Rehabilitation of Cervical Spine, Brachial Plexus, and Peripheral Nerve Injuries

Microsurgical procedures on injured peripheral nerves have been performed in Institute of neurosurgery in Belgrade for twenty-five years. During this period 1284 procedures, including 1029 on peripheral nerves, and 255 on brachial plexus were done. In this paper we analyze surgical results of individual procedures and the other factors influencing the outcome. Despite advances caused by introduction of the operating microscope, there are numerous controversies mainly in microsurgical technique that are discussed.

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Venipuncture-Related Median Nerve Palsy Disguised as Intraoperative Brachial Plexus Injury

Case Reports in Neurology ◽

10.1159/000515474 ◽

2021 ◽

pp. 361-368

Author(s):

Lisa B.E. Shields ◽

Brandon Sutton ◽

Vasudeva G. Iyer ◽

Christopher B. Shields ◽

Abigail J. Rao

Keyword(s):

Peripheral Nerve ◽

Brachial Plexus ◽

Median Nerve ◽

Vascular Access ◽

Nerve Palsy ◽

Peripheral Nerve Injuries ◽

Nerve Injuries ◽

Sensorimotor Deficits ◽

Median Nerve Palsy ◽

Median Nerve Neuropathy

Iatrogenic peripheral nerve injuries may result from transection, stretch, compression, injections, ligature, heat, anticoagulant use, and radiation. Iatrogenic median nerve palsy has been reported rarely. We report a case of a woman who underwent craniectomy for treatment of trigeminal neuralgia. Intraoperatively, a transient decline in the amplitude of the left upper extremity somatosensory evoked potentials (SSEPs) was noted. This finding was presumed to be due to the traction on the brachial plexus as it improved with repositioning. Immediately upon waking from anesthesia, the patient experienced sensorimotor deficits in the left median nerve distribution. Ecchymoses from venipuncture were observed in this area. Electrodiagnostic studies confirmed a left median nerve neuropathy localized in the antebrachial area. Neurosurgeons and neurologists should be alert to potential iatrogenic median nerve palsy following vascular access at the antebrachial region. Vascular access could be performed under the ultrasound guidance when a patient is under anesthesia or unable to give sensory feedback. Furthermore, placing an additional recording electrode over the proximal upper arm during intraoperative SSEP monitoring aids in distinguishing between brachial plexus and peripheral nerve injuries.

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Supraclavicular brachial plexus and peripheral nerve injuries

Oxford Textbook of Neurological Surgery ◽

10.1093/med/9780198746706.003.0073 ◽

2019 ◽

pp. 847-854

Author(s):

Jonathan Perera ◽

Marco Sinisi

Keyword(s):

Mental Health ◽

Peripheral Nerve ◽

Brachial Plexus ◽

Nerve Injury ◽

Nerve Root ◽

Treatment Options ◽

Peripheral Nerve Injuries ◽

Nerve Injuries ◽

Nerve Roots ◽

Cervical Nerve Roots

Stretching of more than 12% of a nerve or more than 8 hours of ischaemia will result in severe nerve injury. The force required to avulse cervical nerve roots is as little as 200 newtons. The nerve root exiting angles are very important, as different forequarter positions at the time of impact will result in differing force vectors and therefore differing injury. Nerve injuries can be extremely devastating not only for the patient but for their surrounding support structure as well. We discuss and detail the diagnosis and management of these lesions along with the useful investigations and treatment options. The appropriately timed management of these patients can allow good outcomes for both patient physical and subsequent mental health.

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A new method of electrodiagnosis during operations on the brachial plexus and peripheral nerve injuries

International Orthopaedics ◽

10.1007/bf00266953 ◽

1985 ◽

Vol 9 (2) ◽

Cited By ~ 4

Author(s):

M. Kondo ◽

H. Matsuda ◽

Y. Miyawaki ◽

M. Yoshimura ◽

A. Shimazu

Keyword(s):

Peripheral Nerve ◽

Brachial Plexus ◽

New Method ◽

Peripheral Nerve Injuries ◽

Nerve Injuries

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Distribution of Peripheral Nerve Injuries in Patients with a History of Shoulder Trauma Referred to a Tertiary Care Electrodiagnostic Laboratory

Diagnostics ◽

10.3390/diagnostics10110887 ◽

2020 ◽

Vol 10 (11) ◽

pp. 887

Author(s):

Chul-Hyun Cho ◽

Don-Kyu Kim ◽

Du Hwan Kim

Keyword(s):

Peripheral Nerve ◽

Brachial Plexus ◽

Nerve Injury ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Axillary Nerve ◽

Peripheral Nerve Injuries ◽

Nerve Injuries ◽

Shoulder Trauma ◽

History Of

Peripheral nerve injury after shoulder trauma is an underestimated complication. The distribution of the affected nerves has been reported to be heterogeneous in previous studies. This study aimed to describe the distribution of peripheral nerve injuries in patients with a history of shoulder trauma who were referred to a tertiary care electrodiagnostic laboratory. A retrospective chart review was performed for all cases referred to a tertiary care electrodiagnostic laboratory between March 2012 and February 2020. The inclusion criteria were a history of shoulder trauma and electrodiagnostic evidence of nerve injury. Data on patient demographics, mechanism of injury, degree of weakness, clinical outcomes at the final follow-up, and electrodiagnostic results were retrieved from medical records. Fifty-six patients had peripheral nerve injuries after shoulder trauma. Overall, isolated axillary nerve injury was the most common. A brachial plexus lesion affecting the supraclavicular branches (pan-brachial plexus and upper trunk brachial plexus lesions) was the second most common injury. In cases of shoulder dislocation and proximal humerus fracture, isolated axillary nerve injury was the most common. Among acromioclavicular joint injuries and clavicular fractures, lower trunk brachial plexus injuries and ulnar neuropathy were more common than axillary nerve or upper trunk brachial plexus injuries. Patients with isolated axillary nerve lesions showed a relatively good recovery; those with pan-brachial plexus injuries showed a poor recovery. Our study demonstrated the distribution of peripheral nerve injuries remote from displaced bony structures. Mechanisms other than direct compression by displaced bony structures might be involved in nerve injuries associated with shoulder trauma. Electrodiagnostic tests are useful for determining the extent of nerve damage after shoulder trauma.

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