RESTORATION OF HAND FUNCTION AFTER BRACHIAL PLEXUS INJURY

Hand Clinics ◽  
1995 ◽  
Vol 11 (4) ◽  
pp. 647-656
Author(s):  
Chantal Bonnard ◽  
Algimantas Narakas
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Hand Function

scholarly journals Management of Brachial Plexus Injury in Adults

2008 ◽  
Vol 97 (4) ◽  
pp. 317-323 ◽  
Author(s):  
P. Songcharoen
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Nerve Repair ◽  
Hand Function ◽  
Nerve Transfer ◽  
Nerve Grafting ◽  
Muscle Transfer ◽  
Nerve Roots ◽  
Elbow Function ◽  
Motorcycle Accidents

Brachial plexus injury in adults is commonly caused by motorcycle accidents. Surgical management consists of nerve repair and nerve grafting for extraforaminal nerve root or trunk injury, and of neurotization or nerve transfer for nerve roots avulsion. In general, the results regarding restoration of shoulder and elbow function are good but reinnervation of the forearm muscles is less than safisfactory in respect to restoration of hand function. Functioning free muscle transfer in combination with selective nerve transfer is a reasonable alternative surgical procedure.

Role of tacrolimus in return of hand function after brachial plexus injury in a lung transplantation patient

2020 ◽  
Vol 13 (5) ◽  
pp. e233788
Author(s):  
Tiam M Saffari ◽  
Christopher J Arendt ◽  
Robert J Spinner ◽  
Alexander Y Shin
Keyword(s):  
Lung Transplantation ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Hand Function ◽  
Left Hand ◽  
Lower Trunk ◽  
Bilateral Lung Transplantation ◽  
Bilateral Lung ◽  
Transplantation Patient

We report a patient who has been on tacrolimus for bilateral lung transplantation and presented with a brachial plexus injury (BPI), with unusual improvement of lower trunk innervated hand function. The lower trunk injury with resultant left hand paralysis had developed after his sternotomy 18 months ago. He has been treated with tacrolimus as part of his immunosuppression protocol since the surgery, without severe side effects. Physical examination at 18 months demonstrated unusual excellent grip pattern and full opposition of his thumb with slight claw deformity of his ulnar two digits. While the neurotoxic effects of tacrolimus are more emphasised, the neuroregenerative properties have been recently explored. The recovery in this patient is unique and unusual after BPI and is most likely as a result of the low dose tacrolimus treatment.

Reconstruction of hook grip function of the fingers in patients with traumatic brachial plexus injury

2021 ◽  
pp. 175319342110549
Author(s):  
Yuki Hara ◽  
Yasumasa Nishiura ◽  
Yuichi Yoshii ◽  
Shunsuke Asakawa ◽  
Yukei Matsumoto ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Latissimus Dorsi ◽  
Brachial Plexus Injury ◽  
Hand Function ◽  
Latissimus Dorsi Muscle ◽  
Flexor Digitorum Profundus ◽  
Reconstruction Method ◽  
Level Of Evidence ◽  
Pedicle Flap ◽  
Dorsi Muscle

We described a reconstruction method for restoring hook grip function of the fingers in patients with total brachial plexus injury. The paralysed latissimus dorsi muscle was transferred to the upper limb as a pedicle flap and sutured to the flexor digitorum profundus tendons. The muscle was then reanimated with two intercostal donor nerves to the thoraco-dorsal nerve. Fourteen young adult patients (mean 23 years, range 17 to 32 years) with traumatic brachial plexus injury who underwent reconstruction using this technique from 2000 to 2019. After mean follow-up of 65 months (range 20 to 170), finger flexion of strength greater than or equal to M3 was achieved in 10 of the 14 patients. The mean weight that could be lifted using a hook grip was 2.6 kg, and that which could be lifted with both hands was 4.1 kg. The intercostal nerve-innervated latissimus dorsi muscle transfer can provide useful hook grip hand function without the need to sacrifice donor vessels or healthy muscles. Level of evidence: IV

Bionic reconstruction to restore hand function after brachial plexus injury: a case series of three patients

The Lancet ◽  
2015 ◽  
Vol 385 (9983) ◽  
pp. 2183-2189 ◽  
Author(s):  
Oskar C Aszmann ◽  
Aidan D Roche ◽  
Stefan Salminger ◽  
Tatjana Paternostro-Sluga ◽  
Malvina Herceg ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Hand Function ◽  
Case Series ◽  
Bionic Reconstruction

Recovery of upper extremity function following endoscopically assisted contralateral C7 transfer for obstetrical brachial plexus injury

2016 ◽  
Vol 41 (8) ◽  
pp. 863-874 ◽  
Author(s):  
G. Leblebicioglu ◽  
C. Ayhan ◽  
T. Firat ◽  
A. Uzumcugil ◽  
M. Yorubulut ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Hand Function ◽  
Grading System ◽  
Nerve Roots ◽  
Level Of Evidence ◽  
The Mean ◽  
Upper Extremity Function ◽  
Postoperative Shoulder

Transfer of the contralateral C7 nerve for reconstruction of the brachial plexus in infants with obstetrical brachial plexus injury has rarely been reported. We developed a new endoscopy-assisted technique via the prevertebral (retroesophageal) route for the transfer of the contralateral C7 nerve in reconstruction of the brachial plexus. The reconstruction was performed in 20 infants (14 boys and six girls). Motor recovery was assessed using the Gilbert and Raimondi scales. The Narakas Sensory Grading System was used to evaluate hand sensation. The mean follow-up period was 45 months (SD 18.2). Of the 20 children, nine had contralateral C7 transfer to lower nerve roots, two had transfer to upper nerve roots and nine had transfer to both upper and lower roots. The postoperative shoulder and elbow functions were good or satisfactory according to the Gilbert classification in all children whose preoperative scores were poor. All patients with lower roots reconstruction (9) had satisfactory hand function. A total of 15 children had a Narakas score of S3. Our technique enables safe contralateral C7 transfer to the avulsed roots in severe obstetrical brachial plexus injury infants with a satisfactory functional recovery. Level of evidence: Level IV

scholarly journals Nerves transfers for functional hand recovery in traumatic lower brachial plexopathy

2020 ◽  
Vol 11 ◽  
pp. 358
Author(s):  
Fernando Henrique Souza ◽  
Silvya Nery Bernardino ◽  
Auricelio Batista Cezar Junior ◽  
Hugo André de Lima Martins ◽  
Isabel Nery Bernardino Souza ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Hand Function ◽  
Case Series ◽  
Significant Loss ◽  
Plexus Brachialis ◽  
Brachial Plexopathy ◽  
Pronator Quadratus ◽  
Motor Branch ◽  
Nerve Transfers

Background: Distal nerve transfers are an innovative modality for the treatment of C8-T1 brachial plexus lesions. The purpose of this case series is to report the authors’ results with hand restoration function by nerve transfer in patients with lower brachial plexus injury. Methods: Three consecutive nerve transfers were performed in a series of 11 patients to restore hand function after injury to the lower brachial plexus: brachialis motor branch to anterior interosseous nerve (AIN) and supinator branch to the posterior interosseous nerve (PIN) in a first surgical procedure, and AIN to pronator quadratus branch of ulnar nerve between 4 and 6 months later. Results: In all, 11 male patients underwent 33 surgical procedures. Time between brachial plexus injury and surgery was a mean of 11 months (range 4–13 months). Postoperative follow-up ranged from 12 to 24 months. We observed recovery of M3 or better finger flexion strength (AIN) and wrist extension (PIN) in 8 of the 11 surgically treated upper limbs. These patients recovered full thumb and finger extension between 6 and 12 months of surgery, without significant loss of donor function. Conclusion: Nerve transfers represent a way of restoring volitional control of upper extremity function in patients with C8-T1 brachial plexus injury.

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