approach in diagnosing movement disorders (National Institute of Neurological Disorders and Stroke web-site https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Progressive-Supranuclear-Palsy- Fact-Sheet#3281_5).
Neuralgic amyotrophy detected by magnetic resonance neurography: subclinical, bilateral, and multifocal brachial plexus involvement
Published in Neurological Research, 2023
Claudia Cejas, José M. Pastor Rueda, Jairo Hernández Pinzón, Nadia Stefanoff, Fabio Barroso
The use of MRN to study brachial plexus disorders dates to 2007 when Duman et al. [10] presented the first case of acute PTS diagnosed with MRI in a 27-year-old man with sudden onset of severe left shoulder pain of 3 weeks duration, the brachial plexus showed a thickened and hyperintense upper trunk of the left brachial plexus consistent with plexitis [10]. Zara et al. [20] in 2012 suggested MR neurography 3D STIR and TIRM sequences are useful for early diagnosis, especially in cases of slight involvement of brachial plexus, for showing both nerve inflammation and muscle denervation and to assess response to therapy. Updhyaya et al. [13] studied 15 patients with clinical and electrophysiological diagnosis of PTS in a 1.5 T system and described as abnormal findings nerve thickening and hyperintense signal on T2-WI and STIR images, as well as hyperintensity on T2-WI and STIR in the muscles affected, they only found unilateral affection; Gaskin C. and Helms C.14 studied 27 patients with PTS, three of whom had bilateral involvement by consensus between clinical history, physical examination, electrophysiological results and MR shoulders findings. Unlike our cases series where we can observe some degree of bilateral commitment in all our patients, although 11.7% of them had unilateral symptoms; these findings could be related to us using a large FOV that included both shoulders.
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
All surgeries were performed in the supine position. A supraclavicular approach was used for brachial plexus roots exploration and nerve transfer of the spinal accessory to the suprascapular nerve. The spinal accessory nerve was identified on the deep surface of the trapezius muscle and confirmed with a nerve stimulator. The dissection was continued distally to its termination into two or three branches. A vessel loop was placed around it for later identification when it would be transected at this junction for coaptation to the suprascapular nerve stump. The suprascapular nerve was identified as it branches off from the upper trunk of the brachial plexus. It was dissected and traced distally until healthy nerve tissue was encountered. This was verified by its turgor and the visualization of nerve fascicles within the epineurium upon transection of the nerve. When scarred or fibrotic nerve tissue was encountered, the nerve would be progressively cut back distally until a healthy nerve stump was seen. Coaptation of the spinal accessory nerve to the healthy suprascapular nerve stump was performed under magnification with 10–0 nylon sutures, and reinforced with a biological adhesive (TISSEEL Fibrin Sealant, Baxter International Inc.).