scholarly journals Brachial Plexus Injuries with Ulnar Musculocutaneous Transfer: 78 Cases Study Focused on Possible Postoperative Complications

2017 ◽  
Vol 38 (01) ◽  
pp. 007-011
Author(s):  
Márcio Corrêa ◽  
Márcio Cardoso ◽  
Ricardo Gepp ◽  
Marco Quiroga ◽  
Paulo Beraldo
Keyword(s):  
Brachial Plexus ◽  
Medical Records ◽  
Brachial Plexus Injury ◽  
Case Series ◽  
Elbow Flexion ◽  
Surgical Patients ◽  
Inclusion Criteria ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri

Objective To analyze 78 cases of brachial plexus injury submitted to the Oberlin technique between 2003 and 2012. The potential complications of this technique were analyzed, especially motor damage or hypoesthesia of the hand. Method Medical records from patients with brachial plexus injuries at the levels of the C5-C6 and C5-C6-C7 vertebrae were retrospectively analyzed. Cases submitted to the Oberlin procedure with or without concomitant brachial plexus procedures between 2003 and 2012 were evaluated. The minimum follow-up period was of 1 year. In addition to the clinical examination, electromyography and magnetic resonance imaging (MRI) of the brachial plexus were used to diagnose and locate the nerve damage. Results A total of 78 surgical patients met the inclusion criteria. Postoperative neurological changes, mostly transient, were observed in 18 patients. Hypoesthesia in the ulnar side of the hand was observed in seven cases; neuropathic pain in five cases; allodynia in four cases, and hand motor loss in two cases. Conclusion Based on the results of the present case series, we conclude that there are few sequelae in the donor nerve territory compared with the benefit of the Oberlin technique on the recovery of elbow flexion after brachial plexus injuries.

The Diagnostic Value of MRI in Traumatic Brachial Plexus Injury

1994 ◽  
Vol 19 (1) ◽  
pp. 55-59 ◽  
Author(s):  
M. OCHI ◽  
Y. IKUTA ◽  
M. WATANABE ◽  
K. KIMOR ◽  
K. ITOH
Keyword(s):  
Brachial Plexus ◽  
Nerve Root ◽  
Brachial Plexus Injury ◽  
Diagnostic Value ◽  
Resonance Imaging ◽  
Nerve Roots ◽  
Surgical Exploration ◽  
Nerve Root Avulsion ◽  
Magnetic Resonance Imaging Mri ◽  
The Individual

Findings in 34 patients with traumatic brachial plexus injury documented by surgical exploration and intra-operative somatosensory-evoked potentials were correlated with findings on myelography and magnetic resonance imaging (MRI) to determine whether MRI can identify nerve root avulsion. The coronal and sagittal planes were not able to demonstrate avulsion of the individual nerve roots. The axial and axial oblique planes did provide useful information to determine which nerve root was avulsed in the upper plexus, although it was difficult to clearly delineate the lower cervical rootlets. The accuracy of MRI was 73% for C5 and 64% for C6 and that of myelograpby 63% for C5 and 64% for C6. Thus, the diagnostic accuracy of MRI for upper nerve roots was slightly superior to myelography. Although its primary diagnostic value is limited to the upper nerve roots whose avulsion is relatively difficult to diagnose by myelography, MRI can provide useful guidance in the waiting period prior to surgical exploration after brachial plexus injury.

Minimum Ten-Year Outcomes of Partial Ulnar Nerve Transfer for Restoration of Elbow Flexion in Patients with Upper Brachial Plexus Injury

2019 ◽  
Vol 24 (03) ◽  
pp. 283-288
Author(s):  
Yusuke Nagano ◽  
Daisuke Kawamura ◽  
Alaa Terkawi ◽  
Atsushi Urita ◽  
Yuichiro Matsui ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Functional Outcomes ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
The Mean ◽  
Flexion Strength

Background: Partial ulnar nerve transfer to the biceps motor branch of the musculocutaneous nerve (Oberlin’s transfer) is a successful approach to restore elbow flexion in patients with upper brachial plexus injury (BPI). However, there is no report on more than 10 years subjective and objective outcomes. The purpose of this study was to clarify the long-term outcomes of Oberlin’s transfer based on the objective evaluation of elbow flexion strength and subjective functional evaluation of patients. Methods: Six patients with BPI who underwent Oberlin’s transfer were reviewed retrospectively by their medical records. The mean age at surgery was 29.5 years, and the mean follow-up duration was 13 years. The objective functional outcomes were evaluated by biceps muscle strength using the Medical Research Council (MRC) grade at preoperative, postoperative, and final follow-up. The patient-derived subjective functional outcomes were evaluated using the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at final follow-up. Results: All patients had MRC grade 0 (M0) or 1 (M1) elbow flexion strength before operation. Four patients gained M4 postoperatively and maintained or increased muscle strength at the final follow-up. One patient gained M3 postoperatively and at the final follow-up. Although one patient achieved M4 postoperatively, the strength was reduced to M2 due to additional disorder. The mean score of QuickDASH was 36.5 (range, 7–71). Patients were divided into two groups; three patients had lower scores and the other three patients had higher scores of QuickDASH. Conclusions: Oberlin’s transfer is effective in the restoration of elbow flexion and can maintain the strength for more than 10 years. Patients with upper BPI with restored elbow flexion strength and no complicated nerve disorders have over ten-year subjective satisfaction.

Comparison Between Supraclavicular Versus Video-Assisted Intrathoracic Phrenic Nerve Section for Transfer in Patients With Traumatic Brachial Plexus Injuries: Case Series

2020 ◽  
Vol 19 (3) ◽  
pp. 249-254
Author(s):  
Mariano Socolovsky ◽  
Marcio de Mendonça Cardoso ◽  
Ana Lovaglio ◽  
Gilda di Masi ◽  
Gonzalo Bonilla ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Case Series ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Nerve Section ◽  
Video Assisted ◽  
Significant Difference ◽  
Flexion Strength

Abstract BACKGROUND The phrenic nerve has been extensively reported to be a very powerful source of transferable axons in brachial plexus injuries. The most used technique used is supraclavicular sectioning of this nerve. More recently, video-assisted thoracoscopic techniques have been reported as a good alternative, since harvesting a longer phrenic nerve avoids the need of an interposed graft. OBJECTIVE To compare grafting vs phrenic nerve transfer via thoracoscopy with respect to mean elbow strength at final follow-up. METHODS A retrospective analysis was conducted among patients who underwent phrenic nerve transfer for elbow flexion at 2 centers from 2008 to 2017. All data analysis was performed in order to determine statistical significance among the analyzed variables. RESULTS A total of 32 patients underwent supraclavicular phrenic nerve transfer, while 28 underwent phrenic nerve transfer via video-assisted thoracoscopy. Demographic characteristics were similar in both groups. A statistically significant difference in elbow flexion strength recovery was observed, favoring the supraclavicular phrenic nerve section group against the intrathoracic group (P = .036). A moderate though nonsignificant difference was observed favoring the same group in mean elbow flexion strength. Also, statistical differences included patient age (P = .01) and earlier time from trauma to surgery (P = .069). CONCLUSION Comparing supraclavicular sectioning of the nerve vs video-assisted, intrathoracic nerve sectioning to restore elbow flexion showed that the former yielded statistically better results than the latter, in terms of the percentage of patients who achieve at least level 3 MRC strength at final follow-up. Furthermore, larger scale prospective studies assessing the long-term effects of phrenic nerve transfers remain necessary.

ICHD-II Diagnostic Criteria for Tolosa—Hunt Syndrome in Idiopathic Inflammatory Syndromes of the Orbit and/or the Cavernous Sinus

Cephalalgia ◽  
2008 ◽  
Vol 28 (6) ◽  
pp. 577-584 ◽  
Author(s):  
S Colnaghi ◽  
M Versino ◽  
E Marchioni ◽  
A Pichiecchio ◽  
S Bastianello ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Response To Treatment ◽  
High Dose ◽  
Inclusion Criteria ◽  
Resonance Imaging ◽  
Hunt Syndrome ◽  
Magnetic Resonance Imaging Mri

A bibliographical search was conducted for papers published between 1999 and 2007 to verify the validity of International Classification of Headache Disorders (ICHD)-II criteria for the Tolosa-Hunt syndrome (THS) in terms of (i) the role of magnetic resonance imaging (MRI); (ii) which steroid treatment should be considered as adequate; and (iii) the response to treatment. Of 536 articles, 48, reporting on 62 patients, met the inclusion criteria. MRI was positive in 92.1% of the cases and it normalized after clinical resolution. There was no evidence of which steroid schedule should be considered as adequate; high-dose steroids are likely to be more effective both to induce resolution and to avoid recurrences. Pain subsided within the time limit required by the ICHD-II criteria, but signs did not. We conclude that THS diagnostic criteria can be improved on the basis of currently available data. MRI should play a pivotal role both to diagnose and to follow-up THS.

Obstetrical brachial plexus injuries: Late functional results of the Steindler procedure

2014 ◽  
Vol 39 (8) ◽  
pp. 868-875 ◽  
Author(s):  
A. Gilbert ◽  
S. Valbuena ◽  
C. Posso
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Elbow Flexion ◽  
Functional Results ◽  
Obstetrical Brachial Plexus Palsy ◽  
Long Term Follow Up ◽  
The Mean ◽  
Extensor Lag

We reviewed late functional results of a modified Steindler procedure in patients with obstetrical brachial plexus palsy and poor active elbow flexion. From 1982 to 2005, we reviewed final functional results and complications of 27 cases with flexion weakness of the elbow secondary to obstetrical brachial plexus injury, treated with a modified Steindler procedure. At the end of the follow-up, the mean active elbow flexion was 97° and the mean extensor lag was 10°. In the long-term follow-up, the modified Steindler procedure maintained good results in 67% of the cases in our series, and this percentage raised by 82% when the wrist extensor was present or restored before the Steindler procedure. There were poor results in 19% of the patients, but no major complications.

A Prospective Study Comparing Single and Double Fascicular Transfer to Restore Elbow Flexion After Brachial Plexus Injury

Neurosurgery ◽  
2013 ◽  
Vol 72 (5) ◽  
pp. 709-715 ◽  
Author(s):  
Roberto Sergio Martins ◽  
Mario Gilberto Siqueira ◽  
Carlos Otto Heise ◽  
Luciano Foroni ◽  
Manoel Jacobsen Teixeira
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Elbow Flexion ◽  
Pinch Strength ◽  
Muscle Reinnervation ◽  
Double Muscle ◽  
A Prospective Study ◽  
Push And Pull ◽  
Flexion Strength

Abstract BACKGROUND: The recovery of elbow flexion in upper brachial plexus injury can be achieved by the reinnervation of the biceps muscle (single reinnervation), but concomitant restoration of brachialis and biceps function (double reinnervation) has been recommended to improve elbow flexion strength. OBJECTIVE: To prospectively compare morbidity and outcomes of single or double muscle reinnervation in restoring elbow flexion following incomplete injury to the brachial plexus. METHODS: Forty consecutive patients were prospectively submitted to single or double muscle reinnervation. Elbow flexion strength was evaluated with a push-and-pull dynamometer 12 months after surgery. Hand morbidity related to the procedures was evaluated by the Semmes-Weinstein monofilaments test, quantification of static 2-point discrimination, and measurements of handgrip and lateral pinch strength in serial evaluations up to the final follow-up. RESULTS: Similar results for the strength of elbow flexion were observed in both groups. A worsening of sensibility, measured by using Semmes-Weinstein monofilaments, was identified in 8 patients, all of whom showed recovery during follow-up. No worsening of 2-point discrimination was observed. A decrease in handgrip and lateral pinch strength was identified in 8 and 9 patients, respectively, which improved during follow-up. There was no difference between the groups in the incidence of hand motor morbidity parameters. CONCLUSION: The strength of elbow flexion did not differ significantly between the groups treated with single or double muscle reinnervation. Deterioration of handgrip, lateral pinch strength, and sensibility measured by using Semmes-Weinstein monofilaments, was temporary, resulting in low morbidity for both techniques.

scholarly journals Amyotrophic Monoplegia Secondary to Posttraumatic Rupture of the Brachial Plexus’s Roots: A Case Report and Review of the Literature

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Oumniya Abouhanine ◽  
Hasnaa Belgadir ◽  
Vianney Ndayishimiye ◽  
Omar Amriss ◽  
Aicha Merzem ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Case Report ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Review Of The Literature ◽  
Resonance Imaging ◽  
Left Limb ◽  
Limb Trauma ◽  
Cervical Magnetic Resonance Imaging ◽  
Magnetic Resonance Imaging Mri

Brachial plexus lesions most often occur in multiple trauma. We report a case of a 37-year-old patient who presented an upper left limb total sensitivomotor deficit and amyotrophy after a cervical and upper limb trauma. Cervical magnetic resonance imaging (MRI) was performed. It noted pseudomeningoceles at the levels of C6-C7, C7-D1, and D1-D2 in T1 hyposignal , T2 and STIR hypersignal , not enhanced by the injection of Gadolinium extending in foraminal and extraforaminal spaces without visualization of the corresponding rootlets. Traumatic brachial plexus injury is a potentially serious debilitating injury which can be well explored on MRI.

Use of Myoelectric Limb Orthoses for Elbow Flexion in Patients with Brachial Plexus Injury: A Case Series

2020 ◽  
Vol 33 (1) ◽  
pp. 70-72
Author(s):  
Gregory R. Anderson ◽  
Taylor R. Beahrs ◽  
Michelle F. Kircher ◽  
Alexander Y. Shin
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Case Series ◽  
Elbow Flexion

Isolated C5–C6 avulsion in obstetric brachial plexus palsy treated by ipsilateral C7 neurotization to the upper trunk: outcomes at a mean follow-up of 9 years

2015 ◽  
Vol 41 (2) ◽  
pp. 185-190 ◽  
Author(s):  
E. Gibon ◽  
C. Romana ◽  
R. Vialle ◽  
F. Fitoussi
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Elbow Flexion ◽  
Root Avulsion ◽  
Pattern Of Injury ◽  
Muscle Transfers ◽  
Obstetric Brachial Plexus ◽  
Elbow Function ◽  
Nerve Root Avulsion

Cervical root avulsions are the worst pattern of injury in obstetrical brachial plexus injury (OBPI). The prognosis is poor and the treatment is mainly surgical with extraplexual neurotizations or muscle transfers. We present the outcomes of a technique performed in our institution to treat C5–C6 avulsion in obstetrical brachial plexus injury. This technique consists of a total ipsilateral C7 neurotization to the upper trunk. Ten babies with isolated C5–C6 root avulsion were operated on; we were able to review nine of them at over 12 months follow-up. The shoulder and the elbow function were assessed, as well as the Mallet Score. The mean follow-up was 9.2 years (SD 5.7). After a follow-up of 6 years, elbow flexion was restored with a range of motion ⩾130° and a motor function ⩾M3 in all patients. The average Mallet score was 18.1 (SD 1.2). This approach appears to be a viable alternative to extraplexual neurotizations for the treatment of C5–C6 nerve root avulsion.

scholarly journals MENISCAL REPAIR RESULTS COMPARING MRI, ARTHRO-MRI, AND ARTHRO-CT

2018 ◽  
Vol 26 (3) ◽  
pp. 166-169
Author(s):  
ADRIANO MARQUES DE ALMEIDA ◽  
MARCELO BORDALO RODRIGUES ◽  
MARCIA UCHÔA DE REZENDE ◽  
ANDRÉ PEDRINELLI ◽  
ARNALDO JOSÉ HERNANDEZ
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Case Series ◽  
Meniscal Repair ◽  
Resonance Imaging ◽  
Level Of Evidence ◽  
Meniscal Suture ◽  
Imaging Results ◽  
Magnetic Resonance Imaging Mri

ABSTRACT Objective To clinically and radiologically evaluate patients who received meniscal suture using the outside-in technique, comparing magnetic resonance imaging (MRI), arthro-magnetic resonance imaging (arthro-MRI), and arthro-computed tomography (arthro-CT) to evaluate the healing of meniscal sutures. Methods We evaluated eight patients with an average follow-up of 15 months. The evaluation analyzed clinical parameters using the Lysholm and IKDC scores as well as MRI, arthro-MRI, and arthro-CT imaging. Results At the end of the follow-up period, mean Lysholm score was 89.5 and mean IKDC score was 78.6. In the MRI, signs of meniscal healing were observed in 50% of the cases. The arthro-MRI and arthro-CT showed signs of healing in 75% of cases. There was a positive correlation between arthro-MRI and arthro-CT results in all the cases studied (kappa correlation index=1). Conclusion Meniscal suture using the outside-in technique presented good or excellent results in 87.5% of our patients. The arthro-CT and arthro-MRI showed the same level of accuracy in detecting healing of the sutured region of the meniscus. Level of Evidence IV; Case series.

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