Transposition of branches of radial nerve innervating supinator to posterior interosseous nerve for functional reconstruction of finger and thumb extension in 4 patients with middle and lower trunk root avulsion injuries of brachial plexus

2017 ◽  
Vol 37 (6) ◽  
pp. 933-937 ◽  
Author(s):  
Xia Wu ◽  
Xiao-bing Cong ◽  
Qi-shun Huang ◽  
Fang-xin Ai ◽  
Yu-tian Liu ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Radial Nerve ◽  
Posterior Interosseous Nerve ◽  
Root Avulsion ◽  
Functional Reconstruction ◽  
Lower Trunk

scholarly journals Complications of contralateral C-7 transfer through the modified prespinal route for repairing brachial plexus root avulsion injury: a retrospective study of 425 patients

2015 ◽  
Vol 122 (6) ◽  
pp. 1421-1428 ◽  
Author(s):  
Wenjun Li ◽  
Shufeng Wang ◽  
Jianyong Zhao ◽  
M. Fazlur Rahman ◽  
Yucheng Li ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Vertebral Artery ◽  
Upper Extremity ◽  
Nerve Root ◽  
Severe Bleeding ◽  
Root Avulsion ◽  
Avulsion Injury ◽  
Lower Trunk ◽  
Study Population ◽  
Posterior Division

OBJECT In this report, the authors review complications related to the modified prespinal route in contralateral C-7 transfer for repairing brachial plexus nerve root avulsion injury and suggest a prevention strategy. METHODS A retrospective, nonselected amalgamation of every case of modified contralateral C-7 transfer through the prespinal route was undertaken. The study population comprised 425 patients treated between February 2002 and August 2009. The patients were managed according to a standardized protocol by one senior professor. The surgical complications were grouped into one of the following categories: those associated with tunnel making through the prespinal route, those related to the dissection and transection of the contralateral C-7 nerve root, and those that occurred in the postoperative period. RESULTS The study population included 379 male and 46 female patients whose average age was 21 years (range 3 months to 56 years). A total of 401 patients were diagnosed with traumatic brachial plexus injury, the leading cause of which was motor vehicle accident, and 24 patients were diagnosed with obstetrical brachial plexus palsy. The contralateral C-7 nerve root was cut at the proximal side of the division portion of the middle trunk in 15 cases and sectioned at the distal end of the anterior and posterior divisions in 410 cases. The overall incidence of complications was 5.4% (23 of 425). Complications associated with making a prespinal tunnel occurred in 12 cases, including severe bleeding due to vertebral artery injury during the procedure in 2 cases (0.47%), temporary recurrent laryngeal nerve palsy in 5 cases (1.18%), pain and numbness in the donor upper extremity during swallowing in 4 cases (0.94%), and dyspnea caused by thrombosis of the brainstem 42 hours postoperatively in 1 case (0.24%); this last patient died 38 days after the operation. Complications related to exploration and transection of the contralateral C-7 nerve root occurred in 11 cases, including deficiency in extensor strength of the fingers and thumb in 4 cases (0.94%) due to injury to the posterior division of the lower trunk, unbearable pain on the donor upper extremity in 3 cases (0.71%), Horner's syndrome in 2 children (0.47%) who suffered birth palsy, a section of C-6 nerve root mistaken as C-7 in l case (0.24%), and atrophy of the sternocostal part of the pectoralis major in 1 case (0.24%). CONCLUSIONS The most serious complications of using the modified prespinal route in contralateral C-7 transfer were vertebral artery laceration and injury to the posterior division of the lower trunk. The prevention of such complications is necessary to popularize this surgical procedure and attain good long-term clinical results.

Spinal Nerve Origins of the Muscular Branches of the Radial Nerve

Neurosurgery ◽  
2012 ◽  
Vol 70 (6) ◽  
pp. 1438-1441 ◽  
Author(s):  
Lei Zhang ◽  
Cheng-Gang Zhang ◽  
Zhen Dong ◽  
Yu-Dong Gu
Keyword(s):  
Brachial Plexus ◽  
Radial Nerve ◽  
Compound Muscle Action Potential ◽  
Electrophysiological Study ◽  
Spinal Nerve ◽  
Posterior Interosseous Nerve ◽  
Triceps Brachii ◽  
Nerve Roots ◽  
Extensor Pollicis Longus ◽  
Significant Difference

Abstract BACKGROUND: In injuries of the lower brachial plexus, finger flexion can be restored by nerve or tendon transfer. However, there is no technique that can guarantee good recovery of finger and thumb extension. OBJECTIVE: To determine the spinal nerve origins of the muscular branches of the radial nerve and identify potential intraplexus donor nerves for neurotization of the posterior interosseous nerve in patients with lower brachial plexus injuries. METHODS: An intraoperative electrophysiological study was carried out during 16 contralateral C7 nerve transfers. The compound muscle action potential of each muscle innervated by the radial nerve was recorded while the C5-T1 nerves were individually stimulated. RESULTS: The triceps brachii muscle primarily received root contributions from C7. The C5 and C6 nerve roots displayed greater amplitudes for the brachioradialis and supinator muscles compared with those of the C7, C8, and T1 nerve roots (P < .05). The extensor carpi radialis branch was innervated by C5, C6, and C7, and no significant differences were detected between them (P > .05). The amplitudes obtained for the extensor digitorum communis branch were the largest from C7 and C8, without a significant difference between them (P > .05), whereas the amplitudes of the extensor carpi ulnaris and extensor pollicis longus were largest from the C8 root (P < .05). CONCLUSION: The supinator muscle branch is likely the best donor nerve for the repair of lower brachial plexus injuries affecting muscles that are innervated by the posterior interosseous nerve.

A rare variation in the formation of the lower trunk of the brachial plexus its embryological basis and clinical importance - a case report

2012 ◽  
Vol 6 (4) ◽  
pp. 49-52
Author(s):  
N Satyanarayana ◽  
R Guha ◽  
P Sunitha ◽  
GN Reddy ◽  
G Praveen ◽  
...  
Keyword(s):  
Case Report ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Clinical Importance ◽  
Medical Sciences ◽  
Nerve Roots ◽  
Rare Variation ◽  
Lower Trunk ◽  
Male Cadaver ◽  
The Right

Brachial plexus is the plexus of nerves, that supplies the upper limb.Variations in the branches of brachial plexus are common but variations in the roots and trunks are very rare. Here, we report one of the such rare variations in the formations of the lower trunk of the brachial plexus in the right upper limb of a male cadaver. In the present case the lower trunk was formed by the union of ventral rami of C7,C8 and T1 nerve roots. The middle trunk was absent. Upper trunk formation was normal. Journal of College of Medical Sciences-Nepal,2011,Vol-6,No-4, 49-52 DOI: http://dx.doi.org/10.3126/jcmsn.v6i4.6727

Paralysis in Root Avulsion of the Brachial Plexus

1984 ◽  
Vol 11 (1) ◽  
pp. 137-142
Author(s):  
Y. Allien ◽  
J.M. Privat ◽  
F. Bonnel
Keyword(s):  
Brachial Plexus ◽  
Root Avulsion

Trends in Brachial Plexus Surgery: Characterizing Contemporary Practices for Exploration of Supraclavicular Plexus

Hand ◽  
2021 ◽  
pp. 155894472110146
Author(s):  
J. Ryan Hill ◽  
Steven T. Lanier ◽  
Liz Rolf ◽  
Aimee S. James ◽  
David M. Brogan ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Treatment Strategies ◽  
Technical Difficulty ◽  
Nerve Grafting ◽  
Structured Interviews ◽  
Lower Trunk ◽  
Nerve Transfers ◽  
Case Vignettes ◽  
Distal Nerve

Background There is variability in treatment strategies for patients with brachial plexus injury (BPI). We used qualitative research methods to better understand surgeons’ rationale for treatment approaches. We hypothesized that distal nerve transfers would be preferred over exploration and nerve grafting of the brachial plexus. Methods We conducted semi-structured interviews with BPI surgeons to discuss 3 case vignettes: pan-plexus injury, upper trunk injury, and lower trunk injury. The interview guide included questions regarding overall treatment strategy, indications and utility of brachial plexus exploration, and the role of nerve grafting and/or nerve transfers. Interview transcripts were coded by 2 researchers. We performed inductive thematic analysis to collate these codes into themes, focusing on the role of brachial plexus exploration in the treatment of BPI. Results Most surgeons routinely explore the supraclavicular brachial plexus in situations of pan-plexus and upper trunk injuries. Reasons to explore included the importance of obtaining a definitive root level diagnosis, perceived availability of donor nerve roots, timing of anticipated recovery, plans for distal reconstruction, and the potential for neurolysis. Very few explore lower trunk injuries, citing concern with technical difficulty and unfavorable risk-benefit profile. Conclusions Our analysis suggests that supraclavicular exploration remains a foundational component of surgical management of BPI, despite increasing utilization of distal nerve transfers. Availability of abundant donor axons and establishing an accurate diagnosis were cited as primary reasons in support of exploration. This analysis of surgeon interviews characterizes contemporary practices regarding the role of brachial plexus exploration in the treatment of BPI.

Transfer of a Motor Fascicle From the Ulnar Nerve to the Branch of the Radial Nerve Destined to the Long Head of the Triceps for Restoration of Elbow Extension in Brachial Plexus Surgery

Neurosurgery ◽  
2011 ◽  
Vol 70 (2) ◽  
pp. E516-E520 ◽  
Author(s):  
Leandro Pretto Flores
Keyword(s):  
Computed Tomography ◽  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Radial Nerve ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Elbow Extension ◽  
Long Head ◽  
Brachial Plexus Surgery

Abstract BACKGROUND AND IMPORTANCE: Restoration of elbow extension has not been considered of much importance regarding functional outcomes in brachial plexus surgery; however, the flexion of the elbow joint is only fully effective if the motion can be stabilized, what can be achieved solely if the triceps brachii is coactivated. To present a novel nerve transfer of a healthy motor fascicle from the ulnar nerve to the nerve of the long head of the triceps to restore the elbow extension function in brachial plexus injuries involving the upper and middle trunks. CLINICAL PRESENTATION: Case 1 is a 32-year-old man sustaining a right brachial extended upper plexus injury in a motorcycle accident 5 months before admission. The computed tomography myelogram demonstrated avulsion of the C5 and C6 roots. Case 2 is a 24-year-old man who sustained a C5-C7 injury to the left brachial plexus in a traffic accident 4 months before admission. Computed tomography myelogram demonstrated signs of C6 and C7 root avulsion. The technique included an incision at the medial border of the biceps, in the proximal third of the involved arm, followed by identification of the ulnar nerve, the radial nerve, and the branch to the long head of the triceps. The proximal stump of a motor fascicle from the ulnar nerve was sutured directly to the distal stump of the nerve of the long head of the triceps. Techniques to restore elbow flexion and shoulder abduction were applied in both cases. Triceps strength Medical Research Council M4 grade was obtained in both cases. CONCLUSION: The attempted nerve transfer was effective for restoration of elbow extension in primary brachial plexus surgery; however, it should be selected only for cases in which other reliable donor nerves were used to restore elbow flexion.

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