Surgical management of axillary nerve and suprascapular nerve lesions

Object The aim of this retrospective study was to evaluate the restoration of shoulder function by means of supra-scapular nerve neurotization in adult patients with proximal C-5 and C-6 lesions due to a severe brachial plexus traction injury (BPTI). The primary goal of brachial plexus reconstructive surgery was to restore the biceps muscle function and, secondarily, to reanimate shoulder function. Methods Suprascapular nerve neurotization was performed by grafting the C-5 nerve in 24 patients and by accessory or hypoglossal nerve transfer in 29 patients. Additional neurotization involving the axillary nerve could be performed in 18 patients. Postoperative needle electromyography studies of the supraspinatus, infraspinatus, and deltoid muscles showed signs of reinnervation in most patients; however, active glenohumeral shoulder function recovery was poor. In nine (17%) of 53 patients supraspinatus muscle strength was Medical Research Council (MRC) Grade 3 or 4 and in four (8%) infraspinatus muscle power was Grade 3 or 4. In 18 patients in whom deltoid muscle reinnervation was attempted, MRC Grade 3 or 4 function was demonstrated in two (11%). In the overall group, eight patients (15%) exhibited glenohumeral abduction with a mean of 44 ± 17° (standard deviation [SD]) (median 45°) and four patients (8%) exhibited glenohumeral exorotation with a mean of 48 ± 24° (SD) (median 53°). In only three patients (6%) were both functions regained. Conclusions The reanimation of shoulder function in patients with proximal C-5 and C-6 BPTIs following supra-scapular nerve neurotization is disappointingly low.

Download Full-text

Nerves originating from brachial plexus in the porcupine (Hystrix cristata)

Veterinární Medicína ◽

10.17221/5685-vetmed ◽

2012 ◽

Vol 49 (No. 4) ◽

pp. 123-128 ◽

Cited By ~ 2

Author(s):

A. Aydin

Keyword(s):

Brachial Plexus ◽

Biceps Brachii ◽

Cranial Nerves ◽

Suprascapular Nerve ◽

Axillary Nerve ◽

Biceps Brachii Muscle ◽

Caudal Part ◽

Hystrix Cristata ◽

Dorsi Muscle ◽

Thoracodorsal Nerve

In this study, dissemination of forelimb’s nerves of the porcupine (Hystrix cristata) was investigated. Four porcupines (two males and two females) were used and nerves originating from brachial their plexus were dissected. Origin and dissemination of forelimb’s nerves orginated from brachial plexus constituted from cranial and caudal trunks were examined. Suprascapular nerve and the first branch of subscapular nerve orginated from cranial and caudal part of cranial trunk, respectively. Nerves orginated from caudal trunk, pectoral cranial nerves, constituted four branches spreading in pectoral muscles. Musculocutenoeus nerve gives a branche to brachial muscle and, after giving medial cutaneus antebrachii nerve was divided to two branches (digital dorsal commun I and II nerve). Axillary nerve gives a branche to subscapular muscle and ends as cranial cutaneous antebrachii. Radial nerve separated to branches as ramus profundus and ramus superficial which also was divided to digital dorsal commun III and IV nerve and lateral cutaneus antebrachial nerve. Thoracodorsal nerve spreaded to latismus dorsi muscle. Median nerve was divided to digital dorsal commun I, II, III and IV nerve. Ulnar nerve was divided to digital dorsal commun V and digital dorsal commun V nerve after giving caudal cutaneous antebrachi. An undefined nerve branche orginated from caudal trunk entered corachobrachial muscle and biceps brachii muscle. Lateral thoracic and caudal pectoral nerves orginated from caudal trunk. In the porcupine, branche which goes to corachobrachial muscle directly from caudal trunk of the brachial plexus and distrubutions of musculocutaneous, radial, ulnar and median nerves were different from rodantia and other mammals.

Download Full-text

Repair of isolated axillary nerve lesions after infraclavicular brachial plexus injuries

Neurosurgery ◽

10.1097/00006123-199009000-00010 ◽

1990 ◽

pp. 403 ◽

Cited By ~ 1

Author(s):

A H Friedman ◽

J A Nunley ◽

J R Urbaniak ◽

R D Goldner

Keyword(s):

Brachial Plexus ◽

Axillary Nerve ◽

Nerve Lesions

Download Full-text

Prognostic Factors for the Surgical Management of Peripheral Nerve Lesions

The Tohoku Journal of Experimental Medicine ◽

10.1620/tjem.205.269 ◽

2005 ◽

Vol 205 (3) ◽

pp. 269-275 ◽

Cited By ~ 18

Author(s):

Mehmet Daneyemez ◽

Ilker Solmaz ◽

Yusuf Izci

Keyword(s):

Prognostic Factors ◽

Peripheral Nerve ◽

Surgical Management ◽

Nerve Lesions ◽

Peripheral Nerve Lesions

Download Full-text

The 7-o'clock Posteroinferior Portal for Shoulder Arthroscopy

The American Journal of Sports Medicine ◽

10.1177/03635465020300051101 ◽

2002 ◽

Vol 30 (5) ◽

pp. 693-696 ◽

Cited By ~ 56

Author(s):

Philip A. Davidson ◽

Dennis W. Rivenburgh

Keyword(s):

Glenohumeral Joint ◽

Shoulder Arthroscopy ◽

Suprascapular Nerve ◽

Skin Incision ◽

Axillary Nerve ◽

Anatomic Study ◽

Effective Technique ◽

Alternative Approach ◽

Flexion Extension ◽

Differential Distance

Background: Access to the inferior glenohumeral joint of the shoulder is very limited through the traditional 2- or 3-o'clock anterior portals. Hypothesis: The 7-o'clock posteroinferior portal offers an excellent alternative approach. Study Design: Descriptive anatomic study. Methods: Six paired cadaveric shoulders were used to arthroscopically develop and test a 7-o'clock posteroinferior portal. The distances between the portal and the subscapular and axillary nerves were measured with the arm in six different positions, combining flexion, extension, abduction, and adduction. Results: The distance from the 7-o'clock posteroinferior portal to the axillary nerve was 39 ± 4 mm and to the suprascapular nerve was 28 ± 2 mm. There was no statistically significant nerve-to-portal differential distance when the arm was placed in flexion, extension, abduction, or adduction. The inside-to-outside technique produced a 7-o'clock posteroinferior portal approximately 5 mm further from both the axillary and suprascapular nerves than did the outside-to-inside method. The angle of divergence from the 7-o'clock posterior portal skin incision to the axillary nerve was 47° and to the suprascapular nerve was 33°. Conclusions: The 7-o'clock portal affords safe, direct working access to the inferior capsular recess of the glenohumeral joint. Clinical Relevance: The 7-o'clock portal is a safe and effective technique for use by shoulder surgeons.

Download Full-text

Randomized comparison between interscalene and costoclavicular blocks for arthroscopic shoulder surgery

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2018-100055 ◽

2019 ◽

Vol 44 (4) ◽

pp. 472-477 ◽

Cited By ~ 6

Author(s):

Julián Aliste ◽

Daniela Bravo ◽

Sebastián Layera ◽

Diego Fernández ◽

Álvaro Jara ◽

...

Keyword(s):

Patient Satisfaction ◽

Side Effects ◽

Onset Time ◽

Suprascapular Nerve ◽

Axillary Nerve ◽

Shoulder Surgery ◽

Sensory Function ◽

Ultrasound Guided ◽

Pain Scores ◽

Arthroscopic Shoulder Surgery

BackgroundThis randomized trial compared ultrasound-guided interscalene block (ISB) and costoclavicular brachial plexus block (CCB) for arthroscopic shoulder surgery. We hypothesized that CCB would provide equivalent analgesia to ISB 30 min after surgery without the risk of hemidiaphragmatic paralysis.MethodsAll 44 patients received an ultrasound-guided block of the intermediate cervical plexus. Subsequently, they were randomized to ISB or CCB. The local anesthetic agent (20 mL of levobupivacaine 0.5% and epinephrine 5 µg/mL) and pharmacological block adjunct (4 mg of intravenous dexamethasone) were identical for all study participants. After the block performance, a blinded investigator assessed ISBs and CCBs every 5 min until 30 min using a composite scale that encompassed the sensory function of the supraclavicular nerves, the sensorimotor function of the axillary nerve and the motor function of the suprascapular nerve. A complete block was defined as one displaying a minimal score of six points (out of a maximum of eight points) at 30 min. Onset time was defined as the time required to reach the six-point minimal composite score. The blinded investigator also assessed the presence of hemidiaphragmatic paralysis at 30 min with ultrasonography.Subsequently, all patients underwent general anesthesia. Postoperatively, a blinded investigator recorded pain scores at rest at 0.5, 1, 2, 3, 6, 12, and 24 hours. Patient satisfaction at 24 hours, consumption of intraoperative and postoperative narcotics, and opioid-related side effects (eg, nausea/vomiting, pruritus) were also tabulated.ResultsBoth groups displayed equivalent postoperative pain scores at 0.5, 1, 2, 3, 6, 12, and 24 hours. ISB resulted in a higher incidence of hemidiaphragmatic paralysis (100% vs 0%; P < 0.001) as well as a shorter onset time (14.0 (5.0) vs 21.6 (6.4) minutes; p<0.001). However, no intergroup differences were found in terms of proportion of patients with minimal composite scores of 6 points at 30 min, intraoperative/postoperative opioid consumption, side effects, and patient satisfaction at 24 hours.ConclusionCompared to ISB, CCB results in equivalent postoperative analgesia while circumventing the risk of hemidiaphragmatic paralysis. Further confirmatory trials are required. Future studies should also investigate if CCB can provide surgical anesthesia for arthroscopic shoulder surgery.Clinical Trials RegistrationNCT03411343.

Download Full-text